Asthma Watch

Pharmacy Times, Volume 0, 0

Acetaminophen, Childhood Asthma Linked

Children given acetaminophen to reduce fever during their firstyear of life are more prone to developing asthma as they getolder, according to study findings reported in the September20, 2008, issue of The Lancet. For the study, the researcherscollected data on 205,487 children from 31 countries aroundthe world. The children participated in the International Studyof Asthma and Allergies in Childhood.

The researchers learned that children had a 46% increasedrisk of developing asthma when they were 6 to 7 years old.Furthermore, children given high doses of acetaminophenwithin the past year had a >3 times increased risk of developingthe condition. The children given medium doses faced a61% increased risk of developing asthma. Acetaminophenuse also was linked with a greater risk of severe asthma ofapproximately 22% to 38%, found the researchers.

The researchers concluded that acetaminophen use in largeamounts is unnecessary. "It should be limited to high fevers,"said lead researcher Richard Beasley, MBChB, FRACP.

Day Care May Lead to Lower Asthma Risk

Children who attend day care may have alower risk of developing asthma later on,according to a study reported recentlyin the Journal of Allergy and Clinical Immunology.

For the study, the researchers followed1085 children from birth to age 5.The results indicated that children whowent to day care had a lower risk ofwheezing by the time they were 5 yearsold, compared with children who stayedat home or with a babysitter.

The risk was especially low amongchildren who entered day care whenthey were between the ages of 6 and 12months. This group was 75% less likely todevelop a wheezing problem, comparedwith children cared for at home.

Children who attended day care after12 months had a 35% lower risk ofwheezing.

Steroids Less Effective inObese Patients

Glucocorticoids (steroids) are 40% lesseffective in overweight and obese asthmapatients, compared with normal-weightindividuals. The researchers looked at 45nonsmoking adults and measured theresponses of cells to the steroid dexamethasone.Steroids interfere with inflammatorysignaling pathways by raising the levelof MAP kinase phosphatase-1 (MKP-1).

When the researchers applied dexamethasoneto the cultures of the participants?blood cells, they found that steroidsdid not increase MKP-1 as effectively inoverweight and obese patients with asthma,compared with thinner patients withthe condition. The steroid increased thelevels of MKP-1 by 5.27 times in culturedblood cells from slimmer patients withasthma, compared with an increase ofonly 3.11 times in overweight and obesepatients with asthma. The findings werereported in the October 1, 2008, issue ofthe American Journal of Respiratory andCritical Care Medicine.

Mortality Higher for Poor AsthmaControl, Severity

A study of 865 adults admitted to KaiserPermanente hospitals for asthma foundthat greater asthma severity and poorerperceived asthma control are linkedwith an increased risk of death in adultpatients in this patient population.

The study's purpose was to examinethe mortality risk factors among thesepatients. Sociodemographic data, asthmahistory and severity, health status,and scores on measures of perceivedasthma control were recorded and theimpact of each factor on mortality wasassessed. During the 781 days patientswere followed, 123 patients died.

When the researchers factored in otherpotential influences, the researcher foundan association between higher initialseverity of asthma scores combined withlower perceived asthma control scoresand a greater risk of all-cause mortality.

The findings were reported in theAugust 2008 issue of the Annals ofAllergy, Asthma, and Immunology.

Inhaled SteroidBenefits GoBeyond AsthmaControl

Older women with asthma who useinhaled steroids are considerably lesslikely to die from any cause, comparedwith women not using the medication.

The findings are based on responsesfrom a 1998 supplementary asthma questionnairesubmitted by 2671 women withpersistent asthma participating in theNurses' Health Study. Of the participants,54% reported inhaled steroid use in 1998.During the next 5 years, 87 women died(22 from cardiovascular disease, 31 fromcancer, and 34 from "other" causes).

The researchers found that use ofinhaled steroids at the outset was linkedwith a 42% reduced risk of dying fromany cause and a 65% reduced likelihoodof dying from a heart-related cause. Thestudy was reported in Chest (September2008).

F A S T F A C T: Approximately15% to 23% of asthma cases inthe United States are due tooccupational exposures.