Asthma / Asthma Abstracts

submitted by Dr. Gary Farr Last Updated February, 12, 2002

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Benefits and complications of troleandomycin (TAO) in young children with steroid-dependent asthma.

Flotte TR; Loughlin GM.
Pediatr Pulmonol, 10(3):178-82 1991

This study shows that use of troleandomycin in children with severe, steroid-dependent asthma, reduces steroid requirements and hospitalization rates, but increases the rate of steroid-dependent complications. In particular, the rate of cataracts increased from 11% to 33% and the rate of hypercholesterolemia increased from 22% to 78%.

Increased morbidity and mortality related to asthma among asthmatic patients who use major tranquillisers

Joseph, K S. et al.
BMJ 1996;312:79-81 (13 January)

This study shows that asthmatic patients using major tranquillisers have an over three-fold increased risk of death or near death from asthma, compared to nonusers. The risk seems to be particularly high in patients who recently discontinued the use of tranquillisers.

Relation of infant diet to childhood health: seven year follow up of cohort of children in Dundee infant feeding study

Wilson AC. Et al.
BMJ 1998;316:21-25 (3 January)

This study, conducted on 545 infants followed up for approximately 7 years, shows that the incidence of respiratory illnesses was greatly reduced in infants who were exclusively breast fed for at least 15 weeks (17%) compared to those who were partially breast-fed or bottle fed (31% and 32% respectively). Introduction of solid foods before 15 weeks was associated with increased risk of wheeze during childhood (21% vs. 10%), and with increased percentage of body fat and weight in childhood. Bottle feeding was associated with a significant increase in systolic blood pressure compared to breast feeding (mean systolic blood pressure 94.2 mm Hg vs. 90.7 mm Hg). The results of this study show that breast feeding and avoidance of solid foods during the infants' first 15 weeks can have a great impact on the health of children and later, adults.

US in the dark on doubling in asthma death rates. News

Roberts, J.
BMJ 1996;312:1246 (18 May)

This article reports on a study from the Centers for Disease Control and Prevention (CDC) revealing that in the U.S., rates of death due to asthma more than doubled in the period from 1980 to 1993. This increase in death occurred especially among African American, who, in 1993, were 6 times more likely to die of asthma in the first 4 years of life and from the age of 15 to that of 24, compared to whites. Since asthma mortality rates have been used as a marker of effective health care delivery, these data seem to indicate problems in the health care system.

Controversies involving inhaled beta-agonists and inhaled corticosteroids in the treatment of asthma.

Fahy JV, Boushey HA
Clin Chest Med 1995 Dec;16(4):715-33

This article reviews some of the controversies surrounding the use of
inhaled beta-agonists and inhaled corticosteroids in asthma patients. While it is well known that excessive use of beta-agonists increases the risk of asthmatic death, it is yet to be defined whether regular use may be associated with worsening of asthma control. As for inhaled corticosteroids, the issue is whether the benefits derived by their use outweigh the risks of long-term toxicity such as osteoporosis, cataracts and stunted growth, and whether treatment benefits are only short-lasting.

Case-control study of salmeterol and near-fatal attacks of asthma.

Williams C, et al.
Thorax 1998 Jan;53(1):7-13

This case-control study shows that asthmatic patients receiving the beta agonist salmeterol have a 2.3-fold increased risk of near-fatal asthma attacks compared to nonusers. When the analysis was restricted to severe cases only, the risk was increased by 40%. The risk of near fatal asthma attacks was associated with the mode of delivery of the drug. In particular, patients receiving a beta agonist by metered dose inhaler did not have an increased risk, while those who received it by nebulizer had an almost 4-fold increased rate of near fatal asthma attacks. Asthmatic patients receiving oral theophylline were 2.5-times more likely to have a near fatal asthma attack compared to nonusers.

The association between beta-agonist use and death from asthma. A meta-analytic integration of case-control studies.

Mullen M, Mullen B, Carey M
JAMA 1993 Oct 20;270(15):1842-5

This study analyzed 6 case-control studies investigating the relationship between use of beta agonists and death from asthma. The results of the analysis revealed that use of beta agonists by nebulizer, but not by metered-dose inhaler, is significantly associated with increased risk of death. The risk is particularly elevated in adults compared to adolescents.

Prescribed drug therapy and near-fatal asthma attacks.

Burgess C, et al.
Eur Respir J 1994 Mar;7(3):498-503

This study shows that the rate of near fatal asthma attacks is doubled in patients receiving fenoterol versus nonusers. Use of theophylline was associated with a 90% increased risk of near fatal asthma attacks.

Asthma medications and disease exacerbations: an epidemiological study as a method for asthma surveillance.

Van Ganse E, et al.
Eur Respir J 1995 Nov;8(11):1856-60

This study, conducted on a sample group of 680 asthmatic patients, shows that use of oral xanthines and inhaled fenoterol is associated with an increased likelihood of asthma exacerbation.

Long-and short-acting beta 2-adrenergic agonists. Effects on airway function in patients with asthma.

Busse WW.
Arch Intern Med 1996 Jul 22;156(14):1514-20

This article reports that use of beta agonist bronchodilators was first shown to be associated with increased asthma morbidity and mortality in the 1960s in U.K. and in the 1970s in New Zealand. However, to this day, controversies about their safety and efficacy still exist, and there are concerns that long-term use of this class of drug may be associated with loss of asthma control in some patients.

The beta-agonist controversy.

Taylor DR, Sears MR, Cockcroft DW
Med Clin North Am 1996 Jul;80(4):719-48

This article emphasizes that treatment with short-acting beta agonists is strongly associated with increased death from asthma. Furthermore, the evidence that long-term beta agonist therapy improves symptoms and lung functionality in asthmatic patients is meager, while adverse events from treatment are well documented. Long-term use of short-acting beta agonists as also been associated with deterioration of asthma control. Whether also long-acting beta agonists produce the same effect is not yet clearly defined.

Regular inhaled beta agonist in asthma: effects on exacerbations and lung function.

Taylor DR, et al.
Thorax 1993 Feb;48(2):134-8

This double-blind placebo controlled crossover study shows that asthmatic patients who use regularly the beta agonist fenoterol have higher rates of asthma attacks, significant worsening of lung function and increased airway responsiveness compared to patients who take the drug "as needed".

Hospital treatment of asthma: lack of benefit from theophylline given in addition to nebulized albuterol and intravenously administered corticosteroid.

DiGiulio GA, Kercsmar CM, Krug SE, Alpert SE, Marx CM
J Pediatr 1993 Mar;122(3):464-9

This double-blind, placebo controlled study shows that the addiction of theophylline to a drug regimen consisting of nebulized albuterol and intravenous steroids in children hospitalized for asthma may not be justified since it is not associated with improvement of asthma symptoms and lung functionality nor with reduced length of hospitalization.

Aminophylline toxicity--how many hospital asthma deaths does it cause?

Eason J, Markowe HL
Respir Med 1989 May;83(3):219-26

This study shows that 21% of patients who died from asthma attacks might have had toxic theophylline levels in their blood, compared to only 7% of those who were hospitalized for acute asthma but survived the attack.
It is possible that theophylline toxicity may contribute to death from asthma in a significant proportion of patients.

Life-threatening events after theophylline overdose: a 10-year prospective analysis.

Shannon M
Arch Intern Med 1999 May 10;159(9):989-94

This study shows that in spite of a decline in use of theophyllines in the treatment of asthma, cases of fatal or near fatal intoxication are still occurring.
Three hundred fifty-six patients with theophylline toxicity were followed up prospectively. Cardiac arrhythmias occurred in 21%, seizures in 8%, and death in 4.2% (15) of patients. About 75% of patients who died were chronically overmedicated. The authors conclude that theophylline toxicity is associated with substantial morbidity and mortality, and its use should be reduced to a minimal.

Risk factors for death from asthma, chronic obstructive pulmonary disease & cardiovascular disease after a hospital admission for asthma.

Guite HF, Dundas R, Burney PG
Thorax 1999 Apr;54(4):301-7

This study shows that patients treated with ipratropium bromide, an anticholinergic agent used as bronchodilator in maintenance therapy of asthmatic patients, are four times more likely to die from asthma compared to nonusers. Asthmatic patients taking pratropium bromide have also an almost 8-fold increased risk of death from chronic obstructive pulmonary disease, and a 3.5-fold increased risk of death from cardiovascular diseases.

Near-death asthmatic reaction induced by disodium cromoglycate.

Katayama H, et al.
Intern Med 1996 Dec;35(12):976-8

This study reports on the case of a patient who suffered from a near death asthmatic attack after inhaling disodium cromoglycate (DSCG). This article emphasizes a possible association between DSCG and fatal asthma.

Risk of non-fatal cardiac failure and ischaemic heart disease with long acting beta 2 agonists.

Martin RM, Dunn NR, Freemantle SN, Mann RD
Thorax 1998 Jul;53(7):558-62

This study evaluated the risk of non-fatal cardiac failure and ischemic heart disease in over 12,000 asthmatic patients taking nedocromil, over 15,000 patients taking the beta agonist salmeterol, and approximately 8,000 patients taking the beta agonist bambuterol. Patients receiving bambuterol and salmeterol had a 3.4-fold and 10% increased risk of non fatal cardiac failure, respectively, compared to patients taking nedocromil. The risk of non fatal ischemic heart disease was increased by 23% and 7% in patients taking bambuterol and salmeterol, respectively, compared to those receiving nedocromil. Asthmatic patients who just started therapy with bambuterol had a 4-fold increased risk of ischemic heart disease in the first month of treatment.

Aminophylline in acute asthma.

Olson LG
Aust N Z J Med 1987 Apr;17(2):263-6

This article reports on the results of several trials showing that the drug theophylline used in patients treated with high doses of beta agonists adds no benefits in terms of reduced morbidity or mortality. Since, on the other hand, it is difficult to keep theophylline serum concentration within safe limits, and, furthermore, the effects of toxic levels can be very serious, the author recommends that the drug be used only in restricted circumstances and in limited amounts.

Use of inhaled corticosteroids and the risk of cataracts.

Cumming RG ; Mitchell P ; Leeder SR
N Engl J Med, 337(1):8-14 1997 Jul 3

This study, conducted on 3,654 individuals aged 49 years and older, shows that current or previous users of inhaled corticosteroids have twice the risk of posterior subcapsular cataracts -the most serious type of cataract- compared to nonusers. The risk of cataracts increases with increasing use of inhaled corticosteroids, and 27% of individuals who took the drug for the longest time developed cataracts, more than five times the usual. This is the first study to reveal that the association between steroids and cataracts is not restricted to systemic and ocular corticosteroids but includes the inhaled forms.

Inhaled corticosteroids and cataract: prevalence, prevention & management.

Cumming RG, Mitchell P
Drug Saf 1999 Jan;20(1):77-84

This article emphasizes that the association between inhaled corticosteroids and the risk of developing the most serious type of cataract is so strong that is likely to be causal. Since inhaled corticosteroids have the potential to cause severe side effects, they should be used at the lowest doses and for the shortest possible length of time, in agreement with effective asthma management.