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Asthma Treatment
Arlene M. Butz, RN, CRNP, ScD; Mona G. Tsoukleris, PharmD, BCPS; Michele Donithan, MHS; Van Doren Hsu, PharmD; Ilene Zuckerman, PharmD, PhD; Kim Elizabeth Mudd, MSN; Richard E. Thompson, PhD; Cindy Rand, PhD; Mary Elizabeth Bollinger, DO
Arch Pediatr Adolesc Med. 2006;160:622-628.
Objective To determine the effectiveness of a home-based asthma education intervention in increasing appropriate nebulizer use and reducing symptom frequency, emergency department (ED) visits, and hospitalizations over 12 months.
Design A randomized clinical trial.
Settings Pediatric primary care, pulmonary/allergy, and ED practices associated with the University of Maryland Medical System and The Johns Hopkins Hospital, Baltimore.
Participants Children with persistent asthma, aged 2 to 9 years, with regular nebulizer use and an ED visit or hospitalization within the past 12 months. Children were randomized into the intervention (n = 110) or control (n = 111) group. Follow-up data were available for 95 intervention and 86 control children.
Intervention Home-based asthma education, including symptom recognition, home treatment of acute symptoms, appropriate asthma medication, and nebulizer practice.
Main Outcome Measures Estimates of mean differences in asthma symptom frequency, number of ED visits and hospitalizations and appropriate quick relief, controller medication, and nebulizer practice over 12 months.
Results Of the 221 children, 181 (81.9%) completed the study. There were no significant differences in home nebulizer practice, asthma morbidity, ED visits, or hospitalizations between groups (P range, .11-.79). Although most children received appropriate nonurgent asthma care (mean, 2 visits per 6 months), more than one third of all children received at least 6 quick-relief medication prescriptions during 12 months, with no difference by group.
Conclusions A nebulizer education intervention had no effect on asthma severity or health care use. Of concern is the high quick-relief and low controller medication use in young children with asthma seen nearly every 3 months for nonurgent care.
Author Affiliations: Divisions of General Pediatrics (Dr Butz) and Pediatric Allergy and Immunology (Ms Mudd), Department of Pulmonary and Critical Care (Dr Rand), The Johns Hopkins University Medical Institutions; University of Maryland School of Pharmacy (Drs Tsoukleris, Hsu, and Zuckerman); Departments of Epidemiology (Ms Donithan) and Biostatistics (Dr Thompson), The Johns Hopkins University Bloomberg School of Public Health; and The University of Maryland School of Medicine (Dr Bollinger), Baltimore, Md.
Asthma Treatment
Asthmatics who undertake regular breathing exercises could expect to reduce their preventer medication levels by up to half and reliever use by up to 86%, if the results of a research paper published in the latest edition of Thorax are any indication.
The Asthma CRC study, conducted by researchers and doctors at Sydney's Woolcock Institute of Medical Research and the Alfred Hospital in Melbourne, tracked 57 participants over a 30 week period to compare the effects on asthma of two different breathing exercise techniques.
Shallow, slow exhalation, nasal breathing was compared to general upper-body and chest exercises, with participants divided into two parallel study groups for the purpose of comparison. The trial was designed to monitor the effect of the different exercise regimes on a person's asthma symptoms, lung function, use of medication and quality of life.
While results found there was no evidence to favour one breathing technique over the other, it did demonstrate across both groups a dramatic reduction in reliever use by 86% and a reduction in inhaled corticosteroid (ICS) dose by 50%.
Quality of Life scores remained unchanged but good asthma control was maintained despite the reduction in medication use. The exercises did not affect lung function or airway responsiveness.
According to Prof Christine Jenkins the Project Leader, the results are important and relevant to asthma management.
'The reductions in reliever use and ICS dose are of a similar magnitude to those observed in conventional clinical trials which have assessed pharmacological interventions to improve asthma control,' she said.
'Given that the two breathing techniques tested in the study were so different from each other, yet produced similar effects on asthma, it appears the clinical improvements are not due to the use of a particular exercise type. Instead, the process of simply doing the required exercises as a first-line symptom treatment looks to have reinforced the message of relaxation and self-efficacy and provided a deferral strategy for beta-agonist use.'
Trial participants were given a video from which to learn their allocated breathing exercises. They were asked to practice the exercises for 20 minutes each day and to use a shorter version for the relief of symptoms. If unsuccessful, reliever medication was to be used. Participants were required to answer daily questions about their asthma.
'The results of this study could be particularly beneficial to the management of patients with mild asthma symptoms who use a reliever frequently,' Prof Jenkins explained.
'Patients are interested in complementary approaches to asthma management so it is important for health professionals to study and better understand non-drug interventions that patients perceive as useful in controlling their asthma symptoms.'
The controlled, double-blind, randomised parallel group study was funded by the Asthma CRC.
Woolcock Institute of Medical Research
http://www.woolcock.org.au
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Asthma Treatment
My interest in foods causing chronic maladies was aroused in 1983. A mother had two sons suffering from asthma. Riding his bicycle in cold weather aggravated the elder son's asthma, and the second son suffered from recurrent abscesses in his ears that required frequent drainage with grommets inserted into the drums. One day the mother brought me a book to read entitled The 5 Day Allergy Relief System by Dr Marshall Mandell, of Norwalk, Connecticut, USA.
I read the book and it made sense to me. I placed the children on an elimination and rotation food programme with good results 'C the abscesses and asthma ceased. I therefore applied the diet to patients suffering from irritable bowel syndrome (spastic colon) and obtained good results. I subsequently investigated other conditions, and again obtained good results. I have presented papers on these various maladies and published articles in medical journals both locally and overseas. The conditions relieved include acne,1 asthma,2 eczema,3 hypertension and coronary artery thrombosis,4 irritable bowel syndrome (spastic colon),5 migraine,6 ulcerative colitis,7,8 Crohn's disease and ulcerative colitis,9 attention deficit syndrome,10 chronic fatigue syndrome,11 rheumatoid arthritis,12 and atopy (the incidence in chronic recurrent maladies).13
Asthma is the most debilitating disease. Besides the cough, tight chest and sniffling, sufferers fear they may be caught one day without their bronchial tubes dilator pump to relieve a sudden spasm that may develop, and land up in the emergency ward of a hospital, as previously experienced.
Asthma and foods in 102 adults
I attempted to conduct trials on asthma and foods at medical school hospitals in Cape Town, Witwatersrand, Pretoria, Bloemfontein and Durban without success. I therefore decided to conduct an asthma trial in private practice. I recruited asthma patients via the media, radio talks, press adverts, adverts on posters, and in the trading block where my practice was situated. Professor J M Loots, previously of the Pretoria University Sports Research Centre, performed the original lung function tests, and if volunteers satisfied conditions to be classified as asthmatic, he randomised them into controls and diet programme according to a statistical table. One hundred and two asthmatics satisfied the conditions of the trial. Half were put on the diet, and the other half remained on their own doctor's treatment.
Professor Loots repeated the lung function tests, weekly in both groups for 6 weeks. The lung function of the diet group improved by 21%, whereas the control group improved by only 1.8%. After 6 weeks, 27 of the control group decided to go on the diet and their lung function improved by a further 20%. The results were excellent, 70% of asthma attacks were due to foods only, 20% due to a food and an inhalant, and 10% due to inhalants only.
Of the 78 patients who were using various inhaled bronchodilator medications only 17 needed such therapy occasionally when they inadvertently ate a processed food containing the trigger. Similarly of the 67 patients using oral or inhaled corticosteroids only 8 needed this therapy after avoiding the trigger foods. Although 4 patients were symptom-free, they were advised by their physicians not to stop this therapy. One patient no longer needed to receive monthly cortisone injections. Nebulizer inhalation therapy used by 10 patients became redundant in all but 2 cases. Patients using fenoterol (5), ipratropium bromide (4) and fenoterol/ipratropium (1) were free of therapy except in 2 cases needing fenoterol for emergencies.
Smoking played a minor role. Of 102 asthmatics more than half (69) had never smoked, (21) had stopped smoking, and only (12) still smoked. In 8 patients passive cigarette smoke triggered wheezing.
The foods involved were:
Plant life products were the most common group of foods triggering asthma symptoms. Apples and pears were the most common fruit followed by bananas, citrus, avocado and melons among 5 other fruits. Among vegetables potato was the most common, followed by tomato, onion and 8 others. Spices only affected 3 cases. Nuts, walnuts, almonds and cashews were triggers in only 5 cases. No peanuts were involved.
Proteins were next in line. Milk products were the most common trigger. Milk itself was most common, followed by cheese, yoghurt and feta cheese. Beef figured more into the equation than other animal or bird protein.
Among grains, bread was the most common trigger, followed by wheat foods such as pasta, cakes and biscuits made with wheat. Maize followed, as well as rice, oats, tasty wheat and guava roll.
Processed foods played less of a role in 14 instances only. Beverages played the smallest role. Wine was the most common trigger followed by beer, fruit juices, coffee, tea, and in one instance only, tomato sauce.
Pollens are accepted to trigger asthma. Pollens grow into plants, trees, leaves and roots that consist of the same chemicals. So why can't pollen products trigger asthma?
Asthma and foods in 60 children
A paediatrician, specialising in lung conditions, randomised 60 children aged 6 months to 12 years into control and diet groups. He kept 30 of the control group on therapy, and referred 30 of the diet group to be placed on the elimination and rotation diet. He assessed the severity of asthma in both groups before and after the trial period. I controlled the diets.
Asthma was relieved in 25 of 30 children in the diet group without the need for any therapy. Four were on reduced therapy needing 50 mcg of cortisone inhalants once daily, instead of 250 mcg twice daily. Only one patient showed no improvement. All 30 children in the control group needed therapy to control their asthma.
After 6 weeks, those in the diet group who had not improved totally were investigated for environmental factors. Inhalants affected 5 of the children as well as foods.
The foods involved were:
Proteins: Milk and milk products (17 instances) and beef (3), were the main triggers, followed by chicken and eggs (1 each). Fruits and vegetables: (9 instances), squash family (2), and apple, banana, paw-paw, potato, tomato, beans and soya (1 each). Grains: Bread and wheat (9), and maize (1). Processed foods: (11 instances), chocolate (3), crisps (2), and Liqui Fruit fruit juice, ice cream, tomato crisps, slush puppies, and take-away chicken and hamburger (1 each). All of these processed foods contain either milk, wheat, fruit or a protein that were among the trigger foods. Only one child's asthma was triggered by preserved foods.
Follow-up: 1 - 2 years. Besides the 4 children on reduced therapy, 4 other children who originally reacted to foods only, needed therapy when they transgressed and ate foods that triggered their symptoms.
Asthma and foods in 12 breastfed infants
The mothers of 12 breastfed infants were placed on an elimination and rotation diet programme to identify whether any foods in the mothers' diet or environmental factors may trigger asthma symptoms (mucus on the chest, cough and/or rib retraction) in their infants. As few modern mothers have the time for breastfeeding, no controls were considered for a crossover investigation.
Eleven of the 12 infants were symptom-free when the mother avoided the triggers. Only one infant showed no improvement. Cow's milk was the trigger in 6 instances, wheat (2), and chocolate, wine, and citrus (1 each). Besides cow's milk an inhalant (the mother's perfume) made one infant's symptoms worse.
Conclusion
The identification and avoidance of foods that provoke asthma will lead to asthma relief in all age groups. A smaller percentage reacted to environmental factors as well. In only 2 adults, 1 child and 1 infant were no triggering factors (food or environmental) established.
The elimination diet
The purpose of the diet is to identify any food you may react to. Foods may be steamed, grilled, baked, or microwaved, but no fried foods are allowed. Only water may be drunk during the first week. Only salt may be added to foods; no spices, herbs, or sauces are allowed. Each day a different grain, fruit, vegetable and protein is allowed. Only one or two food types are eaten at any one meal. A different grain or fruit is eaten for breakfast, and a different fruit each day for lunch. Supper is a different protein and one type of vegetable each day. An unrestricted amount of the food item may be eaten at any meal. Initially the favourite food/s of an individual are omitted.
A record is kept of all symptoms that occur after each meal. Any food associated with particular symptoms that week is replaced with a different food the following week, until the patient is symptom-free. Thereafter each day only one different food or spice is added until the offending food triggering the complaints is identified. Tea, coffee and other beverages are added on different days, after the first week.
References
1. Borok G. Asthma and foods. South African Family Practice Journal 1990; 11: 355-362.
2. Borok G. Acne and foods. South African Family Practice Journal. 1989; 10: 591-592.
3. Borok G. Eczema and foods. SAMJ 2003; 93: 118-120.
4. Borok G, Loots J M, Daehne H O, van Wyk G J, Krogscheepers Z. Coronary artery disease and glucose toxicity 'C the role of refined foods. Cardiovascular Journal of South Africa 1995; 6: 96-101.
5. Borok G, Segal I. The irritated gastro-intestinal syndrome: dietary rehabilitation. South African Family Practice Journal 1991; 12: 520-527.
6. Borok G. Migraine 'C the role of foods. South African Journal of Natural Medicine 2003; 9: 24-26.
7. Borok G. Ulcerative colitis: a patient report 'C a case history, explaining the importance of food. South African Family Practice Journal 1989; 10: 468-474.
8. Candy S, Borok G, Wright J P, Boniface V, Goodman R. The value of an elimination diet in management of patients with ulcerative colitis. SAMJ 1995; 85: 1176-1179.
9. Borok G, Segal I. Inflammatory bowel disease: individualised dietary therapy. South African Family Practice Journal 1995; 18: 393-399.
10. Behaviour and Foods. Brain and Behaviour Society Congress. S A Brain and Behaviour Society Congress. Postgraduate Medical Centre, University of South Africa. 1986: 93-107.
11. Borok G. Chronic fatigue syndrome: an atopic state. Journal of Chronic Fatigue Syndrome of America. 1998; 4: 39-57.
12. Borok G. Rheumatoid arthritis and foods 'C a patient study. South African Family Practice Journal 1989; 10: 523-524.
Initiation of three placebo-controlled, double-blind phase IIa clinical trials with 116 patients suffering from house dust mite allergy, hay fever, and atopic dermatitis.
Schlieren (ZURICH), Switzerland, June 12, 2006 - Cytos Biotechnology AG (SWX:CYTN) reported today first promising results from a clinical trial with CYT003-QbG10, a potentially universal vaccine for the treatment of allergic diseases. The Immunodrug? carrier QbG10 has previously shown powerful and sustained efficacy in a phase IIa clinical trial with patients suffering from allergic asthma and rhinitis due to house dust mite allergy when it was applied in combination with an approved house dust mite allergen extract (see Press Release, April 25, 2006). The increase achieved in the median allergen tolerance of a factor of 100, combined with a 100% median reduction of asthma symptoms and a 85% median reduction of rhinitis symptoms in daily life raised the question whether the treatment effect observed was due to an enhanced allergen-specific desensitization process or whether the QbG10 component itself effectively modified the patients' allergic status in an allergenindependent manner.
First results from an ongoing phase IIa clinical trial suggest that the powerful efficacy previously observed is conferred by the QbG10 component alone and that addition of a specific allergen extract may not be required. The present study assessed in an open label setting the exploratory efficacy of QbG10 monotherapy (designated CYT003-QbG10). 10 patients suffering from allergic rhinitis due to grass pollen allergy (hay fever) were treated with 6 weekly injections of CYT003-QbG10. Of these 10 patients, 5 could complete the study before onset of this year's grass pollen season. Treatment of these patients led to a marked improvement of allergy symptoms in the nasal provocation test (p=0.03), with an increase of the median allergen tolerance by a factor of 100. The remaining 5 patients cannot be tested during the current grass pollen season since environmental exposure to pollen interferes with the standardized test procedure applied.
Dr. Renner, CEO of Cytos Biotechnology, commented: 'These are very promising first results suggesting that QbG10 indeed acts through an allergen-independent mechanism of action. This would clearly alter the profile of our vaccine candidate since QbG10 alone could be used as a universal vaccine for the treatment of a broad range of allergic diseases. Addition of specific allergens, which can be problematic particularly in those patients with moderate or severe disease, would no longer be required. To further investigate this exciting product candidate, we are now initiating three placebo-controlled and double-blind phase IIa clinical trials with a total of 116 patients suffering from hay fever, house dust mite allergy and atopic dermatitis, a common skin disease which is most likely caused by the same underlying disease mechanism.'
Two of the studies are placebo-controlled, randomized and double-blind phase IIa clinical trials designed to assess safety, tolerability and exploratory efficacy of different formulations of CYT003- QbG10 in allergy patients. One study will recruit 40 patients suffering from mild to moderate rhinitis due to house dust mite allergy, while the second will recruit 40 patients suffering from the same condition due to grass pollen allergy (hay fever). The third study is a placebo-controlled, randomized and double-blind phase IIa clinical trial that will assess safety, tolerability and exploratory efficacy of CYT003-QbG10 in 36 patients suffering from mild to moderate atopic dermatitis (eczema). About allergic diseases and atopic dermatitis
Allergy as a whole is a widespread disease that ranges from mild hay fever to seriously life threatening forms of asthma and anaphylaxis. According to the World Health Organization, more than 20% of the world population suffers from allergic diseases (WHO, 2002). Allergies due to house dust mites and grass pollen are both very common. Whereas house dust mite allergy is a perennial allergy afflicting about 50% of all allergic patients (Clin Exp Allergy, 2004; 34:597), allergy to grass pollen is one of the most frequent causes of seasonal allergic rhinitis (hay fever) starting in spring every year and affecting 15-20% of the European population (WHO Europe, 2003).
An allergic reaction in general is caused by hypersensitivity of the immune system to a normally harmless substance, the allergen, causing a misdirected, so called Th2 type immune response. Today, three general approaches are pursued to relieve the symptoms of allergic diseases: avoidance of the allergen, prescription of medication that targets allergy symptoms, and specific immunotherapy, also known as desensitization, which is very time-consuming (3-5 years) but the only treatment currently available that reduces allergy symptoms for a longer period of time.
Atopic dermatitis (a certain type of eczema) is a common and chronic skin disease associated with an 'allergic' Th2 type immune status of the patients. An estimated 20% of infants and young children experience disease symptoms and roughly 60% of those continue to have atopic dermatitis also in adulthood (NIH, 2003). The hypersensitivity reaction occurring in the skin causes chronic inflammation so that the skin becomes dry, itchy and scaly. Irritants (e.g. wool, soap), allergens and emotional stress can make disease symptoms worse and further trigger the overactive immune system. There is no cure available. Current medications include phototherapy, immunomodulators, corticosteroids, antihistamines, and immunosuppressants, some of which are associated with sideeffects, especially upon long-term use.
About CYT003-QbG10
CYT003-QbG10 is a therapeutic vaccine in development for the treatment of allergy, asthma and atopic dermatitis. The vaccine consists of the ImmunodrugTM carrier QbG10 which is comprised of the virus-like particle Qb filled with an immunostimulatory DNA sequence called G10. QbG10 is believed to enhance the establishment of a Th1 type immune response. As Th1 type immune responses have been shown to suppress 'allergic' Th2 type immune responses, CYT003-QbG10 thus aims at induction of a strong Th1 type immune response. First promising results indicate that CYT003-QbG10 could thereby act through an allergen-independent mechanism of action so that it could become a causal and disease-modifying treatment for a broad range of allergic diseases. The vaccine candidate named CYT005-AllQbG10, which has been tested earlier for house dust mite allergy, is comprised of CYT003- QbG10 mixed to an approved house dust mite allergen extract.
Glossary Allergen: a normally harmless substance that elicits a misdirected immune response.
Allergen tolerance: non-reactivity to a certain allergen or reactivity only up to the level of a predefined minimal symptom score. Allergic rhinitis: a condition due to allergy that mimics a chronic cold. Rhinitis means "irritation of the nose".
Anaphylaxis: an acute and life-threatening reaction of the immune system to specific stimuli. If untreated, it can result in shock, respiratory and cardiac failure, and death.
Asthma: a chronic inflammatory disorder of the airways leading to recurrent episodes of wheezing, breathlessness, chest tightness and cough in susceptible individuals.
Atopic dermatitis: a chronic skin disease; a certain type of eczema. 'Atopic' refers to a group of diseases with an inherited tendency to develop other allergic conditions (e.g. asthma and hay fever). 'Dermatitis' means inflammation of the skin.
Desensitization: a certain form of immune therapy applied to treat allergy.
Disease-modifying: in contrast to symptomatic treatment, a disease-modifying treatment aims at addressing the cause of disease and modifying the disease progression.
Double-blind: a set-up often used in clinical trials where neither the doctor nor the patient knows if placebo or the active drug is applied. Eczema: a general term for several types of inflammation of the skin including e.g. allergic contact eczema and atopic dermatitis. Efficacy: strength, effectiveness; the ability of a drug to control or cure an illness.
Formulation: the method and process of selecting the components of a mixture and the product of such a process. For drugs the term usually describes the way the final drug is prepared and applied.
Hay fever: seasonal allergic rhinitis.
Hypersensitivity: an excessive immune reaction.
Nasal provocation test: a commonly used test to monitor the allergic status of an individual. Standardized aqueous allergen solutions are applied to the nasal mucosa in increasing concentrations and the score of predefined allergic symptoms is recorded.
Open label: a set-up used in clinical trials where the doctor and the patient know what substance is administered.
Phase IIa: a clinical trial that examines a new drug candidate's safety and exploratory efficacy in the targeted population and can involve between 10 and 100 patients.
Placebo: dummy medical treatment.
QbG10: Cytos Biotechnology's Immunodrug? carrier Qb filled with the immunostimulatory DNA sequence G10. Randomized: random assignation of clinical trial participants to different treatment groups.
Th1 and Th2 type immune responses: describe a subset of T helper cell responses. T helper cells are a subset of T cells that secrete a variety of mediators (cytokines) playing a role in activation of other immune cells. A Th1 type immune response is usually induced by viral infection, or also by potent vaccination. A Th2 type immune response usually manifests an allergic reaction.
Therapeutic vaccine: a preparation of molecules (antigens) that aims at inducing an immune response to such antigens with the goal to modulate an ongoing disease process.
About Cytos Biotechnology AG
Cytos Biotechnology AG is a public Swiss biotechnology company that specializes in the discovery, development and commercialization of a new class of biopharmaceutical products 'C the ImmunodrugsTM. ImmunodrugsTM are intended for use in the treatment and prevention of common chronic diseases, which afflict millions of people worldwide. ImmunodrugsTM are designed to instruct the patient's immune system to produce desired therapeutic antibody or T-cell responses that modulate chronic disease processes. Taking advantage of the high flexibility of its ImmunodrugTM platform, Cytos Biotechnology has built a pipeline of 26 different ImmunodrugTM candidates in various disease areas, of which 7 are currently in clinical development. The Immunodrug? candidates are developed both in-house (23) and together with Novartis (1) and Pfizer Animal Health (2). Founded in 1995 as a spin-off from the Swiss Federal Institute of Technology (ETH) in Zurich, the company is located in Schlieren (Zurich). Currently, the company has 131 employees. Cytos Biotechnology AG has been listed on the SWX Swiss Exchange (SWX:CYTN) since October 2002.
For further information please contact:
Dr. Claudine Blaser
Director Corporate Communications
Phone: +41 44 733 47 20
Fax: +41 44 733 47 18
e-Mail: claudine.blaser@cytos.com Website: www.cytos.com
This foregoing press release may contain forward-looking statements that include words or phrases such as 'potentially', 'may', 'suggest', 'would', 'could', 'will', 'is believed', 'aim at', 'indicate', 'intend', 'designed' or other similar expressions. These forward-looking statements are subject to a variety of significant uncertainties, including scientific, business, economic and financial factors, and therefore actual results may differ significantly from those presented. There can be no assurance that any other therapeutic entities will enter clinical trials, that clinical trial results will be predictive for future results, that therapeutic entities will be the subject of filings for regulatory approval, that any drug candidates will receive marketing approval from the U.S. Food and Drug Administration or equivalent regulatory authorities, or that drugs will be marketed successfully. Against the background of these uncertainties readers should not rely on forwardlooking statements. The company assumes no responsibility to update forward-looking statements or adapt them to future events or developments. This document does not constitute an offer or invitation to subscribe or purchase any securities of Cytos Biotechnology AG.
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Asthma Treatment
The triggers for asthma run the gamut from the obvious to the odd ' not just secondhand smoke and cat fur and perfumes and pollen but vigorous laughing or a good cry. Anything that irritates the lungs can make a susceptible person wheeze or worse, explains respiratory therapist Valerie Morgan-Wallace.
Morgan-Wallace, along with Dr. Loren Greenway, director of the pulmonary medicine division at LDS Hospital, will field calls this morning as part of the Deseret Morning News/Intermountain Healthcare Hotline, from 10 a.m. to noon.
Kim Raff, Deseret Morning News
Loren Greenway, director of the pulmonary medicine division at LDS Hospital, shows a device used to diagnose and monitor asthma.
Not everybody who has allergies has asthma, and not everybody with asthma has allergies. But there's often a crossover. Pulmonary therapists recommend, for starters, trying to stay away from the things you know you're allergic to, or to "premedicate before you do the thing that causes you to be short of breath," Greenway advises. That can also include exercise.
Doctors often recommend that people with asthma get rid of their pets, "but most people don't accept that recommendation," he says. So the follow-up advice is "don't keep pets in your bedroom." Asthma can often flare up at night.
Symptoms include shortness of breath, chest tightness, coughing and wheezing ' but not necessarily all the symptoms at once. A person with asthma may just have one symptom, and sometimes, Morgan-Wallace says, the symptoms can be subtle. "Sometimes it's just clearing your throat all the time."
Asthma is a chronic inflammation of the air passageways. When an irritant is present ' dust, mold, cold air ' the muscles around the bronchial tubes go into spasms, which further narrows the airways and causes an attack.
It's not clear why asthma cases are on the rise, Greenway says. "We know it's on the rise in urbanized areas, which would point to pollution" as a cause. Other reasons for the increase include the increased use of chemicals in the home and in foods, as well as the incidence of children raised in homes where both parents smoke. Heredity also plays a role.
"But if it's treated effectively, it's beaten," he says. Some patients, however, fail to follow their doctor's treatment plan that includes short-acting bronchodilator and anti-inflammatory medications. "You ought to not have any of your activities of daily living precluded by your asthma," he says. "There are world-class athletes with asthma."
The best way to differentiate asthma from a simple allergic reaction or something like bronchitis is to have a pulmonary function test, say Greenway and Morgan-Wallace.
Asthma Treatment
WASHINGTON-Burning off lung tissue in asthma patients can help their breathing, according to a study published last month in the Journal of Respiratory and Critical Care Medicine.
The procedure, known as bronchial thermoplasty, uses a modified bronchoscope to send radiofrequency waves to essentially microwave the smooth mass of muscle in the walls of conducting airways.
According to the study, the treatment reduces the potential for smooth muscle-mediated bronchoconstriction, helping patients to breathe.
The study, performed by researchers at a number of cooperating Canadian universities, looked at 16 subjects with mild to moderate asthma over two years in an attempt to examine the safety of the procedure and its impact on lung function and airway responsiveness.
The subjects completed follow-up evaluations at 12 weeks, one and two years. Data from daily diaries that the subjects kept for the initial 12 weeks indicated significant improvement in breathing on symptom-free days, morning peak flow and evening peak flow measurements. Spirometry measurements remained stable throughout the study period.
The results showed that all patients demonstrated improvement in airway responsiveness and that treatment is well-tolerated in patients with asthma, resulting in decreased airway hyperresponsiveness that persists for at least two years.
According to the study, the side effects of the treatment, which included some coughing and wheezing, are commonly observed after a common bronchoscopy and cleared within a few days.
Asthma Treatment
SYDNEY, Australia, June 5 ' Asthmatics can reduce their habitual dependence on inhalers by the use of breathing exercises, according to researchers here.
Breathing exercises reduced inhaler use by more than 80% in a small group of asthmatics, reported Cassandra Slader, Ph.D., of the University of Sydney, and colleagues, online in the journal Thorax.
This emerged in a study of 57 volunteers with mild asthma who used their inhalers for relief of symptoms at least four times a week. The volunteers were taught breathing exercises by video and were instructed to try the exercises first when symptoms arose. They could use their inhalers if the exercises did not work after three to five minutes.
At 28 weeks of follow-up, inhaler use was down by 86% compared with baseline (P<.0001), the investigators reported.
Overall, the volunteers had reduced their weekly dosage of inhaled corticosteroids by 50% (P<.0001), the study found.
However, quality-of-life scores did not change significantly from baseline (0.7 at baseline versus 0.5 at week 28; P=.11).
In addition, the breathing exercises did not improve physiological aspects of asthma such as lung function or airway responsiveness. At week 28, lung function, as measured by forced expiratory volume in one second (FEV1), improved by less than two points (P=.23). Measurements of airway responsiveness did not improve significantly from baseline (data not shown).
The volunteers were randomized to learn either of two types of breathing exercises. The first type focused on the nasal route of breathing, hypoventilation, and holding one's breath. The second type focused on control of breathing-timing inhalations and exhalations to the rhythm of upper body exercises such as shoulder rotations and arm curls.
The fact that inhaler use decreased by the same amount with both types of exercises, combined with the lack of any measurable physical improvements, led the researchers to conclude their findings may be based on psychological, rather than biological, processes.
"The similarity of the improvements seen in both groups, despite the widely disparate nature of the breathing exercises they were using, suggests that the observed changes were more likely to be attributable to one or more of the shared process elements-such as the instruction to use the exercises initially in place of reliever for symptom relief-than to the breathing exercises themselves," the authors said.
"Presumably, any instruction which defers or delays the taking of a ?2 agonist will minimize its habitual and preemptory use," they said. "Thus, while breathing exercises may not confer any particular physiological benefit, the process of using breathing techniques as first line symptom treatment may allow people to substantially reduce their use of ?2 agonist. This itself may be beneficial by reducing adrenergic side effects, by reducing response to allergens, or by reducing mast cell tachyphylaxis."
Breathing techniques may be useful in the management of patients with mild asthma symptoms who use reliever frequently, but so far there is no evidence to favor one type of exercise over the other, they concluded.
Primary source: Thorax
Source reference:
Cassandra Slader et al. "Double blind randomized controlled trial of two different breathing techniques in the management of asthma." Thorax 2006. Advanced online publication June 4, 2006.
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Asthma Treatment
GRAZAX? is the first tablet-based sublingual immunotherapy treatment to be developed for approval across Europe. New data demonstrate highly significant results (P>0,0001)i, with reduction in rhinoconjunctivitis symptoms (43%) and use of symptomatic medications (68%) from the very first day of the first grass pollen season with GRAZAX? treatment compared with placebo. These positive results were experienced throughout the entire treatment season, with a significant reduction in rhinoconjunctivitis symptoms (30%) (P<0,0001)i and use of symptomatic medications (38%) (P<0,0001)i. In addition, 82% of patients treated with GRAZAX? responded to the treatment, a 49% increase compared with the placebo group.
Compared with traditional symptom-relieving medications, immunotherapy is an innovative treatment that is recognised by the WHO as the only treatment to target the immunological cause of allergy, thereby altering the natural course of the disease. Use of allergen immunotherapy by injection has long been known to induce sustained symptom prevention with a potential to cure the allergic reaction to grass pollen 'C the ultimate goal of therapy 'C in patients with seasonal allergic rhinitis. Specialists have been eagerly awaiting conclusive results to confirm the place of GRAZAX? as an easily administered and convenient immunotherapy treatment that will provide a wider access to this treatment approach and more patients the opportunity of treating their allergic condition and preventing the symptoms of grass allergy:
'We are very excited by these important results from GT-08. Whilst symptomatic medications for treating the eye and nose symptoms of allergy are generally available to grass allergy sufferers everywhere, the accessibility to causal immunotherapy has been limited. The widespread variations in the availability of specialist allergy services across Europe have limited access to effective treatment for grass allergy to only very few people with many waiting in line. With GRAZAX?, we now have a treatment that can be quickly and simply administered at home by the patient', said Professor Dr Claus Bachert, the ENT Department, The University of Ghent.
GT-08 trial participants had a clinical history of grass-pollen-induced allergic rhinoconjunctivitis of two years or more, requiring treatment during the grass pollen season. The study found that the treatment dramatically reduced rhinoconjunctivitis symptoms; such as sneezing and eye and nose irritation, and, importantly, most participants considered the treatment to be convenient.
"It is encouraging to clearly demonstrate that GRAZAX? has positive effects from the beginning of the first treatment season. These results represent another important step in the process of making GRAZAX? available to grass allergic patients across Europe", said Henrik Jacobi, EVP of Research and Development at ALK-Abell'.
On March 14, 2006, the Swedish Medical Products Agency approved GRAZAX? for the treatment of grass pollen allergy. ALK-Abell' has now filed registration applications in other European countries via the mutual recognition procedure. ALK-Abell' still expects to launch GRAZAX? on the first European markets by the end of 2006 and ahead of the 2007 pollen season.
About GRAZAX? GRAZAX? is a once-daily, tablet-based sublingual immunotherapy that forms a new basis for the treatment of grass pollen allergy. It targets the underlying cause of allergy by inducing a protective immune response that reduces, and potentially cures the allergic reaction to grass pollen. GRAZAX? is a convenient treatment that is administered as a fast-dissolving sublingual (under the tongue) tablet that the patient can take at home. In this way, GRAZAX? offers new hope for the large and growing numbers of patients suffering from grass pollen allergy in Europe, as the novel route of administration makes it more convenient and easy, even in countries where specialist allergy services are lacking. About the GT-08 study
The GT-08 study is a double-blind, randomised, placebo-controlled, multi-centre phase IIIb study, designed to evaluate the clinical efficacy and safety of GRAZAX?i. Initiated in late 2004, the study comprises 634 patients allergic to grass pollen at 51 clinics in Denmark, Germany, Italy, the Netherlands, Spain, the United Kingdom, Austria and Sweden. All patients have moderate to severe allergic rhinitis, with or without asthma, and participants were randomly assigned to receive either GRAZAX? or placebo every day.i The GT-08 study will continue in years to come with a view to documenting the long-term benefits of GRAZAX?.
About ALK-Abell' ALK-Abell' is devoted to improving the lives of people with allergies by developing pharmaceutical products that target the cause of their allergic disease. ALK-Abell' is the world leader in the development of immunotherapy treatments 'C a unique treatment that induces a protective immune response with sustained symptom prevention. Allergy immunotherapy is traditionally conducted as subcutaneous injections or sublingual droplets. ALK-Abell' aims to extend the use of immunotherapy by introducing convenient tablets for home treatment, thereby offering many more patients a causal allergy treatment. ALK-Abell' has more than 1,200 employees with subsidiaries, production facilities and distributors throughout the world. The company is headquartered in H?rsholm, Denmark and listed on the Copenhagen Stock Exchange.
Asthma Treatment
Reflux is an extremely common problem, affecting an estimated 20 million Americans. It occurs when food and acid from the stomach back up into the esophagus, or food tube. The most common symptom is heartburn, but reflux can also show up as hoarseness (backed-up acid attacks the vocal cords), sinusitis (acid irritates tissues in the nose), and asthma (droplets of acid get inhaled into the lungs).
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Mostly, reflux is an annoyance. But in some people -- roughly 3 million Americans at any given time -- reflux leads to Barrett's esophagus, a pre-cancerous state in which the body tries to combat the acid by transforming normal esophageal cells into intestinal cells that pump out protective mucus, said Dr. Rosalind Barron , a gastroenterologist at Mount Auburn Hospital in Cambridge.
Once you get Barrett's esophagus, the chances are still small -- about 5 percent -- that it will turn into difficult-to-treat esophageal cancer. But it does often enough that esophageal cancer is now the fastest rising cancer in the country.
``It seems to be almost an epidemic," said Dr. Hiroshi Mashimo , a gastroenterologist at VA Boston Healthcare and Brigham and Women's Hospital. According to American Cancer Society figures, esophageal cancer will strike about 14,550 people this year and will kill 13,770.
So, the trick is to spot those people with reflux who may be heading down this path by screening them with an endoscope, a small viewing tube that is passed down the esophagus to the juncture with the stomach.
Because they are at higher risk for unclear reasons, white males with long-standing reflux -- such as heartburn several times a week for several years -- should have at least one endoscopy in midlife to rule out Barrett's esophagus, said Barron. So should anybody who has trouble swallowing and anyone with a family history of Barrett's.
People with other signs of reflux, such as hoarseness of long duration or chronic cough, should see a doctor.
JUDY FOREMAN
E-mail health questions to Foreman@globe.com.
? Copyright 2006 Globe Newspaper Company.
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