VIENNA—Men with rhinitis may be more likely to have hypertension than men without rhinitis. This was one of the important findings reported at the 2003 Annual Congress of the European Respiratory Society. Other research presented at the meeting explored a link between hormone replacement therapy (HRT) use and asthma, future outcomes in low-birth-weight infants with chronic lung disease, asthma risk in endurance athletes, household exposures and lung disease in women, and exhaled nitric oxide (NO) as a predictor of asthma recurrence.

RHINITIS AND HYPERTENSION IN MEN

Rhinitis may be associated with an increased risk of hypertension—but only in men, not women. In a study of 146 men and 170 women ages 28 to 56, mean systolic blood pressure was 7 mm Hg higher in the men who had rhinitis than in the men without it; no such difference was seen in women. Men who had rhinitis were also two to three times more likely to have hypertension than men without rhinitis. The investigators speculate that the association they found may be partly due to sleep apnea: Rhinitis and hypertension are both associated with the condition. The lack of such an association in women, the authors note, may be due to the cardioprotective benefits conferred by premenopausal status.

HRT LINKED TO ASTHMA?

New evidence suggests HRT may increase the risk of asthma. Svanes et al analyzed 2,589 women 45 and older and found that HRT users were 40% to 50% more likely to have asthma than were women not taking HRT. This risk jumped to 60% for allergic asthma. Additionally, women using HRT were 30% more likely to have hay fever than were women not taking HRT. The researchers note that the results may be due to overlapping characteristics in asthma patients and HRT users, but they suggest that their finding provides an additional argument against routine HRT use in postmenopausal women. In a related study of 6,512 premenopausal women, Svanes et al found that oral contraceptive use increases the risk of asthma and hay fever by about one third.

ADULT OUTCOMES AFTER CHRONIC LUNG DISEASE OF INFANCY

Extremely low-birth-weight (ELBW) babies with chronic lung disease (CLD) fare as well as their healthy counterparts in early adulthood, a new study suggests. Researchers measured lung function across the life span in 646 people; 298 of them had weighed less than 1,000 g at birth (59.1% of this cohort had had CLD as infants), 86 had been considered ELBW but had weighed at least 1,000 g at birth, and 262 had had normal birth weight (NBW). Most children who were ELBW at birth had normal lung function test results at age 8, and these results remained stable through the children’s second decade of life. However, some of the ELBW children had reductions in airflow and air trapping within their lungs. Those who had had CLD as infants had greater reductions in airflow and more air trapping, although most had breathing test results in the normal range. Asthma rates were similar between NBW and ELBW children, even among those who had had CLD.

Smoking, the authors caution, is associated with a more rapid deterioration of the lungs in adults who were ELBW at birth than in adults who were NBW.

ENDURANCE ATHLETES AND ASTHMA

Endurance athletes may be more susceptible than nonathletes to asthma and bronchial hyperreactivity. Members of the Swiss national triathlon team were evaluated for exercise-induced bronchoconstriction with an eight-minute field trial at temperatures slightly above freezing. Lung function was measured before and at two, five, 10, and 15 minutes after exercise. Seven athletes in this sample who did not have asthma at the beginning of the study were observed for three years. Their FEV1 dropped considerably each year. Extrapolating from the observed decline in these athletes’ lung function, the researchers calculated that the athletes would develop asthma after an average of 4.63 years. This corresponds to a rate of asthma development that is 144 times higher than normal.

In a separate but related study, French investigators examined bronchial reactivity levels, inflammation, and dyspnea in 39 athletes and 13 sedentary controls during exercise. The 15 athletes found to have bronchial hyperreactivity and inflammation had a higher incidence of allergies than did the controls or the athletes without bronchial hyperreactivity. Endurance athletes, especially those with allergies, may be more prone to asthma and other respiratory difficulties, the investigators suggested.

LUNG DISEASE IN THE HOME

The role of household exposure as a risk factor for preventable respiratory disease has been overlooked, particularly in women. According to new research, exposure risks may come from routine domestic activities (cooking and cleaning), indoor air quality (mold, environmental tobacco smoke), and/or hobbies (gardening, crafts). Preventable lung problems that can arise from household exposures include irritant lung injury, asthma exacerbations, extrinsic alveolitis, and even mesothelioma and lung cancer. Other respiratory problems that may result from household exposure include lung injury and laryngospasm associated with hypochlorite bleach use. Because women traditionally spend more hours in the home than men do, their duration of exposure to household irritants is longer. Therefore, household-related lung diseases should be considered when diagnosing respiratory problems in women.

EXHALED NO TEST FOR ASTHMA

Many children outgrow asthma during adolescence, remaining free of symptoms even without medication use. However, some of these children may experience a recurrence of their asthma later in life. Pijnenburg et al measured exhaled NO as a predictor of disease recurrence in 38 symptom-free children with asthma. All of the children were still using low-dose anti-inflammatory medications at the start of the study. The NO breath test was conducted before and two, four, 12, and 24 weeks after medication withdrawal. Lung function was measured at the beginning of the study and again after 12 and 24 weeks. At two weeks, NO was significantly higher (35.3 parts per billion [ppb]) in the nine patients whose symptoms recurred after medication discontinuation than it was in the group who remained symptom-free (15.7 ppb). At four weeks, NO levels were even higher (40.8 ppb) in the symptomatic group but remained stable in the asymptomatic group. The researchers note that NO increased before the asthma symptoms returned, which gives the test predictive value.

—Tamara Gibb

Return to table of contents