ASTHMA WATCH

Pharmacy Times, Volume 0, 0

Vitamin Levels Linked with Breathing Risk

Vitamin E levels in pregnant womenare inversely linked with asthma in theirchildren, according to a study reported inthe American Journal of Respiratory andCritical Care Medicine (September 1,2006). In an earlier study, the researchersfound an inverse association betweenmaternal vitamin E levels during pregnancyand the risk of wheezing in their 2-year-old children.

For the current study, the researchersrevisited 1861 children from the earlierstudy at age 5 and assessed their asthma-related outcomes. Food frequencyquestionnaires and blood tests wereused to examine the mothers' nutrientstatus. Respiratory questionnaires, imaging,and skin-prick tests were used toanalyze the presence of asthma in thechildren.

The results indicated that low maternalvitamin E levels were tied with having achild with asthma, constant wheeze,wheezing, or asthma during the previousyear, or ever having a diagnosis of asthma.The inverse association was alsoseen, with elevated vitamin E levels beinglinked with a reduced chance of having achild with asthma or related symptoms.The researchers also discovered a negativeassociation between maternal zinclevels and children with active asthma orthose who had ever been diagnosed withthe disorder. The study indicated that achild's nutrient status was not associatedwith breathing outcomes.

Asthma Associated with Sleep Disorder

Researchers have found that asthma seems toalmost double the risk of obstructive sleep apnea problemsin young mothers. The study included 677 womenwith an average age of about 30 years. Overall, >50% ofthe women reported that they never snored; however,34% (231 patients) reported snoring at least 1 night perweek, and 13% (85 patients) reported snoring "almostalways." Snoring is an indicator of sleep apnea.

The 122 black women in the cohort were significantlymore prone to snore, compared with whites. Patientswithout asthma were also at increased risk for snoring.Furthermore, women diagnosed with asthma and currentlyhaving symptoms were 2 times as likely to snore.

"Knowledge that asthma is associated with increasedrisk of obstructive sleep apnea has thepotential of translating into reduced morbidity due toobstructive sleep apnea, by allowing early diagnosisand treatment," concluded lead investigatorManinder Kalra, MD. (The findings were published inthe August 2006 issue of the Annals of Allergy,Asthma & Immunology).

Blacks Present to the ER with More Severe Asthma

A study reported in the American Journal of Respiratory andCritical Care Medicine (September 2006) found that blacks whocome to the emergency room (ER) for treatment during anasthma attack have more severe flare-ups, compared withwhites with the disease. Yet, the 2 groups respond equally wellto routine "rescue" treatment.

The researchers investigated asthma attack severity andthe effectiveness of beta-2 agonists in 155 adult blacks and140 adult whites seen at 8 different ERs in the Cleveland, Ohio,area. The results showed that blacks had reduced airflow totheir respiratory passages and more serious flare-ups of asthma,compared with the white participants. On the other hand,the beta-2 agonist "albuterol was equally efficacious in bothpopulations, and there was no difference in posttreatment[airflow rates, regardless] of the initial attack intensity," reportedthe researchers. The researchers also discovered therewere no racial differences in the rate of hospital admissionsand discharges.

The researchers were unable to determine why blacks havemore severe flare-ups in the ER. They suggested that blacksmay wait longer to come to the ER and may use short-actingdrug therapy too long to try to control the attack at home.

Drug Use "As Needed" Relieves Asthma

The "as needed" recommendationmay work for individuals withasthma who are on a drug combofor regular maintenance therapy.Taking the medications only whenthey have symptoms seems toimprove overall asthma control.

The results are based on astudy of 3394 patients with moderate-to-severe asthma who stillhad symptoms while takingbudesonide/formoterol maintenancetherapy during a 2-weektrial period. During episodes ofbreathing difficulty, the patientswere randomly assigned to useeither the rapid-acting beta-2agonist terbutaline, formoterol,or the formoterol/budesonidecombo. The researchers foundthat in terms of delaying the firstsevere asthma flare-up, the drugcombination worked better,compared with formoterol alone,which in turn was more effectivethan terbutaline.

Formoterol plus budesonidewas also notably better in loweringthe frequency of asthmaexacerbations. With the drugcombination, 19 severe flare-upsper 100 patients annually occurred,compared with 37 and 29flare-ups with terbutaline and formoterol,respectively. The results"challenge the established use ofmaintenance therapy plus rapid-actingbeta-2 agonists as the onlymeans of controlling asthma,"concluded the researchers. (Thefindings were reported in theLancet, August 26, 2006.)