Asthma - top articles in May 2012

Here are my suggestions for some of the top articles about asthma in May 2012:

Investigating asthma symptoms in primary care | BMJ guide to rational testing

Never assume recurrent shortness of breath is due to asthma without lung function testing, even with history of wheeze. Spirometry with bronchodilator testing is the investigation of choice to diagnose asthma in adults and children older than 10 years. Consider referral for bronchial provocation testing with a direct agent (such as methacholine) or indirect agent (such as mannitol or hypertonic saline) if suggestive history but normal spirometry. Longstanding asthma may evolve in adult life into a syndrome of fixed airflow limitation with poor response to short acting beta agonists (SABAs), so diagnostic reversibility is not always present.

Children living on a farm are at reduced risk of asthma (OR 0.68), hay fever (OR, 0.43), atopic dermatitis (OR, 0.80), atopic sensitization (OR, 0.54)

The developmental trajectory of pediatric asthma in 3- to-10-year-olds: Male gender is a risk factor for childhood asthma development until at least age 10 years

Combination inhaled corticosteroid/LABA: don't let the perfect become the enemy of the good -- ICS/LABA fixed-dose combination therapy perform as well as or better than ICS alone in reducing asthma exacerbations

Older asthmatic patients have a 5-fold increased risk of overall mortality (adjusted odds ratio, 5.2), compared with younger adults. Compared with younger adults, older adults had higher mortality, had higher rates of near-fatal asthma-related events, had higher hospital charges, were more likely to be hospitalized, and had a longer hospital length of stay (P < .001 for all).

Another study casts doubts on the importance of vitamin D levels in asthma

When a patient with asthma starts an inhaled steroid (ICS), the odds are 2 out of 3 that symptoms will improve. However, asthma is a heterogeneous condition that, for the sake of first-line treatment, we have made homogenous. This is the paradox of heterogeneity. When “all comers” are treated with antileukotrienes, the overall therapeutic effect is about half of that observed when a similar group of asthmatic patients is treated with ICSs.

The role of tiotropium in the management of asthma (PDF free full text)

Asthma exacerbations before age 4 may have deleterious long-term effects, reducing lung function at school age

High doses of inhaled ciclesonide do not adversely affect markers of bone turnover in asthmatics over 12 months

The articles were selected from my Twitter and Google Reader streams.

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