Childhood wheeze phenotypes show less than expected growth in FEV1 across adolescence.

Am J Respir Crit Care Med. 2014 May 5;

Authors: Lodge CJ, Lowe AJ, Allen KJ, Zaloumis S, Gurrin LC, Matheson MC, Axelrad C, Welsh L, Bennett CM, Hopper J, Thomas PS, Hill DJ, Hosking CS, Svanes C, Abramson MJ, Dharmage SC

Abstract
Rationale: Better characterization of childhood wheeze phenotypes using newer statistical methods provides a basis for addressing the heterogeneity of childhood asthma. Outcomes of these phenotypes beyond childhood are unknown. Objectives: To determine if adolescent respiratory symptoms, lung function and changes in lung function over adolescence differ by childhood wheeze phenotypes defined through Latent Class Analysis. Methods: A prospective birth cohort (Melbourne Atopy Cohort Study) followed 620 high allergy-risk children, recording respiratory symptoms and spirometry at 12 and 18 years. Regression analyses identified relationships between wheeze phenotypes (Never/Infrequent ; Early Transient ; Early Persistent ; Intermediate Onset ; Late Onset ) and: lung function, change in lung function (12-18yrs), respiratory symptoms, and asthma. Baseline : Never/Infrequent wheeze. Measurements and Main Results: Deficits in expected growth of lung function, measured by change in pre-bronchodilator Forced Expiratory Volume over 1 second (FEV1) between 12 and 18 years were found for: Early Persistent (reduced 290mls; 95%CI 82,498); Intermediate Onset (reduced 210mls; 62,359); and Late Onset wheeze; (reduced 255mls; 69,442 ). Intermediate Onset wheezers had persistent FEV1 deficit post bronchodilator at 18 years (reduced 198mls; 46,350). Current asthma risk was increased for all phenotypes except Early Transient, which was also not associated with lung function deficits at 12 or 18 years. Conclusions: Persistent wheeze phenotypes in childhood were associated with reduced growth in pre-bronchodilator FEV1 over adolescence. Intermediate Onset wheezers showed irreversible airflow limitation by 18 years. Conversely, Early Transient wheeze was a benign condition with no sequelae for respiratory health by age 18.

PMID: 24796409 [PubMed - as supplied by publisher]

In-school asthma management and physical activity: children's perspectives.

J Asthma. 2014 May 6;

Authors: Walker TJ, Reznik M

Abstract
Abstract Objective: Regular physical activity (PA) is an important component of pediatric asthma management. No studies have examined how in-school asthma management influences PA from children's perspectives. The aim of this study was to explore children's perceptions of the impact of in-school asthma management on PA. Methods: Qualitative interviews with 23 inner-city minority children with asthma (ages 8-10 yrs; 12 girls, 11 boys) were conducted in 10 Bronx, New York elementary schools. Sampling continued until saturation was reached. Interviews were recorded, transcribed and independently coded for common themes. Results: Interviews produced five themes representing students' perceptions about 1) asthma symptoms during in-school PA; 2) methods to control asthma episodes during school PA; 3) methods to prevent asthma episodes during school; 4) limited accessibility of asthma medications; and 5) negative feelings about asthma and medication use. The majority of students experienced asthma symptoms while performing PA during school. Primary methods of managing asthma symptoms were sitting out during activity, drinking water, and visiting the nurse. Students lacked awareness or adherence to action plans to prevent or control asthma. Students reported limited access to medication during school and feelings of embarrassment and/or concerns of teasing when medicating in front of others. Conclusions: Our results indicate inappropriate in-school management of asthma symptoms, poor asthma control, lack of accessible medication, and stigma around publicly using asthma medication. Thus, students often missed or were withheld from PA. Interventions to improve in-school asthma care must consider ways to address these issues.

PMID: 24796650 [PubMed - as supplied by publisher]

Defining Phenotypes in Asthma: A Step Towards Personalized Medicine.

Drugs. 2014 May 6;

Authors: Chung KF

Abstract
Asthma is a common disease with a complex pathophysiology. It can present in various clinical forms and with different levels of severity. Unbiased cluster analytic methods have unravelled several phenotypes in cohorts representative of the whole spectrum of severity. Clusters of severe asthma include those on high-dose corticosteroid treatment, often with both inhaled and oral treatment, usually associated with severe airflow obstruction. Phenotypes with concordance between symptoms and sputum eosinophilia have been reported, including an eosinophilic inflammation-predominant group with few symptoms and late-onset disease who have a high prevalence of rhinosinusitis, aspirin sensitivity, and exacerbations. Sputum eosinophilia is also a biomarker that can predict therapeutic responses to antibody-based treatments to block the effects of the T-helper (Th)-2 cytokine, interleukin (IL)-5. Low Th2-expression has been predictive of poor therapeutic response to inhaled corticosteroid therapy. Current asthma schedules emphasise a step-up approach to treating asthma in relation to increasing severity, but, in more severe disease, phenotyping or endotyping of asthma will be necessary to determine new treatment strategies as severe asthma is recognized as being a particularly heterogeneous disease. Much less is known about 'non-eosinophilic' asthma. Phenotypic characterisation of corticosteroid insensitivity and chronic airflow obstruction of severe asthma is also needed. Phenotype-driven treatment of asthma will be further boosted by the advent of transcriptomic and proteomic technologies, with the application of systems biology or medicine approaches to defining phenotypes and biomarkers of disease and therapeutic response. This will pave the way towards personalized medicine and healthcare for asthma.

PMID: 24797157 [PubMed - as supplied by publisher]

Management of Asthma and Chronic Obstructive Pulmonary Disease with Combination Inhaled Corticosteroids and Long-Acting β-Agonists: A Review of Comparative Effectiveness Research.

Drugs. 2014 May 6;

Authors: Mapel DW, Roberts MH

Abstract
The value of combination therapy with inhaled corticosteroids and long-acting β-agonists (ICS/LABA) is well recognized in the management of asthma and chronic obstructive pulmonary disease (COPD). Despite differences in the pharmacological properties between two well-established ICS/LABA products (budesonide/formoterol and fluticasone/salmeterol), data from randomized clinical trials (RCTs) and meta-analyses suggest that these two products perform similarly under RCT conditions. In contrast, a few recently reported real-world comparative effectiveness studies have suggested that there are substantial differences between ICS/LABA combination treatments in terms of clinical and healthcare outcomes in patients with asthma or COPD. The purpose of this article is to provide a brief review of the benefits, as well as the limitations, of comparative effectiveness research (CER) in the therapeutic area of asthma and COPD. We conducted a structured literature review of the current CER studies on ICS/LABA combinations in asthma and COPD. These articles were then used to illustrate the unique challenges of CER studies, providing a summary of study results and limitations. We focus particularly on difficult biases and confounding factors that may be introduced before, during, and after the initiation of therapy. Beyond being a review of these two ICS/LABA combination treatments, this article is intended to help those who wish to assess the quality of CER published projects in asthma and COPD, or guide investigators who wish to design new CER studies for chronic respiratory disease treatments.

PMID: 24797158 [PubMed - as supplied by publisher]