Formoterol Plus Low-Dose Budesonide May Improve Asthma Control

Adding formoterol to low-dose budesonide treatment is more likely to be associated with well-controlled asthma vs a large increase in the dose of an inhaled corticosteroid (ICS), according to the results of a study reported in the December issue of Chest.

"Combination therapy with...ICSs and long-acting beta 2-agonists (LABAs), or treatment with high doses of ICSs alone improves asthma control when therapy with low-dose ICSs is not sufficient," write Paul M. O'Byrne, MB, FCCP, from McMaster University in Hamilton, Ontario, Canada, and colleagues. "However, it is not known which of these treatment options is more effective in sustaining asthma control."

"The addition of formoterol to therapy with low-dose budesonide increases the probability of well-controlled asthma compared to a substantial increase in the dose of an ICS," the study authors write. "This analysis demonstrates no benefit for increasing the ICS doses alone in achieving well-controlled asthma, although reductions in exacerbations and time with poor control were observed."

Inhalers Do Not Improve Outcomes in Preschoolers With Intermittent Wheezing

Corticosteroid and leukotriene antagonist inhalers do not improve outcomes when used episodically by preschool children with moderate-to-severe intermittent wheezing associated with respiratory tract infection, according to a new report.

Many preschoolers who wheeze in the context of respiratory tract infections experience severe exacerbations separated by extended periods of wellness, but evidence for management strategies in these children is lacking.

Dr. Leonard B. Bacharier from Washington University and St. Louis Children's Hospital, St. Louis, Missouri, and colleagues in the Childhood Asthma Research and Education (CARE) Network of the National Heart, Lung, and Blood Institute evaluated the impact of three different treatment strategies on the course of moderate-to-severe intermittent wheezing over a 12-month period.

Improvements in these short-term outcomes were limited to children with positive Asthma Predictive Index (API) status, the investigators say, whereas those with negative API status did not experience significant reductions in any of the symptom scores compared with conventional therapy.

"For those children with a negative API, treatment other than symptom relief is unlikely to be of help," the editorial concludes. "For those children with a positive API, intermittent (or regular) use of oral montelukast or wet nebulized budesonide may be of value."

J Allergy Clin Immunol 2008;122:1127-1137.

Breathing Training Is Beneficial for Asthmatic Patients

Asthmatic adults who receive breathing training show improvements in health status, asthma symptoms, and psychological well-being, even though asthma pathophysiology is not changed.

In the January issue of Thorax, Dr. M. Thomas of the University of Aberdeen, UK, and colleagues report on a prospective, randomized study in which 183 asthma patients with impaired health status received either three sessions of physiotherapist-supervised breathing training or nurse-delivered education.

No association was observed between breathing training and significant changes in airway physiology, inflammation, or hyper-responsiveness.

"This study suggests that breathing exercises may potentially have a role in patients with suboptimally controlled mild to moderate asthma, but the use of such techniques must occur with patient education on the ongoing need ...<< MORE >>

Chest 2008;134:255-262.

Combination therapy with tiotropium and formoterol achieves great improvement in daytime lung function (FEV1) in patients with moderate COPD than does salmeterol and fluticasone.

Dr. Klaus F. Rabe of Leiden University Medical Center and colleagues note that inhaled corticosteroids such as fluticasone along with a long-acting bronchodilator is a popular choice for patients with COPD. However, they observe, use of two bronchodilators from different classes might be of greater help.

To investigate, the researchers studied 592 patients with moderate COPD who were randomized to treatment with once daily tiotropium and twice daily formoterol or twice daily salmeterol ...<< MORE >>

Asthma affects millions of people worldwide. It is one of the disease where the incidence of disease is increasing year by year. It is also the most common chronic disease affecting children. Here are some important facts about asthma that everybody must know about asthma.

1. Asthma is not a communicable disease. You cannot get infected and get asthma by any asthma patient. Asthma is disease where genetic and environmental factors play role.

2. Asthma is caused by the chronic inflammation (swelling) of airways of lungs.

3. Airway inflammation contributes to airway hyperresponsiveness, airflow limitation, respiratory symptoms.

4. Atopy, the genetic predisposition for the development of an immunoglobulin E (IgE)-mediated response to common aeroallergens, is the strongest identifiable predisposing factor for developing asthma.

5. Viral respiratory infections are one of the most important causes of asthma execerbation and may also contribute to the development of asthma.

6. The main symptoms of asthma are wheezing, coughing, recurrent breathlessness or shortness of breath, tightness of the chest, and pain or pressure on the chest.

7. Diagnosis of asthma is made by detailed medical history, physical exam focusing on the upper respiratory tract, chest, and skin and spirometry.

8. Asthma is not a contraindication for doing exercise. Many great athletes suffer from asthma.

9. Two main categories of asthma medication are relievers (used to treat symptoms and exacerbations) and preventer (agents for long-term control, used to achieve and maintain control of persistent asthma) medication.

10. Inhaled route is the most preferred way to deliver asthma medication as it delivers drugs directly to lung airways. So the action is fast and drug side effects are very low.

11. Asthma is one of the most common potentially life-threatening condition complicating pregnancy. Read pregnancy and asthma.

12. Remember that asthma is a treatable disease and you can live a healthy and productive life like any body else with proper treatment.

        

Eating nut (peanut) products during pregnancy increases risk for childhood asthma

Mothers who eat nut products such as peanut butter during pregnancy might be increasing the likelihood of their offspring developing childhood asthma, prospective study findings indicate. “Daily consumption of nut products increased the risk of asthma outcomes during the first 8 years of life” Saskia Willers (Utrecht University, The Netherlands) and colleagues write in the American Journal of Respiratory and Critical Care Medicine. “This study provides evidence on the relationship between maternal diet during pregnancy and longitudinal development of childhood asthma.” The authors found that maternal vegetable, fish, ...<< MORE >>

Complications/ risks of surgery in Asthma patient?

Patients who have asthma are at risk for specific complications during and after surgery. These
complications include:

• Acute bronchoconstriction triggered by intubation,
• Hypoxemia and
• Possible hypercapnia,
• Impaired effectiveness of cough,
• Atelectasis, and
• Respiratory infection
• Latex exposure (allergy)
• Allergy to some anesthetic agents

The likelihood of these complications depends on the severity of the patient’s airway
hyperresponsiveness, airflow obstruction, mucus hypersecretions, latex sensitivity, and
history of prior surgeries, because the latter is a risk factor for both latex and anesthetic
agent sensitivities.
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Actions to be taken before surgery in asthma patients:

Patients who have asthma should have an evaluation before surgery that includes a review of symptoms, medication use (particularly the use of oral systemic corticosteroids for longer than 2 weeks in the past 6 months), and measurement of pulmonary function.

If possible, attempts should be made to improve lung function preoperatively (FEV1 or peak expiratory flow rate [PEFR]) to either their predicted values or their personal best level. A short course of oral systemic corticosteroids may be necessary to optimize lung function.

For patients who have received oral systemic corticosteroids during the past 6 months and for selected patients on a long-term high dose of an ICS, give 100 mg hydrocortisone every 8 hours intravenously during the surgical period and reduce the dose rapidly within 24 hours after surgery. Stress doses of
corticosteroids may be considered for select patients treated with prior high-dose ICS therapy as well, because clinically important adrenal suppression has been reported in such patients, particularly children.
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Gastro-esophageal Reflux syndrome and asthma:

Asthma may be caused or worsened by to gastro-esophageal reflux. The symptoms of GERD are common in both children and adults who have asthma. Reflux during sleep can contribute to nocturnal asthma. Treatment with a proton pump inhibitor was reported to reduce nocturnal symptoms, reduce asthma exacerbations, and improve quality of life related to asthma. Surgical treatment has been reported to reduce the symptoms of asthma and the requirement for medication.
For patients who have poorly controlled asthma, particularly with a nocturnal component, investigation for GERD may be warranted even in the absence of suggestive symptoms
medical management of GERD be instituted for patients who have asthma and complain of frequent heartburn or pyrosis, particularly those who have frequent episodes of nocturnal asthma.

Medical management of GERD includes:

• Avoiding heavy meals, fried food, caffeine, and alcohol.
• Avoiding food and drink within 3 hours of retiring.
• Elevating the head of the bed on 6- to 8-inch blocks.
• Using appropriate pharmacologic therapy.

For patients who have persistent reflux symptoms following optimal therapy, further evaluation
is indicated and surgical treatment may be advised.
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Sugar Intake Linked to Asthma in kids

Diet Rich in Sweets Could Promote Kids' Asthma, Study Shows
Sugar could give kids asthma, animal research suggests. Asthma now affects nearly 9% of children and teens, a figure that has doubled since the 1980s, according to a study published last year.

To test their theory, the researchers studied two groups of mice. One group was given water. The other mice were offered sugar-laced water and allowed to drink up -- as much as they wanted.

"Their behavior was just like in kids," Kierstein tells WebMD. "Once they tasted [the sugar water], they went back again and again."

Both groups of mice were then injected with an allergen in an effort to make them more tolerant to that allergen. The idea of tolerance is to strengthen the immune system to fight off the effects of a future exposure to that allergen. Allergens are substances that can cause allergic reactions such as runny noses and hives and can trigger asthma symptoms.

Then, both groups of mice were reinjected with the same allergen and the researchers looked at whether there was any difference in how susceptible the two groups were to inflammation in the airways and the allergic response.

Kierstein says, "is that the sugar-fed mice had more than twice as much airway inflammation as the water-fed mice. Their immune systems were more activated. This makes them more susceptible to asthma."

High-fructose corn syrup, soda and sugar-laden fruit punch, an ingredient in many fruit drinks, are also rich in sugar or other form of sugar."

Asthma     

        

Mouth breathing worsens lung function in mild asthmatics
Recent research show that, switching from nose to mouth breathing causes a reduction in lung function among normally asymptomatic patients with mild asthma. The adverse effect of mouth breathing is well known in symptomatic asthmatics and contributes to exercise- induced asthma attacks. Nose breathing is protective against exercise-related symptoms. Bypassing the filtering effects of nasal breathing allows more aeroallergens to reach the lungs and causes drying and cooling of bronchial mucosal surfaces, say Hallani et al. After 1 hour of enforced mouth breathing, eight women with mild, asymptomatic asthma had about a 5% reduction in FEV1. They also reported slight breathing difficulties after the experiment, and three participants suffered coughing and/or wheezing.They add: “The combination of symptoms in association with a 5% reduction in FEV1 values suggests that this is a clinically important difference in FEV1.”When the women breathed only through their noses for 1 hour, their lung function was not affected, at 101.2% and 101.1% predicted before and after the experiment, respectively. Asthmatic patients switch from nose to mouth breathing at about half the nasal resistive threshold load of healthy people researchers note.

Respirology 2008; 13: 553–558

Maternal farm exposure can protect newborns from allergies
German researchers have found that babies born to mothers exposed to farms, particularly to barns and farm milk, while pregnant develop protection from allergies. Functional suppression was also more pronounced in offspring of farming mothers.“Early life exposure to a farming environment and in particular maternal exposure to farm milk and barns in pregnancy modulates T regulatory cell function in cord blood,” the authors commented. They concluded: “This may indicate a functional activation of T regulatory cells in neonates, potentially contributing to the allergy-protective effect in farming children.”
American Thoracic Society International Conference; Toronto, Ontario, Canada: 16–21 May 2008

Meta-analysis rejects dietary antioxidant link to asthma
In a meta-analysis it is has been found that low dietary intake of antioxidants is unlikely to account for the rising prevalence of asthma. The meta-analysis was based entirely on cross-sectional studies, but Jinming Gao (Peking Union Medical College Hospital, Beijing, China) and colleagues say their findings are consistent with the results of three prospective studies that failed to demonstrate a protective effect of vitamin C and E supplementation against asthma. Although this finding implies a role for vitamin C in preserving lung function, the team stresses that smoking and second-hand smoke exposure may affect the results by reducing both vitamin C levels and lung function.“The influence of a ‘good diet’ in preventing the development of asthma remains poorly understood and knowledge is limited,” Gao et al conclude. They note: “It remains possible that the current view of the importance of vitamins C and E is due to other associated nutrients and lifestyle exposures that are currently underrecognised.”
Respirology 2008; 13: 528–536

Smoking may reduce allergen tolerance
Cigarette smoke enhances acute allergic airway inflammation and delays tolerance to prolonged challenge with inhaled antigen in experimental asthma, Belgian researchers report in the journal Respiratory Research. Recently, Chris Van Hove and colleagues from Ghent University found that eosinophilic airway inflammation in allergic mice could be cleared by repeated allergen challenge, which resulted in a state of inhalational tolerance.
Respiratory Research 2008; 9: 42

Asthma              Asthma Cause             Asthma Symptoms             Asthma Diagnosis

        

Tree-lined streets may cut asthma risk

May 02, 2008 - MedWire News: Children who live on a tree-lined street have a lower risk for developing asthma than children living on treeless city streets, according to US researchers.

Writing in the Journal of Epidemiology and Community Health, Gina Lovasi and colleagues from Columbia University in New York explain that “street trees were associated with a lower prevalence of early childhood asthma.”

They then used street tree count data provided by the New York City Department of Parks and Recreation to investigate the association between tree density and asthma prevalence ...

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MedWire News: The high prevalence of undiagnosed cases of chronic obstructive pulmonary disease (COPD) in the adult patient population registered to a Polish primary care clinic suggests that case-finding is worthwhile, researchers report.

Writing in the journal Thorax, Michal Bednarek (National Research Institute of Tuberculosis and Lung Diseases, Warsaw, Poland) and colleagues report that a “large number of newly detected patients were symptomatic and needed treatment.”

Epidemiologic studies suggest that only a small fraction of COPD cases are diagnosed in the general population. Bednarek and colleagues investigated the prevalence and severity of COPD, and the fraction of patients already diagnosed ...

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Oral asthma medication are not the first line of treatment for asthma. They are mainly used in stage-III and stage IV of asthma control as an add on to the inhaled medications. Though in some poor countries oral medications are used as the first resort due to their less cost. Oral medications have more side effects than inhaled forms and are also less effective. Consult a asthma specialist before trying any medicine. if you want to read more about oral asthma medication vivit the links below:

Aminophylline tablets:
http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a601015.html

Theophyllin tablets:
http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a681006.html

Salbutamol (Albuterol) tablets:
http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a607004.html

Prednesolone tablets:
http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a601102.html

Methylprednisolone ...

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In 1930s, a provocative study found a high-salt diet worsened asthma symptoms in children. Since then link of salt with asthma has facinated many scientists. A recent work by Tim Mickleborough, Ph.D., a physiologist at Indiana University’s Department of Kinesiology has again proved the link of higher salt intake and poor asthma control even in adults also.

Mickleborough and his colleagues started with 24 young men and women with exercise-induced asthma. Twelve were put on a low-salt diet that allowed them no more than 3,750 mg of salt per day (that’s 1,600 mg sodium, salt being 40 percent sodium). The ...

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