May 2010

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Each year our section honors a member who has gone above and beyond, either for the section or on the job, with a Specialty Practitioner of the Year award. Nominations are being accepted now through Aug. 31, so start brainstorming deserving members and then use our ONLINE nomination form to nominate them for this prestigious honor.

Proximal and Distal Airway NO Changes Influence Clinical Patterns in Asthmatic Children
A new study in the April 28 Epub edition of Respiratory Medicine looked at two different contributions of exhaled nitric oxide (eNO) in 200 children with asthma and 21 non-asthmatic controls. The proximal (J’awNO) and distal contributions (CANO) were characterized using a trumpet-shaped axial diffusion model of NO exchange. Since J’awNO was not correlated with CANO, asthmatic subjects were grouped into four eNO categories based on upper limit thresholds of non-asthmatics for J’awNO and CANO: Type I (normal J’awNO and CANO), Type II (elevated J’awNO and normal CANO), Type III (elevated J’awNO and CANO), and Type IV (normal J’awNO and elevated CANO). Among the results:

• The rate of inhaled corticosteroid use (lowest in Type III) and atopy (highest in Type II) varied significantly amongst the categories influencing J’awNO, but was not related to CANO, asthma control, or morbidity.
• All categories demonstrated normal to near-normal baseline spirometry; however, only eNO categories with increased CANO (III and IV) had significantly worse asthma control and morbidity when compared to categories I and II.

The authors conclude, “J’awNO and CANO reveal inflammatory categories in children with asthma that have distinct clinical features including sensitivity to inhaled corticosteroids and atopy. Only categories with increase[d] CANO were related to poor asthma control and morbidity independent of baseline spirometry, bronchodilator response, atopic status, or use of inhaled corticosteroids.” READ ABSTRACT

No Short Cuts to Asthma Assessment
Asthmatic children are often evaluated using the FEV1, FENO, and/or an asthma control questionnaire. Could just one suffice? No, report Spanish researchers publishing in this month’s Pediatric Pulmonology. They assessed the relationship between all three, finding only a weak association between any of them. The authors conclude, “These are instruments that quantify variables that influence asthma in different ways, in this sense, none can be used instead of another in asthma management although they are complementary.” The study was conducted among 268 children between the ages of 7 and 14. READ ABSTRACT

Occupational Asthma After Removal from Exposure
Researchers who followed 24 workers diagnosed with occupational asthma for four years after removal from exposure find those with high eosinophil counts (Eos+) following exposure to the offending agent fared better than those with low Eos counts (Eos-). Those in the Eos+ group were able to decrease their dose of inhaled corticosteroids and trended toward an improvement in airway responsiveness as well as a stable FEV1. The Eos- group showed a decrease in FEV1 without any improvement in functional parameters and also had an increase in sputum neutrophils after exposure as well as during the follow-up period. The study appeared in the March/April edition of the Canadian Respiratory Journal. READ ABSTRACT

GOLD-0 May Be a More Important Stage than Thought
GOLD stage 0 was removed from the Global Imitative for Obstructive Lung Disease (GOLD) guidelines due to poor prognostic value. A new study out of Australian conducted among 4060 patients at baseline and 3206 at follow up takes a closer look at these patients, finding:

• Baseline GOLD-0 prevalence was 17.0%.
• At follow-up, 39.8% remained stable, 1.4% progressed to GOLD stage 1–2, and 58.8% resolved to no symptoms.
• Persistent GOLD-0 at follow-up was associated with persistent smoking, depressive symptoms, highest quartile of FEV1 decline/year, the metabolic syndrome in males, and older age in females. These associations generally held in smokers and never-smokers.
• Resolving GOLD-0 was associated with smoking cessation, FEV1 decline/year below the median, normal BMI, and younger age groups.
• Sensitivity analyses based on the presence of sputum did not change the observed associations.

The authors conclude persistent GOLD-0 is an important measure. The study was published in the April 23 Epub edition of CHEST. READ ABSTRACT