PHYSICIANS SHOULD EDUCATE PARENTS ABOUT ASTHMA PREVENTION

Researchers are urging physicians to help families identify their children’s asthma triggers and to provide education to parents regarding effective methods for reducing and even eliminating these triggers. According to a study published in the August Journal of Allergy and Clinical Immunology, parents often “spend a great deal of effort and significant resources on actions that are neither recommended nor reasonable.”

Michael D. Cabana, MD, MPH, and colleagues, from the University of Michigan Health System in Ann Arbor, conducted telephone interviews with the parents of 896 asthma patients between the ages of 2 and 12. Parents were asked to identify asthma triggers and to describe actions they took to eliminate them from their homes.

“Eighty percent of parents in this study knew at least one specific factor that triggered their child’s asthma symptoms, and 82% of those had devoted some effort to help their children avoid these triggers,” said Dr. Cabana. “But we also found that a lot of parents were pursuing strategies that haven’t been endorsed by national guidelines or aren’t likely to be helpful given their child’s particular triggers.”

The researchers found that 51% of the respondents’ actions were not useful in addressing specified triggers. The most common action taken by families was purchasing special air filters—only 157 out of 224 respondents who purchased an air filter reported an environmental trigger that could be addressed by this particular action. Other common actions included reducing the child’s exposure to dust, using a specialized vacuum for cleaning, purchasing special bedding, increasing cleaning of the house in general, and reducing exposure to animals.

Toby Lewis, MD, MPH, a coauthor of the study, attributed these actions to the constant bombardment of commercial messages about products purported to help reduce asthma symptoms. “The bottom line is, talk to your doctor before you spend a lot of money, and do the cheap, easy things first,” said Dr. Lewis.

Researchers also found that although “the National Heart, Lung, and Blood Institute guidelines describe tobacco smoke as the ‘most important environmental indoor irritant’ … only 6% of respondents who smoked reported any attempt to reduce their child’s smoke exposure.”

Dr. Cabana concluded that physicians “need to do a better job of providing information and balancing the messages they may hear elsewhere, so parents can do what’s proven to prevent asthma symptoms and attacks.” He also said they need “to help parents match the intervention to the trigger, and to talk about what’s proven to work and what’s less likely to work.”

Cabana MD, Slish KK, Lewis TC, et al. Parental management of asthma triggers within a child’s environment. J Allergy Clin Immunol. 2004;114:352-357.

ACE INHIBITORS AND STATINS DO NOT IMPROVE SURVIVAL IN IDIOPATHIC PULMONARY FIBROSIS

Recent data do not show a beneficial effect of angiotensin-converting enzyme (ACE) inhibitors and/or 3-hydroxy-3-methylglutaryl coenzyme-A reductase inhibitors (statins) on survival in patients with idiopathic pulmonary fibrosis.

According to a report in the August Chest, researchers retrospectively studied 487 patients with idiopathic pulmonary fibrosis who were treated at the Mayo Clinic in Rochester, Minnesota, between 1994 and 1996. The purpose of their study was to compare “survival in a group of patients with idiopathic pulmonary fibrosis … who received ACE inhibitors for primary cardiovascular indications and/or statins for dyslipidemia with that of a large simultaneous cohort of patients with idiopathic pulmonary fibrosis/usual interstitial pneumonia not receiving these drugs.”

During 1998, researchers contacted patients via questionnaires, phone calls, public record review, and patient visits to assess vital status. In 2000, patients were contacted once more to obtain two-year follow-up data.

Researchers found that 52 patients were receiving ACE inhibitors—specifically enalapril, lisinopril, captopril, ramipril, benazepril, or quinapril. Thirty-five patients were receiving statins—lovastatin, simvastatin, pravastatin, or fluvastatin. In addition, five patients were receiving both ACE inhibitors and statins.

Results indicated that there was no difference in survival between patients receiving ACE inhibitors and/or statins versus patients taking neither of the drugs. For patients receiving ACE inhibitors, the median survival was 2.2 years versus 2.9 years for those not receiving ACE inhibitors. Median survival was equivalent (2.9 years) for patients who were receiving statins and those who were not. When comparing those who were receiving ACE inhibitors and/or statins to those receiving neither, median survival was 2.5 years versus three years, respectively.

These results did not change when the researchers adjusted for the presence of coronary artery disease, congestive heart failure, diabetes mellitus, and hypertension. In addition, when adjusting for age, sex, recommended treatment, smoking status, prior oxygen use, FVC, and DLCO, the results remained the same.

Researchers attempted to explain the results by taking into account several limitations to the study. First, the study lacked blinded randomization to ACE inhibitors and/or statins. Second, patients were receiving variations in the types and doses of ACE inhibitors and statins, which may have different fibromodulating properties. Another explanation is that a larger sample of patients might be needed to detect the survival benefit of ACE inhibitors and/or statins.

“We conclude that ACE inhibitors and/or statins are not associated with improved survival in idiopathic pulmonary fibrosis but acknowledge that the limitations of the data set do not definitively preclude an eventual beneficial role for these agents in this enigmatic disorder,” said the researchers.

Nadrous HF, Ryu JH, Douglas WW, et al. Impact of angiotensin-converting enzyme inhibitors and statins on survival in idiopathic pulmonary fibrosis. Chest. 2004;126:438-446.

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