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ASTHMA UPDATES

• ROUGH TRANSITION TO A NEW ASTHMA INHALER Beginning January 1, all albuterol inhalers must be powered by the more eco-friendly chemical HFA, or hydrofluoroalkane.. This change is required by the 2005 federal mandate to comply with the 1987 treaty to protect the earth's ozone layer by banning most uses of  CFCs (chlorofluorocarbon). The new inhalers will be three times the cost of the old ones $30-$60 versus $5-$10- and there are differences in feel, force, taste, and how they are primed and cleaned. There are a number of concerns about whether the medical community, patients and their families, are prepared for this change.
• RISKS OF NEW ASTHMA DRUGS VARY, FDA: Advair does not appear to have an increased risk of serious respiratory complications seen with similar new medicines, according to the FDA.  But a less widely used medication, Serevent, had a significantly higher rate of complications when compared to older treatments, The FDA is concerned about asthma drugs known as LABAs, which already carry warnings. The long-acting medications relax tight muscles around stressed airways and free patients from the need to take a puff from their inhaler every few hours. For many asthma sufferers, that means they can sleep through the night. But LABAs, for reasons that are still being debated, can increase risks of death and respiratory complications in some patients. The risk may be lower when a LABA is used together with a steroid to treat underlying inflammation deep inside the airways. Current medical guidelines suggest using both kinds of drugs together for patients with chronic asthma who are not responding well to other treatments. A review team from the FDA's safety office unanimously recommended that Serevent and Foradil, the two LABA-only drugs, no longer be approved for treating asthma. Safety reviewers also recommended that none of the drugs be used to treat children, because clinical data indicates they are at greater risk of developing respiratory complications with LABAs. Associated Press 12/5/08
• TOO MANY KIDS WITH ASTHMA BREATHING SMOKE: A "distressingly high" proportion of inner-city children with asthma are exposed to cigarette smoke at levels that could be harming their health, a study conducted in Chicago demonstrates. More than two-thirds of the 8- to 14-year-olds in the study had levels of the nicotine byproduct cotinine in their saliva demonstrating that they were breathing enough second-hand smoke to affect their asthma. Researchers surveyed caregivers of 482 8- to 14-year-old children with asthma about tobacco use, and also tested the children's saliva for cotinine, an indicator of tobacco smoke exposure. Nearly half of the caregivers said that there were smokers living in the household, while 31 percent admitted to smoking themselves. But the saliva tests revealed that roughly 68 percent of the children were exposed to tobacco smoke. Among the children with caregivers who reported smoking, cotinine levels were nearly double those of the children whose caregivers didn't smoke. Having a smoker in the household also increased cotinine levels, but to a lesser degree. Journal of Allergy and Clinical Immunology, October 2008
• ALMOST HALF OF KIDS STILL EXPOSED TO SECOND HAND SMOKE: Despite progress in establishing clean indoor air policies, 42 percent of U.S. children are still exposed to secondhand smoke each week, according to a new survey. Among the other major findings from the Social Climate Survey of Tobacco
• SECONDHAND SMOKE INCREASES BEHAVIORAL PROBLEMS IN BOYS WITH ASTHMA: A study 220 boys and girls ages 6 to 12, with asthma found that for each doubling of secondhand smoke exposure, boys showed a twofold increase in behavioral problems such as hyperactivity, aggression, and depression. secondhand smoke had no impact on girls, even though they were on average exposed to higher levels of tobacco smoke than boys. Additional research is needed to explain this gender difference, the researchers said. Journal of Developmental & Behavioral Pediatrics12/08
• ASTHMA LINK TO C-SECTION BABIES: Babies born by Caesarean section are more likely to develop asthma than children delivered naturally, Swiss researchers conclude from a study of 3,000 children whose respiratory health was tracked until they were 8 years of age. At that time, 12% had asthma About 9 percent of the children were born by C-section but these babies were nearly 80 percent more likely to develop asthma compared to those born vaginally. Babies born by C-section are not exposed to their mother's bacteria when they pass through the birth canal -- something that helps prime the immune system and could explain the increased risk, the researchers said. The findings also underscore the potential risks of elective C-sections as more women in Western countries choose to avoid a natural birth. Thorax 12/08
• PLACE OF BIRTH CONTRIBUTES TO ASTHMA DISPARITY: Place of birth plays a role in the occurrence of asthma in a United States black population. The researchers found that within one inner-city population, blacks born in the United States were more likely to have asthma than blacks born outside of the United States. "Within Asian and Hispanic populations, there is research that indicates that asthma varies between those who are born in the U.S. and those who are foreign-born.  "This study cannot be generalized to the U.S. population because we focused on a specific neighborhood in Boston. "If future research confirms that the U.S.-born black population has a higher prevalence of asthma than the foreign-born black population, resources such as asthma screening and detection can be directed to populations or communities most in need."  Journal of Asthma, 2008; 45 (9): 785
• ASTHMA INCREASE IN INFANTS OF MOM'S TAKING FOLATE: Folate is recommended to reduce the risk of birth defects, and many countries fortify their flour with folic acid. Data on more than 32,000 children born between 2000 and 2005 who were part of the Norwegian Mother and Child Cohort Study found that infants whose mothers took folate supplements in the first three months of pregnancy were slightly more likely than other infants to have wheezing and/or respiratory infections up to the age of 18 months. These children were also 24 percent more likely to be admitted to hospital for treatment of their respiratory infection. Archives of Disease in Childhood 12/08
• KIDS TAKE RESPONSIBILITY FOR ASTHMA MEDS EARLY: In surveys of 351 parents of asthmatic children and teenagers, the researchers found that by the age of 7, children were giving themselves their daily controller medication nearly 20 percent of the time. By age 11, they were responsible for taking their medication about half of the time. The findings suggest that even young children should be included when doctors and parents discuss asthma management, researchers report in the journal Pediatrics. There are no general guidelines as to what age children should be given this task. Instead the decision depends on an individual child's readiness. Pediatrics, December 2008
• SCHOOL PROGRAM HELPS CUT ASTHMA RISK: A school-based asthma management program can help children and teens reduce their symptoms and the number of missed school days, a study conducted in a California school district shows. Researchers analyzed the effectiveness of a program called Kickin' Asthma, a four-session curriculum developed by American Lung Association staff and nurses and peer educators from the Oakland Unified School District. The program provides students with information and tools to better manage their asthma, such as teaching them about triggers and telling them when and how to take their medication. Program participation was voluntary, but students who completed the program during the first two years of the study were given a small incentive. About 990 students in grades 7 to 10 from 15 middle schools and three high schools took part in the program. The program achieved measurable improvements in asthma symptoms and correct medication use and a reduction in the rate of asthma occurrence during the first three years. Days for which participants had activity limited or missed school were reduced by a half-day for every four weeks of the program. During the first two years of the program, there was a significant decline in the number of students who reported outpatient emergency care or hospitalization for asthma. Frequency of daytime symptoms also declined during the program's first three years. Journal of School Health 12/08
• BREATHING EXERCISES CAN HELP EASE ASTHMA: While asthma breathing exercises can improve a patient's quality of life, they don't reduce the need for inhalers, according to a study by Scottish researchers. The University of Aberdeen study included nearly 200 adults being treated for mild to moderately severe asthma. About half (94) of the patients did three sessions of breathing exercise training provided by a physiotherapist, while the rest received information and advice about their disease. After one month, both groups showed improvements in quality of life. But after six months, the patients in the breathing exercises group were significantly less anxious and depressed, and tended to control their asthma better than those in the information/advice group. Thorax.12/08
• POOR MENTAL HEALTH MAY BOOST ASTHMA RISK: People who rated their mental health as poor were more likely to have asthma than those who described their mental health as good, Brown University researchers report. Data on 318,151 people, who took part in the Behavioral Risk Factor Surveillance System, found that "any number of days of poor mental health was associated with currently having asthma." "Even low levels of poor mental health were associated with an increased risk of currently having asthma." People who said their mental health was poor or fair were at 1.31 times greater risk of asthma, compared with those who rated their mental health as good, very good or excellent. Chest 12/08
• OBESITY, LACK OF EXERCISE REPORTED IN PEOPLE WITH ASTHMA: Study findings suggest less than one quarter of adults with asthma meet national exercise guidelines and, among this group, obesity may be a greater exercise deterrent than asthma symptoms. People with asthma may get caught in a vicious cycle,. "Obesity leads to worse asthma, which can be associated with less exercise, which predisposes to obesity and long-term (worsening) asthma." Exercise habits were assessed in 258 patients (75 percent women) who were 42 years old. The patients had mild-to-moderate asthma for 21 years on average and, in 37 percent, asthma was well controlled. Overall, 40 percent of the patients were obese, 29 percent were overweight, and 31 percent were of normal weight, the researchers report. Annals of Allergy, Asthma and Immunology 11/08
• INCREASED RISK OF PNEUMOCOCCAL DISEASE IN ASTHMA PATIENTS: Mayo Clinic research shows adults with asthma are at increased risk of serious pneumococcal disease caused by Streptococcus pneumoniae, the most common bacteria causing middle ear infections and community acquired pneumonia. It also causes blood stream infections and brain infections. The researchers recommend including asthma as an indication for pneumococcal vaccination in adults.  "We found that adults with invasive pneumococcal disease, a serious, potentially fatal disease, are seven times more likely to be asthmatics. Our study also showed that 17 percent of the burden of invasive pneumococcal disease can be attributable to asthma at a population level. This is quite a significant impact on the burden of invasive pneumococcal disease," says Young Juhn, M.D., a pediatric and adolescent medicine physician-scientist at Mayo Clinic and lead author of the study. "Invasive pneumococcal disease is a vaccine-preventable disease. The implication is that we have the ability to significantly reduce instances of this potentially fatal disease by expanding the indication for the pneumococcal vaccine to include adults with asthma." Researchers used a population-based, retrospective case-control study of 3,941 records from the Rochester, Minn. population to see if there was a higher incidence of pneumococcal disease among people with asthma. Adults diagnosed with asthma were almost seven times more likely to develop invasive pneumococcal diseases than adults who were not diagnosed with asthma. In children the sample size for was not large enough to draw a definitive conclusion.  Journal of Allergy and Clinical Immunology 10/08

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