By Ves Dimov, MD
Allergist/Immunologist, Assistant Professor, University of Chicago
Posted 20 February 2013
Severe asthma greatly increases the risk of pulmonary embolism
Patients with asthma have activated coagulation within the airways which may lead to an increase in venous thromboembolic events (VTE). This study from The Netherlands assessed the incidence of VTE in 648 patients with mild-moderate and severe asthma as compared to a control population.
648 patients with asthma (283 with severe and 365 patients with mild-moderate asthma) visiting 3 Dutch outpatient asthma clinics were studied. All patients completed a questionnaire about a diagnosis of deep-vein thrombosis (DVT) and pulmonary embolism (PE) in the past, their risk factors, history of asthma and medication use. All VTE were objectively verified.
In total, 35 VTE events occurred at a median age of 39 years, 16 events of deep-vein thrombosis (DVT) and 19 events of pulmonary embolism (PE).
The incidence of PE in patients with severe asthma was 0.93 (per 1000 person-years, 0.33 in mild-moderate asthma, and 0.18 in the control group, respectively. Severe asthma and oral corticosteroid use were independent risk factors of PE (hazard ratios: 3.33 and 2.82 respectively). Asthma was not associated with DVT.
The study authors concluded that severe asthma greatly enhances the risk of pulmonary embolism, particularly if chronic corticosteroids are used.
Source: Majoor CJ, Kamphuisen PW, Zwinderman AH, ten Brinke A, Amelink M et al. Risk of deep-vein thrombosis and pulmonary embolism in asthma. European Respiratory Journal 2012; December, Published online before print. doi:10.1183/09031936.00150312
Image Source: Saphenous vein, Gray's Anatomy, 1918 (public domain)
Diagnosis and management of asthma - 2012 update from U.S. National Guideline Clearinghouse
An updated version of the guideline for diagnosis and management of asthma was released by the Institute for Clinical Systems Improvement and published by the Agency for Healthcare Research and Quality, part of U.S. Department of Health & Human Services. The full text of guideline is freely available online.
Source: Sveum R, Bergstrom J, Brottman G, Hanson M, Heiman M et al. Diagnosis and management of asthma. Bloomington (MN). Institute for Clinical Systems Improvement (ICSI) 2012 July.
Internet-based self-management improved asthma control after 3 months but all benefits were lost after 1 year
Asthma control often is poor in adolescents. Some studies have shown that Internet-based self-management (IBSM) improves asthma-related quality of life in adults.
This randomized controlled trial from The Netherlands included adolescents (12-18 years) with persistent and not well-controlled asthma who were allocated to IBSM (46 patients) or usual care (44).
IBSM consisted of weekly monitoring of asthma control and treatment advice by a web-based algorithm.
At 3 months, asthma-related quality of life (Pediatric Asthma Quality of Life Questionnaire, PAQLQ) improved by IBSM. However, at 12 months there was no difference between the 2 groups. Similar trend was found with Asthma Control Questionnaire (ACQ).
Internet-based self-management (IBSM) improved asthma-related quality of life and asthma control in adolescents after 3 months, but the benefits were lost after 12 months.
Source: Rikkers-Mutsaerts ER, Winters AE, Bakker MJ, van Stel HF, van der Meer V et al. Internet-based self-management compared with usual care in adolescents with asthma: a randomized controlled trial. Pediatric Pulmonology 2012; 47(12):1170-1179. doi:10.1002/ppul.22575