February 8, 2010, 7:56 AM CT

Estrogen-only HRT may increase risk of asthma

Oestrogen-only hormone replacement treatment (HRT) may increase the risk of developing asthma after the menopause, suggests a large scale study published ahead of print in the journal Thorax

The authors base their findings on 57, 664 women, who were quizzed about their use of HRT and development of asthma symptoms every two years between 1990 and 2002.

All the women were taking part in the French E3N study, which includes almost 100, 000 women born between 1925 and 1950, and is the French component of the European Prospective Investigation into Cancer and Nutrition (EPIC).

None of these women had asthma when menopausal symptoms began.

The monitoring period equated to 495,448 person years in all, of which over a third was accounted for by women who had not used HRT (35.7%).

Prior users made up 4.5% while information on how long HRT was used was not known for a further 4%. Of the remainder, just under 56% were recent users of HRT.

Between 1990 and 2002, 569 women were newly diagnosed with asthma, corresponding to a rate of 1.15 cases per 1000 women a year.

Compared with women who had never used any form of HRT, those who did use it were 21% more likely to develop asthma, after adjusting for factors likely to influence the results......... Posted by: JoAnn      Read more         Source

November 30, 2009, 7:56 AM CT

Asthmatic care of minority children

UT Southwestern Medical Center scientists have observed that informed adults can help families stave off complications linked to asthma. The findings, available online and in the recent issue of Pediatrics, suggest that interventions by parent mentors caregivers of asthmatic children who have received specialized topical training can effectively reduce wheezing, asthma attacks, emergency room visits and missed adult workdays.

"Childhood asthma disproportionately affects urban minority children," said Dr. Glenn Flores, professor of pediatrics and the study's main author. "Asthma mortality among African-American children alone is almost five times higher than for white children. The goal for this study was to determine whether parent mentors would be more effective than traditional asthma care in improving asthma outcomes for minority children".

Mentors in the study were parents or caregivers who got professional training from a nurse asthma specialist and a program coordinator on a variety of asthma-correlation topics. Training sessions and a manual were used to present examples of improving asthmatic care and focused on the importance of consistent therapy. The manual also discussed keeping asthmatic children out of hospitals, asthma medications and triggers, and cultural issues that can affect care......... Posted by: JoAnn      Read more         Source

November 20, 2009, 8:48 AM CT

Depression in the mother and asthma in the child

Asthma symptoms can worsen in children with depressed mothers, as per research from Johns Hopkins Children's Center published online in the Journal of Pediatric Psychology.

Analyzing data from interviews with 262 mothers of African-American children with asthma - a population disproportionately affected by this inflammatory airway disorder - the Hopkins researchers observed that children whose mothers had more depressive symptoms had more frequent asthma symptoms during the six-months of the study. On the other hand, children whose mothers reported fewer depressive symptoms had less frequent asthma symptoms.

Scientists tracked ups and downs in maternal depression as correlation to the frequency of symptoms among children.

"Even though our research was not set up to measure just how much a mom's depression increased the frequency of her child's symptoms, a clear pattern emerged in which the latter followed the earlier," says senior investigator Kristin Riekert, Ph.D., a pediatric psychology expert and co-director of the Johns Hopkins Adherence Research Center.

But while maternal depression appeared to aggravate a child's asthma, the opposite was not true: How often a child had symptoms did not seem to affect the mother's depressive symptoms, an important finding that suggests maternal depression is an independent risk factor that can portend a child's symptoms, scientists say......... Posted by: JoAnn      Read more         Source

November 20, 2009, 8:44 AM CT

A new weapon against allergies and asthma

Researchers at Johns Hopkins and their colleagues have developed sugar-coated polymer strands that selectively kill off cells involved in triggering aggressive allergy and asthma attacks. Their advance is a significant step toward crafting pharmaceuticals to fight these often life-endangering conditions in a new way.

For more than a decade, a team led by Bruce S. Bochner, M.D., director of the Division of Allergy and Clinical Immunology at the Johns Hopkins University School of Medicine, has studied a unique protein known as Siglec-8. This protein, whose name is an acronym for Sialic Acid-binding, Immunoglobulin-like LECtin number 8, is present on the surfaces of a few types of immune cells, including eosinophils, basophils and mast cells. These different cell types have diverse but cooperative roles in normal immune function and allergic diseases. When functioning correctly, they are a valuable aid to keeping the body healthy and infection-free. However, in allergic reactions and asthma attacks, the cells unleash an overwhelming response that typically harms the body more than it helps.

The scientists found in prior studies that when they bound antibodies that specifically target Siglec-8 to the protein on eosinophils, the cells promptly died, an effect that might be useful in stemming an allergy or asthma attack. Since producing antibodies can be expensivea potential roadblock to using them as pharmaceuticals in the futurethe scientists sought another way to activate this protein......... Posted by: JoAnn      Read more         Source

November 5, 2009, 8:23 AM CT

Acetaminophen may cause asthma

New research shows that the widely used pain reliever acetaminophen appears to be linked to an increased risk of asthma and wheezing in both children and adults exposed to the drug. Scientists from the University of British Columbia, Vancouver, BC, Canada, conducted a systematic review and metaanalysis of 19 clinical studies (total subjects=425,140) that compared the risk of asthma or wheezing with acetaminophen exposure.

The analysis showed that the pooled odds ratio (odds ratio for all studies combined) for asthma among users of acetaminophen was 1.63. The risk of asthma in children who used acetaminophen in the year previous to asthma diagnosis or in the first year of life was elevated to 1.60 and 1.47, respectively.

Furthermore, results showed a slight increase in the risk of asthma and wheezing with prenatal use of acetaminophen by mothers. Scientists speculate that acetaminophen's lack of inhibition of cyclooxygenase, the key enzyme involved in the inflammatory response of asthma, appears to be one explanation for the potential link between acetaminophen use and asthma......... Posted by: JoAnn      Read more         Source

November 5, 2009, 8:22 AM CT

Women with asthma may benefit from oral contraceptives

New research shows that during natural menstrual cycles, women with asthma who were not taking oral contraceptives (OC) had lower exhaled nitric oxide levels (eNO), a marker of airway inflammation linked to asthma, than women who were taking OC.

Scientists from McMaster University in Hamilton, ON, Canada, studied 17 women with asthma during their menstrual cycles. Results showed that individuals not using oral contraceptives (OC) had higher mean eNO levels than women using OC.

Furthermore, among women not using oral contraceptives, an increase in estrogen levels was linked to a decrease in eNO, while an increase in progesterone was significantly linked to an increase in eNO. Scientists speculate that OC may have a potential role in the management of premenopausal women with asthma......... Posted by: JoAnn      Read more         Source

October 6, 2009, 8:00 AM CT

Did mom use her pump during pregnancy?

Expectant mothers who eschew asthma therapy during pregnancy heighten the risk transmitting the condition to their offspring, as per one of the largest studies of its kind reported in the European Respiratory Journal A research team from the Universit de Montral, the Hpital du Sacr-Cur de Montral and Sainte-Justine University Hospital Research Center observed that 32.6 percent of children born to mothers who neglected to treat their asthma during pregnancy developed the respiratory illness themselves.

"Uncontrolled maternal asthma during pregnancy could trigger a transient yet important reaction in the fetus that affects lung development and could subsequently increase the likelihood of a baby developing asthma in later childhood," warns main author Dr. Lucie Blais, a professor at the Universit de Montral's Faculty of Pharmacy and researcher at the Hpital du Sacr-Cur de Montral.

As part of the study, the research team examined a decade of health records for 8,226 children from birth to 10 years of age born to asthmatic mothers. Parents of these children were also mailed questionnaires requesting additional facts concerning familial medical history, lifestyle habits and environment.

"We observed that failing to control maternal asthma during pregnancy clearly has an impact on asthma in offspring a consequence that is independent of other contributing factors," says Dr. Blais. "It is of great importance for physicians to adequately treat asthmatic mothers during pregnancy, not only for the favourable outcome of pregnancy but also for the benefit of the child."........ Posted by: JoAnn      Read more         Source

September 9, 2009, 7:41 AM CT

'Hygiene hypothesis' challenged

New research hints that the common belief that kids who go to daycare have lower rates of asthma and allergy during the later part of life might be nothing more than wishful thinking. While young children in daycare definitely do get more illnesses and experience more respiratory symptoms as a result, any perceived protection these exposures afford against asthma and allergy seem to disappear by the time the child hits the age of eight.

"We found no evidence for a protective or harmful effect of daycare on the development of asthma symptoms, allergic sensitization, or airway hyper-responsiveness at the age of eight years," wrote Johan C de Jongste, M.D., Ph.D., of Erasmus University in the Netherlands and principle investigator of the study. "Early daycare was linked to more airway symptoms until the age of four years, and only in children without older siblings, with a transient decrease in symptoms between four and eight years".

The results are reported in the September 15 issue of the American Journal of Respiratory and Critical Care Medicine, a journal of the American Thoracic Society.

The scientists prospectively followed a birth cohort of nearly 4,000 Dutch children over the course of eight years in the Prevention and Occurence rate of Asthma and Mite Allergy (PIAMA) Study. Parents completed questionnaires during pregnancy, at three and 12 months, and then yearly until the child reached the age of eight, and reported their children's airway symptoms annually. At the age of eight, more than 3,500 of the children were also assessed for specific allergies. Some also underwent testing for lung function and airway hyper-responsiveness......... Posted by: JoAnn      Read more         Source

August 31, 2009, 9:51 PM CT

New asthma predictors needed

Screening tests used to predict asthma activity in patients may have little tracking success when applied to people with persistent disease who are adhering to their health care regimens, UT Southwestern Medical Center doctor report.

Prior reports have suggested that certain clinical findings and laboratory tests could help predict future asthma attacks. Those earlier conclusions, however, were based on observations of patients with poorly controlled asthma who had not received care based on current guidelines.

The newly released study appears in the recent issue of the Journal of Allergy and Clinical Immunology.

"It was surprising to find that factors often used to predict future asthma risk in poorly treated populations were of no clinical benefit when applied to a well-treated, highly adherent population of inner-city adolescents and young adults with persistent asthma," said Dr. Rebecca Gruchalla, chief of allergy and immunology at UT Southwestern and the newly released study's main author.

Early identification of adolescents and young adults at risk for asthma progression may lead to better therapy opportunities and improved disease outcomes in adulthood.

Typically the study involved 546 adolescents and young adults between the ages of 12 and 20 with persistent asthma, a complex disease of the airways that is characterized by variable and recurring symptoms, airflow obstruction, bronchial hyperresponsiveness and underlying inflammation......... Posted by: JoAnn      Read more         Source

August 26, 2009, 7:00 AM CT

Asthma patients had better results with oral controllers

Mayo Clinic Proceedings published a peer-evaluated comparative effectiveness study performed by HealthCore, Inc. in its August edition. The study demonstrated that asthma patients in general had better clinical outcomes with oral controllers than inhaled corticosteroids.

"WellPoint's National Pharmacy and Therapeutics Committee requested the comparative effectiveness study to help ensure that its drug formulary for asthma therapies was aligned with their real-world use and outcomes," said Dr. Joseph Singer, vice president of clinical affairs for HealthCore, the outcomes research subsidiary for WellPoint, Inc. "We believe the study to be the first comprehensive comparative effectiveness research study on all asthma controller medications".

"Clinical superiority of the inhaled products has been well documented in clinical trials and the HealthCore study confirmed this for those who take their medicine properly," Singer said. "However, we were surprised to discover that in looking at all patients in real-world settings, oral controllers appeared to be a better choice of therapy because of better compliance. Patients with the best outcomes were those who were compliant with inhaled corticosteroids".

The study, "Impact of Asthma Controller Medications on Clinical, Economic and Patient-Reported Outcomes," revealed that users of oral controllers were significantly better at adhering to their medicine than users of inhaled corticosteroids and probably obtained greater therapy benefit. After the study was complete in 2008, WellPoint's National Pharmacy and Therapeutics Committee chose to keep the oral controller used by the vast majority of its members on the same preferred formulary tier and lift its previous authorization requirement......... Posted by: JoAnn      Read more         Source

August 18, 2009, 11:02 PM CT

Milk is safe after treatment for milk allergy

Some children with a history of severe milk allergy can safely drink milk and consume other dairy products every day, as per research led by the Johns Hopkins Children's Center and reported in the Aug. 10 online edition of the Journal of Allergy and Clinical Immunology

Investigators followed up with a subset of children who were part of an earlier Hopkins Children's-led study published in 2008 in which patients allergic to milk were given increasingly higher doses of milk over time. For a number of of them, continuous exposure to milk allergens the proteins that trigger bad reactions slowly and gradually retrained their immune systems to better tolerate the very food that once sent those systems into overdrive.

The follow-up of 18 children ages 6 to 16 whose severe milk allergies had eased or disappeared observed that all children were able to safely consume milk at home, and that reactions, while common, were generally mild and grew milder and milder over time. The follow-up varied from three to 17 months, depending on how long it took patients to increase their milk intake.

These findings also suggest that regular use of milk and dairy foods appears to be needed for children to maintain their tolerance.

"We now have evidence from other studies that some children once successfully treated remain allergy-free even without daily exposure, while in others the allergies return once they stop regular daily exposure to milk," says Robert Wood, M.D., the study's senior investigator and director of Allergy & Immunology at Hopkins Children's. "This may mean that some patients are truly cured of their allergy, while in others the immune system adapts to regular daily exposure to milk and may, in fact, need the exposure to continue to tolerate it," he adds......... Posted by: JoAnn      Read more         Source

August 11, 2009, 11:10 PM CT

Powerful new therapy for asthma

University of Texas Medical Branch at Galveston scientists have observed that a single enzyme is apparently critical to most allergen-provoked asthma attacks and that activity of the enzyme, known as aldose reductase, can be significantly reduced by compounds that have already undergone clinical trials as therapys for complications of diabetes.

The discovery, made in experiments conducted with mice and in human cell cultures, opens the way to human tests of a powerful new therapy for asthma, which today afflicts more than 20 million Americans. Such a development would provide a badly needed alternative to current asthma treatment, which primarily depends on hard-to-calibrate inhaled doses of corticosteroids and bronchodilators, which have many side effects.

"Oral administration of aldose reductase inhibitors works effectively in experimental animals," said UTMB professor Satish Srivastava, senior author of a paper on the discovery appearing in the Aug. 6 issue of the journal PLoS One "If these drugs work as well in humans as they do in animals you could administer them either orally or in a single puff from an inhaler and get long-lasting results."

Srivastava and colleagues (postdoctoral fellows Umesh Yadav and Leopoldo Aguilera-Aguirre, associate professor Kota Venkata Ramana, professor Istvan Boldogh and LSU Health Sciences Center assistant professor Hamid Boulares) focused on aldose reductase inhibition as a possible asthma treatment after establishing an essential role for the enzyme in other diseases also characterized by inflammation. In disorders such as colon cancer, atherosclerosis, sepsis and uveitis, the Srivastava team has found, cells are hit by a sudden overload of reactive oxygen species (varieties of oxygen and oxygen compounds that are particularly eager to react with other molecules). The result is a chain of biochemical reactions that leads the cells' genetic machinery to crank out a barrage of inflammatory signaling proteins. These summon immune system cells and generate even more reactive oxygen species, producing a vicious cycle of ever-increasing inflammation......... Posted by: JoAnn      Read more         Source

June 3, 2009, 5:00 AM CT

Obesity Does Not Worsen Asthma

Being overweight or obese does not make asthma worse in patients with mild and moderate forms of the disease, as per a research studyby National Jewish Health researchers, eventhough it may reduce the response to medications.

"With both asthma and obesity on the rise in recent years, there has been much interest in the possible link between these two conditions," said main author E. Rand Sutherland, Associate Professor of Medicine at National Jewish Health, and main author of the paper appearing in the June 2009 issue of the Journal of Allergy and Clinical Immunology.

"By studying a well characterized group of patients with asthma, we were able to determine that increased weight is not linked to more severe asthma. Eventhough benefits can be obtained with weight loss in other diseases, these findings suggest that an improvement in asthma may not necessarily result from weight loss.

"The findings also suggest that patients and physicians should be aware that obese asthma patients may not respond well to corticosteroids, the most successful controller medicine for asthma, which can affect dosing decisions and choices of possible alternatives to steroids."

Prior studies have suggested that obesity predisposes people to developing asthma, to suffer more severe asthma symptoms, and to respond less to medications. However, the exact mechanism for these links has been unclear, and the studies have generally relied upon patients' reports of their diagnosis and symptoms rather than using more precise tools to characterize patients......... Posted by: JoAnn      Read more         Source

May 27, 2009, 9:18 PM CT

Why Eczema Often Leads To Asthma ?

A number of young children who get a severe skin rash develop asthma months or years later. Doctors call the progression from eczema, or atopic dermatitis, to breathing problems the atopic march.

Now researchers at Washington University School of Medicine in St. Louis have uncovered what might be the key to atopic march. They've shown that a substance secreted by damaged skin circulates through the body and triggers asthmatic symptoms in allergen-exposed laboratory mice.

The findings, published May 19, 2009, in Public Library of Science Biology, suggest that early therapy of skin rash and inhibition of the trigger substance might block asthma development in young patients with eczema.

Fifty percent to 70 percent of children with severe atopic dermatitis go on to develop asthma, studies show. By comparison, the rate of asthma incidence among the general population is only about 9 percent in children and 7 percent in adults. Seventeen percent of U.S. children suffer from atopic dermatitis, eventhough not all cases are considered severe.

"Over the years, the clinical community has struggled to explain atopic march," says study author Raphael Kopan, Ph.D., professor of developmental biology and of dermatology. "So when we observed that the skin of mice with an eczema-like condition produced a substance previously implicated in asthma, we decided to investigate further. We observed that the mice also suffered from asthma-like responses to inhaled allergens, implicating the substance, called TSLP, as the link between eczema and asthma."........ Posted by: JoAnn      Read more         Source

April 30, 2009, 9:50 PM CT

Management of asthma during pregnancy

Pregnant women with asthma, the most common condition affecting the lungs during pregnancy, should actively manage their asthma in order to optimize the health of mother and the baby, as per new management recommendations reported in the current issue of the New England Journal (NEJM)

"Though studies suggest asthma during pregnancy can increase health risks for mom and baby, our research shows that women who manage their asthma can have as healthy a pregnancy as women who don't have asthma," said Michael Schatz, MD, main author of the NEJM recommendations and chief of the Allergy Department at Kaiser Permanente Medical Center, San Diego, Calif. "A number of studies suggest that asthma can increase the risk of pregnancy complications, including preeclampsia, low birth-weight babies or preterm birth, however, women with well-controlled asthma in pregnancy generally have good pregnancy outcomes. Women who have asthma and are considering pregnancy should speak with their doctors to develop a treatment plan".

The recommendations are based to a large degree on a 12-year Kaiser Permanente study of 1,900 pregnant women, and a Maternal Fetal Medicine Units network study of 2,620 women from 16 university hospital centers around the country. Both studies concluded that women with actively managed asthma are just as likely to have healthy pregnancies and babies as women who don't have asthma......... Posted by: Emily      Read more         Source

April 30, 2009, 5:09 AM CT

Folic acid may help treat allergies, asthma

Folic acid, or vitamin B9, essential for red blood cell health and long known to reduce the risk of spinal birth defects, may also suppress allergic reactions and lessen the severity of allergy and asthma symptoms, as per new research from the Johns Hopkins Children's Center.

In what is thought to bethe first study in humans examining the link between blood levels of folate the naturally occurring form of folic acid and allergies, the Hopkins researchers say results add to mounting evidence that folate can help regulate inflammation. Recent studies, including research from Hopkins, have found a link between folate levels and inflammation-mediated diseases, including heart disease. A report on the Hopkins Children's findings appears online ahead of print in the Journal of Allergy & Clinical Immunology

Cautioning that it's far too soon to recommend folic acid supplements to prevent or treat people with asthma and allergies, the scientists emphasize that more research needs to be done to confirm their results, and to establish safe doses and risks.

Reviewing the medical records of more than 8,000 people ages 2 to 85 the researchers tracked the effect of folate levels on respiratory and allergic symptoms and on levels of IgE antibodies, immune system markers that rise in response to an allergen. People with higher blood levels of folate had fewer IgE antibodies, fewer reported allergies, less wheezing and lower likelihood of asthma, scientists report......... Posted by: JoAnn      Read more         Source