DECEMBER 01, 2006

Despair Linked with Poor Asthma Therapy Adherence

A study, reported in Chest (October 2006), examined the effect of depression on adherence to asthma therapy following hospital discharge in 59 patients. The participants were mainly female, black inner-city adults with an average age of 43 who were admitted to the hospital for an asthma flare-up.

While the patients were hospitalized, the researchers assessed their levels of despair and found that 41% had significant levels of depressive symptoms. The researchers also used electronic monitors to evaluate the patients' use of inhaled and oral asthma therapies for 2 weeks after their hospital release. The study's findings indicated that overall adherence to asthma medication was suboptimal, but it was considerably worse in patients with elevated levels of depressive markers.

Specifically, adherence to asthma therapy was 60% in patients showing high levels of depressive symptoms, compared with 74% in patients without depressive signs. When the researchers took into account factors that might impact adherence, "patients who were depressed were about 11 times more likely to be poorly adherent to asthma therapy—meaning taking less than 50% of it," explained lead investigator Susan J. Bartlett, PhD.

Study Finds Asthma and SCD Pain Connection

The combination of painful episodes of sickle cell disease (SCD) and asthma in children are temporally connected with breathing problems. Earlier studies had found a link between asthma and an increased occurrence of painful SCD episodes. Yet, few data were available about the temporal relationship between respiratory symptoms and painful episodes. The current study explored the possible link by examining 124 painful incidences experienced by children over 25 months.

Of the 74 participants, 36 had asthma and 38 were asthma- free. Their mean age was 9.8 years. The study's findings showed that, of the 94 painful episodes (76%) with proper documentation of the presence or lack of respiratory problems, 54% happened in children with asthma and 46% in children without asthma. The researchers reported that 35% of the painful incidences were clearly preceded by respiratory symptoms in children with asthma, compared with 12% who were asthma-free—a 23% difference. (The findings were recently reported in the Journal of Pediatric Hematology and Oncology.)

Hospital Death Toll High with Asthma Flare

In-hospital death rates from asthma exacerbations are relatively high, according to a study reported in the American Journal of Respiratory and Critical Care Medicine (October 2006). Although admission to the hospital for an asthma flare is common in the United States, no national calculations of outcomes have been completed in this population.Also, no evidence exists about ethnicity in asthma deaths among hospitalized patients.

To investigate, the researchers examined 65,381 hospital admissions for asthma exacerbation among patients aged 5 and older. The in-hospital asthma death rate was 0.5%, and the average hospital stay was 2.7 days. Of the 4487 deaths from asthma, 1499 (33%) occurred in patients hospitalized for asthma exacerbations. In terms of racial disparities, black patients had a considerably lower risk of death, compared with white patients (0.3% vs 0.6%, respectively). The results of multivariable analyses indicated no major race difference in hospital deaths.

"Our findings suggest that improvements in the management of asthma exacerbations before hospitalization (eg, at home, during transportation to the emergency department) will have the greatest benefit in further reducing the overall risk of death and in eliminating race disparities in asthma deaths," concluded the researchers.

Infants' Lung Function May Predict Asthma Risk

Lung-function tests at birth may foretell a child's future respiratory health. The study, reported in the New England Journal of Medicine (October 19, 2006), assessed whether or not lung function at birth indicated a greater risk of developing asthma during childhood.

For the study, the Norwegian researchers recruited 616 children who were 10 years old. All of the participants had been administered lung-function tests shortly after birth. They underwent an asthma evaluation that included lung-function tests, a test designed to measure airway response to an irritant, blood samples, and allergy testing. The researchers learned that 20% of the children—or their parents—reported a history of asthma and 11% currently had asthma.

The researchers found that about 16% of those children who had normal lung function at birth had a history of asthma, compared with 24% of those who had less than optimal lung function as infants. Of those participants currently with asthma, 7.5% had normal lung-function tests as infants, compared with 14.6% of those who scored poorly on the test at birth.

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