February 2005 Medical Journal Review
Reviewed by Richard F. Lockey, M.D., Editor-In-Chief
1. THIS 12-MONTH MULTICENTER, DOUBLE-BLIND, PARALLEL-GROUP STUDY OF VIRAL-INDUCED ASTHMA EXACERBATIONS IN CHILDREN, 2 TO 5 YRS, DEMONSTRATED THAT MONTELUKAST REDUCED ASTHMA EXACERBATIONS AND DELAYED THE MEDIAN TIME FOR FIRST EXACERBATION BY TWO MONTHS. CONSISTENT WITH THESE FINDINGS, THE PROPORTION OF PATIENTS REQUIRING INHALED CORTICOSTEROIDS OR ß-AGONIST WERE REDUCTED BY 30% TO 40%, RESPECTIVELY, COMPARED WITH PLACEBO. Editor's comment: montelukast interferes with viral adherence in vitro and may do the same in vivo. Bisgaard H, et al. Am J Respir Crit Care Med 2005; 171: 315.
2. IN A CROSS-SECTIONAL SURVEY NESTED CASE-CONTROL STUDY OF CHILDREN AGE 1 TO 5 YRS IN ETHIOPIA, THERE IS NO REDUCTION IN THE RISK OF ATOPIC DERMATITIS IN RELATION TO INTESTINAL PARASITES INFECTION, FAMILY SIZE, CROWDING IN HOME, OR BREAST-FEEDING. Editor's comment: intestinal parasites infection in this group of children did not decrease the risk for atopic dermatitis. Haileamlak A, et al. J Allergy Clin Immunol 2005; 115: 370.
3. MIXTURES OF NITROGEN DIOXIDE AND OZONE CAN ADD THE CHEMICAL GROUP NITRATE TO THE PROTEIN MOLECULES THAT ACCOUNT FOR UP TO 5% OF PARTICLES IN AIR. NITRATION COULD ENHANCE THE ALLERGENICITY OF ALLERGENS ENABLING THEM TO BIND MORE STRONGLY TO ANTIBODIES THAT CAUSE ALLERGIC REACTIONS. IN A STUDY OF URBAN DUST, UP TO 0.1% OF PROTEINS IN THE DUST WERE NITRATED BY TRAFFIC SMOG. WHEN BIRCH POLLEN WAS LEFT AT A BUSY MUNICH ROAD JUCTION FOR SEVERAL DAYS, THAT FIGURE ROSE TO 10%. Editor's comment: the authors postulate this as a mechanism by which allergens become more allergenic. Franze T, et al. Environ Sci Technol, published on-line doi:10, 1021/eso488737(2005).
4. PEDIATRIC NONADHERENCE IN CHRONIC ILLNESSES IS ≤ 50% OF PRECRIBED MEDICATIONS. IN A CROSS-SECTIONAL, 1-MONTH FOLLOW-UP STUDY IN 75 CHILDREN, 8 TO 16 YRS, WITH PERSISTENT ASTHMA, NONADHERENCE TO LONG-TERM CONTROLLER MEDICATIONS (MEDIAN = 46% OF PRESCRIBED DOSES TAKEN) AND PATTERNS OF QUICK-RELIEF MEDICATION USE (RANGE = 0 TO 251 DOSES/ PER MONTH) WERE DOCUMENTED. Editor's comment: medication compliance in asthma management is a problem in both pediatric and adult populations. Walders N et al. J Pediatr 2005; 146: 177.
5. INFANTS WITH RECURRENT OR CHRONIC WHEEZE DID NOT SHOW IMPROVED LUNG FUNCTION FROM 3 MONTHS TREATMENT WITH FLUTICASONE 200 μg DAILY, INHALED VIA A BABYHALER.® THERE WAS IMPROVEMENT AFTER 6 WEEKS OF TREATMENT BUT NOT AFTER 13 WEEKS OF TREATMENT. TREATMENT EFFECT WAS NOT MODIFIED BY THE PRESENCE OF ATOPY OR ECZEMA. Editor's comment: the wheezy infant remains a therapeutic dilemma. Hofhuis W, et al. Am J Respir Crit Care Med 2005; 171: 328.
6. REVIEW OF THE MANAGEMENT OF HYPERSENSITIVITY REACTIONS TO IODINATED CONTRAST MEDIA. IT CALLS FOR MORE RESEARCH ON THE PATHOPHYSIOLOGY, DIAGNOSTIC TESTING, AND PREMEDICATION. Editor's comment: nice review for everyone to read. Brockow K, et al. Allergy 2005; 60: 150.
7. IN THIS NESTED CASE-CONTROL STUDY WITHIN A COHORT OF 89,877 PATIENTS, AGED = 40 YEARS, WITH PHYSICIAN INSURANCE CLAIMS FOR COPD OR ASTHMA, ENROLLED FOR = 1 YEAR, THERE IS NO INCREASE NONVERTEBRAL FRACTURE RISK EXPOSURE IN RELATION TO INHALED CORTICOSTEROID (ICS) EXPOSURE. Editor's comment: this study did not evaluate very high ICS dose, long-term ICS exposure, or vertebral fracture risk. The authors conclude, never-the-less that the lowest dose of ICS should be used in any patient with COPD or asthma. Johannes CB, et al. Chest 2005; 127: 89.
8. CHILDREN 6 TO 17 YRS WITH MILD- TO-MODERATE PERSISTENT ASTHMA, WERE RANDOMIZED TO ONE OF 2 CROSSOVER SEQUENCES, INCLUDING 8 WEEKS OF FLUTICASONE (100 μg TWICE DAILY), AND 8 WEEKS OF MONTELUKAST (5-10 mg NIGHTLY, DEPENDING ON AGE), IN A MULTICENTER, DOUBLE-MASKED, 18-WEEK TRIAL. CHILDREN WITH LOW PULMONARY FUNCTION OR HIGH LEVELS OF MARKERS OF ALLERGIC INFLAMMATION SHOULD RECEIVE ICS THERAPY AND OTHER CHILDREN EITHER ICS OR LTRAs . Editor's comment: specific asthma characteristics in children do help to determine the type of treatment to which they best respond. Szefler SJ, et al. J Allergy Clin Immunol 2005; 115: 233.
9. IN THIS MULTICENTERED, RANDOMIZED, DOUBLE-BLINDED, PARALLEL-GROUP, PLACEBO-CONTROLLED STUDY, 141 INFANTS, 6 TO 12 MONTHS OF AGE WITH MILD TO MODERATE PERSISTANT ASTHMA OR RECURRENT WHEEZE, RECEIVED 0.5 mg BUDESONIDE, 1.0 mg BUDESONIDE OR PLACEBO ONCE DAILY FOR 12 WEEKS. THE SAFETY PROFILE FOR BUDESONIDE WAS SIMILAR TO THAT OF PLACEBO, WITH NO SUPPRESSIVE EFFECT ON ADRENAL FUNCTION. Editor's comment: inhalational ICS are generally safe, when used at recommended doses or at the lowest dosage necessary to control asthma. Berger WE, et al. J Pediatr 2005; 146: 91.
10. OBSTRUCTIVE SLEEP APNEA IS AN INCREASINGLY COMMON DISORDER THAT IS STRONGLY LINKED TO OBESITY. Editor's comment: sleep apnea is common and often a complicating factor in patients with COPD and/or asthma. Very nice review. Caples SM, et al. Ann Intern Med 2005; 142: 187.
