Demographic characteristics of patients experiencing near-fatal and fatal asthma: results of a regional survey of 400 asthma specialists [see comment].

BACKGROUND: Case-control studies now describe a growing number of younger patients with varying levels of asthma severity who experience near-fatal or fatal asthma unexpectedly at home, en route to the hospital, or in public places. OBJECTIVE: To collect case reports and analyze the demographic characteristics and patient profiles that may help identify predisposing factors which trigger near-fatal and fatal asthma episodes. METHODS: In order to gather case reports and analyze the demographics and clinical characteristics of patients experiencing near-fatal and fatal asthma, a questionnaire on near-fatal and fatal asthma was distributed to 400 regional asthma specialists. RESULTS: Forty physicians reported 25 cases of near-fatal asthma and 20 cases of fatal asthma. Twenty-five patients (13 males and 12 females) with a mean age of 29.4 years experienced near-fatal asthma. The time of onset of the near-fatal event was sudden (less than 3 hours) in 60% of cases and 76% of the episodes occurred at home or en route to the hospital. All 25 patients were using short acting inhaled beta agonists and 88% were reportedly using inhaled corticosteroids on a daily basis. Good to excellent compliance was noted in 60% of patients. Six patients were using a peak flow meter prior to their near-fatal attack. Predisposing psychosocial factors for life threatening asthma were noted in 44% of patients. Twenty patients, (4 males and 16 females) with a mean age of 21.7 years experienced fatal asthma. The time of onset of the fatal event was sudden (less than 3 hours) in 80% of cases and all but one patient died at home, en route to the hospital, or in a public place. All 20 patients were using short acting inhaled beta agonists, 80% were reportedly on daily inhaled corticosteroids and six patients were on oral corticosteroids. Good to excellent compliance was noted in 60% of patients. Only two patients were using a peak flow meter immediately prior to their fatal attack. Predisposing psychosocial factors for life threatening asthma were noted in 45% of decedent patients. Risk factors for fatal asthma included running in cold weather, over relying on home nebulizers, and a delay in seeking care on long holiday weekends. CONCLUSIONS: While approximately 50% of the patients in this survey had moderate to severe asthma tainted by adverse psychosocial factors, nearly half of near-fatal and fatal attacks occurred suddenly and unexpectedly, outside the hospital in stable, younger, atopic, reportedly compliant patients utilizing inhaled corticosteroids on a daily basis. This regional survey supports the need for additional studies and the establishment of a national case registry to collect case reports and analyze the demographics and clinical characteristics of patients experiencing near-fatal and fatal asthma in order to further define the risk factors and develop preventative protocols for patients at risk for near-fatal or fatal asthma.

Once-daily mometasone furoate dry powder inhaler in the treatment of patients with persistent asthma.

BACKGROUND: Although inhaled glucocorticoids are recommended for all stages of persistent asthma, compliance with long-term therapy is often poor, leading to significant morbidity and mortality. A simplified, once-daily dosing regimen may foster improved compliance. OBJECTIVE: To compare the efficacy and safety of once-daily (AM) administration of mometasone furoate dry powder inhaler (MF DPI) 200 microg and 400 microg with placebo in patients with asthma previously maintained only on short-acting inhaled beta-adrenergic receptor agonists. METHODS: This was a 12-week, double-blind, placebo-controlled, parallel group study. The mean change from baseline to endpoint (last treatment visit) for FEV1 was the primary efficacy variable. RESULTS: At endpoint, both doses of MF DPI were significantly more effective than placebo (P < or = .05) in improving FEV1. Based on morning peak expiratory flow rate, once-daily MF DPI 400 microg was more effective than placebo (P < or = .001) at endpoint. Both active treatments also demonstrated improvement at endpoint in asthma symptom scores, physician-evaluated response to therapy and use of rescue medication. Although both MF DPI dosages were efficacious, MF DPI 400 microg provided additional improvement in some measures of pulmonary function (eg, morning PEFR) when these agents were administered once daily in the morning. Both doses of MF DPI were well tolerated and treatment-related adverse events occurred at a similar incidence among the three treatment groups. CONCLUSIONS: The results of this study indicate that once-daily (AM) MF DPI provides a convenient and effective treatment option for patients with mild or moderate persistent asthma.

Distribution of Dermatophagoides spp., D. farinae and D. pteronyssinus, antigen in homes of patients with asthma in eastern Massachusetts.

Regional analysis of dust mite species distribution is pertinent to clinical practice as atopic patients should be tested and, when indicated, receive appropriate immunotherapy with house dust mite antigens indigenous to their geographic locale. Surveys in selected areas of the United States have found D. farinae and D. pteronyssinus to be the two most prevalent mite species. None of these surveys encompassed the populous Northeastern corridor of the United States. This present study describes the distribution of Dermatophagoides spp. antigens within the homes of asthma sufferers living in suburban Massachusetts. A total of 60 dust samples were collected from carpets in the homes of 46 patients with chronic asthma and documented house dust mite sensitivity. Dust samples were obtained from bedroom carpets in 46 homes and both bedroom and family room carpets in 14 homes. Dermatophagoides spp. bedroom carpet levels ranged from 2.3 ug/g to 138.5 ug/g; (mean level 36.1 ug/g). D. farinae was the dominant species in the majority (78%) of sampled homes. D. pteronyssinus predominated in only three (7%) homes. Nearly 80% of surveyed homes and carpet dust mite antigen levels exceeding 10 ug/g. Mean bedroom carpet levels were more than two-fold higher than family room levels, 47.7 ug/g versus 19.5 ug/g. Distribution patterns of D. farinae and D. pteronyssinus in bedroom and living room carpets was similar in 13 of 14 surveyed homes. Although D. farinae is clearly the dominant allergen in the surveyed homes, this study suggests that both D. farinae and D. pteronyssinus antigens should be used for diagnostic testing and, when indicated, immunotherapy in the northeastern United States.

A multicenter trial of nedocromil sodium, 1% nasal solution, compared with cromolyn sodium and placebo in ragweed seasonal allergic rhinitis.

This study was a double-blind, parallel-group study to evaluate a new medication, nedocromil sodium, 1%, in comparison with placebo and cromolyn sodium, 4%, for treatment of ragweed seasonal allergic rhinitis. Two hundred thirty-three patients (aged 12 to 65 years) from eight centers were randomized to treatment, one spray per nostril, four times daily, with nedocromil sodium, cromolyn sodium, or matched placebo (80, 76, and 77 patients, respectively). All patients had at least a 2-year history of ragweed seasonal allergic rhinitis. Treatment was for 8 weeks during the ragweed season, and daily pollen counts were used to identify the peak 3-week period. Clinic examinations were made before and after the 1-week baseline and after 1, 3, 5, and 8 weeks of treatment. Rhinitis symptoms were recorded each day by the patients. Nedocromil sodium was more effective than placebo (p less than 0.05) in relieving symptoms as recorded by the patients. Cromolyn sodium was also more effective than placebo, but the difference was not usually significant. Similarly, the active treatments were both better than placebo for clinical parameters measured at visits and for global opinions of treatment, and more rescue therapy was used by the placebo-treated group. There was no significant difference between the two active treatments, but the trend throughout was in favor of nedocromil sodium. Our findings demonstrated nedocromil sodium to be at least as effective as an established therapy (cromolyn sodium) in reducing symptoms of rhinitis during the peak ragweed pollen season.

Comparison study of sustained-release theophylline products: Slo-bid capsules versus Theo-Dur tablets in 20 children and young adults with asthma.

Because there are few published studies on capsulized sustained-release theophylline (SRT) products in children, we compared Slo-bid capsules to Theo-Dur tablets in a group of school age children and young adults with asthma in an 8-week randomized crossover study design with patients maintaining daily symptom diary cards and peak expiratory flow rates. Theophylline levels were obtained at 8 hours after the morning dose on day 7, 14, and 28 of each study period. Data were analyzed by one-way analysis of variance, regression equation, and Student's t test. Both products were demonstrated to have grossly similar absorption characteristics and efficacy at 12-hour intervals in the age group studied. Average daily dose requirement was 717 mg/day. Considerable week-to-week intrapatient variation in 8-hour theophylline levels was noted in both products, implying that precise dose adjustments cannot be made from a given level. Our literature review reveals the need for more data to support the current widespread practice of dosing children less than 8 years of age at 12-hour intervals. A retrospective review of ingestion before and after breakfast revealed no variation between the seven patients ingesting SRT before breakfast compared to 13 patients routinely ingesting SRT after a typical childhood breakfast.