Updates on the use of inhaled corticosteroids in asthma.

Curr Opin Allergy Clin Immunol. 2011 Aug;11(4):337-44

Authors: Stoloff SW, Kelly HW

The purpose of this review is to compare and contrast the newer inhaled corticosteroid (ICS) ciclesonide with older ICSs in terms of pharmacodynamic and pharmacokinetic properties and how these affect comparative efficacy. In addition, clinical dosing strategies for ICSs including as-needed use will be explored.

PMID: 21720220 [PubMed - in process]

Diagnosing and managing food allergy in children.

Practitioner. 2011 Jun;255(1741):19-22, 2

Authors: Holloway E, Fox A, Fitzsimons R

The prevalence of food allergy in children in the UK is now around 5%. The number of children put on restricted diets by their parents because of presumed allergy is likely to be much higher. Accurate diagnosis of food allergy is essential in order to ensure that the correct foods are carefully avoided while safe foods are not excluded unnecessarily. IgE-mediated (immediate type) reactions are the result of mast cell degranulation leading to histamine release. The typical signs of lip swelling, urticaria and possible progression to respiratory compromise (anaphylaxis) are usually clearly described, occurring within minutes of exposure to the food. Non IgE-mediated (delayed type) responses tend to start 2-6 hours, occasionally longer, after exposure and cause less specific signs/symptoms, less obviously allergic in origin. Where an immediate type allergic reaction is suspected on clinical history, allergy testing should be performed to confirm the diagnosis. This could involve either skin prick testing or specific IgE blood tests. Results must be interpreted in the context of the clinical history. The mainstay of management is allergen avoidance. The child and carers also need to know how to recognise and treat any future allergic reactions. There should be a written emergency plan in place. The plan should include advice to take a fast-acting antihistamine if any accidental exposure and reactions occur. Where there is a history of anaphylactic reaction or ongoing asthma, adrenaline auto-injectors should be prescribed as these are the major risk factors for future severe reactions. Non IgE-mediated food allergy is most common in early infancy. The diagnosis of non IgE-mediated food allergy relies on a two-stage process: strict exclusion of suspected allergen(s), only one at a time; re-challenge with suspected allergen(s), one at a time, to see if symptoms recur.

PMID: 21776913 [PubMed - in process]

Prevalence and impact of rhinitis in asthma. SACRA, a cross-sectional nation-wide study in Japan.

Allergy. 2011 Jul 22;

Authors: Ohta K, Bousquet PJ, Aizawa H, Akiyama K, Adachi M, Ichinose M, Ebisawa M, Tamura G, Nagai A, Nishima S, Fukuda T, Morikawa A, Okamoto Y, Kohno Y, Saito H, Takenaka H, Grouse L, Bousquet J

To cite this article: Ohta K, Bousquet P-J, Aizawa H, Akiyama K, Adachi M, Ichinose M, Ebisawa M, Tamura G, Nagai A, Nishima S, Fukuda T, Morikawa A, Okamoto Y, Kohno Y, Saito H, Takenaka H, Grouse L, Bousquet J. Prevalence and impact of rhinitis in asthma: SACRA, a cross-sectional nation-wide study in Japan. Allergy 2011; DOI: 10.1111/j.1398-9995.2011.02676.x. ABSTRACT: Background:  Asthma and rhinitis are common co-morbidities everywhere in the world but nation-wide studies assessing rhinitis in asthmatics using questionnaires based on guidelines are not available. Objective:  To assess the prevalence, classification, and severity of rhinitis using the Allergic Rhinitis and its Impact on Asthma (ARIA) criteria in Japanese patients with diagnosed and treated asthma. Methods:  The study was performed from March to August 2009. Patients in physicians' waiting rooms, or physicians themselves, filled out questionnaires on rhinitis and asthma based on ARIA and Global Initiative for Asthma (GINA) diagnostic guides. The patients answered questions on the severity of the diseases and a Visual Analog Scale. Their physicians made the diagnosis of rhinitis. Results:  In this study, 1910 physicians enrolled 29 518 asthmatics; 15 051 (51.0%) questionnaires were administered by physician, and 26 680 (90.4%) patients were evaluable. Self- and physician-administered questionnaires gave similar results. Rhinitis was diagnosed in 68.5% of patients with self-administered questionnaires and 66.2% with physician-administered questionnaires. In this study, 994 (7.6%) patients with self-administered and 561 (5.2%) patients with physician-administered questionnaires indicated rhinitis symptoms on the questionnaires without a physician's diagnosis of rhinitis. Most patients with the physician's diagnosis of rhinitis had moderate/severe rhinitis. Asthma control was significantly impaired in patients with a physician's diagnosis of rhinitis for all GINA clinical criteria except exacerbations. There were significantly more patients with uncontrolled asthma as defined by GINA in those with a physician's diagnosis of rhinitis (25.4% and 29.7%) by comparison with those without rhinitis (18.0% and 22.8%). Conclusion:  Rhinitis is common in asthma and impairs asthma control.

PMID: 21781135 [PubMed - as supplied by publisher]

The impact of Tiotropium on Mortality and Exacerbations when added to Inhaled Corticosteroids and Long-Acting Beta-Agonist therapy in COPD.

Chest. 2011 Jul 28;

Authors: Short PM, Williamson PA, Elder DH, Lipworth SI, Schembri S, Lipworth BJ

Abstract BACKGROUND: Tiotropium (Tio) has been shown to improve lung function, quality of life and exacerbations and reduce mortality when compared to placebo in COPD. It remains unclear if benefits are seen when tiotropium is used in conjunction with inhaled corticosteroid (ICS) plus long-acting beta-agonists (LABA). METHODS: We performed a retrospective cohort study using a NHS database of COPD patients in Tayside Scotland, between 2001 and 2010 linked with databases regarding hospital admissions, pharmacy prescriptions and death registries. The impact of the addition of Tio to ICS+LABA therapy on all-cause mortality, hospital admissions due to respiratory disease and emergency oral corticosteroid bursts was evaluated. Adjusted Hazard ratios (HR) were calculated by Cox Regression after inclusion of the following covariates (cardiovascular and respiratory disease, diabetes, smoking, age, sex and deprivation index). RESULTS: 1857 patients were prescribed ICS+LABA+Tio and 996 were prescribed ICS+LABA. Mean follow- up was 4.65yrs. Adjusted HR for all-cause mortality for ICS+LABA+Tio versus ICS+LABA was 0.65 (95%CI 0.57-0.75) p<0.001. Adjusted HR for hospital admissions and oral corticosteroid bursts were 0.85 (95%CI 0.73-0.99) p=0.04 and 0.71 (95%CI 0.63-0.80) p<0.001. CONCLUSION: Our study suggests the addition of tiotropium to inhaled corticosteroids and LABA therapy may confer benefits in reducing all-cause mortality, hospital admissions and oral corticosteroid bursts in COPD patients. Triple therapy is widely used in real-life management of COPD with only limited scientific support. Our study supports the use of triple therapy in COPD and provides a platform for randomised controlled trials specifically addressing this topic.

PMID: 21799028 [PubMed - as supplied by publisher]