By Ves Dimov, M.D.
Allergist/Immunologist, Assistant Professor of Medicine and Pediatrics, University of Chicago
Editor, WAO Small Airways Working Group Website
Posted 17 February 2012
PPI lansoprazole does not help children with poorly controlled asthma if they do not have reflux symptoms
Asymptomatic gastroesophageal reflux (GER) is prevalent in children with asthma. Untreated GER has been postulated to be a cause of inadequate asthma control. However, it it not clear if treating asymptomatic GER with proton pump inhibitors (PPI) helps the asthma symptoms.
306 children with asthma with mean age of 11 years were enrolled at 19 academic clinical centers in the USA and were followed up for 6 months.
There were no significant differences in:
- the Asthma Control Questionnaire (ACQ) score (primary outcome),
- FEV1, forced expiratory volume in the first second
- asthma-related quality of life
- asthma exacerbations
Among the 115 children with esophageal pH studies, the prevalence of GER was 43%. In the subgroup with a positive pH study, lansoprazole did not affect asthma outcomes.
In addition, there were slightly more respiratory infections in the PPI group (relative risk, 1.3).
In this trial of children with poorly controlled asthma without symptoms of GER who were using inhaled corticosteroids, the addition of lansoprazole, did not improve symptoms or lung function.
Source: Writing Committee for the American Lung Assocation Asthma Clinical Research Centers. Lansoprazole for Children With Poorly Controlled Asthma. A Randomized Controlled Trial. JAMA. 2012; 307(4): 373-380. (doi: 10.1001/jama.2011.2035)
Author Video / Author Interview
Indoor chlorinated swimming pools are associated with airway changes in “healthy” swimmers
Airway disorders are common in regular chlorinated swimming pool attendees, particularly competitive athletes. Are there arirway changes in “healthy swimmers? This study evaluated airway inflammation and remodeling in 26 elite healthy swimmers without history of asthma, and 20 controls (10 with asthma and 10 healthy subjects).
Swimmers had increased airway mucosa eosinophil and mast cell counts. They also had more goblet cell hyperplasia and higher mucin expression. However, exhaled nitric oxide (FeNO) and airway responsiveness to methacholine did not correlate with the inflammatory and remodeling changes.
The authors concluded that intense, long-term swimming training in indoor chlorinated swimming pools is associated with airway changes similar to those seen in mild asthma, but with higher mucin expression. The long-term clinical consequences need to be clarified in future studies to determine of these changes could lead to asthma.
Source: Bougault V, Loubaki L, Joubert P, Turmel J, Couture C et al. Airway remodeling and inflammation in competitive swimmers training in indoor chlorinated swimming pools. Valérie Bougault et al. The Journal of Allergy and Clinical Immunology, 2012; 129(2): 351-358.e1.
Asthmatics exhale fewer airway particles than healthy controls
Particles in exhaled air reflect the composition of respiratory tract lining fluid and could serve as biomarkers for respiratory diseases such as asthma. Investigators in Sweden studied the particles exhaled from 15 patients with asthma and 11 controls using time-of-flight–secondary ion mass spectrometry (TOF-SIMS).
Asthmatics exhaled fewer particles than controls. The ratio of unsaturated to saturated phospholipids was also lower in patients with asthma.
The study authors concluded that analysis of exhaled particles is a promising method to examine the composition of respiratory tract lining fluid. This exploratory study successfully differentiated asthmatics and healthy controls based on spectrometry of exhaled air.
Source: TOF-SIMS analysis of exhaled particles from patients with asthma and healthy controls
Almstrand A-C, Josefson M, Bredberg A, Lausmaa J, Sjövall P et al. European Respiratory Journal 2012; 39(1): 59-66.
Posted 17 February 2012