American Thoracic Society Journal news tips for December 2004 (second issue)

December 15, 2004

HIGH-RISK ASTHMA PATIENTS REDUCE ASTHMA MEDICATION USE AFTER HOSPITALIZATION

In a study of high-risk patients with severe asthma who were hospitalized for serious exacerbations, researchers showed that within 7 days of discharge their use of prescribed inhaled corticosteroids and oral steroids had fallen rapidly to approximately 50 percent of their prescribed dose. The investigators measured post-hospital adherence in 52 inner city asthmatics by means of electronic medication monitors, self-report, canister weight (for inhaled corticosteroids) and pill counts (for oral corticosteroids). The researchers noted that their results provided strong evidence that even under optimal conditions with free medications and intensive inpatient education, discontinuation of both inhaled corticosteroids and oral corticosteroids was common within 7 days of discharge from the hospital. The participants were almost exclusively African-American with 65 percent (34 patients) being female, and almost half having a history of near-fatal asthma. For the most part, they were unemployed and unmarried. Asthma affects 15 to 20 million people in the U.S. Although effective medical therapies are available, the illness results in severe asthma exacerbations, causing 465,000 hospitalizations and 5,000 deaths per year. Hospitalization and death related to asthma exacerbations are two to three times more likely among African-Americans and minority patients, according to the authors. The research appears in the second issue for December 2004 of the American Thoracic Society's peer-reviewed American Journal of Respiratory and Critical Care Medicine.

LOSS OF BONE DENSITY WITH INHALED CORTICOSTEROIDS

Study participants with mild to moderate chronic obstructive pulmonary disease (COPD) who used 1,200 micrograms per day over 3 years of an inhaled corticosteroid, triamcinalon, in an attempt to slow lung function decline showed reduced bone density in both the lumbar spine and neck of the femur (thigh). The researchers investigated bone metabolism in COPD in 412 subgroup participants involved in Lung Health Study II. All subjects, who were either current smokers or recent quitters, underwent bone mineral density scans of the hip and lumbar spine with dual-energy X-ray absorptiometry at the start of the study, after 1 year, and at the end of year 3. (In COPD, patients have persistent obstruction of the airways associated with either emphysema or chronic bronchitis, caused by years of smoking.) The reductions were 1.78 percent in femoral neck bone mass density and 1.33 percent in lumbar spine bone mass density. The declines occurred in both the men and women patients who were from 55 to 57 years old. Good adherence to therapy (more than 9 puffs of inhaled corticosteroid per day over 3 years) was seen in almost 47 percent of the patients. The authors said that there was little or no decline in bone mass density until after the first year of the study, but reductions did occur during the second and third years of the trial. Since smoking prevalence is high in persons with COPD, the authors urged doctors to encourage patients to quit. The study appears in the second issue for December 2004 of the American Thoracic Society's peer-reviewed American Journal of Respiratory and Critical Care Medicine.

SEARCHING FOR THE CAUSE FOR SARCOIDOSIS

In a large study involving 10 clinical research centers throughout the United States, researchers found strong positive associations between the disease sarcoidosis and occupational exposure to insecticides in both agricultural and industrial settings, as well as with occupational exposure to "moldy" and "musty" environments. The investigators studied 706 newly diagnosed sarcoidosis patients, together with an equal number of age-race-, and sex-matched control subjects. They were trying to understand what environmental and occupational exposures were associated with the disease. (Although it has no known etiology, sarcoidosis is an illness in which abnormal clusters of inflammatory cells called granulomas form in many organs of the body, especially in the lungs. In those organs, inflammation can lead to scarring and cyst formation.) The authors noted that one of the strongest positive associations in the study was for occupational exposure to insecticides at any time before participation in the study, particularly in the 3 years preceding diagnosis. They point out that agricultural workers encounter high levels of exposure to chemicals and aerosolized particulates, including grains, bedding materials, silicates, animal proteins, insect proteins, fungi, bacteria, mycotoxins, and endotoxins. They pointed out that exposure to tobacco smoke at any time in the past seemed to provide a strong negative association with sarcoidosis, a finding which they could not explain. The study appears in the second issue for December 2004 of the American Thoracic Society's peer-reviewed American Journal of Respiratory and Critical Care Medicine.
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For the complete text of these articles, please see the American Thoracic Society Online Web Site at http://www.atsjournals.org. For either contact information or to request a complimentary journalist subscription to ATS journals online, or if you would like to add your name to the Society's twice monthly journal news e-mail list, contact Cathy Carlomagno at 212-315-6442, or by e-mail at ccarlomagno@thoracic.org.

American Thoracic Society

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