‘Early growth’ linked to asthma

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20 January 2012 Last updated at 08:21 GMT Researchers studied over 5,000 children Babies who grow rapidly in the first three months of life may be more likely to develop asthma as children, say Dutch researchers.

They found "accelerated weight gain" was linked to a higher chance of symptoms such as wheezing.

The study of 5,125 children by the Erasmus Medical Center in Rotterdam suggested no connection with earlier impaired growth in the womb.

Asthma UK said parents should keep following official baby-feeding advice.

The origins of asthma are still not fully understood, although many researchers believe there is some connection with the way the foetus develops and grows through pregnancy.

The study in the American Journal of Respiratory and Critical Care Medicine compared pregnancy and baby records measuring foetal and postnatal weight gain.

'Critical period'

The babies were then followed up at yearly intervals and their parents questioned about breathing symptoms, as the presence of these can be a reasonable indicator of whether or not a child will go on to develop full blown asthma.

They found that, compared with babies whose growth followed the normal pattern in the months after birth, babies who gained weight rapidly were 44% more likely to suffer wheezing, 22% more likely to have shortness of breath and 30% more likely to have persistent phlegm.

There was no apparent relationship between the fast-growing babies and being underweight in the womb.

Although routine foetal measurement can be imprecise, this suggested that the sudden weight gain was not necessarily the baby "catching up" from reduced growth in the womb.

Dr Liesbeth Dujits said that early infancy might be a "critical period" for asthma development.

She said: "We know that low birth weight is associated with an increased risk of asthma symptoms, but the effects of specific foetal and infant growth patterns had not been examined yet.

"Our results suggest that the relationship between infant weight gain and asthma symptoms is not due to the accelerated growth of foetal growth-restricted infants only.

"While the mechanisms underlying this are unclear, accelerated weight growth in early life might adversely affect lung growth."

Leanne Metcalf, from Asthma UK, said that while the study offered more insight into the possible development of asthma, it was too early for parents to change the way they cared for their children.

"This is an interesting preliminary study, but parents should follow existing advice from health professionals when it comes to feeding their babies in the first few months.

"We know that early life does appear to influence the risk of developing asthma later on, but there are a lot of other potential factors that have to be taken into consideration."

Source BBC

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Asthma drugs may increase attacks in kids: report

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By Genevra Pittman

NEW YORK | Tue Oct 25, 2011 5:19pm EDT

NEW YORK (Reuters Health) - One class of drugs used to prevent wheezing and shortness of breath in people with asthma may increase kids' risk of being hospitalized for an asthma attack, according to a new analysis from the U.S. Food and Drug Administration.

However, researchers said, it's possible that when the drugs, called long-acting beta-agonists or LABAs, are used in combination with inhaled corticosteroid medications, that extra risk disappears.

"These studies confirm our recommendations at the FDA that are already (on drug labels) for children and adolescents to use inhaled corticosteroids and LABAs together in one asthma product," said Dr. Ann McMahon, who led the study.

But, she added, the researchers weren't completely convinced from the data they had that inhaled corticosteroids take away all extra risk.

According to the Centers for Disease Control and Prevention, seven million children in the U.S. have asthma (about nine percent), and the rate has been climbing steadily in recent years.

Some kids and adults with asthma are prescribed LABAs to relax muscles around the airway and prevent symptoms like wheezing. But there's also evidence that long-term use of the drugs may slightly increase the risk of sudden serious symptoms.

LABAs are also used by people with chronic obstructive pulmonary disorder, or COPD.

The FDA report combines safety data from over 100 studies including about 60,000 people with asthma. The original trials were done by companies that market LABAs.

The drugs include Merck's Foradil and GlaxoSmithKline's Serevent.

Compared to all patients who didn't take LABAs, adults and kids who were prescribed the drugs were 27 percent more likely to end up in the hospital, or in rare cases die or require intubation, because of an asthma attack.

That extra risk was greatest in the youngest study participants. Kids between age four and 11 who were taking a LABA were 67 percent more likely to have an asthma-related hospitalization than those who weren't getting the medication.

That means that over a one-year period, there would be an extra three hospitalizations for every 100 kids taking LABAs.

A small number of people of all ages who were regularly taking an inhaled corticosteroid together with a LABA didn't seem to have any extra risk of hospitalization, according to the report published in Pediatrics.

"Although we were able to be somewhat reassured... it was a small enough sample that we didn't feel entirely confident, and we need to have further analysis," McMahon told Reuters Health.

The finding of an extra hospitalization risk in people taking LABAs alone isn't new. Last year, after other research suggested that risk, the FDA began requiring drugmakers to write on LABA labels that the drugs should not be used without a long-term asthma control medication like an inhaled corticosteroid.

Some asthma medications, including GlaxoSmithKline's Advair and AstraZeneca's Symbicort, contain both a LABA and corticosteroid. The FDA recommends such combined products for kids with asthma.

"The thing that's new in this paper... is they've highlighted the fact that younger-age children may have a higher risk" when taking a LABA alone, said Dr. Scott Weiss, as asthma researcher from Harvard Medical School in Boston who was not involved in the report.

Weiss reported financial ties to the drug company Novartis, and was formerly linked to GlaxoSmithKline and AstraZeneca.

McMahon said the analysis wasn't designed to examine the reason for extra risks due to LABA use in kids, and didn't want to speculate. But Weiss said it could be related to their smaller airways.

He agreed that it's important for future studies to look directly at the issue of serious attacks in LABA users to determine the underlying cause behind those attacks -- and whether they're directly due to the medications themselves.

Still, he told Reuters Health, "Nobody is really prescribing a LABA on its own -- that's basically off the market."

SOURCE: bit.ly/txNP6y Pediatrics, online October 24, 2011.

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Asthma tied to poorer diabetes control in kids

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By Amy Norton

NEW YORK | Mon Sep 26, 2011 2:16pm EDT

NEW YORK (Reuters Health) - Kids with diabetes may have a higher-than-average rate of asthma, and those with both conditions seem to have a tougher time keeping their blood sugar under control, a study out Monday suggests.

Researchers found that among 2,000 3- to 21-year-olds with diabetes, 11 percent had asthma -- higher than the roughly 9 percent rate among children and young adults in the U.S.

The difference was bigger when the researchers looked at the 311 young people with type 2 diabetes, the form associated with obesity and usually diagnosed in adults.

In that group, 16 percent had asthma, compared with 10 percent of those with type 1 diabetes.

Type 1 diabetes is caused by an abnormal immune system reaction that kills off the pancreatic cells that make insulin, a hormone that helps shuttle sugar from the blood and into body cells to be used for energy. People with the disease have to take shots of synthetic insulin (or use an insulin pump) every day to keep their blood sugar levels normalized.

In this study, kids with both type 1 diabetes and asthma were more likely to have poor blood sugar control than their peers who were asthma-free: 15.5 percent, versus 9 percent.

"Poor" blood sugar control meant having a hemoglobin A1C level of more than 9.5 percent. Hemoglobin A1C is a measure of long-term blood sugar control, and experts say it should be kept below 7 percent in adults, while children's can go as high as 8.5 percent depending on their age.

The reasons for the findings, which appear in the journal Pediatrics, are not completely clear.

But the higher rate of asthma among young people with type 2 diabetes suggests a role for obesity, according to lead researcher Mary Helen Black, of the department of research and evaluation at Kaiser Permanente Southern California.

"It's pretty well-established that there's an obesity-asthma connection," Black told Reuters Health in an interview.

As for why young people with type 1 diabetes and asthma had poorer blood sugar control, one possibility is that there is a "real biological connection," Black said.

Some past research, for example, has found that people with poorly controlled diabetes are more likely to show dips in lung function over time than those with well-controlled diabetes. But the reasons for that are unknown.

On the other hand, Black said, it may simply be tougher for kids with type 1 diabetes to control their blood sugar when they have another chronic health problem.

"It can be incredibly challenging to manage both conditions," Black said.

The researchers did find that when kids with both diseases were on asthma medication, their blood sugar control was better.

In particular, poor blood sugar control was seen in less than 5 percent of those taking asthma drugs called leukotriene modifiers (sold under the brand-names Singulair, Accolate and Zyflo).

That compared with about 30 percent of type 1 diabetics who were not on medication for their asthma.

The researchers are not sure if that means there's an effect of the asthma drugs themselves. It may just be that kids with better-controlled asthma are also more likely to have well-controlled diabetes, according to Black.

She said the bottom line for doctors and parents is to be aware that kids with diabetes may have a somewhat higher rate of asthma -- and that those with both may have more trouble with blood sugar control.

If parents notice potential signs of asthma -- like wheezing, coughing or breathing problems that are not related to a cold or other infection -- they should talk to their child's doctor, Black said.

SOURCE: bit.ly/pTAIqi Pediatrics, online September 26, 2011.

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FDA: Ozone-Unfriendly Asthma Inhalers Won't Be Available After 2011

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Asthma patients who rely on over-the-counter inhalers will need to switch to prescription-only alternatives as part of the federal government's latest attempt to protect the Earth's atmosphere.

The Food and Drug Administration said Thursday patients who use the epinephrine inhalers to treat mild asthma will need to switch by Dec. 31 to other types that do not contain chlorofluorocarbons, an aerosol substance once found in a variety of spray products.

The action is part of an agreement signed by the U.S. and other nations to stop using substances that deplete the ozone layer, a region in the atmosphere that helps block harmful ultraviolet rays from the Sun.

But the switch to a greener inhaler will cost consumers more. Epinephrine inhalers are available via online retailers for around $20, whereas the alternatives, which contain the drug albuterol, range from $30 to $60.

The FDA finalized plans to phase out the products in 2008 and currently only Armstrong Pharmaceutical's Primatene mist is available in the U.S. Other manufacturers have switched to an environmentally-friendly propellant called hydrofluoroalkane. Both types of inhalers offer quick-relief to symptoms like shortness of breath and chest tightness, but the environmentally-friendly inhalers are only available via prescription.

"If you rely on an over-the-counter inhaler to relieve your asthma symptoms, it is important that you contact a health care professional to talk about switching to a different medicine to treat your asthma," said Badrul Chowdhury, FDA's director of pulmonary drug division.

Chowdhury told reporters and doctors via teleconference that "in the worst case scenario we are looking at 1 to 2 million people using" Primatene, adding that most of those patients likely use multiple medications to treat their asthma.

—By MATTHEW PERRONE

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