Doug Brunk

SAN FRANCISCO – During 2009's peak influenza season, children with asthma were nearly twice as likely to be infected with the novel H1N1 influenza virus compared with other viruses, results from a prospective single-center study demonstrated.

In addition, H1N1 influenza infection caused increased severity of both cold and asthma symptoms compared with other infections.

Although reasons for the association remain unclear, “this really proves that asthmatics need to be vaccinated for the flu, because we can see that they're more susceptible to be infected when they're exposed, and they're more susceptible to have loss of asthma control when they get it,” lead investigator Dr. Kirsten M. Kloepfer said in an interview during a poster session at the meetingo

Dr. Kloepfer, a fellow in allergy and clinical immunology at the University of Wisconsin, Madison, and her associates evaluated 161 children aged 4–12 years who provided at least six of eight consecutive weekly nasal samples between Sept. 5 and Oct. 24, 2009. The children also submitted daily cold symptom diaries, and when applicable, asthma symptom diaries including frequency of albuterol use and daily peak flow. The researchers used reverse transcriptase polymerase chain reaction testing to evaluate the nasal specimens.

Of these 161 children, 94 had asthma and 67 did not. Their mean age was 9 years, and 60% were male.

Dr. Kloepfer reported that the incidence of H1N1 influenza infection was 39% in asthmatics and 25% in nonasthmatics, a difference that was not statistically significant, with an odds ratio of 1.9 (P = .06).

However, after adjustment for race, sex, and allergic sensitization, the difference became statistically significant, increasing to an OR of 3.5 (P less than .002).

The incidence of human rhinovirus was statistically similar between the two groups (89% in asthmatics vs. 93% in nonasthmatics), as was the incidence of other viral infections (37% vs. 42%).

Both asthmatics and nonasthmatics reported significant increases in moderate and severe cold symptoms with H1N1, compared with human rhinovirus (63% vs. 28%).

Also, a significantly higher proportion of moderate to severe asthma severity was observed in patients infected with H1N1 influenza, compared with those infected with human rhinovirus (48% vs. 23%). This association held true for severe asthma symptoms as well (19% vs. 4%).

Dr. Kloepfer acknowledged certain limitations of the study, including its single-center design, the fact that it included only children aged 4–12 years, and the fact that it lasted only 8 weeks.

The study was supported by grants from the National Institutes of Health.

Dr. Kloepfer said that she had no other relevant financial disclosures.

SAN FRANCISCO – During 2009's peak influenza season, children with asthma were nearly twice as likely to be infected with the novel H1N1 influenza virus compared with other viruses, results from a prospective single-center study demonstrated.

In addition, H1N1 influenza infection caused increased severity of both cold and asthma symptoms compared with other infections.

Although reasons for the association remain unclear, “this really proves that asthmatics need to be vaccinated for the flu, because we can see that they're more susceptible to be infected when they're exposed, and they're more susceptible to have loss of asthma control when they get it,” lead investigator Dr. Kirsten M. Kloepfer said in an interview during a poster session at the meetingo

Dr. Kloepfer, a fellow in allergy and clinical immunology at the University of Wisconsin, Madison, and her associates evaluated 161 children aged 4–12 years who provided at least six of eight consecutive weekly nasal samples between Sept. 5 and Oct. 24, 2009. The children also submitted daily cold symptom diaries, and when applicable, asthma symptom diaries including frequency of albuterol use and daily peak flow. The researchers used reverse transcriptase polymerase chain reaction testing to evaluate the nasal specimens.

Of these 161 children, 94 had asthma and 67 did not. Their mean age was 9 years, and 60% were male.

Dr. Kloepfer reported that the incidence of H1N1 influenza infection was 39% in asthmatics and 25% in nonasthmatics, a difference that was not statistically significant, with an odds ratio of 1.9 (P = .06).

However, after adjustment for race, sex, and allergic sensitization, the difference became statistically significant, increasing to an OR of 3.5 (P less than .002).

The incidence of human rhinovirus was statistically similar between the two groups (89% in asthmatics vs. 93% in nonasthmatics), as was the incidence of other viral infections (37% vs. 42%).

Both asthmatics and nonasthmatics reported significant increases in moderate and severe cold symptoms with H1N1, compared with human rhinovirus (63% vs. 28%).

Also, a significantly higher proportion of moderate to severe asthma severity was observed in patients infected with H1N1 influenza, compared with those infected with human rhinovirus (48% vs. 23%). This association held true for severe asthma symptoms as well (19% vs. 4%).

Dr. Kloepfer acknowledged certain limitations of the study, including its single-center design, the fact that it included only children aged 4–12 years, and the fact that it lasted only 8 weeks.

The study was supported by grants from the National Institutes of Health.

Dr. Kloepfer said that she had no other relevant financial disclosures.

SAN FRANCISCO – During 2009's peak influenza season, children with asthma were nearly twice as likely to be infected with the novel H1N1 influenza virus compared with other viruses, results from a prospective single-center study demonstrated.

In addition, H1N1 influenza infection caused increased severity of both cold and asthma symptoms compared with other infections.

Although reasons for the association remain unclear, “this really proves that asthmatics need to be vaccinated for the flu, because we can see that they're more susceptible to be infected when they're exposed, and they're more susceptible to have loss of asthma control when they get it,” lead investigator Dr. Kirsten M. Kloepfer said in an interview during a poster session at the meetingo

Dr. Kloepfer, a fellow in allergy and clinical immunology at the University of Wisconsin, Madison, and her associates evaluated 161 children aged 4–12 years who provided at least six of eight consecutive weekly nasal samples between Sept. 5 and Oct. 24, 2009. The children also submitted daily cold symptom diaries, and when applicable, asthma symptom diaries including frequency of albuterol use and daily peak flow. The researchers used reverse transcriptase polymerase chain reaction testing to evaluate the nasal specimens.

Of these 161 children, 94 had asthma and 67 did not. Their mean age was 9 years, and 60% were male.

Dr. Kloepfer reported that the incidence of H1N1 influenza infection was 39% in asthmatics and 25% in nonasthmatics, a difference that was not statistically significant, with an odds ratio of 1.9 (P = .06).

However, after adjustment for race, sex, and allergic sensitization, the difference became statistically significant, increasing to an OR of 3.5 (P less than .002).

The incidence of human rhinovirus was statistically similar between the two groups (89% in asthmatics vs. 93% in nonasthmatics), as was the incidence of other viral infections (37% vs. 42%).

Both asthmatics and nonasthmatics reported significant increases in moderate and severe cold symptoms with H1N1, compared with human rhinovirus (63% vs. 28%).

Also, a significantly higher proportion of moderate to severe asthma severity was observed in patients infected with H1N1 influenza, compared with those infected with human rhinovirus (48% vs. 23%). This association held true for severe asthma symptoms as well (19% vs. 4%).

Dr. Kloepfer acknowledged certain limitations of the study, including its single-center design, the fact that it included only children aged 4–12 years, and the fact that it lasted only 8 weeks.

The study was supported by grants from the National Institutes of Health.

Dr. Kloepfer said that she had no other relevant financial disclosures.

SAN FRANCISCO – During 2009’s peak influenza season, children with asthma were nearly twice as likely to be infected with the novel H1N1 influenza virus compared with other viruses, results from a prospective single-center study demonstrated.

In addition, H1N1 influenza infection caused increased severity of both cold and asthma symptoms compared with other infections.

Although reasons for the association remain unclear, "this really proves that asthmatics need to be vaccinated for the flu, because we can see that they’re more susceptible to be infected when they’re exposed, and they’re more susceptible to have loss of asthma control when they get it," lead investigator Dr. Kirsten M. Kloepfer said in an interview during a poster session at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

Dr. Kloepfer, a fellow in allergy and clinical immunology at the University of Wisconsin, Madison, and her associates evaluated 161 children aged 4-12 years who provided at least six of eight consecutive weekly nasal samples between Sept. 5 and Oct. 24, 2009. The children also submitted daily cold symptom diaries, and when applicable, asthma symptom diaries including frequency of albuterol use and daily peak flow. The researchers used reverse transcriptase polymerase chain reaction testing to evaluate the nasal specimens.

Of these 161 children, 94 had asthma and 67 did not. Their mean age was 9 years, and 60% were male.

Dr. Kloepfer reported that the incidence of H1N1 influenza infection was 39% in asthmatics and 25% in nonasthmatics, a difference that was not statistically significant, with an odds ratio of 1.9 (P = .06). However, after adjustment for race, sex, and allergic sensitization, the difference became statistically significant, increasing to an OR of 3.5 (P less than .002).

The incidence of human rhinovirus was statistically similar between the two groups (89% in asthmatics vs. 93% in nonasthmatics), as was the incidence of other viral infections (37% vs. 42%).

Both asthmatics and nonasthmatics reported significant increases in moderate and severe cold symptoms with H1N1, compared with human rhinovirus (63% vs. 28%). Also, a significantly higher proportion of moderate to severe asthma severity was observed in patients infected with H1N1 influenza, compared with those infected with human rhinovirus (48% vs. 23%). This association held true for severe asthma symptoms as well (19% vs. 4%).

Dr. Kloepfer acknowledged certain limitations of the study, including its single-center design, the fact that it included only children aged 4-12 years, and the fact that it lasted only 8 weeks.

The study was supported by grants from the National Institutes of Health. Dr. Kloepfer said that she had no other relevant financial disclosures.

SAN FRANCISCO – During 2009’s peak influenza season, children with asthma were nearly twice as likely to be infected with the novel H1N1 influenza virus compared with other viruses, results from a prospective single-center study demonstrated.

In addition, H1N1 influenza infection caused increased severity of both cold and asthma symptoms compared with other infections.

Although reasons for the association remain unclear, "this really proves that asthmatics need to be vaccinated for the flu, because we can see that they’re more susceptible to be infected when they’re exposed, and they’re more susceptible to have loss of asthma control when they get it," lead investigator Dr. Kirsten M. Kloepfer said in an interview during a poster session at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

Dr. Kloepfer, a fellow in allergy and clinical immunology at the University of Wisconsin, Madison, and her associates evaluated 161 children aged 4-12 years who provided at least six of eight consecutive weekly nasal samples between Sept. 5 and Oct. 24, 2009. The children also submitted daily cold symptom diaries, and when applicable, asthma symptom diaries including frequency of albuterol use and daily peak flow. The researchers used reverse transcriptase polymerase chain reaction testing to evaluate the nasal specimens.

Of these 161 children, 94 had asthma and 67 did not. Their mean age was 9 years, and 60% were male.

Dr. Kloepfer reported that the incidence of H1N1 influenza infection was 39% in asthmatics and 25% in nonasthmatics, a difference that was not statistically significant, with an odds ratio of 1.9 (P = .06). However, after adjustment for race, sex, and allergic sensitization, the difference became statistically significant, increasing to an OR of 3.5 (P less than .002).

The incidence of human rhinovirus was statistically similar between the two groups (89% in asthmatics vs. 93% in nonasthmatics), as was the incidence of other viral infections (37% vs. 42%).

Both asthmatics and nonasthmatics reported significant increases in moderate and severe cold symptoms with H1N1, compared with human rhinovirus (63% vs. 28%). Also, a significantly higher proportion of moderate to severe asthma severity was observed in patients infected with H1N1 influenza, compared with those infected with human rhinovirus (48% vs. 23%). This association held true for severe asthma symptoms as well (19% vs. 4%).

Dr. Kloepfer acknowledged certain limitations of the study, including its single-center design, the fact that it included only children aged 4-12 years, and the fact that it lasted only 8 weeks.

The study was supported by grants from the National Institutes of Health. Dr. Kloepfer said that she had no other relevant financial disclosures.

SAN FRANCISCO – During 2009’s peak influenza season, children with asthma were nearly twice as likely to be infected with the novel H1N1 influenza virus compared with other viruses, results from a prospective single-center study demonstrated.

In addition, H1N1 influenza infection caused increased severity of both cold and asthma symptoms compared with other infections.

Although reasons for the association remain unclear, "this really proves that asthmatics need to be vaccinated for the flu, because we can see that they’re more susceptible to be infected when they’re exposed, and they’re more susceptible to have loss of asthma control when they get it," lead investigator Dr. Kirsten M. Kloepfer said in an interview during a poster session at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

Dr. Kloepfer, a fellow in allergy and clinical immunology at the University of Wisconsin, Madison, and her associates evaluated 161 children aged 4-12 years who provided at least six of eight consecutive weekly nasal samples between Sept. 5 and Oct. 24, 2009. The children also submitted daily cold symptom diaries, and when applicable, asthma symptom diaries including frequency of albuterol use and daily peak flow. The researchers used reverse transcriptase polymerase chain reaction testing to evaluate the nasal specimens.

Of these 161 children, 94 had asthma and 67 did not. Their mean age was 9 years, and 60% were male.

Dr. Kloepfer reported that the incidence of H1N1 influenza infection was 39% in asthmatics and 25% in nonasthmatics, a difference that was not statistically significant, with an odds ratio of 1.9 (P = .06). However, after adjustment for race, sex, and allergic sensitization, the difference became statistically significant, increasing to an OR of 3.5 (P less than .002).

The incidence of human rhinovirus was statistically similar between the two groups (89% in asthmatics vs. 93% in nonasthmatics), as was the incidence of other viral infections (37% vs. 42%).

Both asthmatics and nonasthmatics reported significant increases in moderate and severe cold symptoms with H1N1, compared with human rhinovirus (63% vs. 28%). Also, a significantly higher proportion of moderate to severe asthma severity was observed in patients infected with H1N1 influenza, compared with those infected with human rhinovirus (48% vs. 23%). This association held true for severe asthma symptoms as well (19% vs. 4%).

Dr. Kloepfer acknowledged certain limitations of the study, including its single-center design, the fact that it included only children aged 4-12 years, and the fact that it lasted only 8 weeks.

The study was supported by grants from the National Institutes of Health. Dr. Kloepfer said that she had no other relevant financial disclosures.

SAN FRANCISCO – During 2009’s peak influenza season, children with asthma were nearly twice as likely to be infected with the novel H1N1 influenza virus compared with other viruses, results from a prospective single-center study demonstrated.

In addition, H1N1 influenza infection caused increased severity of both cold and asthma symptoms compared with other infections.

Although reasons for the association remain unclear, "this really proves that asthmatics need to be vaccinated for the flu, because we can see that they’re more susceptible to be infected when they’re exposed, and they’re more susceptible to have loss of asthma control when they get it," lead investigator Dr. Kirsten M. Kloepfer said in an interview during a poster session at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

Dr. Kloepfer, a fellow in allergy and clinical immunology at the University of Wisconsin, Madison, and her associates evaluated 161 children aged 4-12 years who provided at least six of eight consecutive weekly nasal samples between Sept. 5 and Oct. 24, 2009. The children also submitted daily cold symptom diaries, and when applicable, asthma symptom diaries including frequency of albuterol use and daily peak flow. The researchers used reverse transcriptase polymerase chain reaction testing to evaluate the nasal specimens.

Of these 161 children, 94 had asthma and 67 did not. Their mean age was 9 years, and 60% were male.

Dr. Kloepfer reported that the incidence of H1N1 influenza infection was 39% in asthmatics and 25% in nonasthmatics, a difference that was not statistically significant, with an odds ratio of 1.9 (P = .06). However, after adjustment for race, sex, and allergic sensitization, the difference became statistically significant, increasing to an OR of 3.5 (P less than .002).

The incidence of human rhinovirus was statistically similar between the two groups (89% in asthmatics vs. 93% in nonasthmatics), as was the incidence of other viral infections (37% vs. 42%).

Both asthmatics and nonasthmatics reported significant increases in moderate and severe cold symptoms with H1N1, compared with human rhinovirus (63% vs. 28%). Also, a significantly higher proportion of moderate to severe asthma severity was observed in patients infected with H1N1 influenza, compared with those infected with human rhinovirus (48% vs. 23%). This association held true for severe asthma symptoms as well (19% vs. 4%).

Dr. Kloepfer acknowledged certain limitations of the study, including its single-center design, the fact that it included only children aged 4-12 years, and the fact that it lasted only 8 weeks.

The study was supported by grants from the National Institutes of Health. Dr. Kloepfer said that she had no other relevant financial disclosures.

SAN FRANCISCO – During 2009’s peak influenza season, children with asthma were nearly twice as likely to be infected with the novel H1N1 influenza virus compared with other viruses, results from a prospective single-center study demonstrated.

In addition, H1N1 influenza infection caused increased severity of both cold and asthma symptoms compared with other infections.

Although reasons for the association remain unclear, "this really proves that asthmatics need to be vaccinated for the flu, because we can see that they’re more susceptible to be infected when they’re exposed, and they’re more susceptible to have loss of asthma control when they get it," lead investigator Dr. Kirsten M. Kloepfer said in an interview during a poster session at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

Dr. Kloepfer, a fellow in allergy and clinical immunology at the University of Wisconsin, Madison, and her associates evaluated 161 children aged 4-12 years who provided at least six of eight consecutive weekly nasal samples between Sept. 5 and Oct. 24, 2009. The children also submitted daily cold symptom diaries, and when applicable, asthma symptom diaries including frequency of albuterol use and daily peak flow. The researchers used reverse transcriptase polymerase chain reaction testing to evaluate the nasal specimens.

Of these 161 children, 94 had asthma and 67 did not. Their mean age was 9 years, and 60% were male.

Dr. Kloepfer reported that the incidence of H1N1 influenza infection was 39% in asthmatics and 25% in nonasthmatics, a difference that was not statistically significant, with an odds ratio of 1.9 (P = .06). However, after adjustment for race, sex, and allergic sensitization, the difference became statistically significant, increasing to an OR of 3.5 (P less than .002).

The incidence of human rhinovirus was statistically similar between the two groups (89% in asthmatics vs. 93% in nonasthmatics), as was the incidence of other viral infections (37% vs. 42%).

Both asthmatics and nonasthmatics reported significant increases in moderate and severe cold symptoms with H1N1, compared with human rhinovirus (63% vs. 28%). Also, a significantly higher proportion of moderate to severe asthma severity was observed in patients infected with H1N1 influenza, compared with those infected with human rhinovirus (48% vs. 23%). This association held true for severe asthma symptoms as well (19% vs. 4%).

Dr. Kloepfer acknowledged certain limitations of the study, including its single-center design, the fact that it included only children aged 4-12 years, and the fact that it lasted only 8 weeks.

The study was supported by grants from the National Institutes of Health. Dr. Kloepfer said that she had no other relevant financial disclosures.

SAN FRANCISCO – During 2009’s peak influenza season, children with asthma were nearly twice as likely to be infected with the novel H1N1 influenza virus compared with other viruses, results from a prospective single-center study demonstrated.

In addition, H1N1 influenza infection caused increased severity of both cold and asthma symptoms compared with other infections.

Although reasons for the association remain unclear, "this really proves that asthmatics need to be vaccinated for the flu, because we can see that they’re more susceptible to be infected when they’re exposed, and they’re more susceptible to have loss of asthma control when they get it," lead investigator Dr. Kirsten M. Kloepfer said in an interview during a poster session at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

Dr. Kloepfer, a fellow in allergy and clinical immunology at the University of Wisconsin, Madison, and her associates evaluated 161 children aged 4-12 years who provided at least six of eight consecutive weekly nasal samples between Sept. 5 and Oct. 24, 2009. The children also submitted daily cold symptom diaries, and when applicable, asthma symptom diaries including frequency of albuterol use and daily peak flow. The researchers used reverse transcriptase polymerase chain reaction testing to evaluate the nasal specimens.

Of these 161 children, 94 had asthma and 67 did not. Their mean age was 9 years, and 60% were male.

Dr. Kloepfer reported that the incidence of H1N1 influenza infection was 39% in asthmatics and 25% in nonasthmatics, a difference that was not statistically significant, with an odds ratio of 1.9 (P = .06). However, after adjustment for race, sex, and allergic sensitization, the difference became statistically significant, increasing to an OR of 3.5 (P less than .002).

The incidence of human rhinovirus was statistically similar between the two groups (89% in asthmatics vs. 93% in nonasthmatics), as was the incidence of other viral infections (37% vs. 42%).

Both asthmatics and nonasthmatics reported significant increases in moderate and severe cold symptoms with H1N1, compared with human rhinovirus (63% vs. 28%). Also, a significantly higher proportion of moderate to severe asthma severity was observed in patients infected with H1N1 influenza, compared with those infected with human rhinovirus (48% vs. 23%). This association held true for severe asthma symptoms as well (19% vs. 4%).

Dr. Kloepfer acknowledged certain limitations of the study, including its single-center design, the fact that it included only children aged 4-12 years, and the fact that it lasted only 8 weeks.

The study was supported by grants from the National Institutes of Health. Dr. Kloepfer said that she had no other relevant financial disclosures.

DENVER – A high intake of insoluble dietary fiber is associated with reduced inflammation and all-cause mortality in patients with chronic kidney disease, results from a large observational analysis showed.

The finding underscores the importance of a fiber-rich diet in this patient population, which often presents with a low intake of dietary fiber, Dr. Neelakanta A. Dadi said in an interview during a poster session at the annual meeting of the American Society of Nephrology.

“I think this study tells us that patients with chronic kidney disease need to consume more dietary fiber such as vegetables, fruits, and oatmeal,” said Dr. Dadi of the University of Utah, Salt Lake City.

He and his associates used the National Health and Nutrition Examination Survey III to evaluate the association between elevated C-reactive protein (defined as greater than 3 mg/L) and all-cause mortality in 1,105 patients with chronic kidney disease. The researchers estimated intake of insoluble dietary fiber from 24-hour recalls and obtained mortality data through the National Center for Health Statistics by linkage with National Death Index records through 2006.

Low total dietary fiber intake was defined as less than 13.5 g/day while high dietary fiber intake was defined as 13.5 g/day or greater.

The mean age of patients was 69 years and 36% were male.

In a multivariate logistic regression analysis adjusted for age, sex, race, smoking, alcohol, systolic blood pressure, diastolic blood pressure, cancer, physical activity, calorie intake, protein intake, myocardial infarction, heart failure, and stroke, each 10-g/day increase in dietary fiber was associated with a significantly decreased odds of elevated serum C-reactive protein and all-cause mortality (OR, 0.56 and 0.80). A similar association was seen after further adjustment for waist circumference, diabetes, triglycerides, and HDL cholesterol level (OR, 0.56 and 0.76).

Dr. Dadi said that the observational design of NHANES III is a limitation. “It remains unclear what the major cause of mortality is in this population,” he said. “It could be cancer or cardiovascular events.”

The study was funded by a National Kidney Foundation Fellowship Grant and by grants from the Public Health Service and the National Center for Research Resources.

DENVER – A high intake of insoluble dietary fiber is associated with reduced inflammation and all-cause mortality in patients with chronic kidney disease, results from a large observational analysis showed.

The finding underscores the importance of a fiber-rich diet in this patient population, which often presents with a low intake of dietary fiber, Dr. Neelakanta A. Dadi said in an interview during a poster session at the annual meeting of the American Society of Nephrology.

“I think this study tells us that patients with chronic kidney disease need to consume more dietary fiber such as vegetables, fruits, and oatmeal,” said Dr. Dadi of the University of Utah, Salt Lake City.

He and his associates used the National Health and Nutrition Examination Survey III to evaluate the association between elevated C-reactive protein (defined as greater than 3 mg/L) and all-cause mortality in 1,105 patients with chronic kidney disease. The researchers estimated intake of insoluble dietary fiber from 24-hour recalls and obtained mortality data through the National Center for Health Statistics by linkage with National Death Index records through 2006.

Low total dietary fiber intake was defined as less than 13.5 g/day while high dietary fiber intake was defined as 13.5 g/day or greater.

The mean age of patients was 69 years and 36% were male.

In a multivariate logistic regression analysis adjusted for age, sex, race, smoking, alcohol, systolic blood pressure, diastolic blood pressure, cancer, physical activity, calorie intake, protein intake, myocardial infarction, heart failure, and stroke, each 10-g/day increase in dietary fiber was associated with a significantly decreased odds of elevated serum C-reactive protein and all-cause mortality (OR, 0.56 and 0.80). A similar association was seen after further adjustment for waist circumference, diabetes, triglycerides, and HDL cholesterol level (OR, 0.56 and 0.76).

Dr. Dadi said that the observational design of NHANES III is a limitation. “It remains unclear what the major cause of mortality is in this population,” he said. “It could be cancer or cardiovascular events.”

The study was funded by a National Kidney Foundation Fellowship Grant and by grants from the Public Health Service and the National Center for Research Resources.

DENVER – A high intake of insoluble dietary fiber is associated with reduced inflammation and all-cause mortality in patients with chronic kidney disease, results from a large observational analysis showed.

The finding underscores the importance of a fiber-rich diet in this patient population, which often presents with a low intake of dietary fiber, Dr. Neelakanta A. Dadi said in an interview during a poster session at the annual meeting of the American Society of Nephrology.

“I think this study tells us that patients with chronic kidney disease need to consume more dietary fiber such as vegetables, fruits, and oatmeal,” said Dr. Dadi of the University of Utah, Salt Lake City.

He and his associates used the National Health and Nutrition Examination Survey III to evaluate the association between elevated C-reactive protein (defined as greater than 3 mg/L) and all-cause mortality in 1,105 patients with chronic kidney disease. The researchers estimated intake of insoluble dietary fiber from 24-hour recalls and obtained mortality data through the National Center for Health Statistics by linkage with National Death Index records through 2006.

Low total dietary fiber intake was defined as less than 13.5 g/day while high dietary fiber intake was defined as 13.5 g/day or greater.

The mean age of patients was 69 years and 36% were male.

In a multivariate logistic regression analysis adjusted for age, sex, race, smoking, alcohol, systolic blood pressure, diastolic blood pressure, cancer, physical activity, calorie intake, protein intake, myocardial infarction, heart failure, and stroke, each 10-g/day increase in dietary fiber was associated with a significantly decreased odds of elevated serum C-reactive protein and all-cause mortality (OR, 0.56 and 0.80). A similar association was seen after further adjustment for waist circumference, diabetes, triglycerides, and HDL cholesterol level (OR, 0.56 and 0.76).

Dr. Dadi said that the observational design of NHANES III is a limitation. “It remains unclear what the major cause of mortality is in this population,” he said. “It could be cancer or cardiovascular events.”

The study was funded by a National Kidney Foundation Fellowship Grant and by grants from the Public Health Service and the National Center for Research Resources.

DENVER – A high intake of insoluble dietary fiber is associated with reduced inflammation and all-cause mortality in patients with chronic kidney disease, results from a large observational analysis showed.

The finding underscores the importance of a fiber-rich diet in this patient population, which often presents with a low intake of dietary fiber, Dr. Neelakanta A. Dadi said in an interview during a poster session at the annual meeting of the American Society of Nephrology.

“I think this study tells us that patients with chronic kidney disease need to consume more dietary fiber such as vegetables, fruits, and oatmeal,” said Dr. Dadi of the University of Utah, Salt Lake City.

He and his associates used the National Health and Nutrition Examination Survey III to evaluate the association between elevated C-reactive protein (defined as greater than 3 mg/L) and all-cause mortality in 1,105 patients with chronic kidney disease. The researchers estimated intake of insoluble dietary fiber from 24-hour recalls and obtained mortality data through the National Center for Health Statistics by linkage with National Death Index records through 2006.

Low total dietary fiber intake was defined as less than 13.5 g/day while high dietary fiber intake was defined as 13.5 g/day or greater.

The mean age of patients was 69 years and 36% were male.

In a multivariate logistic regression analysis adjusted for age, sex, race, smoking, alcohol, systolic blood pressure, diastolic blood pressure, cancer, physical activity, calorie intake, protein intake, myocardial infarction, heart failure, and stroke, each 10-g/day increase in dietary fiber was associated with a significantly decreased odds of elevated serum C-reactive protein and all-cause mortality (OR, 0.56 and 0.80). A similar association was seen after further adjustment for waist circumference, diabetes, triglycerides, and HDL cholesterol level (OR, 0.56 and 0.76).

Dr. Dadi said that the observational design of NHANES III is a limitation. “It remains unclear what the major cause of mortality is in this population,” he said. “It could be cancer or cardiovascular events.”

The study was funded by a National Kidney Foundation Fellowship Grant and by grants from the Public Health Service and the National Center for Research Resources.

DENVER – A high intake of insoluble dietary fiber is associated with reduced inflammation and all-cause mortality in patients with chronic kidney disease, results from a large observational analysis showed.

The finding underscores the importance of a fiber-rich diet in this patient population, which often presents with a low intake of dietary fiber, Dr. Neelakanta A. Dadi said in an interview during a poster session at the annual meeting of the American Society of Nephrology.

“I think this study tells us that patients with chronic kidney disease need to consume more dietary fiber such as vegetables, fruits, and oatmeal,” said Dr. Dadi of the University of Utah, Salt Lake City.

He and his associates used the National Health and Nutrition Examination Survey III to evaluate the association between elevated C-reactive protein (defined as greater than 3 mg/L) and all-cause mortality in 1,105 patients with chronic kidney disease. The researchers estimated intake of insoluble dietary fiber from 24-hour recalls and obtained mortality data through the National Center for Health Statistics by linkage with National Death Index records through 2006.

Low total dietary fiber intake was defined as less than 13.5 g/day while high dietary fiber intake was defined as 13.5 g/day or greater.

The mean age of patients was 69 years and 36% were male.

In a multivariate logistic regression analysis adjusted for age, sex, race, smoking, alcohol, systolic blood pressure, diastolic blood pressure, cancer, physical activity, calorie intake, protein intake, myocardial infarction, heart failure, and stroke, each 10-g/day increase in dietary fiber was associated with a significantly decreased odds of elevated serum C-reactive protein and all-cause mortality (OR, 0.56 and 0.80). A similar association was seen after further adjustment for waist circumference, diabetes, triglycerides, and HDL cholesterol level (OR, 0.56 and 0.76).

Dr. Dadi said that the observational design of NHANES III is a limitation. “It remains unclear what the major cause of mortality is in this population,” he said. “It could be cancer or cardiovascular events.”

The study was funded by a National Kidney Foundation Fellowship Grant and by grants from the Public Health Service and the National Center for Research Resources.

DENVER – A high intake of insoluble dietary fiber is associated with reduced inflammation and all-cause mortality in patients with chronic kidney disease, results from a large observational analysis showed.

The finding underscores the importance of a fiber-rich diet in this patient population, which often presents with a low intake of dietary fiber, Dr. Neelakanta A. Dadi said in an interview during a poster session at the annual meeting of the American Society of Nephrology.

“I think this study tells us that patients with chronic kidney disease need to consume more dietary fiber such as vegetables, fruits, and oatmeal,” said Dr. Dadi of the University of Utah, Salt Lake City.

He and his associates used the National Health and Nutrition Examination Survey III to evaluate the association between elevated C-reactive protein (defined as greater than 3 mg/L) and all-cause mortality in 1,105 patients with chronic kidney disease. The researchers estimated intake of insoluble dietary fiber from 24-hour recalls and obtained mortality data through the National Center for Health Statistics by linkage with National Death Index records through 2006.

Low total dietary fiber intake was defined as less than 13.5 g/day while high dietary fiber intake was defined as 13.5 g/day or greater.

The mean age of patients was 69 years and 36% were male.

In a multivariate logistic regression analysis adjusted for age, sex, race, smoking, alcohol, systolic blood pressure, diastolic blood pressure, cancer, physical activity, calorie intake, protein intake, myocardial infarction, heart failure, and stroke, each 10-g/day increase in dietary fiber was associated with a significantly decreased odds of elevated serum C-reactive protein and all-cause mortality (OR, 0.56 and 0.80). A similar association was seen after further adjustment for waist circumference, diabetes, triglycerides, and HDL cholesterol level (OR, 0.56 and 0.76).

Dr. Dadi said that the observational design of NHANES III is a limitation. “It remains unclear what the major cause of mortality is in this population,” he said. “It could be cancer or cardiovascular events.”

The study was funded by a National Kidney Foundation Fellowship Grant and by grants from the Public Health Service and the National Center for Research Resources.

Dr. Nancy Ostrom discusses the EIB Landmark Survey's findings regarding the impact that exercise-related respiratory symptoms have on people with asthma.

Dr. Nancy Ostrom discusses the EIB Landmark Survey's findings regarding the impact that exercise-related respiratory symptoms have on people with asthma.

Dr. Nancy Ostrom discusses the EIB Landmark Survey's findings regarding the impact that exercise-related respiratory symptoms have on people with asthma.

Dr. Nancy Ostrom discusses the EIB Landmark Survey's findings regarding the impact that exercise-related respiratory symptoms have on people with asthma.

Dr. Nancy Ostrom discusses the EIB Landmark Survey's findings regarding the impact that exercise-related respiratory symptoms have on people with asthma.

Dr. Nancy Ostrom discusses the EIB Landmark Survey's findings regarding the impact that exercise-related respiratory symptoms have on people with asthma.

SAN FRANCISCO – Doubling, quadrupling, or octupling the maintenance dose of inhaled corticosteroids in the early course of an asthma exacerbation did not result in significant differences in symptoms or in the use of oral corticosteroids, results from a randomized controlled study demonstrated.

"If you strongly feel that the patient is deteriorating, you can use clinical judgment and give them an oral corticosteroid; but don’t increase the inhaled corticosteroid dose – it’s not going to make a difference," Dr. Ejaz Yousef said in an interview during a poster session at the annual meeting of the American Academy of Allergy, Asthma, and Immunology. "Increasing the dose of inhaled corticosteroid has some consequences. It can suppress the hypothalamic-pituitary adrenal axis, for example."

As an alternative to oral corticosteroids for the management of asthma exacerbations, the 1997 National Asthma Education and Prevention Program recommended doubling the maintenance dose of inhaled corticosteroids. However, Dr. Yousef said that at least two published studies found no significant improvement in patients treated with twice the inhaled corticosteroid dose, compared with placebo (Thorax 2004;59;550-6 and Lancet 2004;363:271-5). It remains unknown what kind of impact even larger doses would have on the need for oral corticosteroids.

To find out, Dr. Yousef, chief of the division of pediatric allergy/immunology at Nemours Children’s Clinic, Wilmington, Del., and his associates collected data on 197 children aged 2-17 years who had been maintained on inhaled corticosteroids for at least 90 days.

The children were randomly assigned to one of three 12-day treatment protocols to be implemented if they developed an exacerbation of their asthma symptoms: twice their maintenance dose, four times their maintenance dose, or eight times their maintenance dose. Physicians assessed the children’s clinical status with symptom scores via telephone calls or clinic visits following initiation of therapy protocol.

The researchers excluded children who had chronic, unstable asthma, those who had lung pathology as well as asthma, and those who had additional medical conditions or a history of smoking or substance abuse. An increase in symptoms was defined as a decrease in peak flow values of 50%-80% of the patient’s best and/or increased cough and/or wheezing present for 24-72 hours responsive to beta-agonist therapy. Patients were required to report symptoms within 72 hours of onset.

Symptom scores were obtained via telephone on day 3, 7, and 14 of the treatment plan and included the presence and severity of day and nighttime cough and wheeze, shortness of breath, and exercise intolerance. Scores ranged from 0 to 4 for each symptom, with 0 meaning none and 4 meaning severe.

The primary outcome was the frequency of need to progress to therapy with systemic corticosteroids.

Of the 197 patients, 82 completed the increased dosing protocol, and their mean age was 6 years. Among those 82 patients, only four required treatment with systemic corticosteroids: two from the double maintenance dose group and two from the quadruple maintenance dose group.

Dr. Yousef reported that there was no significant difference in mean symptom scores among the three groups at baseline or at days 3, 7, and 14. In all groups, the scores improved over the course of treatment regardless of the dosage of inhaled corticosteroids administered. There was no significant difference in the time from onset of symptoms to the initiation of the study protocol in the three groups and no difference between patients who did and did not require treatment with systemic corticosteroids.

The results suggest "that it was not the medication alone that improved the outcome," the researchers wrote in their abstract. "It is possible that placebo effect of administering a medication, close contact with a supervising physician, and contact early in the course of an exacerbation played a significant role in obtaining this outcome."

Dr. Yousef said that he had no relevant financial conflicts to disclose.

SAN FRANCISCO – Doubling, quadrupling, or octupling the maintenance dose of inhaled corticosteroids in the early course of an asthma exacerbation did not result in significant differences in symptoms or in the use of oral corticosteroids, results from a randomized controlled study demonstrated.

"If you strongly feel that the patient is deteriorating, you can use clinical judgment and give them an oral corticosteroid; but don’t increase the inhaled corticosteroid dose – it’s not going to make a difference," Dr. Ejaz Yousef said in an interview during a poster session at the annual meeting of the American Academy of Allergy, Asthma, and Immunology. "Increasing the dose of inhaled corticosteroid has some consequences. It can suppress the hypothalamic-pituitary adrenal axis, for example."

As an alternative to oral corticosteroids for the management of asthma exacerbations, the 1997 National Asthma Education and Prevention Program recommended doubling the maintenance dose of inhaled corticosteroids. However, Dr. Yousef said that at least two published studies found no significant improvement in patients treated with twice the inhaled corticosteroid dose, compared with placebo (Thorax 2004;59;550-6 and Lancet 2004;363:271-5). It remains unknown what kind of impact even larger doses would have on the need for oral corticosteroids.

To find out, Dr. Yousef, chief of the division of pediatric allergy/immunology at Nemours Children’s Clinic, Wilmington, Del., and his associates collected data on 197 children aged 2-17 years who had been maintained on inhaled corticosteroids for at least 90 days.

The children were randomly assigned to one of three 12-day treatment protocols to be implemented if they developed an exacerbation of their asthma symptoms: twice their maintenance dose, four times their maintenance dose, or eight times their maintenance dose. Physicians assessed the children’s clinical status with symptom scores via telephone calls or clinic visits following initiation of therapy protocol.

The researchers excluded children who had chronic, unstable asthma, those who had lung pathology as well as asthma, and those who had additional medical conditions or a history of smoking or substance abuse. An increase in symptoms was defined as a decrease in peak flow values of 50%-80% of the patient’s best and/or increased cough and/or wheezing present for 24-72 hours responsive to beta-agonist therapy. Patients were required to report symptoms within 72 hours of onset.

Symptom scores were obtained via telephone on day 3, 7, and 14 of the treatment plan and included the presence and severity of day and nighttime cough and wheeze, shortness of breath, and exercise intolerance. Scores ranged from 0 to 4 for each symptom, with 0 meaning none and 4 meaning severe.

The primary outcome was the frequency of need to progress to therapy with systemic corticosteroids.

Of the 197 patients, 82 completed the increased dosing protocol, and their mean age was 6 years. Among those 82 patients, only four required treatment with systemic corticosteroids: two from the double maintenance dose group and two from the quadruple maintenance dose group.

Dr. Yousef reported that there was no significant difference in mean symptom scores among the three groups at baseline or at days 3, 7, and 14. In all groups, the scores improved over the course of treatment regardless of the dosage of inhaled corticosteroids administered. There was no significant difference in the time from onset of symptoms to the initiation of the study protocol in the three groups and no difference between patients who did and did not require treatment with systemic corticosteroids.

The results suggest "that it was not the medication alone that improved the outcome," the researchers wrote in their abstract. "It is possible that placebo effect of administering a medication, close contact with a supervising physician, and contact early in the course of an exacerbation played a significant role in obtaining this outcome."

Dr. Yousef said that he had no relevant financial conflicts to disclose.

SAN FRANCISCO – Doubling, quadrupling, or octupling the maintenance dose of inhaled corticosteroids in the early course of an asthma exacerbation did not result in significant differences in symptoms or in the use of oral corticosteroids, results from a randomized controlled study demonstrated.

"If you strongly feel that the patient is deteriorating, you can use clinical judgment and give them an oral corticosteroid; but don’t increase the inhaled corticosteroid dose – it’s not going to make a difference," Dr. Ejaz Yousef said in an interview during a poster session at the annual meeting of the American Academy of Allergy, Asthma, and Immunology. "Increasing the dose of inhaled corticosteroid has some consequences. It can suppress the hypothalamic-pituitary adrenal axis, for example."

As an alternative to oral corticosteroids for the management of asthma exacerbations, the 1997 National Asthma Education and Prevention Program recommended doubling the maintenance dose of inhaled corticosteroids. However, Dr. Yousef said that at least two published studies found no significant improvement in patients treated with twice the inhaled corticosteroid dose, compared with placebo (Thorax 2004;59;550-6 and Lancet 2004;363:271-5). It remains unknown what kind of impact even larger doses would have on the need for oral corticosteroids.

To find out, Dr. Yousef, chief of the division of pediatric allergy/immunology at Nemours Children’s Clinic, Wilmington, Del., and his associates collected data on 197 children aged 2-17 years who had been maintained on inhaled corticosteroids for at least 90 days.

The children were randomly assigned to one of three 12-day treatment protocols to be implemented if they developed an exacerbation of their asthma symptoms: twice their maintenance dose, four times their maintenance dose, or eight times their maintenance dose. Physicians assessed the children’s clinical status with symptom scores via telephone calls or clinic visits following initiation of therapy protocol.

The researchers excluded children who had chronic, unstable asthma, those who had lung pathology as well as asthma, and those who had additional medical conditions or a history of smoking or substance abuse. An increase in symptoms was defined as a decrease in peak flow values of 50%-80% of the patient’s best and/or increased cough and/or wheezing present for 24-72 hours responsive to beta-agonist therapy. Patients were required to report symptoms within 72 hours of onset.

Symptom scores were obtained via telephone on day 3, 7, and 14 of the treatment plan and included the presence and severity of day and nighttime cough and wheeze, shortness of breath, and exercise intolerance. Scores ranged from 0 to 4 for each symptom, with 0 meaning none and 4 meaning severe.

The primary outcome was the frequency of need to progress to therapy with systemic corticosteroids.

Of the 197 patients, 82 completed the increased dosing protocol, and their mean age was 6 years. Among those 82 patients, only four required treatment with systemic corticosteroids: two from the double maintenance dose group and two from the quadruple maintenance dose group.

Dr. Yousef reported that there was no significant difference in mean symptom scores among the three groups at baseline or at days 3, 7, and 14. In all groups, the scores improved over the course of treatment regardless of the dosage of inhaled corticosteroids administered. There was no significant difference in the time from onset of symptoms to the initiation of the study protocol in the three groups and no difference between patients who did and did not require treatment with systemic corticosteroids.

The results suggest "that it was not the medication alone that improved the outcome," the researchers wrote in their abstract. "It is possible that placebo effect of administering a medication, close contact with a supervising physician, and contact early in the course of an exacerbation played a significant role in obtaining this outcome."

Dr. Yousef said that he had no relevant financial conflicts to disclose.

SAN FRANCISCO – Doubling, quadrupling, or octupling the maintenance dose of inhaled corticosteroids in the early course of an asthma exacerbation did not result in significant differences in symptoms or in the use of oral corticosteroids, results from a randomized controlled study demonstrated.

"If you strongly feel that the patient is deteriorating, you can use clinical judgment and give them an oral corticosteroid; but don’t increase the inhaled corticosteroid dose – it’s not going to make a difference," Dr. Ejaz Yousef said in an interview during a poster session at the annual meeting of the American Academy of Allergy, Asthma, and Immunology. "Increasing the dose of inhaled corticosteroid has some consequences. It can suppress the hypothalamic-pituitary adrenal axis, for example."

As an alternative to oral corticosteroids for the management of asthma exacerbations, the 1997 National Asthma Education and Prevention Program recommended doubling the maintenance dose of inhaled corticosteroids. However, Dr. Yousef said that at least two published studies found no significant improvement in patients treated with twice the inhaled corticosteroid dose, compared with placebo (Thorax 2004;59;550-6 and Lancet 2004;363:271-5). It remains unknown what kind of impact even larger doses would have on the need for oral corticosteroids.

To find out, Dr. Yousef, chief of the division of pediatric allergy/immunology at Nemours Children’s Clinic, Wilmington, Del., and his associates collected data on 197 children aged 2-17 years who had been maintained on inhaled corticosteroids for at least 90 days.

The children were randomly assigned to one of three 12-day treatment protocols to be implemented if they developed an exacerbation of their asthma symptoms: twice their maintenance dose, four times their maintenance dose, or eight times their maintenance dose. Physicians assessed the children’s clinical status with symptom scores via telephone calls or clinic visits following initiation of therapy protocol.

The researchers excluded children who had chronic, unstable asthma, those who had lung pathology as well as asthma, and those who had additional medical conditions or a history of smoking or substance abuse. An increase in symptoms was defined as a decrease in peak flow values of 50%-80% of the patient’s best and/or increased cough and/or wheezing present for 24-72 hours responsive to beta-agonist therapy. Patients were required to report symptoms within 72 hours of onset.

Symptom scores were obtained via telephone on day 3, 7, and 14 of the treatment plan and included the presence and severity of day and nighttime cough and wheeze, shortness of breath, and exercise intolerance. Scores ranged from 0 to 4 for each symptom, with 0 meaning none and 4 meaning severe.

The primary outcome was the frequency of need to progress to therapy with systemic corticosteroids.

Of the 197 patients, 82 completed the increased dosing protocol, and their mean age was 6 years. Among those 82 patients, only four required treatment with systemic corticosteroids: two from the double maintenance dose group and two from the quadruple maintenance dose group.

Dr. Yousef reported that there was no significant difference in mean symptom scores among the three groups at baseline or at days 3, 7, and 14. In all groups, the scores improved over the course of treatment regardless of the dosage of inhaled corticosteroids administered. There was no significant difference in the time from onset of symptoms to the initiation of the study protocol in the three groups and no difference between patients who did and did not require treatment with systemic corticosteroids.

The results suggest "that it was not the medication alone that improved the outcome," the researchers wrote in their abstract. "It is possible that placebo effect of administering a medication, close contact with a supervising physician, and contact early in the course of an exacerbation played a significant role in obtaining this outcome."

Dr. Yousef said that he had no relevant financial conflicts to disclose.

SAN FRANCISCO – Doubling, quadrupling, or octupling the maintenance dose of inhaled corticosteroids in the early course of an asthma exacerbation did not result in significant differences in symptoms or in the use of oral corticosteroids, results from a randomized controlled study demonstrated.

"If you strongly feel that the patient is deteriorating, you can use clinical judgment and give them an oral corticosteroid; but don’t increase the inhaled corticosteroid dose – it’s not going to make a difference," Dr. Ejaz Yousef said in an interview during a poster session at the annual meeting of the American Academy of Allergy, Asthma, and Immunology. "Increasing the dose of inhaled corticosteroid has some consequences. It can suppress the hypothalamic-pituitary adrenal axis, for example."

As an alternative to oral corticosteroids for the management of asthma exacerbations, the 1997 National Asthma Education and Prevention Program recommended doubling the maintenance dose of inhaled corticosteroids. However, Dr. Yousef said that at least two published studies found no significant improvement in patients treated with twice the inhaled corticosteroid dose, compared with placebo (Thorax 2004;59;550-6 and Lancet 2004;363:271-5). It remains unknown what kind of impact even larger doses would have on the need for oral corticosteroids.

To find out, Dr. Yousef, chief of the division of pediatric allergy/immunology at Nemours Children’s Clinic, Wilmington, Del., and his associates collected data on 197 children aged 2-17 years who had been maintained on inhaled corticosteroids for at least 90 days.

The children were randomly assigned to one of three 12-day treatment protocols to be implemented if they developed an exacerbation of their asthma symptoms: twice their maintenance dose, four times their maintenance dose, or eight times their maintenance dose. Physicians assessed the children’s clinical status with symptom scores via telephone calls or clinic visits following initiation of therapy protocol.

The researchers excluded children who had chronic, unstable asthma, those who had lung pathology as well as asthma, and those who had additional medical conditions or a history of smoking or substance abuse. An increase in symptoms was defined as a decrease in peak flow values of 50%-80% of the patient’s best and/or increased cough and/or wheezing present for 24-72 hours responsive to beta-agonist therapy. Patients were required to report symptoms within 72 hours of onset.

Symptom scores were obtained via telephone on day 3, 7, and 14 of the treatment plan and included the presence and severity of day and nighttime cough and wheeze, shortness of breath, and exercise intolerance. Scores ranged from 0 to 4 for each symptom, with 0 meaning none and 4 meaning severe.

The primary outcome was the frequency of need to progress to therapy with systemic corticosteroids.

Of the 197 patients, 82 completed the increased dosing protocol, and their mean age was 6 years. Among those 82 patients, only four required treatment with systemic corticosteroids: two from the double maintenance dose group and two from the quadruple maintenance dose group.

Dr. Yousef reported that there was no significant difference in mean symptom scores among the three groups at baseline or at days 3, 7, and 14. In all groups, the scores improved over the course of treatment regardless of the dosage of inhaled corticosteroids administered. There was no significant difference in the time from onset of symptoms to the initiation of the study protocol in the three groups and no difference between patients who did and did not require treatment with systemic corticosteroids.

The results suggest "that it was not the medication alone that improved the outcome," the researchers wrote in their abstract. "It is possible that placebo effect of administering a medication, close contact with a supervising physician, and contact early in the course of an exacerbation played a significant role in obtaining this outcome."

Dr. Yousef said that he had no relevant financial conflicts to disclose.

SAN FRANCISCO – Doubling, quadrupling, or octupling the maintenance dose of inhaled corticosteroids in the early course of an asthma exacerbation did not result in significant differences in symptoms or in the use of oral corticosteroids, results from a randomized controlled study demonstrated.

"If you strongly feel that the patient is deteriorating, you can use clinical judgment and give them an oral corticosteroid; but don’t increase the inhaled corticosteroid dose – it’s not going to make a difference," Dr. Ejaz Yousef said in an interview during a poster session at the annual meeting of the American Academy of Allergy, Asthma, and Immunology. "Increasing the dose of inhaled corticosteroid has some consequences. It can suppress the hypothalamic-pituitary adrenal axis, for example."

As an alternative to oral corticosteroids for the management of asthma exacerbations, the 1997 National Asthma Education and Prevention Program recommended doubling the maintenance dose of inhaled corticosteroids. However, Dr. Yousef said that at least two published studies found no significant improvement in patients treated with twice the inhaled corticosteroid dose, compared with placebo (Thorax 2004;59;550-6 and Lancet 2004;363:271-5). It remains unknown what kind of impact even larger doses would have on the need for oral corticosteroids.

To find out, Dr. Yousef, chief of the division of pediatric allergy/immunology at Nemours Children’s Clinic, Wilmington, Del., and his associates collected data on 197 children aged 2-17 years who had been maintained on inhaled corticosteroids for at least 90 days.

The children were randomly assigned to one of three 12-day treatment protocols to be implemented if they developed an exacerbation of their asthma symptoms: twice their maintenance dose, four times their maintenance dose, or eight times their maintenance dose. Physicians assessed the children’s clinical status with symptom scores via telephone calls or clinic visits following initiation of therapy protocol.

The researchers excluded children who had chronic, unstable asthma, those who had lung pathology as well as asthma, and those who had additional medical conditions or a history of smoking or substance abuse. An increase in symptoms was defined as a decrease in peak flow values of 50%-80% of the patient’s best and/or increased cough and/or wheezing present for 24-72 hours responsive to beta-agonist therapy. Patients were required to report symptoms within 72 hours of onset.

Symptom scores were obtained via telephone on day 3, 7, and 14 of the treatment plan and included the presence and severity of day and nighttime cough and wheeze, shortness of breath, and exercise intolerance. Scores ranged from 0 to 4 for each symptom, with 0 meaning none and 4 meaning severe.

The primary outcome was the frequency of need to progress to therapy with systemic corticosteroids.

Of the 197 patients, 82 completed the increased dosing protocol, and their mean age was 6 years. Among those 82 patients, only four required treatment with systemic corticosteroids: two from the double maintenance dose group and two from the quadruple maintenance dose group.

Dr. Yousef reported that there was no significant difference in mean symptom scores among the three groups at baseline or at days 3, 7, and 14. In all groups, the scores improved over the course of treatment regardless of the dosage of inhaled corticosteroids administered. There was no significant difference in the time from onset of symptoms to the initiation of the study protocol in the three groups and no difference between patients who did and did not require treatment with systemic corticosteroids.

The results suggest "that it was not the medication alone that improved the outcome," the researchers wrote in their abstract. "It is possible that placebo effect of administering a medication, close contact with a supervising physician, and contact early in the course of an exacerbation played a significant role in obtaining this outcome."

Dr. Yousef said that he had no relevant financial conflicts to disclose.

SAN FRANCISCO – Doubling, quadrupling, or octupling the maintenance dose of inhaled corticosteroids in the early course of an asthma exacerbation did not result in significant differences in symptoms or in the use of oral corticosteroids, results from a randomized controlled study demonstrated.

"If you strongly feel that the patient is deteriorating, you can use clinical judgment and give them an oral corticosteroid; but don’t increase the inhaled corticosteroid dose – it’s not going to make a difference," Dr. Ejaz Yousef said in an interview during a poster session at the annual meeting of the American Academy of Allergy, Asthma, and Immunology. "Increasing the dose of inhaled corticosteroid has some consequences. It can suppress the hypothalamic-pituitary adrenal axis, for example."

As an alternative to oral corticosteroids for the management of asthma exacerbations, the 1997 National Asthma Education and Prevention Program recommended doubling the maintenance dose of inhaled corticosteroids. However, Dr. Yousef said that at least two published studies found no significant improvement in patients treated with twice the inhaled corticosteroid dose, compared with placebo (Thorax 2004;59;550-6 and Lancet 2004;363:271-5). It remains unknown what kind of impact even larger doses would have on the need for oral corticosteroids.

To find out, Dr. Yousef, chief of the division of pediatric allergy/immunology at Nemours Children’s Clinic, Wilmington, Del., and his associates collected data on 197 children aged 2-17 years who had been maintained on inhaled corticosteroids for at least 90 days.

The children were randomly assigned to one of three 12-day treatment protocols to be implemented if they developed an exacerbation of their asthma symptoms: twice their maintenance dose, four times their maintenance dose, or eight times their maintenance dose. Physicians assessed the children’s clinical status with symptom scores via telephone calls or clinic visits following initiation of therapy protocol.

The researchers excluded children who had chronic, unstable asthma, those who had lung pathology as well as asthma, and those who had additional medical conditions or a history of smoking or substance abuse. An increase in symptoms was defined as a decrease in peak flow values of 50%-80% of the patient’s best and/or increased cough and/or wheezing present for 24-72 hours responsive to beta-agonist therapy. Patients were required to report symptoms within 72 hours of onset.

Symptom scores were obtained via telephone on day 3, 7, and 14 of the treatment plan and included the presence and severity of day and nighttime cough and wheeze, shortness of breath, and exercise intolerance. Scores ranged from 0 to 4 for each symptom, with 0 meaning none and 4 meaning severe.

The primary outcome was the frequency of need to progress to therapy with systemic corticosteroids.

Of the 197 patients, 82 completed the increased dosing protocol, and their mean age was 6 years. Among those 82 patients, only four required treatment with systemic corticosteroids: two from the double maintenance dose group and two from the quadruple maintenance dose group.

Dr. Yousef reported that there was no significant difference in mean symptom scores among the three groups at baseline or at days 3, 7, and 14. In all groups, the scores improved over the course of treatment regardless of the dosage of inhaled corticosteroids administered. There was no significant difference in the time from onset of symptoms to the initiation of the study protocol in the three groups and no difference between patients who did and did not require treatment with systemic corticosteroids.

The results suggest "that it was not the medication alone that improved the outcome," the researchers wrote in their abstract. "It is possible that placebo effect of administering a medication, close contact with a supervising physician, and contact early in the course of an exacerbation played a significant role in obtaining this outcome."

Dr. Yousef said that he had no relevant financial conflicts to disclose.

SAN FRANCISCO – Doubling, quadrupling, or octupling the maintenance dose of inhaled corticosteroids in the early course of an asthma exacerbation did not result in significant differences in symptoms or in the use of oral corticosteroids, results from a randomized controlled study demonstrated.

"If you strongly feel that the patient is deteriorating, you can use clinical judgment and give them an oral corticosteroid; but don’t increase the inhaled corticosteroid dose – it’s not going to make a difference," Dr. Ejaz Yousef said in an interview during a poster session at the annual meeting of the American Academy of Allergy, Asthma, and Immunology. "Increasing the dose of inhaled corticosteroid has some consequences. It can suppress the hypothalamic-pituitary adrenal axis, for example."

As an alternative to oral corticosteroids for the management of asthma exacerbations, the 1997 National Asthma Education and Prevention Program recommended doubling the maintenance dose of inhaled corticosteroids. However, Dr. Yousef said that at least two published studies found no significant improvement in patients treated with twice the inhaled corticosteroid dose, compared with placebo (Thorax 2004;59;550-6 and Lancet 2004;363:271-5). It remains unknown what kind of impact even larger doses would have on the need for oral corticosteroids.

To find out, Dr. Yousef, chief of the division of pediatric allergy/immunology at Nemours Children’s Clinic, Wilmington, Del., and his associates collected data on 197 children aged 2-17 years who had been maintained on inhaled corticosteroids for at least 90 days.

The children were randomly assigned to one of three 12-day treatment protocols to be implemented if they developed an exacerbation of their asthma symptoms: twice their maintenance dose, four times their maintenance dose, or eight times their maintenance dose. Physicians assessed the children’s clinical status with symptom scores via telephone calls or clinic visits following initiation of therapy protocol.

The researchers excluded children who had chronic, unstable asthma, those who had lung pathology as well as asthma, and those who had additional medical conditions or a history of smoking or substance abuse. An increase in symptoms was defined as a decrease in peak flow values of 50%-80% of the patient’s best and/or increased cough and/or wheezing present for 24-72 hours responsive to beta-agonist therapy. Patients were required to report symptoms within 72 hours of onset.

Symptom scores were obtained via telephone on day 3, 7, and 14 of the treatment plan and included the presence and severity of day and nighttime cough and wheeze, shortness of breath, and exercise intolerance. Scores ranged from 0 to 4 for each symptom, with 0 meaning none and 4 meaning severe.

The primary outcome was the frequency of need to progress to therapy with systemic corticosteroids.

Of the 197 patients, 82 completed the increased dosing protocol, and their mean age was 6 years. Among those 82 patients, only four required treatment with systemic corticosteroids: two from the double maintenance dose group and two from the quadruple maintenance dose group.

Dr. Yousef reported that there was no significant difference in mean symptom scores among the three groups at baseline or at days 3, 7, and 14. In all groups, the scores improved over the course of treatment regardless of the dosage of inhaled corticosteroids administered. There was no significant difference in the time from onset of symptoms to the initiation of the study protocol in the three groups and no difference between patients who did and did not require treatment with systemic corticosteroids.

The results suggest "that it was not the medication alone that improved the outcome," the researchers wrote in their abstract. "It is possible that placebo effect of administering a medication, close contact with a supervising physician, and contact early in the course of an exacerbation played a significant role in obtaining this outcome."

Dr. Yousef said that he had no relevant financial conflicts to disclose.

SAN FRANCISCO – Doubling, quadrupling, or octupling the maintenance dose of inhaled corticosteroids in the early course of an asthma exacerbation did not result in significant differences in symptoms or in the use of oral corticosteroids, results from a randomized controlled study demonstrated.

"If you strongly feel that the patient is deteriorating, you can use clinical judgment and give them an oral corticosteroid; but don’t increase the inhaled corticosteroid dose – it’s not going to make a difference," Dr. Ejaz Yousef said in an interview during a poster session at the annual meeting of the American Academy of Allergy, Asthma, and Immunology. "Increasing the dose of inhaled corticosteroid has some consequences. It can suppress the hypothalamic-pituitary adrenal axis, for example."

As an alternative to oral corticosteroids for the management of asthma exacerbations, the 1997 National Asthma Education and Prevention Program recommended doubling the maintenance dose of inhaled corticosteroids. However, Dr. Yousef said that at least two published studies found no significant improvement in patients treated with twice the inhaled corticosteroid dose, compared with placebo (Thorax 2004;59;550-6 and Lancet 2004;363:271-5). It remains unknown what kind of impact even larger doses would have on the need for oral corticosteroids.

To find out, Dr. Yousef, chief of the division of pediatric allergy/immunology at Nemours Children’s Clinic, Wilmington, Del., and his associates collected data on 197 children aged 2-17 years who had been maintained on inhaled corticosteroids for at least 90 days.

The children were randomly assigned to one of three 12-day treatment protocols to be implemented if they developed an exacerbation of their asthma symptoms: twice their maintenance dose, four times their maintenance dose, or eight times their maintenance dose. Physicians assessed the children’s clinical status with symptom scores via telephone calls or clinic visits following initiation of therapy protocol.

The researchers excluded children who had chronic, unstable asthma, those who had lung pathology as well as asthma, and those who had additional medical conditions or a history of smoking or substance abuse. An increase in symptoms was defined as a decrease in peak flow values of 50%-80% of the patient’s best and/or increased cough and/or wheezing present for 24-72 hours responsive to beta-agonist therapy. Patients were required to report symptoms within 72 hours of onset.

Symptom scores were obtained via telephone on day 3, 7, and 14 of the treatment plan and included the presence and severity of day and nighttime cough and wheeze, shortness of breath, and exercise intolerance. Scores ranged from 0 to 4 for each symptom, with 0 meaning none and 4 meaning severe.

The primary outcome was the frequency of need to progress to therapy with systemic corticosteroids.

Of the 197 patients, 82 completed the increased dosing protocol, and their mean age was 6 years. Among those 82 patients, only four required treatment with systemic corticosteroids: two from the double maintenance dose group and two from the quadruple maintenance dose group.

Dr. Yousef reported that there was no significant difference in mean symptom scores among the three groups at baseline or at days 3, 7, and 14. In all groups, the scores improved over the course of treatment regardless of the dosage of inhaled corticosteroids administered. There was no significant difference in the time from onset of symptoms to the initiation of the study protocol in the three groups and no difference between patients who did and did not require treatment with systemic corticosteroids.

The results suggest "that it was not the medication alone that improved the outcome," the researchers wrote in their abstract. "It is possible that placebo effect of administering a medication, close contact with a supervising physician, and contact early in the course of an exacerbation played a significant role in obtaining this outcome."

Dr. Yousef said that he had no relevant financial conflicts to disclose.