Related Articles

The association between BMI, vigorous physical activity and television viewing and the risk of symptoms of asthma, rhinoconjunctivitis and eczema in children and adolescents: ISAAC Phase Three.

Clin Exp Allergy. 2013 Jan;43(1):73-84

Authors: Mitchell EA, Beasley R, Björkstén B, Crane J, García-Marcos L, Keil U, the ISAAC Phase Three Study Group

Abstract
BACKGROUND: Several studies have observed an association between obesity and asthma, but whether or not there is an association with rhinoconjunctivitis or eczema is unclear. AIMS: To examine the relationship between body mass index categories (underweight, overweight and obesity), vigorous physical activity and television viewing and the risk of symptoms of asthma, rhinoconjunctivitis and eczema. METHODS: As part of International Study of Asthma and Allergies in Childhood (ISAAC) Phase Three, parents or guardians of children aged 6-7 years completed written questionnaires about symptoms of asthma, rhinoconjunctivitis and eczema, and several potential risk factors, such as vigorous physical activity and television viewing, and other information such as the child's height and weight. Adolescents aged 13-14 years self-completed the questionnaires on these symptoms and potential risk factors and reported their own height and weight. For 28% of children and 24% of adolescents, the height and weight was objectively measured. RESULTS: A total of 76 164 children aged 6-7 years (from 29 centres and 17 countries) and 201 370 adolescents aged 13-14 years (from 73 centres and 35 countries) provided data meeting the inclusion criteria. There were associations between overweight and obesity, but not underweight, and symptoms of asthma and eczema but not rhinoconjunctivitis. Vigorous physical activity was positively associated with symptoms of asthma, rhinoconjunctivitis and eczema in adolescents, but not children. Viewing television for five or more hours/day was associated with an increased risk of symptoms of asthma, rhinoconjunctivitis and eczema in adolescents and symptoms of asthma in children. CONCLUSIONS AND CLINICAL RELEVANCE: This study has confirmed the association between overweight and obesity and symptoms of asthma. It has extended these observations to include significant associations with symptoms of eczema, but not rhinoconjunctivitis. There are complex relationships between obesity, vigorous physical activity and sedentary behaviour and the symptoms of asthma, rhinoconjunctivitis and eczema in children.

PMID: 23278882 [PubMed - as supplied by publisher]

Elevated risk of asthma after hospitalization for respiratory syncytial virus infection in infancy.

Paediatr Respir Rev. 2013 Jan;13 Suppl 2:S9-S15

Authors: Szabo SM, Levy AR, Gooch KL, Bradt P, Wijaya H, Mitchell I

Abstract
Severe respiratory syncytial virus (RSV) infection in infancy is associated with substantial morbidity worldwide; whether it is a risk factor for childhood asthma is contentious. A systematic review of 28 articles was conducted, summarizing estimates of asthma risk after RSV hospitalization during infancy. Prevalence estimates of asthma, among those hospitalized for RSV in infancy, were from 8% to 63%, 10% to 92%, and 37%, at ages <5, 5 to 11, and ≥12 years, respectively. These rates were higher than those among non-hospitalized comparisons. The attributable risk of asthma due to RSV ranged from 13% to 22% and from 11% to 27% among children aged ≤5 and aged 5 to 11, respectively, and was 32% among children ≥ 12 years of age. Overall, 59% of asthma prevalence estimates from those previously hospitalized for RSV exceeded 20%, compared to only 6% of non-hospitalized comparison estimates. Despite variability in asthma prevalence estimates after RSV-related hospitalization, available data suggest a link between severe RSV infection in infancy and childhood asthma.

PMID: 23269182 [PubMed - in process]

Fluticasone/formoterol: a new single-aerosol combination therapy for patients with asthma.

Respir Med. 2012 Dec;106 Suppl 1:S20-8

Authors: Dissanayake S, Grothe B, Kaiser K

Abstract
International asthma management guidelines recommend a long-acting β(2)-agonist (LABA) as add-on therapy in patients whose asthma is not controlled by low-dose inhaled corticosteroid (ICS) monotherapy. Treatment with a single inhaler containing an ICS/LABA combination is advocated because it may facilitate adherence to a regimen. When prescribing ICS/LABA combination therapy, the potency of the ICS and the speed of onset of the LABA are considered important factors; therefore, an inhaled therapy containing components with these properties may be valued by physicians. The ICS fluticasone propionate (fluticasone) has potent and sustained anti-inflammatory effects, and the LABA formoterol fumarate (formoterol) provides rapid bronchodilation; the efficacy and safety profiles of these agents have been well established in clinical practice. Fluticasone and formoterol have been combined, for the first time, in a single hydrofluoroalkane-based aerosol (flutiform®; fluticasone propionate/formoterol fumarate). Here, we review data from the published randomized, controlled, clinical trials that demonstrate the efficacy and tolerability of this product. It has been shown that fluticasone/formoterol is more efficacious than fluticasone or formoterol given alone, and provides similar improvements in lung function to fluticasone and formoterol administered concurrently via separate inhalers. Fluticasone/formoterol has similar efficacy and tolerability profiles to budesonide/formoterol and fluticasone/salmeterol, but with the additional benefit of more rapid bronchodilation than fluticasone/salmeterol.

PMID: 23273163 [PubMed - in process]

Inhaled corticosteroid and long-acting β(2)-agonist pharmacological profiles: effective asthma therapy in practice.

Respir Med. 2012 Dec;106 Suppl 1:S9-S19

Authors: Tamm M, Richards DH, Beghé B, Fabbri L

Abstract
Fixed-dose combinations of inhaled corticosteroids (ICSs) and long-acting β2-agonists (LABAs) have been used to manage asthma for several years. They are the preferred therapy option for patients who do not achieve optimal control of their asthma with low-dose ICS monotherapy. In Europe, four ICS/LABA products are commercially available for asthma maintenance therapy (fluticasone propionate/formoterol fumarate, fluticasone propionate/salmeterol xinafoate, budesonide/formoterol fumarate and beclometasone dipropionate/formoterol fumarate), and other combinations are likely to be developed over the next few years (e.g. mometasone/formoterol fumarate, fluticasone furoate/vilanterol, mometasone/indacaterol). Data from randomized, controlled, clinical trials do not demonstrate a clear overall efficacy difference among ICS/LABA combinations approved for asthma therapy. Conversely, pharmacological data indicate that there may be certain advantages to using one ICS or LABA over another because of the specific pharmacodynamic and pharmacokinetic profiles associated with particular treatments. This review article summarizes the pharmacological characteristics oft he various ICSs and LABAs available for the treatment of asthma, including the potential for ICS and LABA synergy, and gives an insight into the rationale for the development of the latest ICS/LABA combination approved for asthma maintenance therapy.

PMID: 23273165 [PubMed - in process]