Posts Tagged ‘asthma’

Asthma Pops Up After Step Down

Many patients with asthma experience exacerbations within 2 years of receiving step down medications, new respiratory disease research shows.

Asthma Exacerbations Occur in One-third of Patients

• About one-third of patients with asthma have an exacerbation within 2 years of stepping down controller medication, according to the results of new retrospective study.

• Researchers used a US claims database spanning 2000-2012 to conduct a time-to-event analysis.

• A step down event was defined by a 50% or more decrease in days-supplied of controller medications from one event to the next.

Younger, Female, African American Patients at Increased Risk

• Researchers monitored each patient for 10 consecutive 4-month intervals, 3 prior to stepping down, 1 when the step down occurred, and 6 after the step down.

• Among the 26,292 patients in the study, 32% had an asthma exacerbation in the 2-year period after step down of asthma controller medication, although only 7% visited an emergency department or were hospitalized for asthma.

• Patients at increased risk for a quicker asthma exacerbation included those aged 19 years and younger, females, and African Americans.

Take-home Message:

• About one-third of patients have an asthma exacerbation in the 2 years after a step down event.

• Source: Rank MA, Johnson R, Branda M, et al. Long term outcomes after stepping down asthma controller medications: a claims-based, time-to-event analysis. Chest. 2015 May 21. doi:10.1378/chest.15-0301. [Epub ahead of print]

Sleep Apnea Risk Swells With Asthma

If you have asthma, you may be at increased risk for sleep apnea, too.

A new study assessed the relationship of asthma with obstructive sleep apnea (OSA) using laboratory-based sleep studies, and found that pre-existent asthma was a risk factor for the development of clinically relevant OSA in adults over a 4-year period.

What’s more, this association was stronger among those who had asthma longer, according to the authors, led by Mihaela Teodorescu, MD, MS, of the William S. Middleton Memorial Veteran’s Hospital and the University of Wisconsin School of Medicine and Public Health in Madison.

OSA is very common and becoming increasingly prevalent among adults with asthma.

It adversely affects health and leads to a higher risk of death.

Earlier studies had suggested an association between asthma and OSA.

This study examined the prospective relationship of asthma with OSA.


Dr Teodorescu and colleagues used data from the Wisconsin Sleep Cohort Study, a population-based prospective epidemiologic study that included randomly selected adult employees of state agencies, age 30 to 60 years, in 1988.

The patients were recruited to attend overnight sleep studies and fill out health-related questionnaires about every 4 years.

Eligible participants were identified as free of OSA at study entry by 2 baseline sleep studies.

Slightly more than one-quarter of the 81 participants with asthma experienced incident OSA over their first observed 4-year follow-up intervals.

This compared to 16% of the 466 participants without asthma.

With the use of all available 4-year intervals, including multiple 4-year interval observations per participant, those with asthma experienced 45 incident OSA cases during 167 4-year intervals (27%) and those without asthma experienced 160 incident OSA cases during 938 4-year intervals (17%).

The risk of new OSA was increased nearly 40% in participants with preexisting asthma compared with those without asthma after the investigators controlled for sex, age, and baseline and change in body mass index — all factors known to contribute to sleep apnea.

The researchers asked the participants, “Do you have feelings of excessive daytime sleepiness?” to help determine habitual sleepiness.

Asthma duration was related to both new OSA and new OSA with habitual sleepiness, defined as answering “often” (5 to 15 times a month) and “almost always” (more than 15 times a month).

“Studies investigating the mechanisms underlying this association and the value of periodic OSA evaluation in patients with asthma are warranted,” the researchers stated.


If these results are confirmed in a larger study with more asthma cases, the finding would have important clinical relevance, they suggested.

Dr Teodorescu recommends that physicians “look for OSA symptoms among asthma patients.

The literature suggests that OSA worsens asthma.

Treatment for OSA improves asthma symptoms during the day and night, as well as quality of life and lung function measures.

If you identify and treat OSA, the hope is that asthma control will improve.”

The researchers published their results in the January 13 issue of JAMA.

Obstructive Lung Disease Tied to Cognitive Impairment

If you have obstructive lung disease such as asthma, bronchitis, or chronic obstructive pulmonary disease (COPD), you may be more likely to have problems with memory and information processing.

New evidence suggests that the more diminished your airflow, the greater your impairment.

“Persons with obstructive lung disease experience cognitive impairment mainly in memory and information processing, which is partially related to impaired lung function,” said Fiona Cleutjens, MSc, of the Center of Expertise in Chronic Organ Failure in Horn, the Netherlands.

“We know from other studies that cognitive impairment may have negative consequences for daily functioning, health status, and treatment adherence.”

The researchers presented their results at the 2013 European Respiratory Society Annual Congress.

Earlier studies suggested that those with obstructive lung disease often experience problems with a range of mental processes.

But those studies looked only at global cognitive function.

The new study looked at specific cognitive functions that affect those with obstructive lung disease.

Cleutjens and colleagues conducted a large prospective cohort study of more than 500,000 Scottish, English, and Welsh persons aged 40 to 70 years that focused on genetics, environmental exposures, and lifestyle.

They identified more than 5000 men and women who had obstructive lung disease and more than 37,000 comparable people who did not have lung disease.

All completed several tests to examine cognitive performance and lung function.

Worse Scores on Memory Tests

Those with obstructive lung disease had significantly worse scores on memory tests as well as slower reaction speeds compared with those without lung disease, which is an indirect indication of the cognitive processing speed, Ms Cleutjens said.

They also scored worse on tests that reflect the capacity to understand and remember the spatial relations among objects.

They also scored significantly more poorly for all but the test of fluid intelligence, which Ms Cleutjens described as reflecting the capacity to solve problems that require logic and reasoning ability.

Those with the least severe obstructive airway disease had significantly better fluid intelligence scores than those in the intermediate group and significantly better numeric memory than those in the most impaired group.

Ms Cleutjens noted that cognitive problems associated with obstructive lung disease can be debilitating, particularly for a patient who is already dealing with the symptoms of lung disease.

She added that obstructive lung diseases such as asthma and COPD often exist alongside other conditions.

Routine Screening for Cognitive Problems

Ms Cleutjens recommended routine screening for cognitive problems in patients with obstructive lung disease and suggested that a simple screening questionnaire would be a good first step.

Then any patients showing problems could be tested further with a neurocognitive battery to determine which aspects of cognition are impaired or a physician may decide to test only those patients who report cognitive difficulties or who have other risk factors for cognitive impairment, such as vascular problems.

Medications also may affect cognitive performance.

For example, anticholinergic drugs often prescribed for obstructive lung disease are associated with memory loss in some patients.

Ms Cleutjens noted, “Clinicians and health care professionals need to be alert to the possible impact of cognitive impairment in the self-management, clinical management, and pulmonary rehabilitation of obstructive lung disease patients.”