Related Articles

House dust mite sublingual immunotherapy: a double-blind, placebo-controlled study in elderly patients with allergic rhinitis.

Clin Exp Allergy. 2013 Feb;43(2):242-8

Authors: Bozek A, Ignasiak B, Filipowska B, Jarzab J

Abstract
BACKGROUND: Immunotherapy in elderly patients is controversial, and there is still no evidence supporting this treatment's safety and efficacy in this population. This study was performed to evaluate the safety and efficacy of specific sublingual immunotherapy for house dust mite (HDM) allergens in patients over 60 years of age with allergic rhinitis and a confirmed allergy to HDM.
OBJECTIVE: This study sought to assess nasal symptoms during HDM season, reduce medication use and monitor for adverse reactions during immunotherapy.
METHODS: One hundred and eleven 60- to 75-year-old patients with allergic rhinitis and a confirmed Dermatophagoides pteronyssinus and Dermatophagoides farinae allergy were included in the study. The patients were individually randomized to active or placebo groups using a double-blind method (NCTO01605760 ClinicalTrials.gov). A total of 51 subjects in the sublingual allergen-specific immunotherapy (SLIT) group (Staloral 300R, Stallergenes, France) and 57 subjects in the placebo group were monitored for 3 years.
RESULTS: Forty-seven patients completed 3 years of SLIT, and 48 subjects finished the placebo treatment in the same time period. The total nasal symptom score decreased by 44% in the active group and 6% in the placebo group after 3 years of SLIT. This difference was only significant in the active group (P < 0.05). At the end of therapy, the total medication score of the active group decreased significantly by a maximum of 51% (P < 0.05), whereas the total medication score of the placebo control group showed an insignificant decrease (P = 0.56). There were no systemic adverse reactions during the study. CONCLUSIONS & CLINICAL RELEVANCE: Sublingual allergen-specific immunotherapy in elderly patients with a HDM allergy to D. pteronyssinus and D. farinae generated a significant clinical improvement in the active group compared with the placebo group, particularly during the heating season. This therapy was well tolerated.

PMID: 23331565 [PubMed - in process]

A scoring algorithm for predicting the presence of adult asthma: a prospective derivation study.

Prim Care Respir J. 2013 Jan 24;

Authors: Tomita K, Sano H, Chiba Y, Sato R, Sano A, Nishiyama O, Iwanaga T, Higashimoto Y, Haraguchi R, Tohda Y

Abstract
BACKGROUND: To predict the presence of asthma in adult patients with respiratory symptoms, we developed a scoring algorithm using clinical parameters. METHODS: We prospectively analysed 566 adult outpatients who visited Kinki University Hospital for the first time with complaints of nonspecific respiratory symptoms. Asthma was comprehensively diagnosed by specialists using symptoms, signs, and objective tools including bronchodilator reversibility and/or the assessment of bronchial hyperresponsiveness (BHR). Multiple logistic regression analysis was performed to categorise patients and determine the accuracy of diagnosing asthma. RESULTS: A scoring algorithm using the symptom-sign score was developed, based on diurnal variation of symptoms (1 point), recurrent episodes (2 points), medical history of allergic diseases (1 point), and wheeze sound (2 points). A score of >3 had 35% sensitivity and 97% specificity for discriminating between patients with and without asthma and assigned a high probability of having asthma (accuracy 90%). A score of 1 or 2 points assigned intermediate probability (accuracy 68%). After providing additional data of forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) ratio <0.7, the post-test probability of having asthma was increased to 93%. A score of 0 points assigned low probability (accuracy 31%). After providing additional data of positive reversibility, the post-test probability of having asthma was increased to 88%. CONCLUSIONS: This pragmatic diagnostic algorithm is useful for predicting the presence of adult asthma and for determining the appropriate time for consultation with a pulmonologist.

PMID: 23348712 [PubMed - as supplied by publisher]

Small airway involvement in cystic fibrosis lung disease: Routine spirometry as an early and sensitive marker.

Pediatr Pulmonol. 2013 Feb 8;

Authors: Bakker EM, Borsboom GJ, van der Wiel-Kooij EC, Caudri D, Rosenfeld M, Tiddens HA

Abstract
BACKGROUND: In young children with cystic fibrosis (CF) the forced expiratory volume in 1 second (FEV(1) ) is often normal and a more sensitive measure to detect early obstructive lung disease is needed. AIM: To evaluate the progression of selected spirometry parameters with age in a cohort of CF patients and healthy children aged 6 to 20 years. METHODS: Retrospective comparison of longitudinal spirometry data from CF patients with data from two cohort studies in healthy subjects. Quantile regression was used to calculate the longitudinal 10th percentile (P(10) ), 50th percentile (P(50) ), and 90th percentile (P(90) ) of forced vital capacity (FVC), FEV(1) , and the forced expiratory flow at 75% of FVC (FEF(75) ). Sample size estimates were calculated using these three parameters as clinical trial endpoints. RESULTS: FVC, FEV(1) , and FEF(75) were all significantly lower in CF patients than healthy children. Abnormalities in FEF(75) occurred at younger ages and remained substantially larger than abnormalities in FEV(1) or FVC throughout childhood. Therefore, fewer patients would be required to detect a similar treatment effect if FEF(75) is used as a primary endpoint compared with FEV(1) or FVC. CONCLUSIONS: Our data support the use of FEF(75) as a more sensitive marker of early CF lung disease than FEV(1) and FVC, because abnormalities in FEF(75) occur at younger age and FEF(75) is diminished more than other parameters. Pediatr Pulmonol. © 2013 Wiley Periodicals, Inc.

PMID: 23401260 [PubMed - as supplied by publisher]

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Characteristics of stable chronic obstructive pulmonary disease patients in the pulmonology clinics of seven Asian cities.

Int J Chron Obstruct Pulmon Dis. 2013;8:31-9

Authors: Oh YM, Bhome AB, Boonsawat W, Gunasekera KD, Madegedara D, Idolor L, Roa C, Kim WJ, Kuo HP, Wang CH, Lan le TT, Loh LC, Ong CK, Ng A, Nishimura M, Makita H, Silverman EK, Lee JS, Yang T, Lin Y, Wang C, Lee SD

Abstract
BACKGROUND AND OBJECTIVES: Chronic obstructive pulmonary disease (COPD) is responsible for significant morbidity and mortality worldwide. We evaluated the characteristics of stable COPD patients in the pulmonology clinics of seven Asian cities and also evaluated whether the exposure to biomass fuels and dusty jobs were related to respiratory symptoms, airflow limitation, and quality of life in the COPD patients.
METHODS: This cross-sectional observational study recruited 922 COPD patients from seven cities of Asia. The patients underwent spirometry and were administered questionnaires about their exposure to cigarette smoking, biomass fuels, and dusty jobs in addition to respiratory symptoms and health related quality of life.
RESULTS: Of the patients, there appeared to be variations from city to city in the history of exposure to biomass fuels and dusty jobs and also in respiratory symptoms of cough, phlegm, wheeze, and dyspnea. These symptoms were more frequent in those COPD patients with a history of exposure to biomass fuels than without and those with a history of exposure to dusty jobs than without (P < 0.01 for all comparisons). Airflow limitation was more severe in those COPD patients with a history of exposure to biomass fuels than without (52.2% predicted versus 55.9% of post-bronchodilator forced expiratory volume in 1 second [FEV(1)], P = 0.009); quality of life was poorer in those with exposure to biomass fuels than without (40.4 versus 36.2 of the St George's Respiratory Questionnaire [SGRQ] total score, P = 0.001). Airflow limitation was more severe in those COPD patients with a history of exposure to dusty jobs than without (51.2% predicted versus 57.3% of post-bronchodilator FEV(1), P < 0.001); quality of life was poorer in those with dusty jobs than without (41.0 versus 34.6 of SGRQ score, P = 0.006).
CONCLUSION: In Asian cities, the characteristics of COPD patients vary and the history of exposure to biomass fuels or dusty jobs was related to frequency of symptoms, severe airflow limitation, and poor quality of life.

PMID: 23378753 [PubMed - in process]