What Is New In Small Airways Research
By Ves Dimov, M.D.
Assistant Professor of Medicine and Pediatrics
University of Chicago
Thiazolidinediones may provide a new anti-inflammatory approach to asthma
Thiazolidinediones are oral diabetes medications that activate peroxisome proliferator-activated receptor gamma and have anti-inflammatory properties. Some studies have found improvements in pulmonary function in asthma patients treated with thiazolidinediones.
This cohort study included diabetic Veterans with asthma who were taking oral diabetes medications (2,178 patients were on thiazolidinediones). Thiazolidinediones were associated with reductions in risk of asthma exacerbation (OR = 0.79) and oral steroid prescription (OR = 0.73).
Thiazolidinediones may provide a novel anti-inflammatory approach to asthma management by preventing exacerbations and decreasing the use of oral steroids.
Disclaimer: The editor co-authored the first human study of thiazolidinediones in asthma which was cited in the article (Ann Allergy Asthma Immunol 2012, 109(1):75-77)
Source: Rinne ST, Feemster LC, Collins BF, Au DH, Perkins M, Bryson CL, O’Riordan TG, and Liu CF. Thiazolidinediones and the risk of asthma exacerbation among patients with diabetes: a cohort study. Allergy, Asthma & Clinical Immunology 2014, 10:34. (doi:10.1186/1710-1492-10-34)
Full Text, Open Access
Image Source: The chemical structure of thiazolidinedione, Wikipedia, public domain.
Omalizumab may have anti-inflammatory effects on small airways and reverse airway remodeling
Omalizumab, a humanized anti-IgE monoclonal antibody, is an effective treatment for severe allergic asthma. This prospective, single-arm observational study, evaluated its effects on small airways and airway remodeling, in 26 adult patients with severe refractory asthma (48 weeks of omalizumab treatment).
Asthma Quality of Life Questionnaire scores and peak expiratory flow improved. Asthma exacerbations requiring systemic corticosteroids, fractional exhaled nitric oxide at 50 mL/s and alveolar nitric oxide levels, sputum eosinophil proportions, and airway-wall thickness as assessed by computed tomography also decreased.
Omalizumab may have anti-inflammatory effects on small airways and reverse airway remodeling.
Source: Tajiri T, Niimi A, Matsumoto H, Ito I, Oguma T et al. Comprehensive efficacy of omalizumab for severe refractory asthma: a time-series observational study. Annals of Allergy Asthma & Immunology. 2014; Correct proof, published online before print 1 July. (doi: 10.1016/j.anai.2014.06.004)
Children treated daily with ICS grow 0.5 cm less during the first year of treatment, no difference second year
Two literature reviews by The Cochrane Collaboration evaluated the effect of inhaled corticosteroids (ICS) on growth in children with asthma. The first review included 25 trials with 8471 children (5128 ICS-treated and 3343 control) with mild to moderate persistent asthma. The second review included 17 group comparisons derived from 10 trials (3394 children with mild to moderate asthma). Trials used ICS (beclomethasone, budesonide, ciclesonide, fluticasone or mometasone) as monotherapy or as combination therapy.
Regular use of ICS at low or medium daily doses was associated with a mean reduction of 0.48 cm/y in linear growth velocity and a 0.61-cm change from baseline in height during a one-year treatment period in children with mild to moderate persistent asthma. The effect size of ICS on linear growth velocity appears to be associated more strongly with the ICS molecule than with the device or dose. ICS-induced growth suppression seems to be maximal during the first year of therapy and less pronounced in subsequent years of treatment. Findings support use of the minimal effective ICS dose in children with asthma.
Zhang L, Prietsch SOM, Ducharme FM. Inhaled corticosteroids in children with persistent asthma: effects on growth. Cochrane Database of Systematic Reviews 2014; Issue 7. Art. No.: CD009471. DOI: 10.1002/14651858.CD009471.pub2.
Pruteanu AI, Chauhan BF, Zhang L, Prietsch SOM, Ducharme F. Inhaled corticosteroids in children with persistent asthma: dose-response effects on growth. Cochrane Database of Systematic Reviews 2014; Issue 7. Art. No.: CD009878. DOI: 10.1002/14651858.CD009878.pub2.