Research Reviews, October 2011
Allergist/Immunologist, Assistant Professor of Pediatrics, University of Chicago
Editor, WAO Small Airways Working Group website
Posted 18 October 2011
Nocturnal symptoms may not predict the onset of asthma exacerbations in children.
Although nocturnal awakenings help categorize asthma severity and control, their clinical significance has not been thoroughly studied. A recent study examined the clinical consequences of nocturnal asthma symptoms requiring albuterol (NASRAs) in 285 children aged 6 to 14 years with mild-to-moderate persistent asthma.
NASRAs occurred in 72.2% of participants at least once, and in 24.3% of participants they occurred 13 or more times.
The majority (81.3%) of nocturnal symptoms occurred outside of exacerbation periods and were associated the next day with the following events: albuterol use (56.9%, relative risk [RR], 2.3), school absence (5.0%, RR, 10.6), and doctor contact (3.7%, RR, 8.8). Similar findings were noted during exacerbation periods (RRs of 1.7 for albuterol use, 5.5 for school absence, and 4.9 for doctor contacts). Nocturnal symptoms did not predict the onset of exacerbations.
NASRAs in children with mild-to-moderate persistent asthma receiving controller therapy occurred predominantly outside of exacerbation periods. However, considering that NASRAs were associated with increases in albuterol use, school absences, and doctor contacts, the clinical implications will depend on how we define an asthma exacerbation and its severity.
Source: Horner CC, David Mauger D, Strunk RC, Graber NJ, Lemanske Jr RF et al. Most nocturnal asthma symptoms occur outside of exacerbations and associate with morbidity. The Journal of Allergy and Clinical Immunology. August 2011 [Epub ahead of print]
Once-daily fluticasone furoate is an effective treatment for mild-to-moderate asthma.
Fluticasone furoate (FF) is a new long-acting inhaled corticosteroid (ICS). A double-blind, placebo-controlled randomized trial evaluated the efficacy and safety of FF 200 mcg or 400 mcg once daily, either in the morning or in the evening, and FF 200 mcg twice daily (morning and evening), for 8 weeks in 545 patients with persistent asthma.
All patients in FF treatment groups had an improvement in FEV1 compared with placebo (p<0.05). FF 400 mcg once daily in the evening and FF 200 mcg twice daily produced similar improvements. FF 400 mcg once daily in the morning, although effective, resulted in a smaller improvement than FF 200 mcg twice daily.
FF 400 mcg once daily in the evening had similar efficacy to FF 200 mcg twice daily. Fluticasone furoate may be an effective and well tolerated once-daily treatment for mild-to-moderate asthma.
Disclosure: The trial was sponsored by the manufacturer of FF, GlaxoSmithKline, and one of the article’s authors is employed by the company.
Source: Woodcock A, Bateman ED, Busse WW, Lotvall J, Snowise NG et al. Efficacy in asthma of once-daily treatment with fluticasone furoate: a randomized, placebo-controlled trial. Respiratory Research. 2011; 12(132). [doi:10.1186/1465-9921-12-132]
Trial registration: NCT00398645.
Allergic rhinitis as an indicator of an “asthma march”.
Allergic rhinitis (AR) may precede and promote the onset of asthma. A study assessed forced expiratory flow at 25-75% (FEF25-75), FEV1, and response to bronchodilation test in 1605 adult patients with allergic rhinitis (AR).
There were 8.4% of patients with abnormal FEV1 values, 24.7% had impaired FEF25-75, and 66% had reversibility with bronchodilation. This study again highlights the close link between upper and lower airways (the so called "united airway concept”) and suggests the possible existence of a progression from AR toward asthma, such as an “asthma march”. Asthma should be suspected and carefully investigated in most patients with allergic rhinitis.
Source: Ciprandi G, Signori A, Tosca MA, and Cirillo I. Spirometric abnormalities in patients with allergic rhinitis: Indicator of an “asthma march“? American Journal of Rhinology & Allergy. 2011; 25(5): e181-e185(5).
Posted 18 October 2011