Category: Featured Stories and Interviews

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Asthma study: Spiriva as good as Serevent

Asthma study: Spiriva as good as Serevent Says Press Reports

According to press reports published in the USATODAY, researchers say they’ve found a possible new treatment for adults with hard-to-control asthma. Their discovery, however, came at a price.

Scientists of a U.S. government-funded asthma study had to spend nearly $1 million of taxpayers’ money after British drugmaker GlaxoSmithKline PLC declined to donate its asthma drug and look-alike dummy medicine for the study, which compared two other treatments.

Editors of the New England Journal of Medicine, which published the study, chastised Glaxo, saying its actions made the research harder and more expensive to do. Drug companies aren’t required to supply their medicines for study, but they often do.

“In the end, the study results provided the truth” — the drug, Spiriva, was as good as Glaxo’s Serevent, they wrote. The study was published online Sunday to coincide with a presentation at a medical meeting in Barcelona, Spain.

About 300 million people worldwide suffer from asthma. In the U.S., 22 million Americans have asthma, which kills about 4,000 a year. For people who can’t control their asthma with inhaled steroid medicine, current guidelines call for doubling the dose or adding a different drug that relaxes the muscles to help patients breathe.

Researchers tested three inhaled treatments: doubling the steroid dose, adding Glaxo’s Serevent or adding Boehringer Ingelheim’s Spiriva, which is approved for emphysema and other chronic lung conditions, but not asthma.

The study involved 210 people whose asthma was not well controlled. They took each drug for 14 weeks with two-week breaks in between treatment.

Researchers found Spiriva worked better than a double steroid dose and was as effective as Serevent. When the study first began, patients on average had 77 asthma-free days a year — days in which they had no symptoms and did not have to use their rescue inhaler.

Doubling the steroid medicine gave patients an extra 19 asthma-free days; taking Spiriva gave them an additional 48 days with no symptoms, and taking Serevent gave them an extra 51 days.

Spiriva is a promising alternative asthma treatment and some doctors are already using it in people who don’t respond to steroid medicine, but more study on drug safety is needed, Dr. Lewis Smith of Northwestern University wrote in an accompanying editorial.

Two years ago, safety concerns were raised with Spiriva inhalers. But the Food and Drug Administration earlier this year said recent data do not show a connection between the inhaler and previously reported risks of stroke, heart attack and death.

The $5.3 million study was funded by the National Heart, Lung and Blood Institute. Teva Pharmaceutical Industries supplied the inhaled steroid medicine and Boehringer Ingelheim provided Spiriva. Both companies also donated matching placebos. Researchers bought Glaxo’s Serevent.

Glaxo declined to participate because Spiriva is not approved for treating asthma. The company also “lacked adequate information in this case to understand what the impact would be on patients in the trial,” said company spokeswoman Mary Anne Rhyne.

The study’s leader, Dr. Stephen Peters of Wake Forest University Baptist Medical Center in North Carolina, said that since his team did not have access to Glaxo’s drug, they bought it from a third-party supplier and hired another company to make the placebo — at a cost of $900,000.

Peters said it’s harder to get drug companies to donate their medicine for research compared with a decade ago.

“Now more drug companies are more likely to ponder whether a trial could help them in the marketplace” and decline to provide their products for studies, Peter said.

Peters has received lecture fees from Teva. Several other researchers on the team reported ties with Glaxo and other drug companies.

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Asthma And Allergy – No Link Between Mould Growth

Asthma And Allergy – No Link Between Mould Growth Development Says Study

A recent PhD study shows that there is no link between mould-spore concentrations in the indoor air and development of asthma and allergy among children.

Many studies around the world have concluded that moisture-related problems in buildings increase the risk of health effects such as respiratory symptoms, asthma and allergy in both adults and children. However, there is only limited knowledge on which agents in indoor air or dust that cause the reported negative health effects. Biological pollutants such as moulds has been suggested.

– Surprising
In the recent PhD study on “Mould growth in buildings”, carried out at NTNU (Norwegian University of Science and Technology), researcher Jonas Holme at SINTEF Building and Infrastructure has suggested different approaches on how to increase the knowledge of mould growth in buildings, and possible links between mould growth and health effects in humans.

– The perhaps most surprising discovery was that there was no link between mould-spore concentrations (CFU) in the investigated children’s bedrooms and asthma or allergy among the children. These results demonstrate that there is no reason to carry out one-time air sampling of mould CFU in indoor air of homes in order to identify risk factors for asthma/allergy in children living in Scandinavian countries, Holme says.

Other agents possible cause
The results indicate that there could be agents other than mould spores that cause the health effects in damp buildings. In another publication based on the same study, a link between phthalates and allergic reactions among children was found.

– We should now concentrate more on the links between chemical exposure in the indoor environment and development of asthma and allergy in order to ensure the proper, corrective measures to reduce indoor environmental problems, says Holme, referring to his study published in the recognized journal Indoor Air.

Natural ventilation causes moisture
A link is also found between houses with one or more moisture indicators and types of ventilation, types of foundation and building period. There were more cases of registered mould growth in houses with no ventilation or natural ventilation compared to houses with mechanical ventilation, and in houses with basement cellars compared to those with slab on ground. There was also greater registered mould growth in older houses compared to newer ones.

– These are not particularly surprising observations, rather they support the fact that proper ventilation reduces the risk of moisture damage or defects. In older houses it might be useful to carry out an upgrading or rehabilitation of the foundations and external thermal insulation, Holme says.

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Severe Asthma and Nasal Symptoms

Severe Asthma and Nasal Symptoms Related Says Swedish Study

Multi-symptom asthma is closely related to nasal blockage, rhinorrhea and symptoms of chronic rhinosinusitis – evidence from the West Sweden Asthma Study

We have previously shown that approximately 25% of those with asthma in West Sweden have multiple asthma symptoms, which may describe a group of patients with more severe disease. Furthermore, asthma is associated with several co-morbid diseases, including rhinitis and chronic rhino-sinusitis.

The aim of this study was to determine whether multi-symptom asthma is related to signs of severe asthma, and to investigate the association between multi-symptom asthma and different symptoms of allergic and chronic rhinosinusitis.

Methods: This study analyzed data on asthma symptoms, rhinitis, and chronic rhinosinusitis from the 2008 West Sweden Asthma Study, which is an epidemiologically based study using the OLIN and GA2LEN respiratory and allergy focused questionnaires.

Results: Multi-symptom asthma was present in 2.1% of the general population. Subjects with multi-symptom asthma had more than double the risk of having night-time awakenings caused by asthma compared with those with fewer asthma symptoms (P<0.001). The prevalence of allergic rhinitis was similar in the fewer- and multi-symptom asthma groups, but nasal blockage and rhinorrhea were significantly increased in those with multi- versus fewer-symptom asthma (odds ratio 2.21; 95% confidence interval 1.64-2.97, versus 1.49; 1.10-2.02, respectively). Having any, or one to four symptoms of chronic rhinosinusitis significantly increased the risk of having multi- versus fewer-symptom asthma (P<0.01). Conclusion: An epidemiologically identified group of individuals with multiple asthma symptoms harbour to greater extent those with signs of severe asthma. The degree of rhinitis, described by the presence of symptoms of nasal blockage or rhinorrhea, as well as the presence of any or several signs of chronic rhinosinusitis, significantly increases the risk of having multi-symptom asthma. Author: Jan Lotvall Linda Ekerljung Bo Lundback

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Combatting Asthma – New task force Assembled

New task force assembled at University of Leicester to Combat Asthma

A new task force for combating asthma in Leicester is being spearheaded by a University of Leicester medical researcher.

Dr Monica Lakhanpaul, Senior Lecturer in Child Health and Consultant Community Paediatrician and her co-researchers, have won a grant from the NIHR Health Services Research programme to work with the community, families, children and professionals to develop a tailored management and intervention programme for asthma in South Asian children in Leicester.

The team will be interviewing members of the community, children with asthma and their parents to give them a voice in academic and clinical forums, so that the end product interventions are informed by the views and experiences of people who suffer with asthma and who live with asthma patients.

“This means we will be developing services with the community for the community,” said Dr Lakhanpaul. “The research will serve as a model for working collaboratively to develop community health care programmes across the UK – for all communities.”

Dr Lakhanpaul said: “Asthma is one of the most common long-term childhood conditions, affecting 1 in 11 children in the UK. South Asian children with asthma suffer poorer health and outcomes than others.

“On completion, our research will provide evidence to be used when tailoring and delivering intervention programmes by providing a template for child, family, community and professional collaboration in intervention design that is intended to be transferrable to children with other chronic conditions or from other population groups.

The study will explore the perceptions and experiences of parents and children, the attitudes and experiences of the wider community in relation to child health and those of healthcare professionals involved in commissioning or delivering services for children and families.”

An important feature about the study is how it brings together researchers in the medical field with social scientists and psychologists to work together.

Dr Lakhanpaul will lead a team from the University of Leicester, De Montfort University, Leicester City Primary Care Trust and University Hospitals of Leicester NHS Trust in order to work with South Asian children, adults and healthcare professionals to understand the problem and find solutions.

Her co-researchers are:

Deborah Bird, Clinical Research Fellow on the project, University of Leicester; Lorraine Culley, Professor of Social Science and Health, De Montfort University; Jonathon Grigg, Professor, Queen Mary University London; Narynder Johal, Parent Representative ; Mark Johnson, Professor of Diversity in Health and Social Care, De Montfort University; Mel McFeeters, Consultant Nurse for Children’s Respiratory Disease, University Hospitals of Leicester NHS Trust; Noelle Robertson,Senior Lecturer in Clinical Psychology and Research Director D Clin Psy, University of Leicester and Joanne Wilson, Paediatric Advanced Nurse Practitioner, Leicester City Primary Care Trust

Dr Lakhanpaul said: “In Leicester, a multi-cultural city with a 30% South Asian population, the rate of admission per 100,000 children was found to be 4.6 times higher in South Asian children than other children. One suggestion is that South Asian children are being under-diagnosed and under-treated at home and in the community, which may explain the increased use and need for hospital care.”

The Management and Interventions for Asthma Study (MIA) will develop suggestions for improving access to, and use of, services and ways of increasing success and confidence in self-management of asthma amongst South Asian communities.

Dr Lakhanpaul said: “MIA’s strength comes from its collaborative approach to research: it is hoped that by working with children, families and professionals, the study will be kept focussed on the issues that are important to the people affected by asthma and that the solutions are both practical and appropriate.

The lessons learnt from the study will help others to work collaboratively with communities to identify health issues which are of concern to them and to develop improved ways of tackling these.

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Research and Markets: Asthma: Modern Therapeutic Targets

Research and Markets: Asthma: Modern Therapeutic Targets

Research and Markets has announced the addition of the “Asthma: Modern Therapeutic Targets” book to their offering.

The care of an increasing number of adult and child patients with asthma has become a major task for clinicians, and a growing concern for public health physicians and health care administrators. At the same time, and in response to this situation, a considerable effort is being made in basic and clinical research to develop new treatments. This book looks into the future and assesses the possibilities of a number of new therapies for asthma under exploration and development. A group of distinguished international authors examine the potential of new agents working on various targets that are currently under evaluation, including autocoids and their inhibitors, enzyme-inhibitors, sensory nerves and sensory neuropeptides, and receptors in immunology Asthma: Modern Therapeutic Targets provides physicians with an appreciation of the future directions of treatment. It provides clinical pharmacologists and researchers with an up-to-date insight into advances in this exciting field. This book will also be a valuable tool for researchers in the pharmaceutical industry.

Benefits:

* Presents a comprehensive review of current treatment options
* Latest guidelines on clinical management reviewed from an international perspective
* Provides background on pharmacology and mechanisms of drug action
* Provides a key resource for individual patient care

Readership:

* Specialists in respiratory medicine, allergy and immunology
* General physicians
* Clinical pharmacologists
* Doctors in training

Key Topics Covered:

Section I: Autocoids and their receptors in airway diseases

* Adenosine receptors: novel molecular targets in asthma
* The role of transforming growth factors in asthma and their potential as a target for therapy
* The role of transcription factors in asthma: can we modify them for therapeutic purposes?
* Is IKK a feasible therapeutic target for allergic asthma?

Section II: Enzyme inhibitors

* Protease-activated receptors: targets for therapeutic intervention in asthma
* Nitric oxide synthase as a therapeutic target in asthma
* Metalloproteinases and asthma: untried potential for new therapeutic strategies

Section III: Sensory nerves and sensory neuropeptides

* Sensory neuropeptides as innovative targets in asthma
* Rationale for vanilloid receptor 1 antagonist-based therapies in asthma

Section IV: Receptors in immunology

* Anticytokines and cytokines as asthma therapy
* Tumour necrosis factor alpha and asthma
* Are chemokines viable targets for asthma?
* Antagonism of the chemokine receptor CCR3 as a potential therapeutic treatment for asthma

Author:

* R Polosa, Presidio Ospedaliero Ascoli-Tomaselli, Catania, Italy
* ST Holgate, Southampton General Hospital, Southampton, UK

For more information visit http://www.researchandmarkets.com/research/a7c5bf/asthma_modern_the

Contacts

Research and Markets
Laura Wood, Senior Manager,
press@researchandmarkets.com
U.S. Fax: 646-607-1907
Fax (outside U.S.): +353-1-481-1716

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Childhood Asthma Foundation Invests Millions

Childhood Asthma Foundation Invests Millions to Implement Best Practices

Childhood asthma foundation invests millions to implement best practices to manage the disease
November 10th, 2010

The Merck Childhood Asthma Network, Inc. (MCAN), today announced it is targeting four high risk cities with nearly $4 million for programs that will combine evidence-based science, case management and asthma trigger removal plans to manage a disease that requires more than the right medical care. Programs in Chicago, Los Angeles, Philadelphia and San Juan, Puerto Rico – all cities with high rates of childhood asthma – will enroll children and families in the most comprehensive asthma management research program ever designed for the community level.

MCAN’s funding, an investment that will cover a four-year period of enrollment, education, implementation and evaluation, follows previous investments in each of the cities that resulted in positive health outcomes. While still being analyzed, results include decreasing the number of missed school days in half, a decrease in symptom days and an increase in the number of families whose children have asthma action plans.

“When it comes to overcoming the enormous cost, health and personal burdens of childhood asthma, we knew it required more than dusting off the clinical research and parachuting it into different parts of the country. We needed to be there, to see how the research translated on the ground,” said Dr. Floyd Malveaux Executive Director of MCAN and former Dean of the College of Medicine at Howard University. “Our continued community partnerships will reveal the best ways to manage a disease with roots that are both biological and environmental.”

The evidence-based programs allow the different communities to both adhere to rigorous asthma management fundamentals and tailor the approach to meet their particular needs. To evaluate the effectiveness of this approach, researchers at the Center for Managing Chronic Disease at the University of Michigan will lead a cross-site program evaluation and help disseminate findings that could impact public health practices and policies surrounding the management of childhood asthma.

The Addressing Asthma in Englewood Project is based on the Southside of Chicago and is a collaborative effort of the University of Illinois, School of Public Health and the Respiratory Health Association of Metropolitan Chicago. The program centers around a community educator model and links children with asthma to appropriate services, education programs in schools, community groups, and local agencies; and a home visit case management program to enhance asthma education, identification and mitigation of asthma triggers.

In Los Angeles, MCAN is partnering with the LA Unified School District for the “Yes We Can” Children’s Asthma Program in the nation’s second largest school district. The program involves a care coordination and education model that will extend beyond the immediate school clinic to include system changes between health, educational and community settings. The program will triage students and families into the appropriate level of intervention, improve the coordination of care between schools, clinics and community providers, and will focus on measuring symptom reduction and school days missed.

In Philadelphia, the Children’s Hospital of Philadelphia’s You Can Control Asthma Care Coordination Program will utilize asthma health care navigators located within four primary care centers operated by the hospital. Navigators will work with primary care providers as an integral member of the family’s asthma care team assisting families in the identification and reduction of asthma triggers in the home, providing self-management education, and other support and resources for families of high risk children with asthma.

The La Red de Asma Infantil de Merck de Puerto Rico program involves evidence-based interventions as part of an asthma care coordination program across home, health care and community settings. The program will be implemented in the Nemesio Canales Housing Project in San Juan, Puerto Rico by the University of Puerto Rico and RAND Health. “La Red” aims to promote asthma-friendly communities throughout the island of Puerto Rico and to enhance access to quality asthma healthcare for this highly vulnerable and underserved community.

According to Dr. Malveaux, one of the keys to moving forward and making broad, systemic change, will be to demonstrate the results, disseminate the approaches and sustain the important work MCAN’s partners are achieving in their communities.

“While the health improvements we have seen to date in individual communities have been overwhelmingly positive, the real potential lies in the ability to make the lessons learned applied as broadly as possible, to help as many children with asthma as possible,” Dr. Malveaux said. “Long term and wide spread change is the goal of our next phase of work.”

Provided by The Merck Childhood Asthma Network, Inc.

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Asthma and Soy Beans Clinical Trial

For many asthma sufferers who aren’t able to control their symptoms with medication, the key may be to eat more soybeans.

The St Louis Post Dispatch is reporting that the Washington University School of Medicine is one of 19 institutions across the country conducting a clinical trial to test the effect of soy compounds on the respiratory disease.

“The number of people in the United States who have asthma has increased in recent years,” said Dr. Mario Castro, lung specialist at Barnes-Jewish Hospital and lead investigator for the St. Louis study. “One reason for the increase could be dietary changes that decrease consumption of foods, such as soy, that are rich in antioxidants.”

In 2007, the Centers for Disease Control and Prevention reported 34 million people had been diagnosed with asthma. That equated to about 13.1 percent of children under the age of 18, and 10.9 percent of adults. The disease also took the lives of almost 3,500 people that year and cost the country $30 billion in treatment costs.

Scientists are looking to soybeans as a possible treatment because they contain powerful antioxidants called isoflavones. Pilot studies have found that isoflavones can reduce the production of inflammatory compounds produced by white blood cells. Airway inflammation is an important cause of asthma symptoms.

Castro also helped conduct a survey 10 years ago that found those who consumed the least amount of soy had the most flare-ups of their asthma.

Alternative treatments are needed because many patients aren’t able to control the disease with available medications, Castro said.

“We see a need for a different approach, and if soy proves to be beneficial for asthma, a simple modification in diet could be a workable and inexpensive solution for many patients,” he said.

The trial, called the Study of Soy Isoflavones in Asthma, is administered by the American Lung Association Asthma Clinical Research Centers.

The nationwide study will enroll 380 asthma patients age 12 and older who are taking either inhaled corticosteroids or a leukotriene modifier and still have uncontrollable symptoms. All participants must also have low levels of soy in their diet.

Castro said poorly controlled asthma includes: Feeling short of breath more than once a week, waking up at night more than once a week from asthma symptoms or using rescue inhalers a couple times a week.

Over the 24-week study, participants will continue their medications and be randomly assigned to receive soy isoflavones or placebo tablets. They will be paid $430 for time spent recording daily symptoms and visiting a clinic nine times for asthma tests.

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Asthma vs. COPD

What Is The Difference Between Asthma And COPD (Chronic Obstructive Pulmonary Disease)?

Bruce Bochner, M.D., Chief, Division of Allergy and Clinical Immunology, The Johns Hopkins School of Medicine responds on ABC by saying this:

Answer: So, we’ve talked about asthma being a disease of airways obstruction where people can get the air in and because the airways are a little bit twitchy and narrow, it then becomes more difficult to get the air out, and it leads to wheezing. In that particular situation, most of the problem in most individuals is reversible with medications.

Now COPD stands for Chronic Obstructive Pulmonary Disease and you notice the obstruction word is there and also in my definition of asthma. The main difference in COPD is that the key problem there is primarily destruction of the very peripheral parts of the lung, most commonly nowadays in people who smoke.

That we believe, at least at the present time, is an irreversible process in the periphery of the lungs and it leads to a completely different kind of problem that we treat sometimes with similar medicines to asthma, but it’s usually a more severe and progressive disease. People with COPD are more likely eventually to end up on home oxygen, for example.

So as it stands right now, we don’t think that asthma leads to COPD, nor do we think that COPD leads to asthma, but keep in mind that we see people with asthma who smoke and so sometimes we see both conditions in the same person simultaneously.

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Important Asthma Facts – 2.4 million asthma patients in Korea

The Korea Times is reporting that people with asthma are quite vulnerable to cold weather, allergies and dust. In low temperatures and dusty environments asthma suffers cough more often and breathing problems.

According to the definition provided by the U.S. National Institutes of Health, asthma is a chronic lung disease that inflames and narrows the airways. Asthma causes recurring periods of wheezing (a whistling sound made when you breathe), chest tightness, shortness of breath, and coughing. The coughing often occurs at night or early in the morning.

As of the latest report in 2007, there are more than 2.4 million asthma patients in Korea.

If you have been kept awake during the night because of excessive coughing or shortness of breath; or have always felt short of breath after exercise; suffered from colds or flu for more than three weeks; have had breathing problems after taking cough drops or hypertension pills or have eczema, you should consult your doctor because you might have asthma.

Dr. Shin Jong-wook of Chung-Ang University Hospital says people with incorrect information about the disease may make symptoms worse. He mentioned several misconceptions people have about asthma.

1. Jogging and hiking are good for asthma: Wrong

Asthma patients with breathing difficulties are mistaken when they believe that running, cycling or hiking will help their lung capacity.

Actually, early morning exercise could worsen their symptoms. The cold air gets into the lungs and stimulates the respiratory organs.

It is much better to take a walk or stretch. Avoid going to “dry” areas.

Swimming is recommended. Immersed in water and moisture, this exercise is much safer. Although right after swimming your body temperature falls, so take precautions as not to worsen your symptoms.

2. Smoking is bad but drinking is okay: Wrong

Nowadays everyone knows that drinking is not good for your health. However, many asthmatics underestimate the high risks of drinking alcohol, which contains sulfites that causes bronchial tubes to shrink.

Sulfites can also be found in dried fruits, juice, beer, potatoes and shrimp.

3. Only children suffer from asthma: wrong

It is true that asthma is more commonly detected among children and teenagers. But according to a report by the Ministry of Health and Welfare, the prevalence rate among people over 50 years old is now higher than average: the overall prevalence rate is 3 percent. It seems that the disease first appears in childhood then gets better but relapses in adulthood.

Therefore, those who had asthma in the past should always check their condition. Elderly people should take extra care because asthma could lead to chronic obstructive pulmonary disease.

4. Refrain from using drugs with steroids: wrong

Doctors prescribe drugs that contain steroids to expand the shrunken bronchial tubes and fix possible inflammation. However, steroids are known for their negative side effects such as hypertension, weight gain, osteoporosis and stomach ulcers among others, which deter many patients from taking them.

However, commonly prescribed steroids in artificial inhalers are only used for the bronchial tubes and one does not have to worry too much about the side effects.

5. Asthma is a serious condition: correct

The general public may disregard the seriousness of asthma but it is in fact a deadly disease. Experts grade it into four stages and the fourth level can cause death. Those who are diagnosed with asthma shouldn’t be overly concerned, but at the same time should remain alert to their sensitive condition.
bjs@koreatimes.co.kr