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E-Only Content Conference News Update American Academy of Allergy, Asthma, and Immunology 2009 Annual Meeting—Washington, DC
Adequate insurance coverage and access to health care providers may not necessarily lead to better asthma control, according to study findings. To investigate the relationship between medical insurance coverage and measures of asthma severity, researchers asked 153 asthmatic students to complete questionnaires as part of the Denver Public School Asthma Program. Of the respondents, 58% with an identified physician reported using emergency care, compared with 27% of those without an identified provider. In addition, 92% of students reported having a physician caring for their asthma, whereas 89% specified they had medical insurance. Regardless of whether or not students had insurance, Tracy L. Kruzick, MD, and colleagues at National Jewish Health in Denver found uniformly high rates of prednisone use, hospitalization, emergency care, and uncontrolled daytime and nighttime symptoms among the cohort. These findings illustrate the need for programs that can identify and monitor children at risk for high asthma morbidity, they stated. Children taking recent asthma medications had better disease control than a cohort of severely asthmatic children studied a decade ago, researchers observed. Joseph D. Spahn, MD, and colleagues at National Jewish Health in Denver compared the results of a review of severely asthmatic children referred to the National Jewish Health Day Program between 2004 and 2007 with the results of a published study that involved children presenting with severe asthma from 1993 to 1997. The percentage of patients who required chronic oral glucocorticoid therapy along with the average dose was lower and the duration of oral glucocorticoid use was shorter in the current cohort than in the previous one. Fewer glucocorticoid-induced adverse effects were found in the current study, compared with the older study. Additionally, the present cohort had higher FEV1, required less albuterol, and had fewer intubations than the previous cohort, the researchers noted. These findings are likely due to the asthma medications used by the current cohort, the authors concluded, which are more effective than older treatments.
New research reported success in using MP3s as tools for asthma education and treatment adherence. Giselle S. Mosnaim, MD, of the Department of Immunology and Microbiology at Rush University Medical Center in Chicago, and colleagues evaluated a cohort of 12- to 18-year-old low-income African Americans with moderate persistent asthma—a population group that typically has high asthma morbidity. The aim of the study was to increase adherence to daily inhaled steroids using coping peer asthma messages delivered between MP3 music tracks for eight weeks. Adherence to steroids was measured with an electronic dose counter and asthma control through use of the Asthma Control Test (ACT). Prior to treatment, adherence was less than 40% on average but increased by more than 70% throughout treatment. In addition, the average pooled baseline ACT score was 19 but exceeded 20 during treatment, which is the clinically significant cut-point for asthma control, the researchers found.
Asthmatic children who had lessons in basketball skills paired with education about their disease were found to have improved outcomes, new data suggested. Researchers at Allegheny General Hospital in Pittsburgh evaluated 21 children ages 6 to 12 who were enrolled in a day-long camp that included comprehensive asthma education and basketball workshops. A health care utilization survey that assessed emergency department (ED) visits, physician contacts, and oral steroid use was completed at baseline and then two and four months later. Surveys results indicated a significant decrease in physician contacts and a trend toward decreased ED visits following the camp. No impact on oral steroid use was found. Additional research on using sports oriented asthma education is needed, the investigators suggested.
Metacholine and adenosine bronchial challenges have very high concordance, observed María Pedrosa, MD, Department of Pediatric Allergies at the University Hospital La Paz in Madrid, and colleagues. In a prospective, randomized, crossover, single-blind study, the investigators compared the efficacy of both direct (ie, methacholine) and indirect (adenosine) agonists to measure bronchial hyperresponsiveness in the diagnosis of asthma. A total of 54 patients underwent both challenges: 30 tested positive with adenosine versus 24 with metacholine. All patients who tested negative with adenosine also tested negative with methacholine, the researchers noted. Results of both challenges were concordant in 94.4% of patients. The most common symptoms observed during the challenges—coughing and wheezing—were significantly more frequent with adenosine (40.4% and 26.3%, respectively) than with metacholine (20.4% and 7.4%).
Eosinophil and neutrophil inflammatory mediators involved in the pathogenesis of asthma are capable of comparable leukotriene production in vitro, according to researchers from the University of Wisconsin. In younger (ages 20 to 40) and aging (ages 50 to 70) patients with mild-to-moderate asthma, Sharmilee M. Nyenhuis, MD, and colleagues assessed baseline lung function characteristics and performed a sputum analysis.There was no significant difference in the percentage of eosinophils or neutrophils between the younger and aging groups; however, the aging group showed a trend towards a higher percentage of neutrophils, the investigators noted. In vitro production of leukotriene C4, eosinophil-derived neurotoxin, and leukotriene B4 in calcium ionophore–stimulated eosinophils and neutrophils was similar between age-groups.
Approximately 72% of children with respiratory allergies have clinical reactivity to food proteins, as per study results reported by Meenu Singh, MD, of the Department of Pediatrics, Advanced Pediatrics Center in Chandigarh, India, and colleagues. The investigators evaluated 50 children (ages 5 to 12) with respiratory allergies who had a history of worsening symptoms upon the consumption of specific foods. Skin prick tests (SPTs) were positive for 37 children; 25 children were allergic to two allergens, 20 children to four allergens, and four children to six allergens. In addition, 23 children who underwent immunoglobulin profiles were positive and clinically correlated for offending food antigen, the researchers noted. This study marked the first time an association between food allergies and asthma has been demonstrated in Indian children, they pointed out.
Physicians should consider pneumococcal pneumonia vaccination for adult patients with asthma, according to new research findings. In a retrospective case-control study, investigators reviewed 3,941 medical records for residents of Rochester in Montana and identified 146 cases of pneumonia between 1964 and 1983. Of these cases, eight patients had asthma, compared with nine patients in 292 controls. After adjusting for high-risk conditions for invasive pneumoccocal disease and tobacco smoking, the researchers found that asthma status was not significantly associated with pneumonia risk in children and adults (adjusted odds ratio [OR], 3.34). However, in adults, asthma status was associated with a significantly increased risk for pneumoccocal pneumonia (adjusted OR, 5.14), noted Kwang H. Yoo, MD, PhD, Department of Internal Medicine a the Kunkook University in Seoul, South Korea, and colleagues.
Asthma care management with shared treatment decision-making (SDM) may benefit white and Asian patients with poorly controlled asthma, but not African American patients, reported researchers of the BOAT (Better Outcomes of Asthma Treatment) trial. In a multi-site, randomized controlled trial, Sandra R. Wilson, PhD, of the Palo Alto Medical Foundation Research Institute in California, and colleagues evaluated the effects of ethnicity, income, and education among patients with poorly controlled asthma randomized to receive SDM, guideline-based management (GBM), or usual care. In 612 adult patients ages 18 to 70, controller medication adherence was significantly greater in white patients (n = 379) and Asian patients (n = 60) using SDM than in patients receiving usual care. Adherence was significantly greater in white patients using SMD compared with white patients using GBM. No difference in adherence was observed between Asian patients using SMD or GBM. Asthma controller medication adherence was similar in African Americans (n = 96) using SMD, GMB, and usual care, the authors noted. Income and education were not found to be significant factors of adherence between groups.
Persons older than 65 with asthma may not address disease-specific issues with their physicians or family members, researchers observed. Forty-six asthma patients older than 65 (mean age, 72.6) participated in six focus groups with semi-structured questions regarding asthma education, symptoms, and management. Most study participants also had coexisting conditions, including cardiac disease and hypertension. Age-specific domains—including atypical asthma symptoms and inability to distinguish asthma from other medical conditions—were identified in all focus groups, the authors observed. Others were use of complementary and alternative therapies, desire for independence in asthma management, and lack of participation in asthma education. “There are concerns, challenges, and obstacles unique to the geriatric asthmatic population,” observed Alan P. Baptist, MD, MPH, of the University of Michigan, and colleagues. “Optimal care will require physicians and researchers to explicitly address these issues.”
For adults, US hospitalizations for asthma as a secondary condition increased by 113% from the years 2000 to 2005 and by 54% in children from 1997 to 2006, reported researchers. For the study, the investigators performed a cross-sectional analysis of two health care databases from the Healthcare Cost and Utilization Project. They found that approximately 123,000 adults and 53,200 children with pneumonia also had asthma. In addition, infants (age < 1 year) were four times more likely to be hospitalized for asthma than were children 15 to 17 years. Furthermore, adults living in the northeast were more likely to have asthma than adults living in the west, and both adults and children from poorer communities were more likely to be hospitalized for asthma than persons from wealthier communities, investigators noted.
Asthma prevalence is as high in rural areas as in urban areas, researchers reported. Investigators from the CDC used national survey data to estimate asthma prevalence in urban-rural areas and found that asthma prevalence was not significantly different between the two. After adjustment for sociodemographic and health behaviors, adjacent metropolitan and remote residents were less likely to report asthma compared with metropolitan resident (odds ratios, 0.91 and 0.87, respectively). “Sociodemographic and health behavior characteristics unique to residence impact disease,” the researchers concluded. “Allocating resources to address these characteristics may reduce asthma impact.”
Pneumonia in infancy is associated with asthma beyond the effects of antibiotic use alone, new data suggests. In a family-based food cohort, Amy L. Shroeder, MD, from the Children’s Memorial Hospital in Chicago, and colleagues assessed antibiotic use in the first year of life in 1,131 children (mean age, 6.5 years) using data collected from parental questionnaire interviews. Antibiotic use in infancy was reported in 58.3% of the cases, of which 41.9% had a history of otitis media and 3.3% a history of pneumonia. Asthma, diagnosed in 29.8% of the children, was found to be associated with antibiotic use (odds ratio [OR], 1.9). In a multivariate analysis, otitis media and pneumonia also were associated with asthma (OR, 1.6 and 2.6, respectively). After adjustment for covariates, only the association between asthma, antibiotic use, and pneumonia remained.
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