Pharmacy Times, Volume 0, 0

Despair Linked with Poor Asthma Therapy Adherence

A study, reported in Chest (October2006), examined the effect of depressionon adherence to asthma therapy followinghospital discharge in 59 patients. Theparticipants were mainly female, blackinner-city adults with an average age of43 who were admitted to the hospital foran asthma flare-up.

While the patients were hospitalized,the researchers assessed their levels ofdespair and found that 41% had significantlevels of depressive symptoms. Theresearchers also used electronic monitorsto evaluate the patients' use ofinhaled and oral asthma therapies for 2weeks after their hospital release. Thestudy's findings indicated that overalladherence to asthma medication wassuboptimal, but it was considerablyworse in patients with elevated levels ofdepressive markers.

Specifically, adherence to asthmatherapy was 60% in patients showinghigh levels of depressive symptoms,compared with 74% in patients withoutdepressive signs. When the researcherstook into account factors that mightimpact adherence, "patients who weredepressed were about 11 times morelikely to be poorly adherent to asthmatherapy—meaning taking less than 50%of it," explained lead investigator Susan J.Bartlett, PhD.

Study Finds Asthma andSCD Pain Connection

The combination of painful episodes of sickle cell disease(SCD) and asthma in children are temporally connected withbreathing problems. Earlier studies had found a link betweenasthma and an increased occurrence of painful SCDepisodes. Yet, few data were available about the temporalrelationship between respiratory symptoms and painfulepisodes. The current study explored the possible link byexamining 124 painful incidences experienced by childrenover 25 months.

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

Hospital Death Toll High with Asthma Flare

In-hospital death rates from asthma exacerbations are relativelyhigh, according to a study reported in the AmericanJournal of Respiratory and Critical Care Medicine (October 2006).Although admission to the hospital for an asthma flare is commonin the United States, no national calculations of outcomeshave been completed in this population.Also, no evidence existsabout ethnicity in asthma deaths among hospitalized patients.

To investigate, the researchers examined 65,381 hospitaladmissions for asthma exacerbation among patients aged 5 andolder. The in-hospital asthma death rate was 0.5%, and the averagehospital 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 considerablylower risk of death, compared with white patients(0.3% vs 0.6%, respectively). The results of multivariable analysesindicated no major race difference in hospital deaths.

"Our findings suggest that improvements in the managementof asthma exacerbations before hospitalization (eg, athome, during transportation to the emergency department) willhave the greatest benefit in further reducing the overall risk ofdeath and in eliminating race disparities in asthma deaths," concluded the researchers.

Infants' Lung Function May Predict Asthma Risk

Lung-function tests at birthmay foretell a child's futurerespiratory health. The study,reported in the New EnglandJournal of Medicine (October19, 2006), assessed whetheror not lung function at birthindicated a greater risk ofdeveloping asthma duringchildhood.

For the study, the Norwegianresearchers recruited616 children who were 10years old. All of the participantshad been administeredlung-function tests shortlyafter birth. They underwent anasthma evaluation that includedlung-function tests, a testdesigned to measure airwayresponse to an irritant, bloodsamples, and allergy testing.The researchers learned that20% of the children—or theirparents—reported a history ofasthma and 11% currently hadasthma.

The researchers found thatabout 16% of those childrenwho had normal lung functionat birth had a history of asthma,compared with 24% ofthose who had less than optimallung function as infants. Ofthose participants currentlywith asthma, 7.5% had normallung-function tests as infants,compared with 14.6% of thosewho scored poorly on the testat birth.