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Rapid Infant Growth Linked to Asthma in Study
Posted: 1/30/2012
By HealthDay:
Rapid growth during the first three months of life is associated with an increased risk of asthma symptoms in preschool children, a new study indicates.
The findings suggest that early infancy might be a critical period for the development of asthma, said the researchers at Erasmus Medical Center in the Netherlands.
They examined data collected from 5,125 children who were followed from the fetal stage until they were 4 years old.
The researchers found no link between fetal growth and asthma symptoms. But in children with normal fetal growth, accelerated weight gain from birth to 3 months of age was associated with increased risk of asthma symptoms, such as wheezing, shortness of breath, dry cough and persistent phlegm.
The study appears online ahead of print in the American Journal of Respiratory and Critical Care Medicine.
Previous research has shown an association between low birth weight and increased risk of asthma symptoms in children. This is the first study to examine specific fetal and infant growth patterns on asthma risk.
"Our results suggest that the relationship between infant weight gain and asthma symptoms is not due to the accelerated growth of fetal growth-restricted infants only," researcher Dr. Liesbeth Duijts said in a journal news release. "While the mechanisms underlying this relationship are unclear, accelerated weight growth in early life might adversely affect lung growth and might be associated with adverse changes in the immune system."
She added: "Further research is needed to replicate our findings and explore the mechanisms that contribute to the effects of growth acceleration in infancy on respiratory health. The effects of infant growth patterns on asthma phenotypes [observable characteristics] in later life should also be examined."
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UVa researcher finds common asthma treatment unbeneficial
Posted: 1/30/2012
By The Daily Progress:
A new study led by a University of Virginia researcher has found that a common asthma treatment didn't benefit children and actually put them at greater risk for colds, sore throats and bronchitis.
"It's a treatment that's been used for years in children with asthma, and adults, and it was based on an unproven belief that acid reflux had an important contribution for asthma control, the idea that people with reflux would cough and wheeze due to reflex as much as due to asthma," said UVa's Dr. Gerald Teague, the study's senior investigator.
The treatment was widely used for both adult and pediatric patients, Teague said.
("Treating acid reflux may help ease symptoms caused by either condition," reads a question-and-answer piece written by a medical doctor on the Mayo Clinic's website.)
The pediatric study was a follow-up on a very similar, but not identical, study in adults, he said. The adult study found no benefit to the treatment, while the pediatric study found no benefit, plus the increased risk of some maladies. Even those children with acid reflux saw similar results.
For the pediatric study, patients with poorly controlled asthma from about 15 different study sites were divided into two groups. One group had Prevacid added to inhaled asthma treatments, while the other got a placebo.
They were studied for six months, and the degree to which their asthma came under control was noted.
"We really don't understand the relationship between reflux and asthma like we thought we did," Teague said.
Teague said the use of a treatment against one disease to indirectly fight another is a common tactic in modern medicine.
"It is common in medicine, because, you know, diseases are often interrelated," Teague said.
The results were published last week in the Journal of the American Medical Association, according to a UVa news release.
Researchers weren't able to find a really good study to show them how common the reflux-treatment-to-combat-asthma strategy is, but Teague said it's highly prevalent.
"This drug is huge," he said.
He said he hopes the study will change the way doctors treat children.
Teague is now studying why severe asthma affects different parts of the lungs differently.
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Comparison of the US and Australian cystic fibrosis registries
Posted: 1/30/2012
Abstract
BACKGROUND AND OBJECTIVES: National data registries for cystic fibrosis (CF) enable comparison of health statistics between countries. We examined the US and Australian CF data registries to compare demographics, clinical practice and outcome measures.
METHODS: We compared the 2003 US and Australian registries. Differences in pulmonary and growth outcomes were assessed by creating models controlling for differences in age, gender, genotype, and diagnosis after newborn screening.
RESULTS: Data on 12 994 US and 1220 Australian patients aged ≤18 years were analyzed. A significant difference was noted in the proportion who had been diagnosed after newborn screening (Australian 65.8% vs United States 7.2%; P < .001). Australian children had significantly greater mean height percentile (41.0 vs 32.6; P < .001) and weight percentile (43.5 vs 36.1; P = .028) than US children. Mean forced expiratory volume in 1 second (FEV1) percent predicted adjusted for age, gender, and genotype was similar in the 2 countries (P = .80). Patients diagnosed after newborn screening had higher mean FEV1 (5.3 [95% confidence interval (CI): 3.6?7.0]) percent predicted and BMI (0.26 [95% CI: 0.09?0.43]). Mean FEV1 of Australian patients diagnosed after newborn screening was lower by 5.2 (95% CI: 2.8?7.6) percent predicted compared with US children.
CONCLUSIONS: Children diagnosed with CF after newborn screening benefited from better lung function and BMI than those diagnosed clinically. The benefit of newborn screening on lung function was significantly less in Australian children compared with US children. Statistical comparisons between CF registries are feasible and can contribute to benchmarking and improvements in care.
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Analysis of quality indicators for children in the emergency dept. for asthma
Posted: 1/30/2012
Abstract
OBJECTIVE: To test the hypothesis that an association exists between process and outcome measures of the quality of acute asthma care provided to children in the emergency department.
METHODS: Investigators at 14 US sites prospectively enrolled consecutive children 2 to 17 years of age presenting to the emergency department with acute asthma. In models adjusted for variables commonly associated with the quality of acute asthma care, we measured the association between 7 measures of concordance with national asthma guideline-recommended processes and 2 outcomes. Specifically, we modeled the association between 5 receipt/nonreceipt process measures and successful discharge and the association between 2 timeliness measures and admission.
RESULTS: In this cohort of 1426 patients, 62% were discharged without relapse or ongoing symptoms (successful discharge), 15% were discharged with relapse or ongoing symptoms, and 24% were admitted. The composite score for receipt of all 5 receipt/nonreceipt process measures was 84%, and for timeliness measures, 57% receive a timely corticosteroid and 92% a timely β-agonist. Our adjusted models showed no association between process and outcome measures, with 1 exception: timely β-agonist administration was associated with admission, likely reflecting confounding by severity rather than a true process-outcome association.
CONCLUSIONS: We found no clinically significant association between process and outcome quality measures in the delivery of asthma-related care to children in a multicenter study. Although the quality of emergency department care does not predict successful discharge, other factors, such as outpatient care, may better predict outcomes.
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Maternal asthma medication use and the risk of selected birth defects
Posted: 1/30/2012
Abstract
OBJECTIVES: Approximately 4% to 12% of pregnant women have asthma; few studies have examined the effects of maternal asthma medication use on birth defects. We examined whether maternal asthma medication use during early pregnancy increased the risk of selected birth defects.
METHODS: National Birth Defects Prevention Study data for 2853 infants with 1 or more selected birth defects (diaphragmatic hernia, esophageal atresia, small intestinal atresia, anorectal atresia, neural tube defects, omphalocele, or limb deficiencies) and 6726 unaffected control infants delivered from October 1997 through December 2005 were analyzed. Mothers of cases and controls provided telephone interviews of medication use and additional potential risk factors. Exposure was defined as maternal periconceptional (1 month prior through the third month of pregnancy) asthma medication use (bronchodilator or anti-inflammatory). Associations between maternal periconceptional asthma medication use and individual major birth defects were estimated by using adjusted odds ratios (aOR) and 95% confidence intervals (95%CI).
RESULTS: No statistically significant associations were observed for maternal periconceptional asthma medication use and most defects studied; however, positive associations were observed between maternal asthma medication use and isolated esophageal atresia (bronchodilator use: aOR = 2.39, 95%CI = 1.23, 4.66), isolated anorectal atresia (anti-inflammatory use: aOR = 2.12, 95%CI = 1.09, 4.12), and omphalocele (bronchodilator and anti-inflammatory use: aOR = 4.13, 95%CI = 1.43, 11.95).
CONCLUSIONS: Positive associations were observed for anorectal atresia, esophageal atresia, and omphalocele and maternal periconceptional asthma medication use, but not for other defects studied. It is possible that observed associations may be chance findings or may be a result of maternal asthma severity and related hypoxia rather than medication use.
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New lung cancer test predicts survival
Posted: 1/30/2012
From AFP:
Clinical trials in the United States and China have shown that a new gene-based test for patients with lung cancer beats standard methods in predicting survival, researchers reported Friday.
The findings, published in the British medical journal The Lancet, should help doctors to make more accurate prognoses and better choices for treatment, the scientists said.
Lung cancer is the most lethal type of the disease worldwide, claiming some 1.4 million lives -- more than breast, colon and prostate cancers combined -- each year.
The experimental test measures the activity of fourteen genes within cancerous tissue, and is especially effective is assessing a form called non-squamous non-small cell cancer, commonly brought on by tobacco use.
"This has the potential to help hundreds of thousands of people every year to survive longer," said David Jablons, the main architect of the study and a professor at the University of California in San Francisco (UCSF).
Currently, doctors classify early-stage lung cancers by their size, location and microscopic profile.
Known as staging, this type of assessment guides decisions on the use of supplementary treatment -- including chemotherapy -- after cancerous tissue is removed.
A more precise prognosis would mean "more people who might benefit from additional therapy could receive it after surgery, before any residual cancer has had a chance to grow," Jablons explained in a statement.
Previous research has shown that chemotherapy given in early-stage lung cancer helps thwart recurrence when there is evidence of lymph node involvement.
The problem, however, is that this especially insidious form of the disease is hard to spot early on.
Only some 30 percent of patients in the United States, for example, are detected in the earliest stage, and even then survival is far from guaranteed -- 35 to 45 percent of patients identified with Stage One lung cancer die within five years.
"The prognostic test would address the inability to identify these patients," Jablons said.
In the US trial, the new testing method -- designed at UCSF and developed by the California-based company Pinpoint Genomics -- used an algorithm to calculate the risk of death after examining the tissue of 361 patients at the UCSF Medical Center as low, medium or high.
All of these patients had had surgery to treat non-squamous, non-cell lung cancer.
The algorithm was then applied to 433 other patients with the earliest stage of the same type of cancer, and their survival rate was monitored over five years.
The method accurately identified patients with high, intermediate and low risks of death, the researchers said.
A similar study in China, conducted by the China Clinical Trials Consortium, confirmed the results.
A disclosure notice in The Lancet notes that Jablons and several of the co-authors have paid consultant relationships with Pinpoint Genomics.
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Asthma rate and costs from traffic-related air pollution higher than believed
Posted: 1/26/2012
A research team led by University of Massachusetts Amherst resource economist Sylvia Brandt, with colleagues in California and Switzerland, have revised the cost burden sharply upward for childhood asthma and for the first time include the number of cases attributable to air pollution, in a study released this week in the early online version of the European Respiratory Journal.
The total cost of asthma due to pollution is much higher than past traditional risk assessments have indicated and there is growing evidence that exposure to traffic-related air pollution is a cause of asthma and a trigger for attacks, so it should be included, say the authors. They conducted the study in Long Beach and Riverside, Calif., communities with high regional air pollution levels and large roads near residential neighborhoods.
Total additional asthma-specific costs there due to traffic-related pollution is about $18 million per year, almost half of which is due to new asthma cases caused by pollution, they report. Brandt worked with researchers at the University of Basel, Switzerland, Sonoma Technology, Inc. and the University of Southern California.
Using updated techniques that count asthma cases attributable to air pollution for the first time and including a broader range of health care costs such as parents' missed work days, extra doctor visits and travel time along with prescriptions, the researchers found that a single episode of bronchitic symptoms cost an average $972 in Riverside and $915 in Long Beach. Bronchitic symptoms (daily cough, congestion or phlegm, or bronchitis for three months in a row) are a critical outcome for children with asthma.
Further, people who live in cities with high traffic-related air pollution bear a higher burden of these costs than those in less polluted areas, they say.
Brandt and colleagues say the total annual cost for a typical asthma case was $3,819 in Long Beach and $4,063 in Riverside, and "the largest share of the cost of an asthma case was the indirect cost of asthma-related school absences." School absences are an important economic consequence, they add, because "they often lead to parents or caregivers missing work."
Overall, Brandt points out that the results are relevant and applicable to many settings and "families with children who have asthma are bearing a high cost. The total annual estimate between $3,800 and $4,000 represents 7 percent of median household income in our study in these two communities. This is troublesome because that is higher than the 5 percent considered to be a bearable or sustainable level of health care costs for a family."
Riverside and Long Beach account for about 7 percent of the total population of California, the authors say, which suggests that state-wide costs of asthma related to air pollution are "truly substantial."
For this work, Brandt and colleagues analyzed several surveys on health care visits by children with asthma and their previous estimates of the number of asthma cases attributable to pollution to estimate the annual costs of childhood asthma. They also estimated the cost of asthma exacerbation due to regional air pollutants. They feel the new method does a better job of accounting for the full impact of traffic-related pollution and will be widely applicable in urban areas.
Provided by University of Massachusetts at Amherst
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CPS to enact new policies on allergies, diabetes, asthma management
Posted: 1/25/2012
By Chicago Tribune:
Chicago Public Schools is planning to start stocking epinephrine injectors at schools to treat life-threatening allergic reactions.
A state law signed by the governor this summer allows districts to stock EpiPens and authorizes school officials to give an epinephrine shot to any student suffering a severe allergic reaction. The law came in response to the 2010 death of Chicago Public Schools student Katelyn Carlson, who had an allergic reaction to peanuts during a school party.
By the beginning of next school year, CPS hopes to stock four to six pens per school, costing the district about $195,000.
CPS says an estimated 4,000 students have diagnosed allergies. The district's new policy, on the agenda to be approved by the Board of Education Wednesday, allows a nurse to use the EpiPen on any student believed to be having a life-threatening reaction, even if the child has not been diagnosed with an allergy.
Students will also be allowed to carry and self-administer their own Epi-pens with the written approval of a parent or guardian.
Meanwhile, the district also has developed new asthma and diabetes management policies, which allow students to carry and self-administer asthma inhalers, check glucose levels or self-inject insulin, provided they have written authorization from parents and a valid prescription. Previously, a doctor's consent was required, said CPS spokeswoman Marielle Sainvilus.
Not all CPS schools have a nurse, so the district policies provide for staff to be trained on how to recognize symptoms in emergency situations. With diabetes cases, under state law every student will get a delegated aide trained to assist them. Currently, CPS has 659 students with Type 1 or Type 2 diabetes.
More than 19,000 CPS students suffer from asthma. The district's new policy will require designated staff to complete in-service training once every two years on the management and prevention of asthma symptoms as well as emergency response.
District officials say should the asthma policy be approved Wednesday, CPS will become the first large school district in the country with a standalone policy for students suffering from asthma. The policy will require parents to notify schools upon a child being diagnosed with asthma, informing the district of past asthma episodes, triggers and warning signs.
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Condo residents take neighbors to court over secondhand smoke
Posted: 1/24/2012
By Washington Post Real Estate:
If your home is your castle, you should be able to do anything legal you want in it, including lighting up a cigarette, right?
Some residents in the Washington area are challenging that notion, arguing that secondhand smoke seeps through the walls and affects their health. In some recent cases, residents have taken steps to prevent their neighbors from smoking in their own units, following the lead of other condo associations and groups of residents across the country.
The issue has pitted neighbor against neighbor, taken over homeowner association agendas and led to a major legal debate over public health and the rights of homeowners. Federal incentives have led cities from Austin to Boston to prohibit smoking in public housing. In 2006, a Manhattan judge ruled that secondhand smoke could be a breach of "warranty of habitability" under New York law. And six California cities and counties have banned smoking in all condo units.
Last year at the Promenade Towers in Bethesda, a co-op with more than 1,000 units, neighbors on the first floor complained about a resident chain smoker. The building's management took steps to contain the smoke by sealing gaps in the walls and issuing a "cease and desist" order to the smoker, who installed a second air filtration system. But the smoke, according to some residents, was still unbearable. "I leave doors and windows open, even as I sleep," said Ximena Marquez-Dagan, whose young daughter has asthma. "I've moved to sleep in my daughter's room now because the other side of the apartment is full of smoke."
For years, smoking at home wasn't much of a dilemma. In 1965, 42 percent of Americans smoked, according to the Centers for Disease Control and Prevention, and those who didn't were used to secondhand smoke in offices, stores and other people's homes. Several decades ago, smoking was even advertised as healthful.
But since the U.S. surgeon general's landmark 1964 report on smoking's risks, Americans have slowly turned against "the evil weed"; barely 20 percent smoke today, fewer around Washington. "There is no risk-free level of exposure to secondhand smoke," the surgeon general's Web site emphasizes. Smoking has been banned in most workplaces for decades. More jurisdictions, including many in the Washington area, now ban smoking in restaurants, and some extend that to parks and play areas.
"If you're a homeowner, you should retain the right to smoke. It's your property, and it's a legal product," said Jolyn Tenn, spokesperson for Forces International, a libertarian nonprofit founded to fight nonsmoking laws.
Although public opinion and habits might be changing, the law isn't always very clear.
When indoor smokers Darko and Svetlana Popovic moved into a Greenbelt townhouse next door to non-smoker David S. Schuman in 1996, they shared smoke as well as an attic.
Schuman complained to the building's management company, Greenbelt Homes, about the smoke seeping into his unit. The company caulked around baseboards, plumbing and electrical outlets in both homes in an effort to eliminate the issue. The problem lessened, though Schuman said that this was because the Popovics had begun smoking only outside - not because the caulking had worked.
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Are schools making kids sick?
Posted: 1/17/2012
From CNN Health:
As a third-grader in Winsted, Connecticut, last year, Matthew Asselin was sick - a lot. He was lethargic and plagued with a persistent wet cough, respiratory infections and painful headaches.
As the school year wound down, Matthew's health worsened. He was out for two weeks in the spring with pneumonia and then developed a sinus infection so severe he needed to spend the night at the hospital, where he received intravenous antibiotics and breathing treatments.
In all, Matthew missed 53 days of school.
Sickness shuts school; parents outraged
But over the summer, a strange thing happened. Matthew was healthy. He was energetic. He could ride his bike for hours at a time.
"When we put him back in school this year, within three weeks, he missed 10 days with a respiratory infection," Melissa Asselin said. That's when Matthew's mother had an a-ha moment.
"When he was out of school, he was well. When he was in school, he became ill," Asselin said.
Matthew's parents concluded that the 9-year-old's school, Hinsdale Elementary, was making their son sick.
Figures are hard to come by, but studies have estimated that a third or more of U.S. schools have mold, dust and other indoor air problems serious enough to provoke respiratory issues like asthma in students and teachers.
A national survey of school nurses found that 40% knew children and staff adversely affected by indoor pollutants.
Indoor air affects more than health. A growing body of research suggests students also perform better in schools with healthier air.
"If you get an unhealthy building, you're not going to have a successful school," said Lily Eskelsen, vice president of the National Education Association, the largest teachers' union in the United States.
"Asthma is the number one chronic illness that keeps kids out of school, and it's growing," Eskelsen added.
Melissa Asselin home schools her son Matthew, 9, after she concluded his school was making him sick.
About one in 10 children in the United States now has asthma, which causes them to miss an average of four days of school a year, according to the Centers for Disease Control and Prevention.
Dr. John Santilli, a Connecticut allergist, says he has treated dozens of students sickened by school air. Even when children don't miss school, he said, the medications they take for asthma and conditions like rhinitis, an allergic reaction to mold or dust, can make it harder for them to do their best work.
"They're on antihistamines, they're on nasal sprays, they're on asthma medications, and this limits their ability to perform," Santilli said. "These kids can't concentrate. They can't focus on what's going on."
Dr. Santilli says about 20% to 30% of people are susceptible to mold or dust, which triggers an allergic reaction. The resulting symptoms can include itchy eyes, runny nose, coughing, headaches, fatigue, even memory problems and slowed thinking.
"It takes a lot to make you sick, but it takes very little exposure once you're sensitized to provoke symptoms," Santilli said. "As time goes on, it takes more and more out of you, and you get sicker and sicker."
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Chicago City Colleges approve tobacco ban
Posted: 1/13/2012
The new policy banning tobacco use on college property begins March 1
Smoking on Chicago City College campuses is a thing of the past beginning March 1.
The Board of Trustees on Thursday approved a tobacco-free campus policy that prohibits use of all tobacco products, from cigarettes to smokeless tobacco, on college property including outdoor areas.
The move is part of the Chicago Tobacco Prevention Project to curb smoking. City Colleges of Chicago representatives say college students smoke more than the general population, and tobacco-free policies make it easier for people who want to quit to be successful.
Joel Africk, president and CEO at Respiratory Health Association, said studies have shown that tobacco-free policies make it easier for people who want to quit smoking to be successful and decrease the likelihood that others will start.
"This is especially true when an institution offers group classes or other free resources to help people quit smoking," Africk said.
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Long on decline, whooping cough makes a comeback
Posted: 1/12/2012
From the Chicago Tribune:
Hundreds of thousands of people in the U.S. - many of them children - were coming down with whooping cough each year when vaccines against "this menace," as one newspaper called it, were introduced in the 1930s and 1940s.
"Childhood Cough Is Given Knockout Blow," the Chicago Daily Tribune announced in 1940, and over the next 40 years reported cases of whooping cough would dwindle to about 1,000 nationwide. A childhood scourge for centuries, this sometimes fatal disease seemed destined to become little more than a memory in the U.S.
But in recent years, the number of reported cases of whooping cough, also known as pertussis, has resurged.
By the end of 2011, Illinois health care providers had reported nearly 1,400 cases of the illness, according to the Illinois Department of Public Health. A decade before, they had reported only 194 cases. Ten years before that, the number of reported cases was only 74.
The Chicago suburbs were particularly hard hit last year. The McHenry County Health Department reported more than 270 cases by Dec. 31, and the DuPage County Health Department and Cook County Department of Public Health, which covers much of suburban Cook, reported more than 250 cases each. The Chicago Department of Public Health reported 79 cases. All of these numbers likely underestimate how many people are being sickened by the disease.
In California, nearly 10,000 cases of whooping cough were reported in 2010, the most since the 1940s, according to the U.S. Centers for Disease Control and Prevention. Ten babies died. Ohio, Michigan and other states have also experienced outbreaks.
Why, at a time of high vaccination rates among schoolchildren, does whooping cough appear to be coming back? And why are the victims older, for the most part, than those who became ill in the pre-vaccine era?
Researchers say there is evidence that clusters of unvaccinated children play a role. Better diagnosis and heightened awareness also may have led to increased reporting of cases, said Dr. James Cherry, a pediatric infectious disease specialist at the University of California Los Angeles.
But another factor lies in the history of whooping cough vaccines.
The vaccine children receive today is different from the ones introduced 70 years ago. Some of the original immunizations were "whole-cell" vaccines, made from killed whole cells of the bacterium that causes whooping cough. Eventually, those old whole-cell vaccines led to the development of the diptheria-tetanus-pertussis shot, or DTP, which became a mainstay in the school immunization routine.
"That whole-cell vaccine works well at the beginning, and it lasts and lasts and lasts," said Dr. Roger Baxter, co-director of the Kaiser Permanente Vaccine Study Center.
But, he added: "That fantastic immune response is accompanied by a, well, fantastic immune response."
In other words, the body's reaction to the vaccine sometimes included pain and fevers that could be, in extremely rare cases, high enough to lead to seizures, he said. "This was terrifying to parents," Baxter said.
In a world with a lot of whooping cough, this was a trade-off parents were willing to make. In 1934, a decade before the American Academy of Pediatrics recommended routine immunizations against the disease, there were more than 260,000 reported cases of whoop
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Are vacuum cleaners bad for your health?
Posted: 1/10/2012
From CBS News Health Watch:
You vacuum your house religiously to get rid of all the dust, dirt, and bacteria and make sure your indoor air is up to snuff.
But new research suggests that some vacuum cleaners may actually be making things worse, not better.
Certain vacuum cleaners spit fine dust and bacteria back into the air, where they can spread infections and trigger allergies.
Australian researchers tested 21 vacuum cleaners from 11 manufacturers, including two commercial models. The vacuums were six months to 22 years old, and ranged from less than $100 to almost $800. Brands included Dyson, Electrolux, Hoover, iRobot, and Sanyo. The researchers measured 62 different air emissions.
All released some bacteria, dust, and allergens back into the air. Newer and more expensive vacuum cleaners generally caused less indoor air pollution than older, cheaper models, the study showed.
Vacuums with high-efficiency particulate air (HEPA) filters released only slightly lower levels of dust and bacteria than vacuums that did not use these special filters. HEPA filters are supposed to remove 99.9% of the pollen, animal dander, and even bacteria from the air.
The new findings appear in Environmental Science & Technology.
"Both vacuum cleaning and the act of vacuuming can release and re-suspend dust and allergens, leading to increased exposure," write study researchers from Queensland University of Technology in Brisbane, Australia.
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Study Offers Clues to Why Some Don't Benefit From Asthma Drugs
Posted: 1/9/2012
From HealthDay News:
Almost half of patients with mild or moderate asthma may have a different type of disease than those with more severe symptoms, perhaps explaining why common treatments don't work well for them, new research suggests.
"We are beginning to understand that different 'flavors' of asthma probably have different molecular mechanisms," said Dr. John Fahy, director of the Airway Clinical Research Center at the University of California, San Francisco. He is the senior author of the new study, published online Friday in the American Journal of Respiratory and Critical Care Medicine.
Asthma is a chronic disease involving inflamed airways. As the airways become more swollen, the muscles around them can tighten when something triggers symptoms such as coughing, wheezing and shortness of breath.
Current anti-inflammatory treatments target a condition called eosinophilic airway inflammation, which is common in asthma. Eosinophils are a type of white blood cell that help fight off infection and play a role in the immune response.
However, the new research finds that nearly half of the 995 patients studied did not have this condition.
Fahy's team repeatedly measured these white blood cells in sputum samples of the volunteers with asthma who were enrolled in nine clinical trials.
Nearly half, or 47 percent, had no airway eosinophilia on any test of their sputum. Some had the condition intermittently and some had it on each test.
The investigators found that only 36 percent of those not taking an inhaled corticosteroid, an anti-inflammatory, had the condition, while 17 percent of those who used the inhaled steroids did.
After two weeks of giving the participants anti-inflammatories and bronchodilator therapy, Fahy found those with the airway eosinophilia responded and had better airflow. But those who didn't have the condition did not respond. The responses to the bronchodilators - other medicines commonly used for asthma that work by helping to open the bronchial tubes - were similar in both groups, however.
Previous studies looked at a single sample to assess whether those with asthma had the white blood cell involvement, Fahy explained, while this study looked at many over time.
"This study reinforces the idea that asthma is not a one-type disease," he said.
Even within the nearly 50 percent without the white blood cell involvement, there are probably many different subtypes, Fahy noted.
The test used was a complicated research test, Fahy pointed out, and it is not easily done in clinical practice.
Based on the study results, researchers might next work on a simpler test to determine if those with asthma have involvement of these white blood cells, he said. Eventually, the findings may help doctors better individualize asthma treatment.
The findings suggest that a sizeable group of people with mild to moderate asthma have a type of disease that is not typical, with poorly understood mechanisms, and that new treatments will be needed, Fahy concluded.
"The finding that half of these had the absence of eosinophils in the sputum was a little surprising," said Dr. Len Horovitz, a pulmonary specialist at Lenox Hill Hospital in New York City.
"It's higher than I thought," Horovitz said.
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Parental Smoking and Vascular Damage in Their 5-year-old Children
Posted: 1/9/2012
From Pediatrics:
Caroline C. Geerts, MD, MSca, Michiel L. Bots, MD, PhDa, Cornelis K. van der Ent, MD, PhDb, Diederick E. Grobbee, MD, PhD, FESCa, and Cuno S. P. M. Uiterwaal, MD, PhDa
Abstract
Background: The relation between smoke exposure in early life, the prenatal period in particular, and the vascular development of young children is largely unknown.
Methods: Data from the birth cohort participating in the WHISTLER-Cardio study were used to relate the smoking of parents during pregnancy to subsequent vascular properties in their children. In 259 participating children who turned 5 years of age, parental smoking data were updated and children?s carotid artery intima-media thickness (CIMT) and arterial wall distensibility were measured by using ultrasonography.
Results: Children of mothers who had smoked throughout pregnancy had 18.8 μm thicker CIMT (95% confidence interval [CI] 1.1, 36.5, P = .04) and 15% lower distensibility (95% CI −0.3, −0.02, P = .02) after adjustment for child?s age, maternal age, gender, and breastfeeding. The associations were not found in children of mothers who had not smoked in pregnancy but had smoked thereafter. The associations were strongest if both parents had smoked during pregnancy, with 27.7 μm thicker CIMT (95% CI 0.2, 55.3) and 21% lower distensibility (95% CI −0.4, −0.03).
Conclusion: Exposure of children to parental tobacco smoke during pregnancy affects their arterial structure and function in early life.
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