Browsed by
Tag: asthma

More asthma research yields hopeful new controls

More asthma research yields hopeful new controls

For quite some time it has been known that calcium plays a major role in muscle contraction. A number of calcium-altering medicines are used to help heart problems and hypertension by relaxing the smooth muscle found in the heart and arteries. Now there may be an application to asthma.

Smooth muscle is also found in our bronchial tubes; constriction of this muscle that occurs through proteins called calcium-sensing receptors causes asthma.

A recent British study examined the use of a class of drugs used to treat osteoporosis called calcilytics. These drugs were administered to asthmatic mice with dramatic results: the drugs blocked the action of calcium-sensing receptors and thus, prevented the smooth muscle constriction.

The scientists are now starting human studies. This research is very compelling as it offers a mechanism to control asthma that has never before been available.

Q – Tips: Asthma and obesity

Q – Tips: Asthma and obesity

A recent Canadian study on obese asthmatics found marked improvement in airway function associated with weight loss. The degree of improvement seemed to track with the amount of weight shed, but notable improvement was found with as little as an eight-pound loss.

Heads-up’ issued for ol’ faithful aspirin: may aggravate respiratory disease

Heads-up’ issued for ol’ faithful aspirin: may aggravate respiratory disease

 

A “pay attention” article was recently published in the Journal of Allergy and Clinical Immunology cautioning adults with asthma to be more aware that aspirin may aggravate their condition.

The authors pointed out that while some adult asthmatics with Aspirin Exacerbated Respiratory Disease (AERD) are cognizant of the negative effects aspirin can have on their health, most are not.

Studies have shown that AERD is more likely to occur if adult asthmatics also have chronic sinus problems and/or nasal polyps. Overall, seven percent of asthmatics have AERD, but 15 percent with severe asthma have it.

Unfortunately there is no simple blood or skin test to diagnose Aspirin Exacerbated Respiratory Disease. Right now, only two ways are available for these patients to become aware of the possibility: 1.) Monitoring their breathing symptoms after ingesting aspirin or other NSAIDS (non-steroid anti-inflammatories). 2.) Doing an aspirin challenge in a doctor’s office by measuring baseline pulmonary function tests and then incrementally increasing doses of aspirin, while repeating the pulmonary tests.

 

Promising new asthma drug nears testing finish line

Promising new asthma drug nears testing finish line

Research on a very exciting new medicine for asthma was featured several weeks ago in The New England Journal of Medicine. This drug — the first ever to work on both the acute and late phases of allergic response — is an enzyme that inactivates GATA-3 messenger RNA, and is being called SB010.

GATA-3 is a signal that favors T-helper cells to follow the TH-2 pathway, which promotes allergy. TH-1 eliminates allergy. Or, to use a Star Wars analogy: TH-1 is the Force, while TH-2 is the Dark Side of the Force.

All allergic reactions, including asthma, are bimodal; that is, after exposure to the allergen there is an immediate response occurring right away and lasting minutes to a few hours, but also a delayed response that builds gradually and lasts for many days. This late phase accounts for the chronic nature of allergies and asthma.

SB010 blocks both responses. In research done at Hannover Medical Center in Germany, patients received SB010 once a day via nebulizer. The results were immediate and dramatic, with most asthmatics experiencing dramatic reduction in their symptoms — even if they were purposely exposed to their causative allergen, such as cat dander.

Also, the medication was very well tolerated with minimal or no side effects. Other medical centers are also completing research on SB010. Hopefully, this will lead to it soon becoming clinically available.

Sleep apnea in asthmatics needs closer attention

Sleep apnea in asthmatics needs closer attention

Tough news reported in research results recently published in The Journal of the American Medical Association that persons with asthma were twice as likely to develop sleep apnea as non-asthmatics.

The study was done at the University of Wisconsin and involved thousands of people over a 25-year period. Sleep studies were done every four years in order to observe the frequency with which sleep apnea developed.

The striking outcome was compelling because asthma itself is a frequent cause of disturbed sleep. Hence, if the asthma gets blamed as the sole cause for nighttime wakening, the sleep apnea will go undetected and therefore, untreated.

The Wisconsin researchers suggested greater awareness of this possibility in asthmatics, their families and their doctors. If family members report snoring or apneic episodes, or if the patient has daytime somnolence, a sleep study should be considered.

Perhaps shared therapies can ease double suffering

Perhaps shared therapies can ease double suffering

What’s known as the Asthma-COPD overlap syndrome was reviewed recently in the Allergy and Asthma Proceedings.

The authors adroitly point out that even though physicians try to pigeon-hole diagnoses, many times people’s health problems don’t fit neatly into a single diagnostic category. This is especially true in the spectrum of chronic airway disorders.

More and more people are being seen by physicians who have both asthma and COPD. The conditions are both similar and different.

In general, asthma (also called reversible airways disease — RADS) is completely reversible with therapies, while COPD (chronic obstructive pulmonary disease) is never (by definition) completely reversible; hence, the adjective “chronic.”

Both conditions are caused by inflammation in the airways. In asthma, the inflammatory cell is the eosinophil, while in COPD it is the neutrophil.

Both conditions tend to have genetic links. In asthma it is the genes that cause allergy. In COPD it is the genes that control alpha-1-antitrypsin (an enzyme that protects the lungs from oxidative stresses).

In general, asthma tends to have onset in childhood, whereas COPD occurs in adults.

Asthma is caused primarily by allergy to inhaled pollens, molds, danders and dust mites. COPD is caused primarily by cigarette smoke and biomass pollutants.

Finally, diffusion capacity is normal or high in asthma, but always reduced in COPD. Diffusion capacity is a measurement of the transfer of oxygen from the lungs into the blood stream.

The most important take-home message is that therapies that were previously used exclusively for one diagnosis may work in both because of the overlap. For instance, inhaled steroids which are a mainstay in the treatment of asthma often benefit patients with COPD.

Also, anticholinergics such as Atrovent, Combivent and Spiriva – originally designed exclusively for COPD – may also benefit people with the overlap syndrome. The bottom line is for patients and physicians to be aware of the overlap, and to look for therapies that are individually stylized to a given person’s need.

Promising asthma drug in pipeline

Promising asthma drug in pipeline

A research study of a new drug given to steroid-dependent asthmatics has produced exciting results.

Reported in a recent article in The New England Journal of Medicine, the new asthma drug, Mepolizamab, was tested at various medical centers around the globe, including the University of Pittsburgh.

Mepolizamab is a humanized monoclonal antibody that inactivates interleukin– 5. Interleukin– 5 is a cell communicator that recruits eosinophils (allergic cells) into the lungs.

The eosinophil is a form of white blood cell that causes airway inflammation — asthma’s hallmark.

The remarkable outcome of this study revealed the participants enjoying a marked reduction or cessation of steroid medication, while having improvement in their asthma, along with fewer flare-ups.

The drug was administered by injection once a month and was relatively free of side effects. The main ones were headache and sore throat.

The drug has not finished all its clinical trials for FDA approval, but it should soon. For now the only other monoclonal asthma therapy is Xolair, which binds to the allergic antibody IgE.

Asthma in seniors calls for adept diagnoses and care

Asthma in seniors calls for adept diagnoses and care

A review of the diagnosis and treatment of asthma in older adults was just published in The American Journal of Medicine. Asthma in older adults can fall into two broad groups: those with long-standing disease, present since childhood; and those with late-onset asthma. The review was aimed at this latter group.

With late-onset asthma there is greater likelihood for confusing asthma with other conditions, especially COPD (chronic obstructive pulmonary disease) and congestive heart failure. In pulmonary testing, patients with both COPD and asthma will show obstruction of air flow, but this obstruction improves with inhalation of a bronchodilator in asthmatics, but not in COPD patients.

Another distinguishing fact in pulmonary testing is how the diffusion capacity of gas from lung to blood- stream is normal in asthma, but is decreased in COPD.

In comparing lifelong asthmatics with late-onset, the former more commonly have other allergic symptoms, such as hay fever or food allergy. The former respond very quickly to a bronchodilator, while the older asthmatic may need up to 30 minutes to feel the benefit of a bronchodilator.

Also, older asthmatics often will respond better to a combination bronchodilator with both albuterol and ipatropium, rather than albuterol alone. The inflammatory cells that cause airway inflammation are different. In young asthmatics it’s neutrophils. This fact alone, coupled with the burgeoning baby-boomer population has led to intense research to find anti-inflammatories that work better on neutrophil cells.

Older asthmatics seem more prone to respiratory infections which exacerbate the asthma. In part, this susceptibility is from aging of the immune system.

But another recently discovered cause is that older asthmatics tend to not keep their inhalers and spacers clean, allowing them to become colonized with disease-causing bacteria.

Mastering asthma rescue dose technique a ‘must’

Mastering asthma rescue dose technique a ‘must’

Dear Dr. K: How can I be sure my four-year old asthmatic daughter actually gets her rescue inhaler dose?

That is an excellent question and one that all parents of asthmatics should ask themselves.

There are actually several ways to answer your question. On a very practical level, if the symptom you were treating (cough, wheeze, shortness of breath) goes away within a few minutes of the treatment, then most likely, your daughter got the medicine and it helped. Also, most of the rescue medicines have mild side effects, especially increasing the heart rate and causing a slight hand tremor.

You could check her pulse before and after the inhalations to see any change.

Your best bet to ensure medicine delivery is to use proper technique. Most research studies looking into whether or not parents use proper technique reveal that only about 10 percent are doing everything right.

The crucial steps include:

  1. 1.  Shake the inhaler before use.
  2. 2.  If the inhaler is new “out of the box,” be sure the indicated priming has been done.
  3. Make sure a good seal is made with the spacer.

              a. For young children the spacer has a face mask that covers the nose and mouth.

              b. For somewhat older children the seal is made by ensuring the lips cover the mouthpiece.

  1. 4.  Do one puff at a time.
  2. 5.  Have the child exhale first, then deliver puff.
  3. 6.  Take six slow, deep breaths for the first puff.
  4. Wait 30 seconds between puffs.
  5. Then repeat steps 5 and 6. If you’re still not sure, bring your spacer and medicine to the next visit with your pediatrician, pulmonologist or allergist, for a critique of your technique.
Statin drugs come with bonus positive prevention attributes

Statin drugs come with bonus positive prevention attributes

The recent Journal of Allergy and Clinical Immunology had an article about statins and asthma. The attention was not just for these drugs’ cholesterol-lowering properties, but also their immune-modulatory and anti-inflammation effects.

You might remember that several years ago there was concern for a possibly highly lethal global flu pandemic. The Center for Disease Control and Prevention recommended stockpiling not only anti-flu medication, but also statins. This is because they can prevent death from an otherwise lethal flu infection thanks to these bonus effects they include.

Well, apparently these same benefits are leading to better asthma outcomes.

A longtime study comparing two asthma groups, one of which was on statins, showed reduction in both rescue inhaler and steroid-burst use and fewer ER visits for the group on statins.

Also of interest are new guidelines for statin use. These new recommendations are to use lower doses, as it seems a large part of the benefit of statins in heart disease is owing to their reducing blood vessel inflammation, not just cholesterol levels. This anti-inflammation effect occurs with lower doses, which are less likely to lead to side effects.