News briefs from the journal CHEST, August 2004

August 09, 2004

BIOFEEDBACK HELPS ASTHMATICS REDUCE STEROID USE

Biofeedback, the conscious control of body functions through the use of electronic monitoring devices, may help asthma patients use less inhaled steroids to manage asthma. Researchers from New Jersey and Ohio divided 94 patients with moderate persistent asthma into four groups based on the following treatments: heart rate variability (HRV) biofeedback and training in pursed lips abdominal breathing; HRV biofeedback alone; placebo biofeedback procedure; and no treatment (control group). Patients in the first three groups received 10 weekly biofeedback sessions and practiced at home for 20 minutes twice daily. Throughout the treatment, asthma symptoms, at-home peak flow readings, pulmonary function tests results, physical examination results, and spirometry test results were recorded. Results showed that HRV biofeedback groups significantly reduced their steroid medication dosage without risk of asthma exacerbation while also reducing their asthma severity to mild persistent asthma. Asthma symptoms improved in both biofeedback groups and the placebo group; however, the placebo group showed no improvement in pulmonary function or use of medication. There were no changes in medication use, asthma severity, or asthma symptoms in the control group and no spirometric changes in any of the treatment groups. The study appears in the August issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians.

ACE INHIBITOR USE MAY CAUSE MOUTH SWELLING IN PATIENTS

Long-term use of angiotensin-converting enzyme inhibitors (ACE inhibitors), commonly used to manage hypertension, may cause lip and tongue swelling, known as angioedema (AE), in some patients, which can lead to airway compromise. Philadelphia researchers reviewed the charts of 70 patients, primarily African American, who had presented with AE over the course of 5 years. Forty-five cases (64 percent) of AE were attributed to ACE inhibitor use, while the remaining cases were attributed to food allergies, antibiotics, infection, or unknown reasons. Ten patients (22 percent) had a history of AE. Although most patients (47 percent) presented with AE within 2 months of initial treatment, researchers noted that 11 patients (24 percent) developed AE after long-term treatment (6 months to 5 years) with ACE inhibitors. Lip and tongue swelling were present in all patients who also experienced varying pulmonary conditions due to AE, including shortness of breath, respiratory failure, cough, and dysphagia. Researchers speculate that due to the increasing use of ACE inhibitors, AE may become more common. They recommend that health-care providers avoid prescribing ACE inhibitors in those patients who have a history of AE. The study appears in the August issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians.

STATINS AND ACE INHIBITORS FAIL TO AFFECT SURVIVAL IN PATIENTS WITH IDIOPATHIC PULMOANRY FIBROSIS

Patients with idiopathic pulmonary fibrosis (IPF) showed no improvements in survival when treated with angiotensin-converting enzyme inhibitors (ACE) inhibitors and/or statins. IPF, an inflammatory lung disease characterized by abnormal formation of fibrous tissue in the lungs, carries a poor prognosis and a median survival of less than 3 years. Optimal therapy for IPF remains controversial, and no treatment has been shown to improve survival or quality of life for patients. Previous studies have shown that ACE Inhibitors and statins, commonly used to manage hypertension and high cholesterol, respectively, may have properties that can slow the progression of IPF. To determine the effect of ACE inhibitors and statins on survival in IPF patients, researchers from the Mayo Clinic in Rochester, MN reviewed the records of 82 patients with IPF receiving ACE inhibitors and/or statins. For patients receiving ACE inhibitors, median survival was 2.2 years compared to 2.9 in patients not prescribed ACE inhibitors. Median survival was 2.9 years for patients receiving or not receiving statins. Median survival was 2.5 years for patients receiving ACE inhibitors or statins, compared to 3 years in those patients receiving neither treatment. Although the treatments did not demonstrate survival benefits in patients, researchers note that, due to study limitations, a beneficial role for these agents cannot be excluded. The study appears in the August issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians.
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American College of Chest Physicians

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