Asthma

Jul 242011
 

Hashimoto et al randomized 95 adults taking chronic prednisone for severe asthma to usual care or home-tapering guided by spirometry, exhaled nitric oxide (from hand-held devices) and a symptom diary. The self-tapered group used significantly less prednisone without a worsening in symptoms (primary endpoint), hospitalizations or exacerbations (2′ endpoints). (n=95) Thorax 2011;66:514-520.

Jul 082011
 

Yao et al report a meta-analysis of 8 studies (n=728) measured hydrogen peroxide in exhaled breath condensate in asthmatics. Overall, concentration of H2O2 did distinguish asthmatics from non-asthmatics, and H2O2 levels correlated with worsening asthma control and with declining FEV1. CHEST 2011;140:108-116.

Jun 252011
 

Hargreave and Nair (PRO) argue the boutique technique is underrated and underused, citing trials showing improvement in severe asthma outcomes when sputum eosinophils are used to guide therapy (1, 2, and studies on IL-5 blockers). Peters (CON) questions the findings of those trials, doubts eosinophil count adds to clinical measures of asthma control, and compares [… read more]

Jun 102011
 

Chinellato et al report that among 45 children with intermittent asthma, only 11% had “adequate” levels of 25-OH-vitamin D (30-40 ng/mL). Low vitamin D was associated with low FEV1, FVC, and exercise bronchospasm. Eur Resp J 2011;37:1366-1370.

Jun 062011
 

TNF-alpha can be elevated in severe asthmatics’ sputum and bronchial tissue. Could blocking it help? Holgate et al randomized 132 people with moderate or severe persistent asthma to receive 25 mg etanercept or placebo injections for 12 weeks. There was no difference in the primary endpoint (change in FEV1 at 12 weeks) nor in exacerbations, [… read more]

May 202011
 

Most clinical trials for asthma drugs exclude ~95% of potential subjects and test under highly controlled conditions, limiting their results’ generalizability. Price et al publish results of 2 “pragmatic” open-label trials set in the real world. In #1, they randomized 300 symptomatic asthmatics in 53 U.K. primary care clinics to get either a leukotriene receptor [… read more]

Mar 152011
 

Busse et al randomized 419 inner-city kids (age 6-20) with uncontrolled, skin-test-positive, mostly severe allergic asthma and IgE < 1,300 IU/mL to 60 weeks of omalizumab or placebo. The treated group had modest improvements: ~1 fewer day of symptoms per month and a 5% absolute reduction in hospitalizations (1.5% vs 6.3%); 18% fewer of them [… read more]

Feb 192011
 

People (n=21) with inadequately controlled asthma in a supervised exercise program for 12 weeks followed by self-motivated exercise for 12 weeks had “clinically significant” 0.5-point lower scores on the Asthma Control Questionnaire, as well as improved aerobic fitness, compared to 16 nonrandomized matched controls. Astonishingly, no serious trial testing exercise in asthma control has ever [… read more]

Feb 172011
 

Daily inhaled corticosteroids (ICS) may retard growth in children, who would rather play than take daily inhalers. Martinez et al randomized children with mild persistent asthma to four groups, one of which was beclomethasone + albuterol as rescue therapy only (i.e., no daily ICS), for 44 months. They did slightly worse than children taking daily [… read more]

Feb 162011
 

Ciclesonide, a new inhaled corticosteroid that seems to cause thrush less often than others, reached for equivalency with salmeterol/fluticasone in mild persistent asthma. Ciclesonide was better than placebo in controlling asthma but Advair users had a longer time to first asthma exacerbation. CHEST 2011;139: online supplement. A Cochrane review on ciclesonide could not establish its [… read more]

Feb 092011
 

The hygiene hypothesis got a boost from Ege et al, who analyzed dust from 16,000 European children’s bedrooms and mattresses (stored with clinical/demographic data in two huge repositories, GABRIELA and PARSIFAL), for bacterial DNA or growth on bacterial/fungal culture media. Children living on farms had odds ratios for asthma of 0.49 to 0.76, compared to [… read more]