This summary was compiled from the tweets posted by some of the allergists who attended the 2011 ACAAI meeting. The tweets were labeled #ACAAI. The text was edited and modified by me.Environmental Tobacco Smoke
Smoking bans reduce childhood asthma morbidity. In the U.S. more than 200,000 asthma admissions per yeat are attributed to Environmental Tobacco Smoke (ETS). The Scottish smoking ban was associated with 18% reduction in hospital admissions for asthma (NEJM 2010).
HEPA filters reduced asthma visits in 6-12-year-old children by 18% when parents smoke.
VCD
Variation on VCD at work is a condition called work-associated irritable larnyx syndrome (WILS) that is found in females with reflux.
Patients with difficult asthma may have a laryngeal dysfunction not just VCD (AJRCCM, a study from Australia).
Tiotropium
Tiotropium works as step-up therapy in adult asthma. There were similar improvements in lung function and symptom-free days as adding LABA (NEJM 2011). Tiotropium was better than doubled ICS and as good as salmeterol in severe asthma.
Tiotropium Respimat inhaler helps patients with asthma but a recent BMJ meta-analysis showed increased cardiovascular mortality with that formulation in COPD (BMJ, 2011).
Anti IL-13 (lebrikuzumab)
Anti IL-13 (lebrikuzumab) shows promise in patients with elevated IL-13 levels in asthma. Lebrikizumab (anti-IL13) was useful for asthma, especially in high periostin subgroup (a marker of airway remodelling). Lebrikizumab improved FEV1, but there was no improvement in symptoms or medication use (NEJM 2011).
Antibiotics
1/6 children with asthma seen the ED are prescribed antibiotics. Generally, antibiotics are not helpful in asthma anyway. More than 2 courses of antibiotics for cough in a 6-month time frame should warrant consideration of asthma as a cause (Pediatrics, 2011).
Mold allergy
In a study in Arizona, Fernandez et al. showed SPT to Alternaria to be surprisingly accurate. 96% of patients with a positive SPT had a positive bronchial provocation test with Alternaria. In Arizona, Alternaria has surpassed dust mite as number one allergen in asthma (due to dry climate).
Immunotherapy
SCIT with HDM allowed for ICS reduction by 50% in children with asthma vs. 30% in controls. PEF also improved. Adding a mite allergoid SCIT to pharmacologic treatment was an effective and safe strategy to reduce corticosteroid doses while maintaining disease control in children with mite-induced allergic asthma (JACI 2011).
ICS/LABA
30% of pediatric patients who stepped down off of ICS/LABA to ICS alone lost asthma control in a study from Louisville. No factors could be identified to predict who would maintain control and who would lose control.
Bronchoconstriction without additional inflammation induces airway remodeling in patients with asthma. Dust mite and methacholine challenge induced constriction. Remodelling was noted with constriction alone, without inflammation. This may suggest a role for LABA in preventing remodelling - an interesting possibility (NEJM).
Inhaled steroids (ICS)
Small particle size inhaled steroids may allow for equal efficacy with 1/2 to 1/3 the dose of a larger size of same steroid.
Inhaled corticosteroids have been associated with decreased risk of cardiovascular deaths in asthmatic women. All cause mortality was lower in asthma patients on inhaled steroids. Does systemic absorption confer a benefit?
SABA update: Levalbuterol may not have any real-life advantages over albuterol. Even in Xopenex package insert, there is a mention that there was no difference in hear rate or tremor.
Antihistamines for asthma?
Symptom scores in asthma patients show comparable improvement when given desloratadine compared to montelukast. Use of antihistamine may prevent the development of asthma in some predisposed children.
Asthma in the elderly
The majority of asthma deaths are in patients older than 65.
Asthma in adults/elderly is still predominantly an atopic disease. In a University of Michigan study, 77% of adult asthma patients were skin test positive.
Depression a significant factor for poor asthma quality of life in the elderly. There was odds ratio of 10.8 for psychological dysfunction in patients with more than 3 exacerbation of asthma in a "severe asthma" cohort (reported in ERJ, 2005).
Allergic diseases in the elderly http://goo.gl/pBLcf - "Immunosenescence" features http://goo.gl/8NQ9D
Other news from the 2011 ACAAI meeting
Text Message Reminders Prompt Kids to Take Asthma Medicine
Children from single-parent homes were more likely to be readmitted to hospital after an asthma exacerbation.
Home Environment Affects Asthmatic Kids
Air Fresheners and Scented Candles May Spur Allergic Reactions
This summary was compiled from some of the tweets posted by Dr. David Fischer @IgECPD4, Robert Silge, MD, @DrSilge, Danny Ramirez, MD @allergysa, and a few others. The tweets were labeled #ACAAI and they reached more than 10,000 people. I would strongly encourage you to post updates on Twitter from the CME conferences that you are planning to attend in the future. Disclaimer: The text was edited, modified, and added to by me.
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