High-Dose Vitamin D During Pregnancy Did Not Reduce Risk of Childhood Asthma

MedicalResearch.com Interview with:

Bo Chawes, MD, PhD, DMScAssociate ProfessorC‌openhagen Prospective Studies on Asthma in ChildhoodH‌erlev and G‌entofte H‌ospitalU‌niversity of C‌openhagen

Dr. Chawes

Bo Chawes, MD, PhD, DMSc
Associate Professor
C‌openhagen Prospective Studies on Asthma in Childhood
H‌erlev and G‌entofte H‌ospital
U‌niversity of C‌openhagen

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: There has been a global surge in vitamin D deficiency happening in parallel with an increase in prevalence of childhood asthma, which suggests that low maternal vitamin D levels during pregnancy may increase asthma risk in the child.

Due to that we conducted a randomized double-blinded controlled trial within the Danish COPSAC2010 cohort (www.copsac.com) of 7-fold (2,800 IU/d) vs. standard dose (400 IU/d) of vitamin D supplementation from pregnancy week 24 aiming to reduce offspring asthma risk. At age 3, we observed a non-significant 24% reduced risk of recurrent asthma-like symptoms, ie. recurrent wheeze, in the high-dose vitamin D group. In the current study, we followed 545 of the 581 children in the study till age 6, where an asthma diagnosis can be established and observed no effect of the high-dose vitamin D supplement on the child’s risk of asthma. 

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Should Hospitalized Asthma Patients Receive Antibiotics?

MedicalResearch.com Interview with:
Mihaela S Stefan, MD, PhD FACP

Research Scientist, Institute for Healthcare Delivery and Population Science
Associate Professor, UMMS-Baystate
Director of Perioperative Clinic and Medical Consultation Program
Academic Hospitalist
Director Quality Assessment, Division of Healthcare Quality
Springfield MA

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: In a prior study we have found that roughly 41% of patients hospitalized with an asthma exacerbation receive antibiotics although the guidelines do not support this practice. We found that the evidence supporting the guidelines was however limited to 6 trials which included a total of only 681 adults and children and most trials’ outcomes were symptoms or lung function not length of stay, need for mechanical ventilation, readmissions or death.

We performed the largest observational study to-date of approximately 20 000 patients hospitalized for asthma exacerbation and found that patients treated with antibiotics did not have better outcomes but instead they had longer hospital stay and an increased risk for antibiotic-related diarrhea. Continue reading

Asthma: Biologic Benralizumab (FASENRA) Reduced Need For Rescue Medication

MedicalResearch.com Interview with:
“Asthma Inhaler” by NIAID is licensed under CC BY 2.0Sean O’Quinn MPH
Director, Patient Reported Outcomes
AstraZeneca 

MedicalResearch.com: What is the background for this study? How does benralizumab differ from traditional medications for asthma?

Response:  FASENRA™ (benralizumab 30mg for subcutaneous injection as add-on maintenance therapy in severe eosinophilic asthma for patients 12 years and older) has a strong clinical profile, including powerful efficacy against exacerbations and the ability to improve lung function. Benralizumab is a respiratory biologic that binds directly to the IL-5α receptor on eosinophils and attracts natural killer cells to induce rapid and near-complete depletion of eosinophils via apoptosis. (NOTE: The mechanism of action of FASENRA in asthma has not been definitively established.) Benralizumab is not indicated for treatment of other eosinophilic conditions or for relief of acute bronchospasm or status asthmaticus. The most common adverse reactions include headache and pharyngitis.

Dependence on rescue medications is indicative of poor asthma control. In the Phase III SIROCCO/CALIMA trials, patients with severe eosinophilic asthma had significantly reduced exacerbation frequency and improved lung function when treated with benralizumab 30mg Q8W (first three doses Q4W) vs. placebo.

Less was known about the effects of benralizumab on rescue medication usage—specifically daily total rescue medication use, daytime and nighttime rescue medication use, and nighttime awakenings requiring rescue medication use. The aim of this analysis was to understand the potential treatment effects of benralizumab on these parameters.  Continue reading

Asthma in Children Can Worsen From Allergy to Secondhand Marijuana

MedicalResearch.com Interview with:
"marijuana joint" by Torben Hansen is licensed under CC BY 2.0Bryce Hoffman, MD

Allergy & Immunology Fellow
National Jewish Health

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Secondhand marijuana exposure is expected to increase as personal cannabis use becomes legalized in more states and countries. Cannabis allergy from firsthand use has been reported in adults but allergy in young children exposed to secondhand smoke has not been previously reported. We present a case of a young child with difficult-to-control asthma who was found to have cannabis allergy after being exposed to secondhand marijuana smoke in his household. This child’s asthma improved after cannabis was removed from the environment.

MedicalResearch.com: What should readers take away from your report?

Response: Children exposed to secondhand marijuana smoke can become allergic to cannabis, which in turn may significantly worsen their asthma or allergy symptoms. This is particularly concerning as the cannabis may not be suspected as a cause. Parents and physicians should consider the possibility of cannabis allergy in any child with uncontrolled asthma who is being exposed to secondhand marijuana smoke. This includes any use of marijuana in the household where the patient lives. These children should be referred to an allergist for further work-up.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: Further studies are needed to replicate these results with more patients in the future, and to optimize methods of testing for cannabis allergy. We need to better understand how secondhand allergy develops – is it from particles in the smoke, or plant particles left over in the environment? We also need to better characterize cannabis allergy and in particular its cross-reactivity with other plant foods and pollens. 

I have no disclosures.

Citation:Abstract MEETING American College of Allergy, Asthma and Immunology 2018 Annual Scientific Meeting

Abstract Title: Cannabis allergy in a young child with severe asthma exposed to secondhand marijuana smoke

Author: Bryce Hoffman, MD

Nov 18, 2018 @ 12:20 pm

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Are Some Dogs Really ‘Allergy Friendly’?

MedicalResearch.com Interview with:
"Dogs and Kids Mix Well" by Tony Alter is licensed under CC BY 2.0Catarina Almqvist Malmros MD, PhD
Professor | Consultant Pediatrician
Dept of Medical Epidemiology and Biostatistics | Karolinska Institutet
Lung and Allergy Unit | Astrid Lindgren Children’s Hospital
Stockholm, Sweden

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We have previously shown an association between growing up with dogs and a lower risk of childhood asthma (doi: 10.1001/jamapediatrics.2015.3219) but it has been unknown whether this link is modified by characteristics of the dog. Sex of the dog may have an effect on expressed allergens, and uncastrated male dogs release more of a certain allergen than castrated male dogs and female dogs. Some breeds are also described as ‘hypoallergenic’, but there is no scientific evidence whether they are more suitable for people with allergies.

We examined how variables such as sex, breed, number of dogs or size of dog are associated with the risk of asthma and allergy among children with a dog in their home during the first year of life. We included all Swedish children born between January 2001 and December 2004 whose parents had a registered dog in a dog-owner register and linked the data to the Swedish population- and health data registers.

Main findings are that children raised with only female dogs at home had a 16 per cent lower risk of asthma than those with male dogs, and that children living with two or more dogs had a 21 per cent lower risk of asthma than those with only one dog. Importantly, families with parental asthma or allergies had ‘hypoallergenic’ breeds more often than children whose parents did not have asthma or allergies; 11.7% compared to 7.6 . Exposure to these breeds was associated with a 27 per cent higher risk of allergy and no decreased risk of asthma.  Continue reading

FDA Approves Dupixent: Only Self-Administered Biologic for Moderate-to-Severe Asthma

MedicalResearch.com Interview with:
RegeneronNeil Graham,  M.B.B.S., M.D., M.P.H
VP of Immunology & Inflammation
Regeneron

MedicalResearch.com: What is the background for this announcement? 

Response: Patients with moderate-to-severe asthma often have uncontrolled, persistent symptoms despite standard-of-care therapy that may make them suitable for treatment with a biologic therapy. They live with coughing, wheezing and difficulty breathing, and are at risk of severe asthma attacks that may require emergency room visits or hospitalizations. [i],[ii] Oral corticosteroids can provide relief for severe, short-term symptoms. However, their chronic use is limited to the most severe patients due to the potential for serious side effects. [iii],[iv]

A particular type of inflammation contributes to the cause of uncontrolled symptoms in multiple inflammatory diseases such as asthma and atopic dermatitis.[v] Dupixent is a medicine that inhibits the overactive signaling of interleukin-4 (IL-4) and interleukin-13 (IL-13), two key proteins that contribute to this type of inflammation. This inhibits cytokine-induced inflammatory responses, including the release of proinflammatory cytokines, chemokines, nitric oxide, and IgE; however, the mechanism of action of Dupixent in asthma has not been definitively established. Continue reading

Asthma: Add-on Maintenance Treatment with FASENRA (benralizumab) Can Reduce Exacerbations

MedicalResearch.com Interview with:

Tosh Butt, MBA VP Respiratory AstraZeneca

Tosh Butt

Tosh Butt, MBA
VP Respiratory
AstraZeneca

MedicalResearch.com: What is the background for this study? How is benralizumab different from more traditional treatments for asthma?

    • BORA is a randomized, double-blind, parallel-group, Phase III extension, and is one of six Phase III trials in the WINDWARD program in asthma. The current analysis includes results for 1,926 patients from the two placebo controlled exacerbation trials, SIROCCO (48 week) and CALIMA (56 weeks). BORA provides evidence that add on maintenance treatment with FASENRA (benralizumab) resulted in a consistent safety profile over a second year of treatment, with no increase in the frequencies of overall or serious adverse events, and sustained efficacy in terms of reducing asthma exacerbations, and improving lung function and asthma symptoms. The BORA trial results could provide confidence to patients with severe eosinophilic asthma and physicians that the positive outcomes they may be seeing with benralizumab can be maintained over a second year of treatment.
  • FASENRA, a different kind of respiratory biologic, has a strong clinical profile which includes the ability to show lung function improvement after the first dose, the potential to reduce – or even stop – oral steroid use, and the convenience of 8-week dosing (no other respiratory biologic offers this dosing). FASENRA is approved for add-on maintenance treatment of patients with severe asthma ages 12 years and older, and with an eosinophilic phenotype. FASENRA binds directly to the IL-5a receptor on an eosinophil and uniquely attracts natural killer cells to induce apoptosis, or cell death. Other biologics currently available are anti-IL5s – a passive approach that primarily acts to block differentiation and survival of the eosinophil.

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Asthma Linked to Increased Risk of Atrial Fibrillation

MedicalResearch.com Interview with:

Aivaras Cepelis, MSci Department of Public Health and Nursing, Faculty of Medicine and Health Science, NTNU, Norwegian University of Science and Technology Trondheim, Norway

Aivaras Cepelis

Aivaras Cepelis, MSci
Department of Public Health and Nursing, Faculty of Medicine and Health Science
NTNU, Norwegian University of Science and Technology
Trondheim, Norway

MedicalResearch.com: What is the background for this study?

Response: Atrial fibrillation is the most common sustained, irregular and often rapid heart rate with a lifetime risk of 26%. The number of adults with atrial fibrillation is projected to double by 2050. Atrial fibrillation is also linked to adverse cardiovascular outcomes such as doubled risk of stroke and cardiovascular mortality. Therefore, we believe that research into the novel risk factors of the disease is highly warranted.

One of the potential condition that could play a role in the growing prevalence of atrial fibrillation is asthma. Asthma is a chronic inflammatory airway disease, affecting as many as 30 million children and adults in Europe. High levels of systemic inflammation biomarkers have been reported in both uncontrolled asthmatics and patients with atrial fibrillation. Furthermore, beta-agonists, the most common prescribed asthma control medication, has been shown to influence heart rate and increase the risk of irregular heartbeat.

However, research looking at asthma and atrial fibrillation link are lacking and no previous studies have assessed the dose-response relationship between levels of asthma control and atrial fibrillation. We utilized over 54 000 adults from a large well-defined Norwegian population cohort The Nord-Trøndelag Health Study (HUNT) to explore this association.

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Two Studies Evaluate Monoclonal Antibody Tralokinumab For Asthma

MedicalResearch.com Interview with:

Reynold A. Panettieri, Jr., M.D. Professor of Medicine, Robert Wood Johnson Medical School Vice Chancellor, Clinical & Translational Science Director, Rutgers Institute for Translational Medicine & Science Emeritus Professor of Medicine, University of Pennsylvania Child Health Institute of New Jersey Rutgers, The State University of New Jersey New Brunswick, NJ  08901

Dr. Panettieri

Reynold A. Panettieri, Jr., M.D.
Professor of Medicine, Robert Wood Johnson Medical School
Vice Chancellor, Clinical & Translational Science
Director, Rutgers Institute for Translational Medicine & Science
Emeritus Professor of Medicine, University of Pennsylvania
Child Health Institute of New Jersey
Rutgers, The State University of New Jersey
New Brunswick, NJ  08901

MedicalResearch.com: What is the background for this study?

Response: Severe asthma is characterized by Type 2 inflammation manifested by increases in IL-13, IL-4 and Il-5 levels in the airways that promotes airway hyperresponsiveness and in part irreversible airway obstruction.  These clinical manifestations profoundly increase asthma morbidity and mortality.

To address an unmet therapeutic need, Tralokinumab was developed as a monoclonal antibody targeting soluble IL-13 with the goal of improving lung function and patient reported outcomes while decreasing annual exacerbation rates.  Stratus 1 and 2 represent two identical randomized, double-blind, placebo-controlled, phase 3 clinical trials in severe asthma.  These international trials enrolled approximately 2000 subjects with severe asthma and examined whether Tralokinumab decreased annualized exacerbation rates (AER) as compared with placebo (primary outcome).

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New Test Can Identify Asthma With Nasal Brush Biomarker

MedicalResearch.com Interview with:
Dr. Supinda Bunyavanich MD

Pediatric Allergy and Immunology
Physician and researcher at the Icahn School of Medicine.

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: In this study, we report on an accurate asthma biomarker we have developed based on a simple nasal brush.

Nasal Brush-based Classifier of Asthma

Asthma is a chronic respiratory disease that affects 10% of children and adults in the U.S. Mild to moderate asthma can be difficult to diagnose because symptoms change over time and can be complicated by other respiratory conditions. Given the high prevalence of asthma, there is high potential impact of improved diagnostic tools on reducing morbidity and mortality from asthma.

Current diagnostic tools for asthma, including spirometry and bronchoscopy, require specialized equipment and expertise to operate properly. Many individuals, particularly young children, have difficulty with pulmonary function testing because it requires, coordinated, forced breaths into a device. Spirometry results are unreliable when done with poor technique. Bronchoscopy is not practical for mild to moderate symptoms. For these reasons, asthma is often diagnosed and managed based on self-reporting of symptoms  This can be unreliable, resulting in repeated doctor visits and even trips to the ER. Thus, a biomarker test for asthma that is easy to implement and interpret is highly desirable for the diagnosis and management of asthma. Continue reading

Study Confirms Dupilumab Reduces Asthma Exacerbations

MedicalResearch.com Interview with:

Mario Castro, M.D., M.P.H. Alan A. and Edith L. Wolff Professor of Pulmonary and Critical Care Medicine, Professor of Medicine, Pediatrics, and Radiology Washington University School of Medicine 

Drr. Castro

Mario Castro, M.D., M.P.H.
Alan A. and Edith L. Wolff Professor of Pulmonary and Critical Care Medicine,
Professor of Medicine, Pediatrics, and Radiology
Washington University School of Medicine 

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: This is a confirmatory phase 3 pivotal study that assessed the efficacy and safety of dupilumab in a population of uncontrolled moderate to severe asthmatics.

This was the largest phase 3 placebo controlled trial conducted in this population evaluating a biologic. It enrolled patients without any minimum requirement for any type of biomarker such as blood eosinophils. It clearly confirmed the efficacy of dupilumab in reducing severe asthma exacerbations, improving lung function, asthma control and quality of life in the overall population. It also showed that patients with evidence of type 2 inflammation (increased blood eosinophils or exhaled NO) had a greater magnitude of effect.

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Quadrupling Inhaled Steroids May Abort Some Asthma Attacks

MedicalResearch.com Interview with:
“Asthma Inhaler” by NIAID is licensed under CC BY 2.0Timothy Harrison, MBBS, BSc, FRCP, MD, MSc
Professor and Honorary Consultant
Faculty of Medicine & Health Sciences
University of Nottingham

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Self management plans are recommend for patients with asthma but previous studies have shown that doubling the dose of inhaled steroids when asthma starts deteriorating is ineffective at preventing the development of an exacerbation.

This study shows that quadrupling the dose is effective and in a real-life setting can reduce severe exacerbations by about 20%

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Intestinal Microbiome Linked To Pediatric Asthma

MedicalResearch.com Interview with:

Anita Kozyrskyj, PhD, Professor, Dept Pediatrics Faculty of Medicine & Dentistry, University of Alberta Edmonton, AB 

Dr. Kozyrskyj

Anita Kozyrskyj, PhD, Professor, Dept Pediatrics
Faculty of Medicine & Dentistry, University of Alberta
Edmonton, AB  

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: I was motivated to study the maternal asthma-infant microbiome link by the well-established fact that maternal asthma affects infant birth weight in a sex-specific manner. Based on data from AllerGen’s CHILD birth cohort, Caucasian baby boys born to pregnant moms with asthma—putting them at the highest risk for developing asthma in early childhood—were one-third as likely to have high levels of the microbe, Lactobacillus, in their gut microbiome at 3-4 months after birth.

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Children With Eczema and Food Allergies At Increased Risk of Developing Asthma

MedicalResearch.com Interview with:
“Eczema” by NIAID is licensed under CC BY 2.0Malcolm R. Sears, MB ChB

Firestone Institute for Respiratory Health
St Joseph’s Healthcare and McMaster University
Ontario Canada. 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The Canadian Healthy Infant Longitudinal Development (CHILD) Study was initiated in 2008, funded by AllerGen NCA and CIHR, to determine root causes of allergy and asthma.

We recruited 3623 pregnant mothers in 4 centers across Canada and are following 3495 eligible children from pregnancy to age 5 years.

In this paper we describe some of the findings in early childhood, namely that children who develop skin conditions generally called eczema or atopic dermatitis, who are also sensitized to food allergens (milk, egg, peanut) at 1 year are at high risk of developing subsequent asthma, whereas those with these skin conditions but not sensitized are not at such risk.

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No Link Found Inhaled Steroids and Bone Fractures in Asthmatic Children

MedicalResearch.com Interview with:
“Asthma” by Michael Havens is licensed under CC BY 2.0Teresa To, PhD
Biostatistics, Design and Analysis
Scientific Director
The Hospital for Sick Children
Dalla Lana School of Public Health, University of Toronto
Institute for Clinical Evaluative Sciences
Toronto, Ontario, Canada

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We studied asthma prescription drug use in Ontario children aged 2 to 18 years with physician diagnosed asthma between 2003 and 2014.

We found that:

  1. Currently in Ontario, nearly 50% of children with asthma did not fill a prescription for an inhaled corticosteroid during the study period, despite these medications being considered the gold-standard for asthma management.
  2. Our findings did not show clinically important association between inhaled corticosteroids and fracture among children with asthma.
  3. However, systemic corticosteroids (oral or injection) are associated with higher fracture risk in children with asthma (17% higher risk).

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Interactive Digital Tool Lungprint Aims To Help Asthma Sufferers Take Control Of Their Symptoms

MedicalResearch.com Interview with:

Frank Trudo, MD, MBA Brand Medical Lead US Respiratory AstraZeneca

Dr. Trudo

Frank Trudo, MD, MBA
Brand Medical Lead US Respiratory
AstraZeneca

MedicalResearch.com: Would you tell us about Lungprint?  How will Lungprint help asthma patients take better control of their disease?

Response: Lungprint is an interactive digital tool that creates a dynamic visual representation of a person’s lungs based on their unique experiences with asthma. It is meant to provide people with asthma a better understanding of the role of asthma in their life and motivate them to have a more personalized conversation with their healthcare provider about the severity of their symptoms, a more individualized treatment plan and a blood test that measures eosinophil levels.

Each person’s Lungprint, which is generated as they respond to a digital questionnaire about their experience with asthma, will help reveal information about their individual experience with asthma. You can visit www.lungprint.com to learn more about the tool and create your own Lungprint.  Continue reading

How Do Viruses Trigger Cough In Asthmatic Children, Even Without Allergies

MedicalResearch.com Interview with:

Giovanni Piedimonte, MD Steven and Nancy Calabrese Endowed Chair for Excellence in Pediatric Care, Research, and Education Professor & Chair of Pediatrics Cleveland Clinic Lerner College of Medicine Case Western Reserve University

Dr. Piedimonte

Giovanni Piedimonte, MD
Steven and Nancy Calabrese Endowed Chair for Excellence in Pediatric Care, Research, and Education
Professor & Chair of Pediatrics
Cleveland Clinic Lerner College of Medicine
Case Western Reserve University

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: This study proves that asthmatic children already have a hyperactive calcium channel that’s extremely sensitive to environmental triggers.

If these children contract a virus, such as RSV, the hyperactive channel causes more severe symptoms that may require care in a hospital setting.

When a child developed asthma or bronchitis in the past, doctors thought these conditions could only be triggered by environmental allergens. There was no explanation why two out of three children ages five and under who wheeze and cough – and still test negative for allergies.

We needed to explore the mechanisms of the calcium molecule and the epithelial cells, which seem to trigger these symptoms without an allergic reaction. If the molecule’s behavior is producing the cough, we just need to figure out how to control the molecule to properly deactivate the cough mechanism in the asthmatic child

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Vitamin D May Have a Role In Reducing Risk of Severe Asthma Attacks

MedicalResearch.com Interview with:

David Jolliffe, PhD Centre for Primary Care and Public Health Blizard Institute Barts and the London School of Medicine and Dentistry London

Dr. Jolliffe

David Jolliffe, PhD
Centre for Primary Care and Public Health
Blizard Institute
Barts and the London School of Medicine and Dentistry
London

MedicalResearch.com: What is the background for this study?

Response: Asthma affects more than 300 million people worldwide and is estimated to cause almost 400,000 deaths annually. Asthma deaths arise primarily during episodes of acute worsening of symptoms, known as attacks or ‘exacerbations’, which are commonly triggered by viral upper respiratory infections. Vitamin D is thought to protect against such attacks by boosting immune responses to respiratory viruses and dampening down harmful airway inflammation.

Several clinical trials have tested whether vitamin D supplementation might protect against asthma attacks, but individually their results are inconclusive. In the current study, we pooled raw data from 955 asthma patients who took part in 7 separate trials, which allowed us to answer two questions:

1, Does vitamin D protects against asthma attacks overall, when data from all trials are pooled?

2, Do people who have lower vitamin D levels to start with particularly benefit from supplementation?

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Asthma Improvement Collaborative Reduced ER Visits and Hospitalizations in Medicaid Population

MedicalResearch.com Interview with:

Dr. Carolyn M. Kercsmar, MD Co-Director, Division of Pulmonary Medicine Director, Asthma Center Cincinnati Children’s Hospital Medical Center Department of Pediatrics, University of Cincinnati, College of Medicine Cincinnati, Ohio

Dr. Kercsmar

Dr. Carolyn M. Kercsmar, MD
Co-Director, Division of Pulmonary Medicine
Director, Asthma Center
Cincinnati Children’s Hospital Medical Center
Department of Pediatrics, University of Cincinnati, College of Medicine
Cincinnati, Ohio 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Asthma is the most common chronic condition of childhood and is responsible for substantial morbidity and health care costs, in large portion as a result of emergency room visits and hospitalizations. Moreover, children who live in poverty and are members of minority groups are disproportionately affected.

Our paper reports the results of a quality improvement project that spanned the inpatient, outpatient and community settings and resulted in significant reduction in emergency department visits and hospitalizations for asthma in urban children insured by Medicaid.

MedicalResearch.com: What should clinicians and patients take away from your report?

Response: Broad based interventions that are based on the chronic care model and involve changes in health care systems across multiple setting and disciplines can improve asthma outcomes.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Future work should focus on replicating these findings in other settings and with other personnel, such as community health workers as interventionalists and a formal economic evaluation of the cost-effectiveness of the program. 

Disclosures: This work was supported by Cincinnati Children’s Hospital Medical Center and in part by a grant from Health Information Technology Beacon Program to the Cincinnati Children’s Hospital Medical Center and grant 90BC00116/01 for development of web-based asthma registry and health care use alerts. 

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Kercsmar CM, Beck AF, Sauers-Ford H, Simmons J, Wiener B, Crosby L, Wade-Murphy S, Schoettker PJ, Chundi PK, Samaan Z, Mansour M. Association of an Asthma Improvement Collaborative With Health Care Utilization in Medicaid-Insured Pediatric Patients in an Urban Community. JAMA Pediatr. Published online September 18, 2017. doi:10.1001/jamapediatrics.2017.2600

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

 

 

 

 

 

Pneumococcal Vaccine Rates Still Too Low Among Adults With Work-Related Asthma

MedicalResearch.com Interview with:

Katelynn Dodd MPH Respiratory Health Division National Institute for Occupational Safety and Health Centers for Disease Control and Prevention Morgantown WV 26505

Katelynn Dodd

Katelynn Dodd MPH
Respiratory Health Division
National Institute for Occupational Safety and Health
Centers for Disease Control and Prevention
Morgantown WV 26505

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Adults with asthma are at increased risk for pneumococcal infection. Adults with asthma who get pneumococcal pneumonia are at risk for additional complications including asthma exacerbation and invasive pneumococcal disease. Our results indicated that adults with work-related asthma were more likely to have received a pneumococcal vaccine than adults with non-work-related asthma—54 percent compared to 35 percent respectively; however, pneumococcal vaccination coverage among all adults with asthma, work-related or not, who have ever been employed in this study falls short of achieving the coverage public health experts recommend. Among adults with work-related asthma, pneumococcal vaccine coverage was lowest among Hispanics (36 percent), those without health insurance (39 percent), and adults aged 18 to 44 years (42 percent).

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Asthma Outcomes Worse in Low Income Groups

MedicalResearch.com Interview with:

Wanda Phipatanakul, MD, MS Associate Professor of Pediatrics Harvard Medical School Director, Asthma Clinical Research Center Boston Children's Hospital Asthma, Allergy and Immunology Boston, MA 02115

Dr. Phipatanakul

Wanda Phipatanakul, MD, MS
Associate Professor of Pediatrics
Harvard Medical School
Director, Asthma Clinical Research Center
Boston Children’s Hospital
Asthma, Allergy and Immunology
Boston, MA 02115

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Observational studies have limitations in their ability to examine disparities in asthma, as these studies have relied on self-reported measures of medication use, asthma diagnosis, severity, outcomes, and access to care.

Using data collected from a randomized controlled trial, we found that subjects with lower income had a significantly higher number of asthma treatment failures and asthma exacerbations, independent of race, BMI, education, perceived stress, baseline lung function, hospitalizations, inhaled corticosteroid adherence, inhaled corticosteroid dose, environmental allergen sensitization, and second-hand smoke exposure.

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Vitamin D Supplements Will Probably Not Help Asthma or Atopic Dermatitis

MedicalResearch.com Interview with:

Brent Richards, MD, MSc</strong> Associate Professor of Medicine William Dawson Scholar / FRQS Clinical Research Scholar Departments of Medicine, Human Genetics, Epidemiology and Biostatistics McGill University Senior Lecturer, King's College London (Honorary)

Dr. Brent Richards

Brent Richards, MD, MSc
Associate Professor of Medicine
William Dawson Scholar / FRQS Clinical Research Scholar
Departments of Medicine, Human Genetics, Epidemiology and Biostatistics McGill University
Senior Lecturer, King’s College London (Honorary)

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Some previous epidemiological studies have suggested that low vitamin D levels are associated with increased rates of asthma, atopic dermatitis—an itchy inflammation of the skin—and elevated levels of IgE, an immune molecule linked to atopic disease (allergies). In our study, we looked at genetic and health data on more than 100,000 individuals from previous large studies to determine whether genetic alterations that are associated with vitamin D levels predispose people to the aforementioned conditions.

We found no statistically significant difference between rates of asthma (including childhood-onset asthma), atopic dermatitis, or IgE levels in people with and without any of the four genetic changes associated with lower levels of 25-hydroxyvitamin D, the form of vitamin D routinely measured in the blood.

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Nurse-Driven Clinical Pathway for Asthma Improves Efficiency, Reduces Length of Stay

MedicalResearch.com Interview with:

Catherine M. Pound MD The Ottawa Children’s Treatment Centre

Dr. Catherine Pound

Catherine M. Pound MD
The Ottawa Children’s Treatment Centre

MedicalResearch.com: What is the background for this study?

Response: Asthma is the most common chronic disease of childhood and contributes to a large portion of Canadian hospital pediatric admissions.  Once patients are admitted to hospitals, they receive salbutamol, a medication used for acute asthma exacerbations, at a pre-determined frequency.  In most hospitals, physicians are the ones to decide of the frequency of administration of the salbutamol, and they decide when to wean patients off it. However, children whose salbutamol treatment administration can be decreased are usually considered stable, and often do not require immediate medical attention, which may results in delays in reassessments as well as administration of unneeded salbutamol treatments, particularly if physicians are busy looking after other sicker patients.  Additionally, physicians’ assessments of children with asthma and their decisions to wean salbutamol frequency are not standardized, and vary among physicians. Therefore, in order to improve efficiency and standardize patient assessments, we developed a clinical pathway allowing nurses to wean salbutamol for children hospitalized with asthma based on a validated asthma scoring system.

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Mouse Allergens Drives Asthma Symptoms In Many Children

MedicalResearch.com Interview with:

Elizabeth C. Matsui, MD MHS Professor of Pediatrics, Epidemiology, and Environmental Health Sciences Johns Hopkins University Baltimore, MD 21287

Dr. Matsui

Elizabeth C. Matsui, MD MHS
Professor of Pediatrics, Epidemiology, and Environmental Health Sciences
Johns Hopkins University
Baltimore, MD 21287 

MedicalResearch.com: What is the background for this study?

Response: We designed this study after our previous work indicated that mouse allergy was common among low-income children living in some urban neighborhoods in the US, that these children also had high levels of mouse allergen exposure in their homes, and that children who are both allergic to mice and exposed to high levels of mouse allergen are at greater risk of asthma symptoms, emergency room visits and hospitalization.   Given this background, we designed a randomized clinical trial to determine if an intensive professionally delivered mouse intervention was better than education about mouse control in reducing asthma symptoms and lowering home mouse allergen levels.

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Sleep Duration and Exhaled Nitric Oxide in Asthma and Health Adults

MedicalResearch.com Interview with:
Rauno Joks, MD

Associate Professor of Clinical Medicine
Chief, Division of Allergy & Immunology
Program Director, Allergy &Immunology Fellowship
SUNY Downstate Medical Center

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: There are circadian and circannular patterns to many diseases, including allergy and asthma. Humans spend roughly one-third of their lifetimes asleep. Your immune system never sleeps, but shifts its activity when you sleep.

It is known that asthma disease activity can be worse at night – the reasons for this are complex, and may involve changes in allergic responses.

We found, in a preliminary study of both adults with and without asthma, that longer duration of nighttime sleep was associated with lower levels of exhaled nitric oxide, a biomarker which is elevated in exhaled breath of those with allergic asthma. This may carry over into the afternoon as well, but the sample size was too small to fully conclude that.

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