July 2012
Microsite Provides a Window on AARC Congress 2012 Venue
The AARC will head to New Orleans this Nov. 10-13 for AARC Congress 2012, but you can take a tour of the city right now through our new microsite, set up especially for the Association by the New Orleans Convention & Visitors Bureau. VISIT SITE
Some Kids with Mild Persistent Asthma Benefit More from ICS than Others
University of Arizona researchers who presented
their findings at the recent American Thoracic Society
meeting suggest all children with mild persistent
asthma benefit from treatment with inhaled corticosteroids
(ICS), but some benefit more than others. The study
analyzed data on 288 children enrolled in the previously
published National Heart, Lung and Blood Institute
trial titled “Treating Children to Prevent
Exacerbations of Asthma” or TREXA. The investigators
compared four ICS treatment strategies: daily treatment
(daily), daily treatment plus symptom-targeted treatment
(combined), symptom-targeted only treatment (rescue),
and placebo. The time to first exacerbation was
reduced by daily treatment, but not by combined
or rescue treatment, compared with placebo. Treatment
failures were reduced by all three active treatment
strategies. A subgroup analyses using either time
to first exacerbation or time to treatment failure
as an outcome found younger children (age 6–11)
in the daily and combined groups, along with non-Hispanic
children, children with eczema, children who were
skin test positive, and children who had IgE levels
>185K/uL, experienced treatment benefit as compared
to those assigned to placebo. Results were similar
for children in the rescue group when using time
to treatment failure as an outcome, but only those
with eczema, high IgE levels, and less than perfect
asthma control during the run-in period benefited
compared to placebo when time to first exacerbation
was used as an outcome. READ
ABSTRACT
Interactive Website Helps Parents Adhere to Kids’ Asthma Therapy
A new study out of Seattle Children’s Research Institute and the University of Washington reports moderate success for an interactive website aimed at helping parents comply with asthma treatments for their children. The site was tested among 603 families who were randomly assigned to receive prompts to assess their child’s asthma every month for six months, along with feedback tailored to improve controller use and adherence. After the first six months, participation in the website was optional. The investigators assessed outcomes at six and 12 months. Results showed:
- Among patients who should have been on controllers at baseline but were not, no statistically significant increase in controller prescriptions were noted at six months.
- There was a trend to improved adherence with controllers among users at six months.
- Among patients who used controller medicine at baseline and six months, users in the intervention arm had significantly greater adherence at six months than those in control arm.
- For patients with persistent asthma at baseline who were on controller medicine at both time points, patients in the intervention arm had significantly better adherence at six months than those in the control arm, but no discernible differences were seen at the 12-month assessment.
The authors conclude, “A tailored interactive
website shows some benefit in improving controller
medication adherence during a period of active intervention.”
The study was published ahead of print in Academic
Pediatrics on June 13.
Predicting Oxygenation Difficulties in ELGANs
Swedish researchers who monitored the alveolar-arterial
oxygen pressure difference (AaDO2) over time in
41 extremely low gestational age newborns (ELGAN)
infants reported their results ahead of print in
Acta Paediatrica on June 20. Twenty-one
had a period of normal lung function in the first
week of life, but oxygenation then deteriorated.
AaDO2 in the first month of life was strongly predicted
by low gestational age and low Apgar score at 5
minutes, while mechanical ventilation did not appear
to pose a risk. At 36 weeks gestational age, lung
function and duration of oxygen treatment were better
predicted by the severity of lung disease in the
first month than by gestational age at birth. The
authors conclude, “Difficulty in oxygenation
was a general observation in ELGANs, and not only
a particular subset…As oxygenation failure often
developed after a few days, the process may be possible
to treat or prevent once the pathogenesis is known.”
READ
ABSTRACT
Pain Predicts Slower Growth in the NICU
Do the painful procedures that your very preterm
patients undergo affect how well they grow? Canadian
researchers who looked at weight and head circumference
in 78 preterm infants born at less than 32 weeks
gestational age believe the answer is yes. They
found infants who were exposed to more skin-breaking
procedures had lower body weights and smaller head
circumferences at 32 weeks post-conceptual age,
even after the findings were adjusted to take medical
cofounders such as illness severity, duration of
mechanical ventilation, infection, and morphine
and corticosteroid exposure into account. At term
equivalent age (40 weeks), later neonatal infection
predicted lower weight. The authors conclude, “Infants
born very preterm undergo repetitive procedural
pain during a period of physiological immaturity
that appears to impact postnatal growth, and may
activate a downstream cascade of stress signaling
that affects later growth in the neonatal intensive
care unit.” The study appears in this month’s
Pain. READ
ABSTRACT
