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What Is New In Small Airways Research

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By Ves Dimov, MD
Allergist/Immunologist, Assistant Professor of Medicine and Pediatrics
University of Chicago

Posted 19 November 2012

Albuterol use predicts asthma outcomes: Each additional SABA canister linked to 8-18% increase in asthma exacerbations.

Short-acting beta-agonist (SABA) use is well established in predicting asthma events in adults. However, this predictive ability has yet to be established in a pediatric population.

A total of 33,793 Medicaid and 101,437 commercial insurance patients were included in this U.S. study sponsored by GlaxoSmithKline (GSK). Use of 3 or more SABA canisters during 12 months was identified in both pediatric Medicaid and commercial populations to best predict an increased risk of an asthma-related exacerbation.

For adults, use of 2 or more SABA canisters was found as the critical value with shorter optimal assessment periods of 3 and 6 months. Each additional SABA canister resulted in an 8% to 14% and 14% to 18% increase in risk of an asthma-related exacerbation in children and adults, respectively.

This study identified critical values of SABA use that predict future asthma events. Each additional SABA canister predicted increases in exacerbation risk in children and adults.


Stanford RH, Shah MB, D'Souza AO, Dhamane AD, Schatz M. Short-acting β-agonist use and its ability to predict future asthma-related outcomes. Annals of Allergy, Asthma & Immunology 2012; Corrected Proof 02 October 2012. DOI:10.1016/j.anai.2012.08.014


Image source: Wikipedia, GNU Free Documentation License


The ACT is preferable to the ACQ. However, neither ACT nor ACQ is useful for assessment of uncontrolled asthma.

This meta-analysis from China explored the diagnostic performances of and compared the Asthma Control Test (ACT) and Asthma Control Questionnaire (ACQ). Twenty-one studies with 11,141 subjects assessed with the ACT and 12,483 assessed with the ACQ were identified.

The ACT and ACQ had significant differences in the assessment of controlled and not well-controlled asthma.

For assessment of uncontrolled asthma, the ACT had poor accuracy, and the cutoff point for the ACQ has not been established. The authors concluded that the ACT is preferable to the ACQ in clinical practice. The ACQ requires further cross-validation. Moreover, neither the ACT nor the ACQ is useful for the assessment of uncontrolled asthma.


Jia CE, Zhang HP, Lv Y, Liang R, Jiang YQ et al. The Asthma Control Test and Asthma Control Questionnaire for assessing asthma control: Systematic review and meta-analysis. Journal of Allergy and Clinical Immunology 2012; Corrected Proof 10 October 2012. DOI:10.1016/jaci.2012.08.023



Inhaled steroids increase the risk of oropharyngeal colonization by Streptococcus pneumoniae in children with asthma.

Recent studies have raised concerns about link between use of inhaled corticosteroids (ICS) and risk of pneumonia in patients with chronic obstructive pulmonary disease and asthma.

This study from Brazil included 200 consecutive patients. The mean daily dose of ICS was 400 mcg of beclomethasone or equivalent and the mean duration of treatment was 8.6 months.

The prevalence of oropharyngeal colonization by S. pneumoniae was higher in the exposed group (treated with daily ICS for at least 30 days) compared to the non-exposed group (no ICS) (27% vs. 8.3%). Use of ICS was an independent risk factor for oropharyngeal carriage of S. pneumoniae, with a prevalence ratio of 3.75.

Children with asthma taking ICS were nearly four times as likely to have oropharyngeal colonization by S. pneumoniae as those not receiving ICS. Further studies should investigate the possible link between ICS and risk of respiratory infections in patients with asthma.


Zhang L, Prietsch SOM, Mendes AP, Von Groll A, Porto Rocha G et al. Inhaled corticosteroids increase the risk of oropharyngeal colonization by Streptococcus pneumoniae in children with asthma. Respirology 2012; Accepted Article. DOI:10.1111/j.1440-1843.2012.02280.x


Posted 19 November 2012

Last updated: Thursday, May 14th, 2015