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Metabolic syndrome and incidence of asthma in adults: the HUNT study.

Eur Respir J. 2013 Jul 11;

Authors: Brumpton BM, Camargo CA, Romundstad PR, Langhammer A, Chen Y, Mai XM

Abstract
Obesity is a risk factor for incident asthma in adults, and obesity is a major component of metabolic syndrome. This study aimed to explore the associations of metabolic syndrome and its components with the cumulative incidence of asthma in adults.We conducted a prospective cohort study of participants who were asthma-free at baseline (n=23 191) in the Nord-Trøndelag Health Study from 1995 to 2008. Baseline metabolic syndrome was categorized using the definition of the Joint Interim Statement from several international organizations. Incident asthma was self-reported at follow-up, which averaged 11 years.Metabolic syndrome was a risk factor for incident asthma (adjusted OR 1.57, 95% CI 1.31 to 1.87). This association was consistent in sensitivity analyses using a stricter asthma definition (adjusted OR 1.42, 95% CI 1.13 to 1.79). Among the components of metabolic syndrome, two remained associated with incident asthma after mutual adjustment for the other metabolic components; high waist circumference (adjusted OR 1.62, 95% CI 1.36 to 1.94), and elevated glucose or diabetes (adjusted OR 1.43, 95% CI 1.01 to 2.04).Metabolic syndrome and two of its components (high waist circumference, and elevated glucose or diabetes) were associated with an increased risk of incident asthma in adults.

PMID: 23845717 [PubMed - as supplied by publisher]

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Efficacy and Safety of Fluticasone Furoate/Vilanterol Compared with Fluticasone Propionate/Salmeterol Combination in Adult and Adolescent Patients with Persistent Asthma: a Randomized Trial.

Chest. 2013 Jul 11;

Authors: Woodcock A, Bleecker ER, Lötvall J, O'Byrne PM, Bateman ED, Medley H, Ellsworth A, Jacques L, Busse WW

Abstract
ABSTRACT BACKGROUND: The combination of fluticasone furoate (FF), a novel inhaled corticosteroid (ICS) and vilanterol (VI), a long-acting beta2 agonist, is under development as a once-daily treatment for asthma and chronic obstructive pulmonary disease. The aim of this study was to compare the efficacy of FF/VI with fluticasone propionate (FP)/salmeterol (SAL) in patients with persistent asthma uncontrolled on medium-dose ICS.
METHODS: In a randomized, double-blind, double-dummy, parallel-group study, 806 patients received FF/VI (100/25 μg, n = 403) once daily in the evening via dry powder inhaler, or FP/SAL (250/50 μg, n = 403) twice daily via Diskus™/Accuhaler™. The primary efficacy measure was 0-24 h serial weighted mean forced expiratory volume in 1 second (wmFEV1) after 24 weeks of treatment.
RESULTS: Improvements from baseline in 0-24 h wmFEV1 were observed with both FF/VI (341 ml) and FP/SAL (377 ml); the adjusted mean treatment difference was not statistically significant (-37 ml [95% confidence interval: -88, 15], p = 0.162). There were no differences between the 0-4 h serial wmFEV1, trough FEV1, and asthma control and quality of life questionnaire scores. There was no difference in reported exacerbations between treatments. Both treatments were well tolerated, with no clinically relevant effect on urinary cortisol excretion or vital signs, and no treatment-related serious adverse events.
CONCLUSIONS: The efficacy of once-daily FF/VI was similar to twice-daily FP/SAL in improving lung function in patients with persistent asthma. No safety issues were identified.
TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT01147848; funded by GSK (HZA113091).

PMID: 23846316 [PubMed - as supplied by publisher]

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Effects of Exercise Training on Airway Hyperreactivity in Asthma: A Systematic Review and Meta-Analysis.

Sports Med. 2013 Jul 12;

Authors: Eichenberger PA, Diener SN, Kofmehl R, Spengler CM

Abstract
BACKGROUND: Although physical exercise is recommended for asthmatics, evidence on the effects of exercise on clinical key factors is still missing.
OBJECTIVES: We performed a systematic review and meta-analysis to determine the effect of exercise training (EXT) on quality of life (QoL), bronchial hyperresponsiveness (BHR), exercise-induced bronchoconstriction (EIB), lung function and exercise capacity, plus the factors affecting changes in QoL and exercise capacity in asthmatics after a period of EXT.
DATA SOURCES: A computerized search was conducted in MEDLINE, EMBASE, and CINAHL (last search on 15 November 2012), without language restriction, and references of original studies and reviews were searched for further relevant studies.
STUDY SELECTION: Two independent investigators screened full-text studies with asthmatic subjects undertaking EXT (defined as training for ≥7 days, ≥2 times per week, ≥5 training sessions in total) that assessed at least one of the following outcomes: QoL, airway hyperreactivity, forced expiratory volume in one second (FEV1), peak expiratory flow (PEF), inflammatory parameters, exercise capacity, or exercise endurance. Potentially relevant studies were excluded if only respiratory muscle training, breathing exercises or yoga was performed, if asthmatic subjects with co-morbidities were investigated, if only data of mixed patient groups without separate results for asthmatics were presented, if training regimens were not sufficiently specified, if no numerical outcome data were presented, and if new long-term medication was introduced in addition to physical training. Of 500 potentially relevant articles, 13.4 % (67 studies including 2,059 subjects) met the eligibility criteria and were included for further analyses.
STUDY APPRAISAL AND SYNTHESIS METHODS: Data extraction and risk of bias assessment was performed according to the Cochrane Handbook for Systematic Reviews of Interventions. A meta-analysis of all randomized controlled trials (RCTs) was performed to determine the effect of EXT on asthma symptoms, BHR, EIB, FEV1, exercise capacity and exercise endurance compared with control training. In addition, relative pre/post changes were analysed in all RCTs and controlled trials. Finally, multiple linear regression models were used to identify effects of relative changes in airway hyperreactivity (BHR or EIB), lung function (FEV1 or PEF) and training hours on QoL and exercise performance.
RESULTS: In a total of 17 studies including 599 subjects, meta-analyses showed a significant improvement in days without asthma symptoms, FEV1 and exercise capacity while BHR only tended to improve. The analysis of relative within-group changes after EXT showed, however, significant improvements in QoL (17 %), BHR (53 %), EIB (9 %), and FEV1 (3 %) compared with control conditions. Multiple linear regression models revealed that changes in airway hyperreactivity and lung function significantly contributed to the change in QoL, while mainly the changes in airway hyperreactivity contributed to the change in exercise capacity.
CONCLUSION: EXT was shown to improve asthma symptoms, QoL, exercise capacity, BHR, EIB, and FEV1 in asthmatics and improvements in BHR explained part of the improvement in QoL and exercise capacity. Thus, physical activity should be recommended as a supplementary therapy to medication. However, more well controlled studies should be performed assessing the relationship of physical activity, QoL, airway hyperreactivity, lung function and especially airway inflammation as well as medication intake.

PMID: 23846823 [PubMed - as supplied by publisher]

Infant anaphylaxis: the importance of early recognition.

J Asthma Allergy. 2013;6:103-107

Authors: Dosanjh A

Abstract
Anaphylaxis is an acute severe reaction involving multiple systems that results from a rapid release of inflammatory mediators. Patients with asthma and prior allergic reactions are at risk for anaphylaxis. Infants can present a special challenge, as the hallmark symptoms and signs of anaphylaxis may be mistaken as normal findings. These include drooling, vomiting or diarrhea, scratching, and drowsiness. The clinical manifestations of anaphylaxis are broad, as a result of it being a systemic response to an external agent. Among infants and children, there are often respiratory and cutaneous findings. There also can be subtle signs and symptoms, which can often be missed or the findings misinterpreted as normal for developmental age. The incidence of anaphylaxis has increased globally among children presenting with allergic reactions. Early recognition of the signs and symptoms is crucial to effective diagnosis and treatment. This is particularly true among infants 13 months of age or younger who are nonverbal and may have subtle signs and symptoms of a life-threatening reaction to allergens. The purpose of this article is to highlight the differential clinical presentations of young children with anaphylaxis.

PMID: 23847427 [PubMed - as supplied by publisher]