Asthma Watch

Pharmacy Times
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Kids' Asthma: Parents' Belief a Factor

Parental beliefs may impact asthma controlfor 1 in 3 children with the condition,according to telephone interviews andfindings reported in the October 2008issue of Pediatrics.

The study included 754 children aged2 to 12 years old with persistent asthma,of whom 280 (27%) had "suboptimalcontrol" of their asthma. Nearly half ofthe children with suboptimal controlunderutilized controller medication. Theresearchers found that children weremore prone to have troublesome asthmasymptoms if their parents had lowexpectations for how well their asthmacould be controlled. The children alsowere more likely to have poorly controlledsymptoms if no set schedule orroutine for taking asthma medicationwere established.

Clinicians recommend asthma controlmedication daily for children with persistentasthma.

Misconceptions among some parentsare that asthma is an intermittent ratherthan chronic condition, that 2 days ofsymptoms per week is adequate control,and that medication use is only neededwhen their child exhibited symptoms ornot at all.

Gene Variations, Secondhand Smoke Related to Asthma

Specific genetic variations previouslyidentified as putting individuals at greaterrisk for asthma appear to only increasethe risk of early-onset asthma, which isa disease seen in children aged 4 andyounger. The risk is further intensified byexposure to secondhand smoke, againearly in life, found a study reported inthe October 16, 2008, issue of the NewEngland Journal of Medicine.

In this study, the researchers tested 36single-nucleotide polymorphisms (SNPs)in the chromosome 17q21 region among1511 patients from 372 families. Theresults indicated that 11 SNPs were "significantlyassociated" with asthma, and3 of those were "strongly associated"with the condition. In addition, 4 SNPswere strongly associated with early-onsetasthma, but had no correlation with lateonsetdisease.

A stronger association also was detectedbetween 6 variants and asthma inpatients exposed to secondhand smokeat a young age. The combination showedan almost 3-fold risk in children underage 4.

Asthma Practice Guidelines Not Followed

The results of a survey found that manyinner-city primary care physicians do notfollow national practice guidelines publishedmore than a decade ago. The surveyincluded 202 primary care providersfrom 4 major general medicine practicesin and around New York City.

In the survey, the physicians reportedtheir adherence to 5 National Heart,Lung, and Blood Institute guideline components:steroid inhaler use, lung functionmonitoring, action plan use, allergytesting, and flu vaccination.The findings revealed that self-reportedfamiliarity with specific components wasonly 56% for steroid inhaler use and 57%for influenza vaccination.

The results were worse for recommendationsabout lung function monitoring(44%), asthma action plan use(32%), and allergy testing referrals(19%), the researchers recently reportedin the Annals of Allergy, Asthma, andImmunology.

The survey also revealed that lack ofconfidence in the ability to implementa guideline and a lower level of trainingwere strongly linked with nonadherenceto steroid use among patients with persistentasthma and with not having anaction plan or recommending the fluvaccine.

F A S T F A C T: In early childhood, asthma is more commonin boys than girls.

Diet May Ward Off Kids' Asthma

New research suggests that children whoeat a Mediterranean-type diet may notdevelop asthma and allergic rhinitis (hayfever). A Mediterranean diet is high invegetables, fruits and nuts, legumes, andfish, and low in dairy products, meat, junkfood, and fat.

The study included 1476 children aged 6to 7 years old. The research analyzed theassociation between both children's dietand their mother's diet during pregnancy,and the development of asthma andhay fever. Among children, the findingsshowed greater adherence in the previousyear to a Mediterranean diet was associatedwith less asthma, wheezing, and hayfever. The researchers found no correlationbetween a Mediterranean diet duringpregnancy and lower risk of asthma or hayfever in children, however.

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