Asthma Watch

Pharmacy Times, April 2011 Allergy & Asthma, Volume 77, Issue 4

Children with Asthma Need More Guidance with Inhalers

When it comes to inhaler use, most children aren’t scoring high marks. A study published in the April issue of Pediatrics finds that fewer than 1 in 10 children with asthma use traditional inhalers correctly, and 1 in 4 are successfully using newly designed inhalers.

Asthma is the most common chronic condition among children in the United States, and one of the most costly. Related health care costs are estimated at more than $6 billion a year, and lost productivity costs associated with working parents caring for children who miss school are estimated at $1 billion a year.

In the study, Betsy Sleath, PhD, and colleagues from the University of North Carolina Eshelman School of Pharmacy studied 296 North Carolina patients aged 8 to 16 years who used 4 different devices to manage their asthma: a metered-dose inhaler; a dry-powder diskus inhaler delivering Advair; a dry-powder turbuhaler delivering Pulimcort or Symbicort; and the peak-flow meter.

They found that only 8.1% of children in the study performed all of the metereddose inhaler steps correctly, and that older children were more likely than younger children to get more of the metered-dose inhaler steps correct. With a diskus, 21.9% of children performed all steps correctly, and 15.6% performed all of the turbuhaler steps correctly. Children using a peak-flow meter did so correctly 23.9% of the time.

The researchers also found that of the 41 health care providers who participated in the study, most did not demonstrate or assess children’s use of the 4 devices during pediatric asthma visits.

“It is crucial that health care providers not only show a child how to use an inhaler correctly, but also have the child demonstrate the device in front of a physician or pharmacist,” Dr. Sleath said. “We need innovative ways to demonstrate and assess device technique among asthmatic children.”

Oral Contraceptive Use Not Linked to Asthma in Offspring

Since the late 1990s, several studies have supported the hypothesis that birth control pill use is associated with the risk of asthma in offspring. However, results of a new study presented at the 2011 Annual Meeting of the American Academy of Allergy, Asthma & Immunology indicate that oral contraceptives taken prior to pregnancy are not related to respiratory outcomes.

The findings may provide reassurance for mothers who have taken birth control pills before becoming pregnant.

In the study, researchers at RTI International, the National Institute of Environmental Health Sciences, and the Norwegian Institute of Public Health examined the associations between the type of oral contraceptive used by mothers before pregnancy and lower respiratory tract infections, wheezing, and asthma in different age groups.

They determined that progestin-only pill use in the year before pregnancy had a slight positive association with wheezing in children at 6 to 8 months old; however, it was noted that very few women used this type of pill, and that the association was small and might be due to residual confounding.

“We found that use of the combined pill, taken by most women who use oral contraceptive pills, was not associated with adverse respiratory outcomes in the offspring,” said Stephanie J. London, MD, DrPH, principal investigator at the National Institute of Environmental Health Sciences and senior author of the study. “This should provide reassurance to the vast majority of women using oral contraceptive pills during their childbearing years.” PT

Asthmatics More Likely to Be Smokers

New research from the University of Cincinnati suggests that being diagnosed with asthma is significantly associated with a greater risk for a lifetime history of daily smoking and nicotine dependence.

In a large epidemiologic survey, lead researcher Alison McLeish and colleagues found that adults who were diagnosed with asthma were 1.26 times more likely to have been smokers, and twice as likely as those without asthma to have been nicotine dependent at some point in their lives. The researchers also found that the asthma—smoking association was stronger when focusing on nicotine dependence in the past 12 months, according to the study, which was published online in the Journal of Health Psychology in February.

“Individuals with asthma were nearly three times as likely as those without asthma to have reported nicotine dependence in the past 12 months after controlling for demographic and drug abuse/dependence variables,” the authors wrote.

Based on the findings, the researchers suggest focusing more clinical attention on addressing tobacco use and dependence in relation to asthma.