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Health Conditions / Asthma Abstracts
Rate of Asthma Doubles July 8, 2000 British researchers report that in the last 20 years allergy-induced asthma has doubled in the adult population. They found no connection between smoking and this doubling of asthma cases since, during the same period, the rate of smoking had declined by 50 percent. As a result of this trend, between 1980 and 1990 prescriptions for inhaled steroids to treat asthma increased by over 600% . Longitudinal growth in infants and young children treated with budesonide inhalation suspension for persistent asthma. Skoner DP, Szefler SJ, Welch M, Walton-Bowen K, Cruz-Rivera M, Smith JA. The results of this study show that treatment with inhaled corticosteroids (budesonide. suspension) negatively affects growth in young asthmatic children. The study presents the results of 3 trials conducted on 670 asthmatic children aged 6 months to 8 years, followed for a year. In the first trial, children were randomly assigned to receive either budesonide inhaled suspension or conventional treatment without steroids; in the other 2 trials, children were randomly assigned to either budesonide inhaled suspension or to conventional treatment with steroids. Children in the first trial who received budesonide manifested significant height reduction and reduced growth velocity, compared to those who did not use inhaled corticosteroids, confirming the results of other studies indicating that inhaled glucocorticosteroids may interfere with growth in children. Frequent paracetamol use and asthma in adults. Shaheen SO, et al. The results of this study show that users of paracetamol have a significantly increased risk of developing asthma and of having more severe disease, compared to nonusers. Paracetamol has been shown in animals to deplete the lung of the natural anti-oxidant glutathione, and may therefore render the lung more susceptible to inflammation. The researchers investigated a possible association between use of this drug and asthma by evaluating paracetamol intake in 664 asthmatic patients and 910 healthy controls. Use of paracetamol was found to be significantly associated with increased risk of asthma. In particular, individuals who took the drug infrequently (less than monthly) had only a 6% increased risk of asthma. The risk, however, increased by 22%, 80%, and 240% times in monthly, weekly, and daily users, respectively, compared to nonusers. The relation between paracetamol intake and asthma was particularly strong in patients with severe disease. Asthmatic patients who took paracetamol had more severe disease, compared to those who did not use it. These results are of particular relevance, since approximately 20% of asthmatic patients in this study were taking paracetamol on a daily or weekly basis. A reduction of the intake of this drug may therefore translate in a significant reduction in asthma morbidity. Preferential pulmonary retention of (S)-albuterol after inhalation of racemic albuterol. Dhand R, et al. This study shows that racemic albuterol, used to relieve bronchocostriction in asthmatic patients, consists of a (R)-enantiomer which induces bronchodilation, and a (S)-enantiomer which causes bronchoconstriction. The metabolism of the two enantiomers differs; the (R)-enantiomer is metabolized faster while the (S)-enantiomer accumulates in the lungs. The preferential retention in the lungs of the (S)-enantiomer could explain the increased airway obstruction that can be seen in patients on long-term treatment with albuterol. Drug use and pulmonary death rates in increasingly symptomatic asthma patients in the UK. Meier CR; Jick H. This study shows that asthma patients receiving ipratropium bromide and theophylline have a 80% and 3-fold increased risk of death from respiratory causes, respectively, compared to those taking salmeterol. All three drug are regularly used for patients with asthma of increasing severity. The effect of drug therapy on long-term outcome of childhood asthma: a possible preview of the international guidelines. KĻonig P; Shaffer J. This retrospective study shows that "as needed" use of bronchodilators does not improve the long-term prognosis of childhood asthma. Adverse effects of inhaled corticosteroids. Hanania NA; Chapman KR; Kesten S. This study shows that the trend of prescribing corticosteroids as anti-inflammatory drugs for adult asthma to a growing number of patients, in larger doses and for longer periods of time, has been associated with an increased rate of potentially serious systemic adverse reactions such as adrenal suppression, osteoporosis, cataract, stunted growth in children, altered metabolism, and behavioral abnormalities. Adverse effects of medications for rhinitis. Milgrom H; Bender B. This article discusses some of the side effects associated with symptomatic treatment of rhinitis such as cardiac arrhythmias, sedation, psychosis, impaired learning and memory. These complications have been reported after use of antihistamines, decongestants, anticholinergic agents, and corticosteroids, used in combination or alone. Introduction: risk management in asthma and allergic diseases. Du Buske LM . This article warns physicians to carefully evaluate the risks and benefits associated with the symptomatic treatment of allergic diseases such as rhinitis, asthma, and urticaria. First-generation antihistamines, for example, are of unproven efficacy and cause potentially dangerous sedation and impairment in cognitive performances. Second-generation antihistamines have been shown to interact with some antibiotics and antifungal agents and potentially causing life-threatening cardiac arrhythmias. Inhaled steroids and the risk of hospitalization for asthma. Donahue JG; et al. This study shows that while inhaled steroids and cromolyn reduce the risk of hospitalization for asthma, increasing use of beta-agonists is associated with increasing risk of hospitalization. The use of children's medical records to predict the risk of asthma attack. Neville RG; Bryce FP; Clark RA; Crombie IK. This study evaluated potential risk factors for the development of an asthma attack. It was shown that 27% of children who received antibiotics for a respiratory infection subsequently had an asthma attack. Actual use of inhaled corticosteroids and risk of hospitalisation: a case-control study.
This study shows that asthmatic patients who rely significantly on beta 2-agonists and use less than optimal doses of inhaled corticosteroids have an over 5-fold increased risk of being hospitalized for asthma. Changing patterns of asthma mortality. Identifying target populations at high risk. This study shows that asthma mortality rates in the 1970s declined by 7.8% per year, while in the 1980s they increased by 6.2% per year. These differences cannot be attributed to changes in the definition of the disease nor to increased detection of asthma cases.. Regular inhaled beta-agonist treatment in bronchial asthma Sears MR et al. This double-blind placebo controlled study conducted on 89 asthmatic patients shows that the majority of patients randomized to fenoterol experienced worsening of asthma compared to those receiving placebo. The authors concluded that regular use of beta-agonists may contribute to the worldwide increase in asthma morbidity. Case-control study of prescribed fenoterol and death from asthma in New Zealand, 1977-81. This case control study shows that asthmatic patients taking fenoterol have a twofold increased risk of death compared to those not taking the drug. In patients taking 3 or more categories of asthma drugs the risk increased by three times; in patients on oral corticosteroids the risk increased by approximately six times, and in those with the most severe asthma (treated with oral corticosteroids and with a history of hospital admission for asthma attack in the previous year) the risk was increased by almost ten times. Prescribed fenoterol and death from asthma in New Zealand, 1981-7: a further case-control study. Grainger J; et al. This study shows that asthmatic patients aged 5 to 45 years who took inhaled fenoterol had an over twofold increased asthma mortality, compared to nonusers. The use of beta-agonists and the risk of death and near death from asthma. Spitzer WO, et al. This study shows that asthmatic patients taking regularly beta-agonists via a metered-dose inhaler have a 2.6-fold increased risk of death from asthma compared to non-users. The risk associated with use of the beta-agonist fenoterol was increased by 5.4-times, and that associated with use of the beta-agonist albuterol was increased by 2.4-times. End of the New Zealand asthma mortality epidemic. Pearce N; Beasley R; Crane J; Burgess C; Jackson R. This study reports on the epidemic of asthma deaths that started in 1976 in New Zealand, concomitantly with the introduction of the asthma drug fenoterol. After a case-control study revealed in 1989 that the drug caused an over twofold increase in mortality, death rates, for the first time after more than a decade, fell by half and remained low in the following years. Asthma medications and disease exacerbations: an epidemiological study as a method for asthma surveillance. Van Ganse E et al. This study, conducted on a sample of 680 asthmatic patients, shows that users of fenoterol and oral xanthines have a higher risk of asthma worsening, compared to nonusers. Sudden death from asthma in 108 children and young adults. Tough SC; Green FH; Paul JE; Wigle DT; Butt JC. J Asthma, 33(3):179-88 1996 This study evaluated factors that may be associated with increased risk of death in a sample of 108 children or young adults who died of acute asthma. Adrenal suppression was found in 18.7% of cases, indicating that complications derived from use of corticosteroids may, in some cases, contribute to death in this population. Bronchodilators and acute cardiac death. Suissa S; Hemmelgarn B; Blais L; Ernst P. This study, conducted on a sample population of 12,301 asthmatic patients, shows that those taking theophylline and beta-agonists have, respectively, a 2.7- and 2.4-fold increased risk of death from cardiovascular complications compared to nonusers. The association with beta-agonists was found for the preparations administered orally or by nebulizer. Treatment of allergic rhinitis: effects of allergic rhinitis and antihistamines on performance. Storms WW. A This study reviews some of the side effects associated with antihistamines, the most commonly used class of drugs for allergic rhinitis, which include sleepiness, impairment in cognitive performances, impaired driving and working performances, and reduced motor and verbal activity. Children's learning skills and performances may be negatively affected by these drugs. Management of steroid-dependent asthma with methotrexate: a meta-analysis of randomized clinical trials. Aaron SD, Dales RE, Pham B. This study evaluated 12 double-blind, placebo controlled trials assessing the effects of low-dose methotrexate in reducing corticosteroids dosage in patients with severe asthma. Methotrexate was associated with an 18% reduction in corticosteroids use, compared to placebo. However, the drug caused a higher rate of gastrointestinal complications and of liver toxicity. Furthermore, among the 159 patients randomized to methotrexate there were three potentially fatal complications (two pneumonias and one severe liver dysfunction), versus none in patients receiving placebo.
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