April 2011

Spring Bulletin Online Now
The Spring issue of our Section Bulletin is ONLINE NOW, with a great article on the psychological causes of habit cough and results of the informal HAST survey conducted by Section Chair Matt O’Brien. Matt also updates us on the diagnostic proposals for the AARC Congress 2011, and Editor Rick Weaver encourages more members to contribute to the Bulletin in his “Notes” column.

FeNO Distinguishes Asthma from Nonasthma in the Clinic Setting
Dutch researchers who set out to determine the discriminative value of fractionated exhaled nitric oxide (FeNO) for asthma and other atopic conditions in the general allergy clinic put the optimal FeNO level to distinguish asthma from nonasthma at 27 ppb, with a sensitivity of 78%, specificity of 92%, positive predictive value of 86%, and negative predictive value of 87%. The study was carried out among 114 steroid-naïve patients, 42 of whom were diagnosed with asthma and 72 of whom were diagnosed with various other allergic and non-allergic conditions. Positive associations were seen between increased FeNO and the presence of respiratory symptoms, airflow reversibility, and total IgE levels. Increased FeNO was negatively correlated with PC20 histamine. Atopy was not a significant predictor of FeNO among asthma patients in the multivariate analysis. The study appeared in the March issue of Allergy and Asthma Proceedings. READ ABSTRACT

Feather Bedding Comes Up Short
Will a feather pillow and quilt really help ease symptoms for children diagnosed with asthma? Australian researchers conclude the answer is no in a new study published ahead of print in the Archives of Disease in Childhood on Mar. 30. They randomized 197 children sensitive to house dust mites to either a duck feather pillow and quilt and a mite-occlusive mattress cover (feather group) or standard care and a mite-occlusive mattress cover (standard group), then followed them for one year. No differences were noted between the groups in frequent wheeze, speech-limiting wheeze, or sleep disruption because of wheezing, although children in the feather group who slept supine did experience fewer sleep disruptions because of wheezing and severe wheeze. READ ABSTRACT

Genetics and Asthma
A new study out of Spain suggests specific genetic factors may lead to poorer asthma control that can be reversed by treatment with inhaled corticosteroids (ICS). Researchers arrived at that conclusion after looking at the Arg/Arg homozygous for the Gly16Arg polymorphism in ADRB2 in 604 asthma patients. Specific results showed:

• There was an increased risk of non-controlled asthma for each Arg allele.
• Among nonusers of ICS, the risk of non-controlled asthma among Arg/Arg vs. Gly/Gly subjects was OR=2.73.
• No increased risk of non-controlled asthma associated with the Arg allele was observed among ICS and/or LABA users.
• For each Arg allele, a decrease of 7.7% in FEV1 decline was found, irrespective of ICS or LABA use.
• Arg/Arg subjects vs. Gly/Gly subjects had an increased risk of bronchial hyperresponsiveness if they did not use ICS.
• The Arg allele was associated with poorer asthma control, a steeper lung function decline, and bronchial hyperresponsiveness.

The study was published ahead of print by the European Respiratory Journal on Mar. 24. READ ABSTRACT

HRCT, FB Help Diagnose Children with Chronic Wet Cough
High-resolution computed tomography (HRCT) and flexible bronchoscopy (FB) can be used as complimentary measures to diagnose children who present with chronic wet cough, report Greek researchers publishing ahead of print in CHEST on Mar. 17. They conducted a retrospective study of 93 children who had been suffering from wet cough for more than six weeks and were deemed unlikely to have asthma. The Bhalla method was used to score the HRCTs, and bronchoscopic findings of bronchitis were grouped into five grades of severity. A positive HRCT was seen in 75.2% of the patients, and a positive correlation was found between Bhalla score and duration of cough. FB/bronchoalveolar lavage (BAL) outperformed HRCT in detecting abnormalities. A positive correlation was noted between the Bhalla score and type III and type IV bronchoscopic lesions. The Bhalla score also correlated positively with the percentage of neutrophils in the BAL. READ ABSTRACT