Asthma at the 2012 American Thoracic Society Meeting
Although the ATS is not the primary asthma-related US meeting, more than 100 studies on asthma will be presented there next week. One that should interest family practitioners and pediatricians is a longitudinal study that followed a cohort of nearly 500 newborns up to age 23. The researchers found a correlation between the timing of solid food introduction and the risk of wheezing at age 23. Infants who received solid food by 8 or 10 weeks of age, regardless of the type of food, were 84% and 122% more likely to be wheezing by age 23.
However, researchers found no increased risk of wheezing in infants who were introduced to solid food at 16 weeks. The study echoes other research showing that introducing solid food before the generally recommended age of 4 to 6 months can increase the risk of eczema. It also provides additional support to another birth cohort study that found that later introduction of solid food had little effect on the risk of developing atopic disease.21,22
Other asthma-related presentations of interest to primary care clinicians:
• Obesity and exercise-induced bronchospasm. Obese children are more likely to have exercise-induced bronchospasm if they have asthma, and worsening lung function is correlated with increasing body mass index (BMI). Researchers found a substantial decrease in FEV1 in obese children without asthma (25%) compared to 18% in those with asthma. Based on their findings, the authors recommended that clinicians screen obese children for pre- and post exercise pulmonary function, whether or not they have asthma.23
• Inhaler technique. One of the major contributors to poor clinical outcomes in asthma patients is poor inhaler technique. Yet physicians often prescribe inhalers without providing adequate instruction on their use. A study that will be presented at ATS evaluated the effects of training instruction based on the American College of Chest Physician guidelines among 69 patients randomized to either verbal training or physical demonstration with a placebo device.
All participants made at least one initial mistake in using the device, most often not breathing out through their mouth before using the inhaler and not breathing in while releasing the medication dose. Doing is learning: Although technique improved significantly after instruction in both groups, the verbal group needed a median of 3 interventions for full improvement, while the demonstration group needed only 2.24 Take-home message: It’s crucial to assure that your patients know how to use their inhalers properly. The best and quickest way to achieve this may be to demonstrate how to use the inhaler, rather than just talking about it.
• Inhaler knowledge. Another problem with devices is that there are just so many. Not just patients but also healthcare providers struggle with this variety. At the ATS meeting, a member of a research team will describe how they assessed 46 doctors, nurses, pharmacists, and respiratory therapists in their knowledge of and ability to use 4 inhaler devices (Spiriva Handihaler®, Advair Diskus®, ProAir HFA®, and Pulmicort Flexhaler®). They found knowledge scores ranging from 77% for PharmDs to 58% for physicians, and technical skill scores ranging from 84% for respiratory therapists to 60% for registered nurses.25 Take-home message: If you don’t understand how to use an inhaler, how can you explain it to your patients?
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The Journal of Respiratory Diseases. COPD, Sleep Apnea, and Asthma: American Thoracic Society Conference Highlights
By Debra Gordon |
May 8, 2012
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1. Jones PW, Harding G, Berry P, et al. Development and first validation of the COPD Assessment Test. Eur Respir J. 2009;34(3):648-54.
2. Toljamo T, et al. Value Of COPD Assessment Test (CAT) In Symptomatic Smokers Without COPD. T. Toljamo, Am J Respir Crit Care Med 185;2012:A1505 3. Miyazaki M, et al. Analysis Of Comorbid Factors Raising CAT Scores In COPD Patients With Mild Airflow Limitation. Am J Respir Crit Care Med;185;2012:A1507 4. Mackay AJ, et al. Utility Of The COPD Assessment Test (CAT) To Evaluate Severity Of COPD Exacerbations. Am J Respir Crit Care Med 185;2012:A1513 5. Gomes T, et al. Measuring The Real Impact To Improve Management Of Disease. Am J Respir Crit Care Med 185;2012:A1508 6. Lin K, Watkins B, Johnson T, Rodriguez JA, Barton MB. Screening for Chronic Obstructive Pulmonary Disease Using Spirometry: Summary of the Evidence for the U.S. Preventive Services Task Force [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008. 7. N. Raghavan, et al. Utility Of The COPD Assessment Test (CAT) In Predicting A Diagnosis Of COPD. Am J Respir Crit Care Med 185;2012:A1506 8. Mullerova H, et al. Disease Burden Of Dyspnea In A Primary Care COPD Population. Am J Respir Crit Care Med 185;2012:A1518 9. Wong CJ, et al. Fatigue in patients with COPD participating in a pulmonary rehabilitation program. Int J Chronic Obstruct Dis. 2010;5:319-326. 10. Kentson MU, et al. Situational, Physiological And Psychological Factors Associated With COPD-Related Fatigue And Functional Limitations Due To Fatigue. Am J Respir Crit Care Med 185;2012:A1519 11. Payne C, Wiffen PJ, Martin S. Interventions for fatigue and weight loss in adults with advanced progressive illness. Cochrane Database Syst Rev. 2012 Jan 18;1:CD008427. 12. Young T, Palta M, Dempsey J, et al. Burden of sleep apnea: rationale, design, and major findings of the Wisconsin Sleep Cohort study. WMJ. 2009;108(5):246 . 13. Epstein LJ, Kristo D, Strollo PJ, et al. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med. 2009;5(3):263. 14. Sliwinksi P, et al. Relationship Between Arterial Hypertension And Impaired Glucose Tolerance (IGT) In Obstructive Sleep Apnoea (OSA) Patients. Am J Respir Crit Care Med. 185;2012:A2161 15. Gu C, et al. Impaired Glucose Tolerance And Pancreatic Beta Cell Function In Patients With Obstructive Sleep Apnea. Am J Respir Crit Care Med. 185;2012:A2165. 16. Zhao Q, et al. Correlation Analysis Of Obstructive Sleep Apnea And Insulin Resistance. Am J Respir Crit Care Med. 185;2012:A2163. 17. Iftikhar I. Meta-Analysis: Continuous Positive Airway Pressure Therapy Improves Insulin Resistance In Patients With Obstructive Sleep Apnea. Am J Respir Crit Care Med. 185;2012:A2162 18. Sharma SK, Agrawal S, Damodaran D, et al. CPAP for the metabolic syndrome in patients with obstructive sleep apnea. N Engl J Med. 2011 Dec 15;365(24):2277-86 19. Chai-Coetzer CL, et al. Randomised Controlled Trial To Evaluate A Simplified Model Of Care For Obstructive Sleep Apnea In Primary Care. Am J Respir Crit Care Med. 185;2012:A3853 20. Black-Shinn JL, et al. Overlap Syndrome Is Associated With Cardiovascular Disease. Am J Respir Crit Care Med. 185;2012:A2169 21. Tarini BA, et al. Systematic Review of the Relationship Between Early Introduction of Solid Foods to Infants and the Development of Allergic Disease. Arch Pediatr Adolesc Med. 2006;160:502-507 22. Zutavern A, et al. Timing of solid food introduction in relation to eczema, asthma, allergic rhinitis, and food and inhalant sensitization at the age of 6 years: results from the prospective birth cohort study LISA. Pediatrics. 2008 Jan;121(1):e44-52. 23. Concepcion E, et al. Exercise Induced Bronchospasm In Asthmatic And Non-Asthmatic Obese Children. Am J Respir Crit Care Med. 185;2012:A1767. 24. Jolly GP, et al. Evaluation Of Inhaler Usage Technique And Response To Educational Training In A Tertiary Health Care Centre. Am J Respir Crit Care Med. 185;2012:A3328 25. Lo T, et al. Modern Inhalers: to What Degree Are We Capable of Remembering How to Use Them? Am J Respir Crit Care Med. 185;2012:A3331 |
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