Steroid Resistant Asthma: More than Meets the Eye.

J Asthma. 2013 Aug 8;

Authors: Reddy D, Little FF

Abstract
Introduction: For decades steroids have been considered as the gold standard for the treatment of asthma. We present a case report of typical steroid resistant asthma and current consensus in definitions of 'severe refractory', 'difficult' and 'steroid resistant' asthma. Methods: Full-text papers and abstracts were identified on the basis of a comprehensive literature search primarily in MEDLINE (1966 to June 2012) but also in the Cochrane Central Register of Controlled Trials database. Results: Steroid resistant asthmatics are a small subset of patients who pose noteworthy diagnostic challenges while contributing disproportionately to health care costs. Recognition of various asthma phenotypes has aided in characterizing groups with severe asthma and given a better understanding of its pathophysiological process. The molecular mechanism of steroid action is complicated and several pathways have been identified to explain drug resistance, which in turn is crucial for drug development. Tobacco smoking appears to be the single most important contributor of steroid resistance. We present the emerging and promising concepts in the management of steroid resistant asthma, which mainly includes drugs targeting specific molecules, receptors, inflammatory cells or immune processes. Conclusion: The challenges in making a diagnosis of Steroid resistant asthma may contribute to underestimating its prevalence and impact on patient care. Considerable progress has been made in identifying distinct phenotypes and mechanisms of steroid resistance; therefore the future of new drug development in management of asthma is promising.

PMID: 23923995 [PubMed - as supplied by publisher]

Increased Asthma Risk and Asthma-Related Health Care Complications Associated with Childhood Obesity.

Am J Epidemiol. 2013 Aug 6;

Authors: Black MH, Zhou H, Takayanagi M, Jacobsen SJ, Koebnick C

Abstract
Asthma is the most common chronic condition of childhood, yet the relationship between obesity and asthma risk and the impact of obesity on clinical asthma outcomes are not well understood. For this population-based, longitudinal study, demographic and clinical data were extracted from administrative and electronic health records of 623,358 patients aged 6-19 years who were enrolled in the Kaiser Permanente Southern California health plan in 2007-2011. Crude asthma incidence ranged from 16.9 per 1,000 person-years among normal-weight youth to 22.3 per 1,000 person-years among extremely obese youth. The adjusted risks of asthma for overweight, moderately obese, and extremely obese youth relative to those of normal weight youth were 1.16 (95% confidence interval: 1.13, 1.20), 1.23 (95% confidence interval: 1.19, 1.28), and 1.37 (95% confidence interval: 1.32, 1.42), respectively (Ptrend < 0.0001). The relationship between obesity and asthma risk was strongest in Asian/Pacific Islanders and in the youngest girls (aged 6-10 years), compared with other groups. Among youth who developed asthma, those who were moderately or extremely obese had more frequent asthma exacerbations requiring emergency department services and/or treatment with oral corticosteroids. In conclusion, obese youth are not only more likely to develop asthma, but they may be more likely to have severe asthma, resulting in a greater need for health care utilization and aggressive asthma treatment.

PMID: 23924576 [PubMed - as supplied by publisher]

Related Articles

Inhaled versus systemic corticosteroids for acute asthma in children. A systematic review.

Pediatr Pulmonol. 2013 Aug 8;

Authors: Beckhaus AA, Riutort MC, Castro-Rodriguez JA

Abstract
OBJECTIVE: To compare the effects of inhaled corticosteroids (ICS) against systemic corticosteroids (SC) in children consulting in emergency department (ED) or equivalent for asthma exacerbation.
METHODS: Electronic search in MEDLINE, CENTRAL, CINAHL, and LILACS databases and other sources. Study selection criteria: children 2-18 years of age, consulting in ED or equivalent for asthma exacerbation, comparison between ICS and SC, randomized controlled trials. Primary outcomes: hospital admission rate, unscheduled visits for asthma symptoms, need of additional course of SC. Secondary outcomes: improvement of lung function, length of stay in ED, clinical scores, and adverse effects.
RESULTS: Eight studies met inclusion criteria (N = 797), published between 1995 and 2006. All used prednisolone as SC and budesonide, fluticasone, dexamethasone, and flunisolide were administered as ICS. No significant difference between ICS versus SC was found in terms of hospital admission (RR: 1.02; 95% CI: 0.41-2.57), unscheduled visits for asthma symptoms (RR: 9.55; 95% CI: 0.53-170.52) nor for need of additional course of SC (RR: 1.45; 95% CI: 0.28-7.62). The change in % of predicted FEV1 at fourth hour was significantly higher for SC group, but there was no significant difference between both groups after this time. There was insufficient data to perform meta-analysis of length of stay during first consult in ED and of symptom scores. Vomiting was similar among both groups.
CONCLUSIONS: There is no evidence of a difference between ICS and SC in terms of hospital admission rates, unscheduled visits for asthma symptoms and need of additional course of SC in children consulting for asthma exacerbations. Pediatr Pulmonol. © 2013 Wiley Periodicals, Inc.

PMID: 23929666 [PubMed - as supplied by publisher]

Related Articles

Association of Hospitalizations for Asthma with Seasonal and Pandemic Influenza.

Respirology. 2013 Aug 12;

Authors: Gerke AK, Yang M, Tang F, Foster ED, Cavanaugh JE, Polgreen PM

Abstract
BACKGROUND AND OBJECTIVE: Although influenza has been associated with asthma exacerbations, it is not clear the extent to which this association affects healthcare use in the United States (U.S.). The first goal of this project was to determine whether, and to what extent, the incidence of asthma hospitalizations is associated with seasonal variation in influenza. Second, we used influenza trends (2000-2008) to help predict asthma admissions during the 2009 H1N1 influenza pandemic.
METHODS: We identified all hospitalizations between 1998 and 2008 in the Nationwide Inpatient Sample from the Healthcare Cost and Utilization Project during which a primary diagnosis of asthma was recorded. Separately, we identified all hospitalizations during which a diagnosis of influenza was recorded. We performed time series regression analyses to investigate the association of monthly asthma admissions with influenza incidence. Finally, we applied these time series regression models using 1998-2008 data, to forecast monthly asthma admissions during the 2009 influenza pandemic.
RESULTS: Based on time series regression models, a strong, significant association exists between concurrent influenza activity and incidence of asthma hospitalizations (p-value<0.0001). Use of influenza data to predict asthma admissions during the 2009 H1N1 pandemic improved the mean squared prediction error by 60.2%.
CONCLUSIONS: Influenza activity in the population is significantly associated with asthma hospitalizations in the U.S., and this association can be exploited to more accurately forecast asthma admissions. Our results suggest that improvements in influenza surveillance, prevention, and treatment may decrease hospitalizations of asthma patients.

PMID: 23931674 [PubMed - as supplied by publisher]