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 for anti-inflammatory pharmacotherapy".

Thorax 2009;64:55-61.

Pravastatin Controls Airway Inflammation in Mouse Model of Allergic Asthma

Pravastatin suppresses sensitization to allergens, down-regulates interleukin-17 (IL-17) production, and appears to suppress inflammation in general in the lungs of sensitized mice.

Dr. M. Imamura and colleagues at the University of Tokyo believe their findings suggest "statins could be a novel therapeutic option for treatment of asthma." Their findings are reported in the January 1 online issue of Thorax.

"Our findings and previous studies with simvastatin indicate that statins could inhibit the progression of ongoing airway inflammation in patients with bronchial asthma. However, whether the results obtained with an animal model can be adapted to human asthma remains unclear," Dr. Imamura and colleagues write.

"Although the animal model using ovalbumin is one of the most popular methods of analyzing allergic airway inflammation, there are some differences between this model and human asthma," the Tokyo team cautions.
Thorax 2009;64:4-5,44-49.

Severe Asthma With Fungal Sensitization May Respond to Oral Antifungal Therapy

Approximately 60% of patients with severe asthma with fungal sensitization (SAFS) respond to antifungal therapy, according to the results of a randomized controlled trial reported in the January 1, 2009, issue of the American Journal of Respiratory and Critical Care Medicine.

"Some patients with severe asthma are immunologically sensitized to one or more fungi, a clinical entity categorized as...SAFS," write David W. Denning, FRCP, from the University of Manchester, United Kingdom, and colleagues from the Fungal Asthma Sensitization Trial Study. "It is not known whether SAFS responds to antifungal therapy."

The goal of this study was to assess the response of patients with SAFS to treatment with oral itraconazole. Participants had severe asthma and were sensitized to at least 1 of 7 fungi based on skin prick or specific immunoglobin E (IgE) testing. In all participants, total IgE levels were less than 1000 IU/mL and Aspergillus precipitins results were negative.

"SAFS responds to oral antifungal therapy as judged by large improvements in quality of life in about 60% of patients," the study authors write.

Limitations of this study include small sample size, imprecise definition of fungal sensitization and fungal allergy, and recruitment lower than the initial target.

"The primary aim of this proof-of-concept study was to contribute key data to the long-standing debate about whether there is any direct link between fungal exposure and asthma," the study authors conclude. "Our data are most consistent with an important and poorly understood relationship. Our study results indicate that a new treatment approach using antifungal therapy in severe asthma is clinically useful, and that we have much to understand about the daily interaction between fungi and humans."
Am J Respir Crit Care Med. 2009;179:11-18.

Increased Leptin Levels Linked to Asthma

Increased serum leptin levels correspond to asthma severity, according to a new study presented here at the American College of Allergy, Asthma & Immunology 2008 Annual Meeting.

The hormone leptin plays important roles in controlling appetite and promoting inflammation. Leptin resistance is commonly observed in obese patients, who can suffer from obesity-related asthma. Epidemiologic studies suggest that the frequency and severity of asthma is higher in obese people.

Asthma is common in extremely obese patients, lead investigator U. García-Ramírez, MD, a resident in allergy and immunology at National Medical Center, Mexico City, told Medscape Allergy & Clinical Immunology. This study "suggests that high serum leptin concentrations [are associated with] an increase in asthma severity." He speculated that reducing a patient's BMI could also reduce asthma severity.

The results suggest that asthma patients could be well served by losing weight, said session moderator Timothy Craig, DO, professor of medicine and pediatrics at Penn State University. "Previous studies are conflicting, but this suggests that there is a correlation. It's probably worth the effort" to get the patient to lose weight.

Still, he and others in attendance noted that the results do not demonstrate a causative link between leptin levels and asthma; an underlying condition could be contributing to both. "It's a question [of which came first], the bird or the egg," said Dr. Craig.
American College of Allergy, Asthma & Immunology (ACAAI) 2008 Annual Meeting: Abstract 5. Presented November 9, 2008.

Breastfeeding May Reduce Child's Risk of Asthma More Than 20%

Breastfeeding reduces risk of childhood wheeze, whether related to viral infections or multiple triggers, for the first 3 years of life, investigators announced here at the 18th Annual Congress of the European Respiratory Society.

The findings, from a community-based cohort study of British children, also indicate that mothers with asthma who breastfeed do not increase their child's risk of asthma.