Model Predicts Children At High Risk For Asthma Related Acute Care Visits

MedicalResearch.com Interview with:
Jill Hanson, MD
Children’s Mercy Hospital
Kansas City MO 

Background from the American College of Allergy, Asthma & Immunology

“Asthma is the most common chronic disease in children, and one of the most difficult to manage, which is one of the reasons there are so many emergency department visits for asthma sufferers in the US.”

Medical Research: What are the main findings of this study?

Dr. Hanson: Our study of asthmatic children found that the number of historical asthma-related acute care visits (i.e. urgent care, emergency department and inpatient admissions) was predictive of future asthma-related acute care visits. 

Continue reading

Children Have Lower Risk of Asthma In Home With Dog

Dr. Tove Fall, PhD Associate Professor in Epidemiology Ingelsson Group Upssala University

Dr. Tove Fall

MedicalResearch.com Interview with:
Dr. Tove Fall, PhD
Associate Professor in Epidemiology
Ingelsson Group
Upssala University

Medical Research: What is the background for this study? What are the main findings?

Dr. Fall: We wanted to make use of the Swedish national dog registers to study the question of whether children exposed to dogs are at lower risk of asthma and compare this to children living in farming environments. Previous studies on this question has been inconclusive. We linked health and population data from all children born in Sweden from 2001-2010 with dog ownership data, and with this detailed data set, we found that children in dog-households had 13% lower risk for asthma at age 6, accounting for factors such as parental asthma, area of residence and socioeconomic status. Children in farming households were at even lower risk, which is consistent with many previous studies.

Continue reading

Immunotherapy May Ward Off Fall Asthma Attacks in Predisposed Children

Stephen J. Teach, MD, MPH Chair, Department of Pediatrics Children's National Health System Washington, DC

Dr. Stephen Teach

MedicalResearch.com Interview with:
Stephen J. Teach
, MD, MPH
Chair, Department of Pediatrics
Children’s National Health System
Washington, DC 

Medical Research: What is the background for this study? What are the main findings?

Dr. Teach: Inner-city children aged 6 to 17 years with moderate to severe asthma continue to experience exacerbations at high rates during the fall season despite therapy which follows the guidelines of the National Institutes of Health. These exacerbations are most common among children with a history of prior exacerbations and sensitivities to common indoor allergens who develop an upper respiratory infection with the common cold virus (rhinovirus). The PROSE study found that treatment with omalizumab begun 4 to 6 weeks before the children return to school, significantly reduced exacerbations of asthma in the first 90 days of the school year. This effect was most dramatic among those children who had experienced an exacerbation in the months preceding the beginning of the school year. Omalizumab is an antibody which binds and deactivates the IgE antibody. The IgE antibody serves as the basis for allergic sensitivity.

Continue reading

Menopause Increases Asthma Risk

Kai Triebner, MSc Department of Clinical Science University of Bergen Bergen, Norway
MedicalResearch.com Interview with:

Kai Triebner, MSc
Department of Clinical Science
University of Bergen
Bergen, Norway


Medical Research: What is the background for this study?

Response: During the last decades female life expectancy has risen far beyond 50
years worldwide. This means that the quality of life after menopause is
highly relevant today. Menopause implies profound hormonal and metabolic
changes leading to higher risk of diabetes and cardiovascular diseases.
Although researchers are increasingly aware that hormonal status and
inflammation may also deteriorate respiratory health, our knowledge is
very scarce. So far, no prospective study had investigated whether
menopause increases the risk of asthma in the general population.

Medical Research:? What are the main findings?

Response: We studied the association between menopausal status and newly diagnosed  asthma, after the age of 44. We found that the odds of getting asthma
were more than twice as high for women going through the menopausal
transition or after menopause, compared to non-menopausal women. The
risk was particularly high for overweight and obese women. These results
were not due to general aging and were independent of smoking and
geographical location.

Continue reading

Sublingual Immunotherapy Not Currently Recommended For Asthma Control

Rebecca Normansell MA MB BChir Cochrane Airways Population Health Research Institute St George’s, University of London

MedicalResearch.com Interview with:
Rebecca Normansell MA MB BChir
Cochrane Airways
Population Health Research Institute
St George’s, University of London

 

 

Medical Research: What is the background for this study?

Response: Asthma is a common, long-term, respiratory condition which affects over 300 million people worldwide. It is a burden not only for the individual with asthma but also for the health services that care for them and the wider economy, due to days lost from work and school.

Asthma therapies aim to prevent attacks and improve symptoms by reducing airway constriction and inflammation, but they come with their own risks of side effects. For example, long-term high-dose inhaled corticosteroids have been associated with growth restriction in children and long-acting beta2-agonists as mono-therapy have been associated with increased risk of death in people with asthma.

There is growing interest in developing novel treatments for asthma and one such treatment is specific allergen immunotherapy. Immunotherapy has the potential to be a useful approach for asthma as it is thought that for approximately half of people with asthma, allergies are an important trigger for their symptoms and attacks. Immunotherapy can be delivered by injection (subcutaneously) or under the tongue (sublingually) and aims to bring about immune tolerance.

Immunotherapy has already been demonstrated to be effective in certain conditions, such as allergic rhinitis and wasp and bee sting allergy, but its effectiveness and safety in asthma is less clear. In fact, immunotherapy is not recommended at all for use in people with severe or uncontrolled asthma due to the risk of triggering a serious respiratory reaction.

Medical Research: What are the main findings?

Response: Our review looked for trials in which people with asthma who were given sublingual immunotherapy (SLIT) were compared with those given placebo, or who continued usual asthma care. We found 52 randomised controlled trials which met our inclusion criteria, allocating over 5,000 people to either SLIT or placebo/usual care. Most of the participants had mild asthma and were allergic to either house dust mite or pollen.

Despite the large number of eligible trials we were only able to perform a limited meta-analysis. This is because most of the trials did not report the efficacy outcomes we were most interested in: exacerbations and quality of life. Asthma symptoms and medication use were both more frequently reported, but often using different, un-validated scales so we did not perform a meta-analysis for these outcomes.

However, we were able to combine serious adverse event data from 22 trials involving 2560 participants and data for all adverse events from 19 trials including 1755 participants. SLIT did not appear to be associated with an increased risk of serious adverse events, although very few events were observed overall. SLIT was associated with a small increase in the risk of all adverse events, which in absolute terms equated to an increase from 222 per 1000 people in the control group to 327 per 1000 (95% confidence intervals 257 to 404). Importantly, many of these events were mild and transient local reactions and did not generally result in participants withdrawing from the trial.

Continue reading

Abnormal Lung Microbiome Linked To Severe Asthma

Yvonne J. Huang, MD Assistant Professor, Division of Pulmonary & Critical Care Medicine University of Michigan Health System Ann Arbor, MI  48109-5642
MedicalResearch.com Interview with:
Yvonne J. Huang, MD

Assistant Professor, Division of Pulmonary & Critical Care Medicine
University of Michigan Health System
Ann Arbor, MI  48109-5642

 

Medical Research: What is the background for this study?

Dr. Huang: Asthma is a disease with many different clinical manifestations, and it is likely that multiple mechanisms play a role in asthma. Understanding the biological processes that contribute to this heterogeneity is an important goal of current translational research in asthma. One hypothesis that dates back several decades is whether asthma, at least in some forms, is linked to chronic airway infection or colonization by particular species of bacteria.  Results of early investigations in this regard were mixed, in part due to reliance on less sensitive methods to detect bacterial infection, but a new spin on this hypothesis has emerged in recent years.   This stems from the technological advances that now enable one to molecularly profile all bacteria present in a sample, such as via sequence analysis of conserved bacterial genes (such as that for 16S ribosomal RNA). 16S rRNA-based methods are now commonly used to profile bacterial microbiota in a variety of human niches, including in studies of respiratory disease.

Prior to our current study, a few investigations had shown that the lower respiratory microbiome in adult asthmatics differs in bacterial composition (i.e. the types and relative abundance of bacteria present), compared to healthy controls.   In a previous study of patients with mild-moderate asthma, we also had found that clinical features of asthma, such as bronchial hyper-responsiveness, were associated with increased abundance of specific bacterial groups.  However, whether similar relationships between clinical features and the  microbiome exist in severe asthma was unknown, which we addressed in the current study.

Continue reading

High Fiber Diet During Pregnancy May Reduce Risk of Childhood Asthma

Dr. Alison Thorburn Ph.D. School of Medical and Applied Sciences, Central Queensland University Rockhampton, Queensland 4702, AustraliaMedicalResearch.com Interview with:
Dr. Alison Thorburn Ph.D.
Department of Immunology
Monash University
Victoria, Australia

Medical Research: What is the background for this study?

Dr. Thorburn: Asthma is a highly prevalent disease in the Western World. The prevailing explanation for this has been the hygiene hypothesis, which proposes that a decline in family size and improved hygiene has decreased exposure to infectious agents and therefore resulted in dysregulated immune responses that lead to asthma. However, recently there has been more attention on the role of diet and the gut microbiota in explaining the prevalence of inflammatory diseases in Western World. Indeed, many studies implicate obesity, as well as a high fat, low fruit and vegetable diet with higher prevalence of asthma. On the other hand, a Mediterranean diet, which is high in fruit and vegetables, is associated with lower prevelance of asthma. Interestingly, the consumption of dietary fiber is reduced in severe asthmatics. These and other data suggest that the diet (particularly dietary fibre) and the gut microbiota may play an important role in the development of asthma.

Medical Research: What are the main findings?

Dr. Thorburn: The main findings of this study are that:

–        In mice: A high-fiber diet promotes a gut microbiota that produces high levels of anti-inflammatory short-chain fatty acids (SCFAs), particularly acetate. Acetate (alkaline form of vinegar) suppressed the development of allergic airways disease (AAD, a model for human asthma) in adult mice and the offspring of pregnant mice.

–        In humans: High dietary fiber intake during late pregnancy is associated with higher acetate levels in the serum and a decrease in the percentage of infants showing predictors for asthma development in later life.

–        The mechanism underlying these findings involves increasing T regulatory cell number and function through epigenetic mechanisms, which enhance immune regulation to prevent inflammation.

Continue reading

Soy Supplement Did Not Improve Asthma Symptoms

Lewis J. Smith, MD Professor of Medicine and Associate Vice President for Research Northwestern University and the Feinberg School of Medicine Chicago, IL 60611MedicalResearch.com Interview with:
Lewis J. Smith, MD

Professor of Medicine and Associate Vice President for Research
Northwestern University and the Feinberg School of Medicine
Chicago, IL 60611

Medical Research: What is the background for this study? What are the main findings?

Dr. Smith: We previously observed in a survey of more than 1,000 patients with asthma that those consuming soy isoflavones in their diet had better lung functioning than their counterparts who consumed little or none.  Using a more detailed soy questionnaire, we confirmed the observation in a different group of patients with asthma, and followed that up with laboratory studies.  In cell culture studies, we saw that genistein, the major soy isoflavone, at levels that are achieved in individuals consuming a high soy diet, reduces eosinophilic inflammation, a key feature in asthma. In addition, people who consume more soy products, mostly in Japan and parts of China, generally have less asthma than in western countries.  Although these data indicate a potential beneficial effect of soy isoflavones in patients with asthma and nutritional supplements are commonly used by people to treat and prevent disease and improve their health, there was little direct data to prove that the supplement is actually effective.  As a result, we explored the effects of a soy isoflavone supplement in 386 adults and children aged 12 or older with poorly controlled asthma. All were taking medicine to treat their asthma – either corticosteroids or leukotriene modifiers – but none consumed soy more than once a week. In the randomized, double-blind study, half of the participants took a soy isoflavone supplement twice daily for six months, and the other half took a placebo. We found that the supplement, though able to increase blood levels of genistein, did not improve lung function, symptoms or measures of inflammation in these individuals.

Continue reading

Epigenetics: More Than 30 Genes Affect Allergies and Asthma

Dr. Liming Liang PhD Assistant Professor of Statistical Genetics Departments of Epidemiology and Biostatistics, Harvard School of Public Health, Boston, Massachusetts Dr. Liming Liang PhD
Assistant Professor of Statistical Genetics
Departments of Epidemiology and Biostatistics,
Harvard School of Public Health, Boston, Massachusetts

 

Allergies affect 30% of the population and 10% of children suffer from asthma. Researchers in the United Kingdom, the United States, Sweden and Canada report in Nature that they have discovered more than 30 genes that have strong effects on Immunoglobulin E (IgE), allergies and asthma. IgE is the antibody that triggers allergic responses.

Amongst the genes are promising novel drug targets for treating allergies and asthma.

The researchers also found that the genes are concentrated in eosinophils, a white cell that ignites inflammation in asthmatic airways. The genes indicate when the eosinophils are activated and primed to cause the most damage.

Therapies that neutralise eosinophils already exist, but they are very expensive and only efficacious in some asthmatics. The newly found activation signals provide a possible means of directing treatments by predicting who will respond before starting therapy.

The research team used a novel technique to discover these genes, known as an “epigenome wide association study (EWAS)”. Epigenetic changes to DNA do not alter the underling sequence of the genetic code but can still be passed on as cells divide. They program the cells to form specialised types and tissues.

Epigenetic changes are most easily detected by alterations in methyl molecules that are attached at the side of the DNA chain. The researchers therefore concentrated on 27,000 methylation hotspots known as CpG islands that are positioned near many genes. They tested whether methylation levels in these islands in white cells from UK families with asthma was correlated with the level of the IgE in the blood.

To be sure of their positive results the researchers tested whether they held true in additional volunteers with high and low levels of IgE from Wales and further asthmatic families from Québèc.

They found strong associations between IgE and CGI methylation at 36 places in 34 genes. Some of the IgE-related genes were known to be present in eosinophil cells. The researchers therefore separated eosinophils from the blood of 24 subjects and showed all 34 genes to have their strongest effects in asthmatics with high IgE levels.

The paper shows the power of epigenome wide association analyses. Previous genetic association studies for IgE levels (looking at changes in DNA sequences) had only found genes that could explain 1% of individual differences in IgE, and did not discover any novel therapeutic targets or pathways underlying IgE regulation

By contrast the epigenetic associations accounted for more than 13% of IgE variation, 10 fold higher than that derived from traditional genetics. The associations identify novel potential drug targets for allergic diseases as well as biomarkers that may determine which patients will respond to particular therapies.

The increased power from epigenetic studies comes at the cost of controlling for many factors such as ageing and gender that are not important for simple genetic studies. The authors had to use advanced statistical techniques to be sure of their results, and as well as testing their validity in multiple additional sample sets.

The Freemasons’ Grand Charity, the Wellcome Trust and grants from the Québec Government provided the principal funding for the study.

Citation:

An epigenome-wide association study of total serum immunoglobulin E concentration

Liming Liang, Saffron A. G. Willis-Owen, Catherine Laprise, Kenny C. C. Wong, Gwyneth A. Davies, Thomas J. Hudson, Aristea Binia, Julian M. Hopkin, Ivana V. Yang, Elin Grundberg, Stephan Busche, Marie Hudson, Lars Rönnblom, Tomi M. Pastinen, David A. Schwartz, G. Mark Lathrop, Miriam F. Moffatt, William O. C. M. Cookson. An epigenome-wide association study of total serum immunoglobulin E concentration. Nature, 2015; DOI: 10.1038/nature14125

 

 

Majority of Asthma Patients Do Not Use Inhalers Correctly

Rana Suzette Bonds, MD The University of Texas Medical BranchMedicalResearch.com Interview with:
Rana Suzette Bonds, MD
The University of Texas Medical Branch

MedicalResearch: What is the background for this study?

Dr. Bonds: Both anaphylaxis and asthma can be life threatening disorders requiring prompt treatment. Each disorder can be successfully treated with medication which is delivered by devices designed for self-administration. Unfortunately there has been evidence in the literature that patients frequently do not use the devices appropriately. We sought to determine which factors were associated with incorrect use of metered dose inhalers and epinephrine autoinjectors, and to determine if rates of correct use have improved since earlier reports.

MedicalResearch: What are the main findings?

Dr. Bonds: Sixteen percent of patients used the epinephrine autoinjector properly and 7 percent of patients used the metered dose inhaler correctly. The most common error with the autoinjector was not holding the unit in place for at least 10 seconds after triggering. For patients using the metered dose inhaler the most commonly missed step was exhaling to functional residual capacity or residual volume prior to actuating the canister. Male sex, Caucasian race, and previous medical education correlated with correct use of epinephrine autoinjector device.

Continue reading

Drug May Reverse Childhood Asthma Caused By Maternal Smoking

Virender K. Rehan, MD LA BioMed Lead ResearcherMedicalResearch.com Interview with:
Virender K. Rehan, MD

LA BioMed Lead Researcher

 

Medical Research: What are the main findings?

Dr. Rehan: A new study holds hope for reversing asthma caused by smoking during
pregnancy. The study, published online by the American Journal of Physiology
– Lung Cellular and Molecular Physiology, reported that a medication that
stimulates certain proteins in the body reversed airway damage in disease
models of asthma caused by prenatal exposure to nicotine.

This is the first study to indicate that the damage caused by exposure to
nicotine during pregnancy could actually be reversed. Earlier studies found
this medication could prevent nicotine-induced asthma when given during
pregnancy. Researchers at Los Angeles Biomedical Research Institute (LA
BioMed) conducted the study to determine if the lung and airway damage
caused by nicotine could be reversed and found it could be.

Continue reading

Asthma in White and Hispanic Women May Increase Risk of Adverse Outcomes

Pauline Mendola, PhD, Investigator Epidemiology Branch Division of Intramural Population Health Research Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH Rockville, MD 20852MedicalResearch.com Interview with:
Pauline Mendola, PhD, Investigator

Epidemiology Branch
Division of Intramural Population Health Research
Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH
Rockville, MD 20852

Medical Research: What is the background for this study? What are the main findings?

Dr. Mendola: Asthma is the most common chronic disease in pregnancy and both asthma and maternal race/ethnicity are associated with adverse pregnancy outcomes. Since the prevalence of asthma also varies by race/ethnicity, we wanted to assess whether asthma was an important contributor to racial/ethnic disparities in pregnancy outcomes. We examined the joint impact of maternal race/ethnicity and asthma status on the risk of obstetric and neonatal outcomes.

In general, maternal asthma did not impact the risk of obstetric and neonatal complications within racial/ethnic groups. However, compared to mothers of the same race/ethnicity without asthma, White and Hispanic asthmatic mothers were more likely to have infants born small-for gestational age or admitted to the NICU. White women with asthma were also at increased risk of preeclampsia and maternal hemorrhage and Hispanic mothers with asthma were more likely to have infants with apnea. Despite their increased risk of maternal asthma and neonatal and obstetric complications, maternal asthma did not impact the risk of complications among Black women or their infants.

Continue reading

Staph Aureus Colonization Linked To Asthma Symptoms in Children and Young Adults

Meghan F. Davis, DVM MPH PhD Assistant Professor Department of Environmental Health Sciences Johns Hopkins Bloomberg School of Public HealthMedicalResearch.com Interview with:
Meghan F. Davis, DVM MPH PhD

Assistant Professor
Department of Environmental Health Sciences
Johns Hopkins Bloomberg School of Public Health

 

Medical Research: What is the background for this study? What are the main findings?

Dr. Davis: Asthma rates have been on the rise, particularly in children. Interventions targeted at allergens and other environmental factors known to exacerbate asthma are only partially successful, suggesting a role for novel drivers of morbidity among existing patients with asthma. In this study, we evaluated associations between nasal colonization with the bacterium Staphylococcus aureus and symptoms related to wheeze and asthma using data from the nationally-representative NHANES database. We found that S. aureus nasal colonization was associated with asthma symptoms in children and young adults, but not in older adults.

Continue reading

Electronic Reminder Improved Asthma Medication Adherence

Amy Chan   BPharm(Hons) RegPharmNZ  MPS  ANZCP Pharmacist / PhD candidate Department of Paediatrics Auckland Hospital Faculty of Medical & Health Sciences University of Auckland  Auckland, New ZealandMedicalResearch.com Interview with:
Amy Chan  
BPharm(Hons) RegPharmNZ  MPS  ANZCP
Pharmacist / PhD candidate
Department of Paediatrics Auckland Hospital
Faculty of Medical & Health Sciences
University of Auckland  Auckland, New Zealand

Medical Research: What is the background for this study? What are the main findings?

Response: Asthma is one of the most common childhood conditions, affecting 1 in 4 children in New Zealand.  Although there are many effective medications available for asthma, of which the most important are inhaled corticosteroids, asthma control remains suboptimal due to poor adherence.  In children, adherence to regular preventive asthma therapy is about 50%, and can be as low as 30%.  Our randomised controlled trial looked at use of an electronic monitoring device with an in-built audiovisual reminder to see if it improved adherence and asthma control.  We recruited 220 children aged between 6-15yrs, who presented to the emergency department with asthma and randomised them to receive the device either with the audiovisual function enabled or disabled.  It found that those who received the audiovisual reminder (the intervention arm) took a median of 84% of their inhaled corticosteroids compared to just 30% in those who did not receive the reminder (control arm).  This equates to a 180% improvement in adherence.  We found significant improvements also in asthma control (including reduced asthma symptoms and increased participation in daily activities) and a reduction in reliever use from 17.4% to 9.5% in those who received the reminder. Continue reading

No Benefit of Omega-3 acid Supplements for Exercise-Induced Bronchoconstriction in Asthma

John Brannan PhD Firestone Institute for Respiratory Health at St Joseph’s Healthcare & McMaster University, Hamilton, Ontario, CanadaMedicalResearch.com Interview with:
John Brannan PhD

Firestone Institute for Respiratory Health at St Joseph’s Healthcare & McMaster University, Hamilton, Ontario, Canada

Medical Research: What is the background for this study?

Response: The use of omega-3 acid supplements as treatments for allergic diseases including asthma is controversial. Studies by investigators from Indiana University in the USA have repeatedly demonstrated a beneficial effect of high dose omega-3 fatty acid supplements over 3 weeks in attenuating exercise-induced bronchoconstriction (EIB) similar or possibly better in potency to what may be expected with a regular inhaled corticosteroids. The study by Brannan et al. attempted to validate these findings by using inhaled mannitol, a bronchial provocation test that was derived from the understanding of exercise-induced bronchoconstriction and which has demonstrated experimentally to be a useful model for exercise-induced bronchoconstriction. All pharmacotherapies that modify exercise-induced bronchoconstriction can modify the airway sensitivity to inhaled mannitol in persons with asthma, thus it was of interest to see if an ‘alternative’ treatment that demonstrated efficacy in exercise-induced bronchoconstriction could too modify the airway response to mannitol.

Medical Research: What are the main findings?

Response: The main findings were, to our surprise, there was no benefit of high dose omega-3 fatty acid supplements on bronchial hyperresponsiveness to mannitol over 3 weeks. This was associated with no changes in airway inflammation (sputum eosinophils), lung function or asthma symptom control. We also found no benefit on resting urinary mast cell metabolites, in contrast to the findings in studies showing a benefit of omega-3 fatty acids on EIB. Our findings suggest that omega-3 supplements in tissues may not be able to penetrate tissue and/or modify the substrate flow of eicosanoids in tissue such as the airways of the asthmatic. We did observed the expected reductions in blood triglycerides which suggests that these doses of omega-3s can modify metabolism in the blood or to some extent tissues that are highly perfused.

Continue reading

Effect of Vitamin C on Exercise-induced Bronchoconstriction

Harri Hemilä, MD PhD Department of Public Health University of Helsinki, POB 41 Helsinki, FinlandMedicalResearch.com Interview with:
Harri Hemilä, MD PhD
Department of Public Health
University of Helsinki, POB 41
Helsinki, Finland

 

Medical Research: What is the background for this study? What are the main findings?

Dr. Hemilä: I have a two decade interest in the effects of vitamin C on respiratory symptoms and I am the first author of the Cochrane review on vitamin C and the common cold. Since there is very strong evidence that vitamin C is better than placebo, in the Cochrane review we encourage common cold patients to try if vitamin C helps them.

In 2009, I was taking a look at the Cochrane review on vitamin C and asthma. I was puzzled with the text and figures since my own impression of the RCTs on vitamin C and asthma was quite different from what the review presented. Therefore I took a close look at the Cochrane review and I saw that it was sloppy. There were severe errors in data extraction and data analysis. For example, they used un-paired t-test when they should have used the paired t-test. That types of questions are very basic in biostatistics. I wrote a feedback to that Cochrane review and the review was withdrawn in 2013. It had been misleading readers for a decade. As a positive result of that incident, I became interested in the effects of vitamin C on asthma and I conducted a meta-analysis of three RCTs on vitamin C and exercise-induced bronchoconstriction (EIB). I calculated that vitamin C caused a 48% reduction (95% CI 33% to 64%) in the postexercise FEV1 decline. That study was published in BMJ Open in 2013 (http://www.ncbi.nlm.nih.gov/pubmed/23794586).

Continue reading

Asthma Increases DNA Damage

Robert H. Schiestl, Ph.D. Professor of Pathology, Environmental Health and Radiation Oncology UCLA Schools of Medicine and Public Health Los Angeles, CA 90095MedicalResearch.com Interview with:
Robert H. Schiestl, Ph.D.
Professor of Pathology, Environmental Health and Radiation Oncology
UCLA Schools of Medicine and Public Health
Los Angeles, CA 90095


Medical Research: What is the background for this study? What are the main findings?

Dr. Schiesti: We studies whether asthma has any effect on peripheral blood and we found that it significantly increased DNA double strand breaks, single strand breaks, oxidative DNA damage, inflammation and oxidative protein damage.

Continue reading

Who Relapses After Emergency Room Visit For Asthma?

Brian H. Rowe, MD, MSc, CCFP(EM), FCCP Tier I Canada Research Chair in Evidence-based Emergency Medicine Scientific Director, Emergency Strategic Clinical Network Professor, Department of Emergency Medicine University of AlbertaMedicalResearch.com Interview with:
Brian H. Rowe, MD, MSc, CCFP(EM), FCCP
Tier I Canada Research Chair in Evidence-based Emergency Medicine
Scientific Director, Emergency Strategic Clinical Network
Professor, Department of Emergency Medicine
University of Alberta

Medical Research: What is the background for this study? What are the main findings?

Dr. Rowe​: The study was designed to evaluate non-pharmacological issues associated with relapse following discharge from the emergency department with acute asthma. Many years of high-quality research have shown that systemic and inhaled corticosteroids (ICS) in combination are required to reduce relapse. In this study all patients received systemic corticosteroids and the majority received inhaled corticosteroids (either as mono-therapy or in combination with long-acting beta-agonists​ {LABA}).

This study ​ design permitted us to evaluate other factors associated with relapse as a guide for clinicians to use in planning discharge.

The main findings include identifying the key factors independently associated with relapse: female sex (OR = 1.9; 95% confidence interval [CI]: 1.2, 3.0), symptom duration of > 24 hours prior to emergency department visit (OR = 1.7; 95% CI: 1.3, 2.3), ever using oral corticosteroids (OR = 1.5; 95% CI: 1.1, 2.0), current use of an ICS/LABA combination product (OR = 1.9; 95% CI: 1.1, 3.2), and owning a spacer device (OR = 1.6; 95% CI: 1.3, 1.9). Continue reading

Racial and Ethnic Disparities Continue In Asthma Rates

Nandita Bhan, ScD MSc MA Research Scientist & Adjunct Assistant Professor Public Health Foundation of India (PHFI)MedicalResearch.com Interview with:
Nandita Bhan, ScD MSc MA
Research Scientist & Adjunct Assistant Professor
Public Health Foundation of India (PHFI)

Medical Research: What are the main findings of the study?

Dr. Bhan: We found that the last decade in the US has seen a rise in racial/ethnic disparities in asthma. Compared to Non-Hispanic White populations, greater rates of asthma were seen among African Americans and lower rates among Hispanic populations. But more importantly, we found that it is not just a question of who you are, but where you live. Results showed heterogeneity by region and place of origin – highlighting that it will be simplistic to assume that asthma rates for Hispanic populations are the same across all states in the US.

While data is unable to explore further granularity by ethnicity, our results add to the developing evidence that state policies and politics have impacts on socioeconomic and racial/ethnic inequalities manifesting in health disparities in the US.
Continue reading

COPD: Combination Long-Acting Beta Agonists with Inhaled Steroids Leads To Fewer Hospitalizations

Andrea Gershon MD, MSc, FRCP(C) Scientist, Institute for Clinical Evaluative Sciences Respirologist, Division of Respirology, Sunnybrook Health Sciences Centre Assistant Professor of Medicine, University of Toronto ICES Central Bayview Avenue, Toronto, OntarioMedicalResearch.com Interview with:
Andrea Gershon MD, MSc, FRCP(C)
Scientist, Institute for Clinical Evaluative Sciences
Respirologist, Division of Respirology, Sunnybrook Health Sciences Centre
Assistant Professor of Medicine, University of Toronto
ICES Central Bayview Avenue, Toronto, Ontario

Medical Research: What are the main findings of the study?

Dr. Gershon: Within a large real world population of people with COPD, those who initiated combination long-acting beta-agonists (LABA) and inhaled corticosteroids (ICS) were less likely to die or be hospitalized for COPD than those who initiated LABA alone. Further those who initiated LABA/ICS combination therapy did not appear to have more pneumonia or osteoporotic fractures – side effects that have been associated with ICS use—than those initiating LABA alone.

A second interesting finding was that people with a co-diagnosis of asthma experienced a greater incremental benefit of LABA/ICS over LABA than people without a co-diagnosis of asthma.

Finally, we found that people who were not also taking an inhaled long-acting anticholinergic medication experienced a greater incremental benefit of LABA/ICS over LABA than people who were.
Continue reading

Addressing Racial Disparities in Childhood Asthma

Lara J. Akinbami, MD Infant, Child and Women's Health Statistics Branch National Center for Health Statistics Centers for Disease Control and Prevention Hyattsville, MD 20782.Medical Research Interview with:
Lara J. Akinbami, MD
Infant, Child and Women’s Health Statistics Branch
National Center for Health Statistics
Centers for Disease Control and Prevention
Hyattsville, MD 20782.

MedicalResearch.com: What are the main findings of the study?

Dr. Akinbami : We analyzed national data to assess recent trends in racial disparities on childhood asthma outcome.  Historically, racial disparities in asthma prevalence (the percent of children who have asthma) were much smaller than those for asthma outcomes (emergency department visits, hospitalizations and deaths).  However, asthma prevalence disparities have recently increased, from 40% higher asthma among black children compared to white children in 2001, to 100% higher in 2010.  Because black children are now twice as likely to have asthma than white children, some of the disparities in adverse outcomes could be due just to this higher rate of asthma.   So we looked at disparities in two ways: the traditional way where populations as a whole are compared, and an “at risk” analysis where we compared asthma outcomes only between black and white children who had asthma.

When comparing populations of black and white children aged 0-18 years as a whole, black-white disparities in asthma outcomes either remained the same from 2001-2010 (asthma emergency department visit rates and hospitalizations were about three times higher among black children), or increased (asthma deaths increased from 5 times higher among black children in 2001 to 7 times higher in 2010).  But when we refocused the analysis to just children who had asthma in an at-risk analysis, we found that racial disparities either remained the same (asthma deaths) or decreased (emergency room visits and hospitalizations).   In 2010, black children with asthma were about twice as likely than white children with asthma to visit the ED or be hospitalized for asthma, and 4 times as likely to die from asthma.

These racial disparities in adverse asthma outcomes among children with asthma are still high, but the pattern of stable or decreasing trends in disparities is very encouraging news.  There has been concerted effort on many fronts to improve asthma outcomes overall, and in particular among populations suffering from high asthma prevalence and morbidity.  Many local studies have shown positive impact of good asthma management, and the national picture reflects this progress.  Unfortunately, it is not known how to prevent children from developing asthma, but the tools to control asthma once it develops have been proven effective.  The national data suggests that these tools may also be important in addressing disparities in asthma outcomes.  When possible, assessing outcomes among the population at risk (i.e., those who have asthma) can provide additional insight into trends in asthma disparities.

Citation:

Trends in racial disparities for asthma outcomes among children 0 to 17 years, 2001-2010
Lara J. Akinbami, MD, Jeanne E. Moorman, MS Alan E. Simon, MD, Kenneth C. Schoendorf, MD, MP

Journal of Allergy and Clinical Immunology Available online 1 August 2014

 

 

Asthma Symptoms and Control Found Not Improved By Yoga

Holger Cramer, PhD Director of Yoga Research University of Duisburg-Essen | Faculty of Medicine Department of Internal and Integrative Medicine | Kliniken Essen-Mitte Essen  Germany MedicalResearch.com Interview with:
Holger Cramer, PhD
Director of Yoga Research
University of Duisburg-Essen | Faculty of Medicine
Department of Internal and Integrative Medicine
Essen  Germany

MedicalResearch: What are the main findings of the study?

Dr. Cramer: There is a number of randomized trials available on yoga for asthma. Based on those trials, there is evidence that yoga can improve asthma symptoms, asthma control, and pulmonary function in patients with asthma. However, yoga does not seem to be superior to sham procedures or breathing exercises and generally the evidence was quite weak. Yoga seems to be relatively safe in this patient population.
Continue reading

Childhood Asthma: Higher Out-of-Pocket Costs May Cause Some Parents to Avoid Care

dr_vicki_fung
MedicalResearch.com Interview with:
Vicki Fung, Ph.D.
Assistant Professor
Department of Medicine, Harvard Medical School
Mongan Institute for Health Policy, Massachusetts General Hospital

 

MedicalResearch: What are the main findings of the study?

Dr. Fung: We found that lower income parents of children with asthma were more likely to delay or avoid taking their children to a doctor’s office visit or to the emergency room if they had to pay higher out-of-pocket costs for care; they were also more likely to report borrowing money to pay for asthma care.
Continue reading

Antibiotics In Infancy and Childhood Asthma, Viral Infections

Adnan Custovic DM MD PhD FRCP Professor of Allergy Institute of Inflammation and Repair University of Manchester University Hospital of South Manchester Manchester M23 9LT, UKMedicalResearch.com Interview with:
Adnan Custovic DM MD PhD FRCP
Professor of Allergy
Institute of Inflammation and Repair
University of Manchester
University Hospital of South Manchester
Manchester M23 9LT, UK

MedicalResearch: What are the main findings of the study?

Dr. Custovic: In a longitudinal analysis of the data from our birth cohort study collected from birth to age eleven years, we demonstrated an association between early-life antibiotic prescription and development of wheezing, but not atopy. Furthermore, amongst children with wheezing, antibiotic prescription in infancy increases the risk of subsequent severe wheeze/asthma exacerbations and hospital admissions. This is the first demonstration that children who receive antibiotics in infancy have impaired antiviral immunity later in life, and that early-life antibiotic prescription is associated with variants on chromosome 17q21 locus (which is an asthma susceptibility locus).

Our findings suggest that the association between antibiotics and childhood asthma reported in previous studies arises through a complex confounding by indication, in which hidden factors which increase the likelihood of both antibiotic prescription in early life and subsequent asthma development are increased susceptibility to virus infections consequent to impaired antiviral immunity, and genetic variants on 17q21. Our results raises an important issue that effects which are often attributed to environmental exposures may be a reflection of genetic predisposition.
Continue reading

Probiotics Ineffective in Preventing Childhood Asthma

Dr. Meghan Azad, PhD Banting Postdoctoral Fellow Department of Pediatrics University of AlbertaMedicalResearch.com Interview with:
Dr. Meghan Azad, PhD
Banting Postdoctoral Fellow
Department of Pediatrics
University of Alberta


MedicalResearch.com: What are the main findings of the study?

Dr. Azad: In this study, our goal was to evaluate the clinical evidence for using probiotics (live “healthy bacteria”) to prevent childhood asthma.  We reviewed the results of 20 clinical trials involving over 4000 infants, where probiotics were administered during pregnancy or the first year of life, and found no evidence to support the use of probiotics for asthma prevention.  Children receiving probiotics were just as likely to develop asthma as children receiving placebo.  Similarly, there was no effect of probiotic supplementation on the development of wheezing.
Continue reading

Childhood Asthma: Novel Susceptibility Gene Identified

MedicalResearch.com Interview Invitation
Klaus Bønnelykke 
MD, PhD



The Faculty of Health Sciences 
University of Copenhagen
The Danish Pediatric Asthma Center
Copenhagen University Hospital
Gentofte
Ledreborg Alle 34
DK-2820 Copenhagen
Denmark

MedicalResearch.com: What are the main findings of the study?


Answer: First, we identified CDHR3 as a novel susceptibility gene. This is likely to represent a yet unknown mechanism of childhood asthma. Based on the replication birth cohorts this gene particularly plays a role for severe asthma attacks in the first 2 years of life while  it is not associated with adult-onset asthma. This suggests a specific mechanism of asthma in early childhood.

Second, we found very strong results (much larger effect sizes than found in previous genome-wide association studies) for known asthma genes, particularly for the children with most frequent asthma attacks. This shows that genetics play a very strong role for these children. Subsequent calculations suggest that the majority of cases with severe asthma are caused by the 5 most significant genes/loci in this study. This means that focusing asthma research on these 5 genetic loci and their effects has the potential to prevent the majority of incidences of severe asthma in early childhood.

MedicalResearch.com: 
Were any of the findings unexpected?

Answer: We were surprised to see so strong results for the already known asthma-genes. From a research perspective this shows the potential (and cost-effectiveness) of focusing on this specific type of disease. By studying these 1,200 children with asthma we got very significant results and similar number of findings as the previously largest genome-wide association study with 10.000 individuals with asthma.

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


Answer: Asthma is a heterogeneous disease and this is probably one main reason for the limited effect of current asthma medications for preventing and treating asthma attacks in young children. Discovery of the genes causing asthma in early childhood is one important step in understanding the disease. Hopefully this will improve prevention and treatment of disease in the future.

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

Answer: Future studies should focus on asthma with severe attacks in early childhood. This is a subtype of disease where we need better understanding. Also, our study suggest that this is a strong approach for learning more about asthma mechanisms in general.

 

Citation:

A genome-wide association study identifies CDHR3 as a susceptibility locus for early childhood asthma with severe exacerbations
Klaus Bønnelykke, Patrick Sleiman, Kasper Nielsen, Eskil Kreiner-Møller, Josep M Mercader, Danielle Belgrave, Herman T den Dekker, Anders Husby, Astrid Sevelsted, Grissel Faura-Tellez, Li Juel Mortensen, Lavinia Paternoster, Richard Flaaten, Anne Mølgaard, David E Smart, Philip F Thomsen, Morten A Rasmussen, Silvia Bonàs-Guarch, Claus Holst, Ellen A Nohr, Rachita Yadav, Michael E March, Thomas Blicher, Peter M Lackie, Vincent W V Jaddoe, Angela Simpson, John W Holloway, Liesbeth Duijts, Adnan Custovic, Donna E Davies, David Torrents, Ramneek Gupta, Mads V Hollegaard, David M Hougaard, Hakon Hakonarson & Hans Bisgaard

Nature Genetics (2013) doi:10.1038/ng.2830

Received 27 May 2013 Accepted 28 October 2013 Published online 17 November 2013

Maternal Grandmother’s Smoking Affects Pediatric Asthma, Especially in Boys

MedicalResearch.com Interview with:
Virender Rehan, MD
Professor of Pediatrics
Chief, Division of Neonatology
Director, Neonatal Intensive Care Unit
Director, Neonatal-Perinatal Fellowship Training Program
Co-Director Perinatal Research Center
Harbor UCLA Medical Center, David Geffen School of Medicine at UCLA
Torrance, CA, 90502

MedicalResearch.com: What are the main findings of the study?

Dr. Rehan: The main findings of the study include the likelihood of transmission of asthma to third generation offspring following maternal smoking during pregnancy even when child’s mother didn’t smoke. And these effects seem to be more profound in the upper airways of males compared to that in females.
Continue reading

Asthma: Genetic Risks of Development and Course

Daniel Belsky, PhD NIA Postdoctoral Fellow Center for the Study of Aging and Human Development Duke UniversityMedicalResearch.com Interview with:

Daniel Belsky, PhD
NIA Postdoctoral Fellow
Center for the Study of Aging and Human Development
Duke University

Polygenic risk and the development and course of asthma: an analysis of data from a four-decade longitudinal study

MedicalResearch.com: What are the main findings of the study?

Dr. Belsky : We looked to the largest-ever genome-wide association study of asthma (that study by the GABRIEL Consortium included more than 26,000 individuals) to identify genetic variants that could be used to construct a genetic profile of asthma risk. We then turned to The Dunedin Multidisciplinary Health and Development Study, a unique cohort of 1,000 individuals who have been followed from birth through their fourth decade of life with extensive measurements of asthma and related traits. We computed a “genetic risk score” for each person based on the variants identified in GWAS.  Then, we looked at who developed asthma, when they developed asthma, and what that asthma looked like in terms of allergic response and impaired lung function.

What we found:

(1) People with higher genetic risk scores were more likely to develop asthma and they developed asthma earlier in life.

(2) Among children who developed asthma, the ones at higher genetic risk were more likely to have persistent asthma through midlife.

(3) Genetic risk was specifically associated with allergic asthma that resulted in chronic symptoms of impaired lung function.

(4) People with higher genetic risk score developed more severe cases of asthma. As compared to people with a lower genetic risk, they were more often absent from school and work because of asthma and they were more likely to be hospitalized for asthma.

(5) The genetic risk score provided new information about asthma risk that could not be obtained from a family history.

Continue reading

Inhibition of Sphingolipid Synthesis Produced Asthmatic Lungs, without Inflammation

MedicalResearch.com eInterview with: Stefan Worgall Ph.D., M.D

Department of Genetic Medicine and 4Department of Pediatrics
Weill Cornell Medical College,
New York, NY 10021, USA.

MedicalResearch.com: What are the main findings of the study?

Dr. Worgall: Asthma is a common disease and large genome-wide association studies  found variation in the gene for ORMDL3, in to up to 30 percent of asthma cases. The over-production ORMDL3 was connected to childhood asthma. ORMDL3 protein inhibits the new production of sphingolipids. Our study connects sphingolipid metabolism mechanistically to human asthma for the first time. We found that inhibition of the enzyme that is critical to sphingolipid synthesis, serine palmitoyl-CoA transferase (SPT),  produced asthmatic lungs in mice and in human bronchi, as it did in mice that had a genetic defect in SPT. When these mice were given methacholine their airways constricted further. We further determined that the airway hyperactivity seen in the mice was not linked to increased inflammation, which is a target for most asthma therapies.

Continue reading

Poorly controlled asthma more than doubles healthcare costs

Poorly controlled asthma more than doubles healthcare costs associated with the disease and threatens educational achievement through a dramatic increase in school absence, according to researchers at National Jewish Health. The research team reported in the August 2011 issue of The Archives of Allergy, Asthma & Immunology that children with “very poorly controlled” asthma missed an average of 18 days of school each year, compared to 2 or less for other asthma patients.

“This study looks for the first time at how effective and ineffective management of severe asthma impacts cost ,” said Stanley Szefler, MD, lead author and Professor of Pediatrics at National Jewish Health. “It highlights the toll that poorly controlled asthma takes on children. It also points to an opportunity – with proper attention and education, many, if not most, of those children could gain control over their asthma, thus reducing healthcare costs, improving their lives and their chances for success.”

The researchers studied 628 children ages 6 to 12 with severe or difficult-to-treat asthma. They evaluated direct medical costs – medications, unscheduled office and emergency visits, and hospital admissions – and indirect costs as measured by school/work days lost. Costs were evaluated at baseline, 12 months and 24 months. Patients were divided into three groups – very poorly controlled, not well controlled and well controlled asthma, according to NIH guidelines.

Very poorly controlled asthma patients incurred at baseline an average of $7,846 in costs associated with asthma, compared to $3,526 for not well controlled asthma patients and $3,766 for well controlled asthma. Two years out, costs for very poorly controlled asthma patients increased to $8,880 while costs for those with well controlled asthma dropped to $1,861. (All costs are in 2002 dollars. Costs in 2011 dollars would be approximately 25 percent greater.)

Direct costs of care were roughly 50 percent higher for poorly controlled asthma at $4,983, compared to $3,236 for not well controlled asthma, and $3,588 for well controlled asthma.

Indirect costs were much greater for poorly controlled asthma as measured by the impact on work and school. Children with poorly controlled asthma missed an average of 18 school days per year, compared to 2 missed days for poorly controlled asthma, and 0 for the well controlled asthma.

The researchers estimated that one parent would have to stay home for each missed school day, at an average cost of $172 dollars per day. Indirect costs for very poorly controlled asthma, $3,078, were more than eight times as great as the costs for not well controlled asthma, $369. With no missed school days among well controlled asthma patients, their indirect costs were $0.

The large variance for missed school days suggested another cost not included in the researchers’ calculations—low educational achievement. They cited a study of 3,812 students in Missouri indicating a much higher chance of failure for those absent an average of 12 school days. The very poorly controlled asthma patients in the current study missed an average of 18 days.

But the researchers also cited another study that suggested about 85 percent of asthma patients can bring asthma under control with careful education and supervision. Their data do indicate that improvement in asthma control does reduce asthma-related costs.

“There are effective strategies to improve asthma control among children,” said Dr. Szefler. “By addressing medication adherence, inhaler technique, proper medications, and other asthma management strategies, we could improve asthma and reduce costs significantly.”