Use Of Antiasthmatic Drugs Research Articles

Healthcare costs and resources utilization in children with difficult-to-control asthma treated with biologic therapies: A population-based cohort study.

Asthma is one of the most common diseases in children, with a variable range of severity. In recent years, treatment for severe asthma has been largely improved by the availability of targeted biologic therapies. Nevertheless, studies reporting real-world data and cost-effectiveness analyses are lacking. The aim of this study was to evaluate, on a population-based cohort of children with asthma, the impact of the treatment with biologics on healthcare service utilization and associated costs. Data were retrieved from Healthcare Utilization database of Lombardy region (Italy). A cohort of 46 asthmatic children aged 6-11 in treatment with dupilumab, mepolizumab or omalizumab was identified during 2017-2021. We compared healthcare resources use between the year before ("baseline period") and the year after the treatment initiation ("follow-up period"). Average 1-year healthcare costs were also calculated. Comparing the baseline with the follow-up period, the number of patients with at least one exacerbation-related hospitalization and ER access decreased by 75.0% and 85.7%, respectively. The use of biologic agents, namely omalizumab, mepolizumab and dupilumab, significantly reduced oral corticosteroids (OCS), short-acting β2-agonists and the association inhaled corticosteroids/long-acting β2-agonists use. ER admissions for non-respiratory causes were also significantly reduced, while discontinuation rate was low (6.5%). The overall costs increased, due to the costs of the biologic agents, but the hospital admission-related costs due to respiratory causes reduced significantly. Our real-world investigation suggests that biologic agents reduced hospital admissions for respiratory causes and use of anti-asthmatic drugs, including OCS. However, long-term healthcare sustainability still needs more in-depth assessments.

Effectiveness and economic impact of Dupilumab in asthma: a population-based cohort study

RationaleSevere asthma is burdened by relevant socio-economic and clinical impact. Randomized controlled trials on Dupilumab showed efficacy and a good safety profile, but post-market studies are needed.ObjectivesTo evaluate the impact of Dupilumab on (i) the use of anti-asthmatic drugs, including oral corticosteroids (OCS), (ii) the rates of asthma exacerbation-related hospital admissions, and (iii) the healthcare costs in patients with asthma.MethodsData were retrieved from Healthcare Utilization database of Lombardy region (Italy). We compared healthcare resources use between the 6 months after Dupilumab initiation (“post-intervention period”) and (i) the 6 months before Dupilumab initiation (“wash-out period”) and (ii) the corresponding 6 months of the prior year (“pre-intervention period”).Main resultsIn a cohort of 176 patients, Dupilumab significantly reduced anti-asthmatic drugs use (including OCS and short-acting β2-agonists, inhaled corticosteroids (ICS)/long-acting β2-agonists and ICS alone) when comparing the “pre-intervention” to the “post-intervention” period. When considering hospital admissions, we observed a not statistically or marginally significant reduction between both periods before Dupilumab and the post-intervention period. Six-months discontinuation rate was 8%. Overall healthcare costs had a tenfold increase between the “pre-intervention” and “post-intervention” period, which was mainly led by the biologic drug cost. Conversely, expenditures connected to hospital admissions did not change.ConclusionsOur real-world investigation suggests that Dupilumab reduced anti-asthmatic drugs use, including OCS, in comparison to a corresponding period in the prior year. However, long-term healthcare sustainability remains an open issue.

Asthma History, Current Situation, an Overview of Its Control History, Challenges, and Ongoing Management Programs: An Updated Review.

Asthma is a disease of the airways that is characterized by chronic inflammation and disordered airway function. The purpose of writing the current review paper is to review the history, current situation, control history, challenges, and ongoing management programs of asthma. Some official websites of known respiratory professional bodies were consulted for asthma guidelines, and information from Google Scholar® and PubMed® was also consulted. We reviewed around two hundred eight papers, and then, inclusion and exclusion criteria were applied to prepare this manuscript. Out of these papers, thirty papers, factsheets, and some official websites were used to prepare this manuscript. Physicians should follow already existing asthma guidelines in order to manage asthma. All prescribed medications should be continued. The government should make and adopt more strategies to promote the rational use of anti-asthmatic drugs and healthcare facilities and also make plans to disseminate more awareness among people about the schemes and programs made for safeguarding people against this life-threatening disease. We have done so much advancement to fight against this deadly disease, and we still need time to make the globe asthma-free. The number of people suffering from asthma is more than the number of people suffering from HIV infection and tuberculosis. Understanding the recommendations of professional bodies will assist in medical decision-making in asthma management. The individual needs of patients should be considered by healthcare professionals.

Allergen immunotherapy effectively reduces the risk of exacerbations and lower respiratory tract infections in both seasonal and perennial allergic asthma: a nationwide epidemiological study.

Allergic asthma is associated with increased risk of respiratory tract infections and exacerbations. It remains unclear whether this susceptibility is conditioned by seasonal or by perennial allergy. To investigate perennial allergy compared with seasonal allergy as a risk factor for lower respiratory tract infections and exacerbations in asthma and whether this risk can be reduced by allergen immunotherapy (AIT). This is a prospective register-based nationwide study of 18-44-year-olds treated with AIT during 1995-2014. Based on the type of AIT and use of anti-asthmatic drugs, patients were subdivided into two groups: perennial allergic asthma (PAA) versus seasonal allergic asthma (SAA). Data on antibiotics against lower respiratory tract infections (LRTI) and oral corticosteroids for exacerbations were analysed before starting AIT (baseline) and 3 years after completing AIT (follow-up). We identified 2688 patients with asthma treated with AIT, of whom 1249 had PAA and 1439 had SAA. At baseline, patients with SAA had more exacerbations (23.8% versus 16.5%, p≤0.001), but there were no differences in LRTI. During the 3-year follow-up, we observed a highly significant reduction of exacerbations with an average decrease of 57% in PAA and 74% in SAA. In addition, we observed a significant reduction of LRTI in both PAA and SAA: 17% and 20% decrease, respectively. AIT effectively reduced the risk of exacerbations and lower respiratory tract infections in both seasonal and perennial allergic asthma. Perennial allergy is seemingly not a stronger risk factor for respiratory infections and exacerbations than seasonal allergy.

Prospective study of disease persistence and lung function trajectories of childhood asthma.

A proportion of asthmatic children outgrow their disease by adulthood, but there are limited data on predictors for asthma persistence. This prospective study characterized the trajectory of spirometric indices and identified predictors for the persistence of childhood asthma. Chinese asthmatic children aged 6-15years from pediatric allergy clinic underwent annual visits for ≥5years and until their adulthood. Pre-bronchodilator spirometry and anti-asthma medications were recorded at baseline and then at least annually. Asthma resolution was defined when patients were free from asthma symptoms and use of anti-asthma drugs for ≥2years. Logistic regression was used to identify predictors for asthma persistence. Generalized estimating equation was used to analyze longitudinal changes in lung function parameters in relation to asthma persistence. 181 asthmatic children aged [mean (SD)] 10.0 (2.7) years were followed for [mean (SD)] 12.5 (2.8) years. One third of them outgrew asthma during follow-up. Female was 3.36 times more likely to have persistent asthma. Inhaled corticosteroid (ICS) treatment ever and frequent asthma exacerbation (AE) predicted asthma persistence with respective odds ratios of 3.19 (95% confidence interval [CI] 1.44-7.09) and 3.05 (95% CI 1.39-6.68). Persistent asthma was inversely associated with baseline forced expiratory volume in 1-second (FEV1 %) with an odds ratio of 0.96 (95% CI 0.93-1.00). Throughout follow-up, patients with persistent asthma had generally lower forced expiratory indices than those with asthma resolution. Children with persistent asthma experienced poorer lung function growth. Female, ICS ever, and frequent AE predicted persistent asthma. Patients with persistent asthma had lower forced expiratory indices and poorer lung function growth into adulthood.

STUDY OF THE QUALIT Y OF PHARMACEUTICAL INFORMATION FOR PATIENTS FROM THE PERSPECTIVE OFTHE PROPER USE OF ANTI-ASTHMATIC DRUGS

RELEVANCE. Bronchial asthma, along with cardiovascular and oncological diseases, is one of the three most common chronic non- communicable diseases. For the most part, anti-asthmatic drugs (LP) are presented in the form of aerosols, powders, solutions for inhalation and other dosage forms intended for administration directly into the human respiratory tract. It is obvious that misunderstanding of the method of application and / or insufficient effectiveness of LP due to improper use can lead to a decrease in patients’ adherence to the prescribed therapy. In this regard, the availability of pharmaceutical information in the instructions becomes important, i.e. the more accessible the information in the instructions is to the patient, the higher the probability of proper use of the drug, maintaining patient compliance and preserving the patient’s quality of life. PURPOSE. The aim of the study was to analyze the completeness of pharmaceutical information provided in the instructions for the medical use of anti-asthmatic drugs (LP) and on the websites of manufacturing companies, from the standpoint of patients’ compliance with the rules for the use of LP. The main objectives of the analysis were: identification of the proportion of anti- asthmatic drugs that have a detailed scheme of use in the instructions; analysis of the instructions of anti-asthmatic drugs from the position of having indications of additional features of the use / use of drugs; analysis of instructions for anti-asthmatic drugs, the use of which is possible for groups of patients with physical or cognitive disabilities; identification of the share of companies producing anti-asthmatic drugs that support patients by conducting a specialized consulting service on the use of drugs. METHODS. The assessment of the quality of pharmaceutical information for patients was carried out on the basis of an analysis of 165 instructions for the medical use of pharmacotherapeutic groups of drugs designated in GINA-2021 (Global Initiative for Asthma-2021) and Federal Clinical Guidelines for the Treatment of Bronchial Asthma of the Russian Respiratory Society (2019) as anti-asthmatic drugs. The analysis was also carried out in relation to the information content of the websites of anti-asthmatic LP manufacturers, additionally, by creating a direct search query, the presence of a private page on the Internet for specific LP was determined. In the course of the research, methods of logical, comparative analysis, as well as generalization and grouping were used. To process the results obtained, the Excel computer program of the Microsoft Office 10 package was used. RESULTS. As a result of the analysis, it was revealed that the vast majority of anti-asthmatic drugs of all the studied pharmacotherapeutic groups are intended for administration directly into the respiratory tract, the article presents the results of a study on the ratio of inhaled and non-inhaled dosage forms in the context of the analyzed pharmacotherapeutic groups. The article presents data on the proportion of anti-asthmatic drugs that have a detailed description in the instructions in addition to the standard method of application (figure, diagram, pictogram) the method of introduction / use of LP. The fact of the absence of a detailed method of application in the instructions of various pharmacotherapeutic groups has been established. The results of the analysis of the number of instructions with the additional properties of LP indicated in them, allowing the use of LP data in patients with physical or cognitive characteristics (limitations), are presented. The number of companies producing anti-asthmatic drugs that have posted detailed information for consumers regarding the use of these drugs on their websites, as well as the number of drugs that have their own website, has been revealed. CONCLUSION. The information in the instructions for the medical use of anti-asthmatic drugs and on the official websites of the manufacturing companies (holders of registration certificates) of the studied drugs is not always exhaustive in terms of the use of inhaled dosage forms, which does not fully ensure the safe and effective receipt of anti-asthmatic pharmacotherapy. According to the authors, improving the quality of information for patients about the rules of using drugs for the treatment of bronchial asthma will simplify the use of dosage forms specific for its therapy, increase patients’ adherence to prescribed pharmacotherapy, reduce the risks from insufficient effectiveness of anti-asthmatic pharmacotherapy and preserve the quality of life of patients associated with the disease.

Use of Antiasthmatic Drugs and the Risk of Type 1 Diabetes in Children: A Nationwide Case-Cohort Study.

Asthma has been reported to be associated with an increased risk of type 1 diabetes mellitus in childhood, but the reasons are unclear. We examined whether the use of antiasthmatic drugs was associated with the development of type 1 diabetes in childhood in a nationwide, register-based case-cohort study. We identified all children who were born January 1, 1995, through December 31, 2008, in Finland and diagnosed with type 1 diabetes by 2010 (n=3,342). A 10% random sample from each birth-year cohort was selected as a reference cohort (n=80,909). Information on all dispensed antiasthmatic drugs (Anatomical Therapeutic Chemical classification system code R03) during 1995-2009 was obtained, and associations between the use of antiasthmatic drugs and the development of type 1 diabetes were investigated using time-dependent and time-sequential Cox regression models. Dispensed inhaled corticosteroids and inhaled β-agonists were associated with an increased risk of type 1 diabetes after adjusting for other antiasthmatic drugs, asthma, sex, and birth decade (hazard ratio=1.29, 95% confidence interval: 1.09, 1.52, and hazard ratio=1.22, 95% confidence interval: 1.07, 1.41, respectively). These findings suggest that children using inhaled corticosteroids or inhaled β-agonists might be at increased risk of type 1 diabetes.

Validity of asthma diagnoses and patterns of anti-asthmatic drug use in a cohort of 2053 Danish children.

Background and AimsWhen investigating and treating asthma in children, diagnosing must be precise and valid. There is a need for studies researching asthma in children showing how to use registry‐based, epidemiological data. We examined the feasibility and validity of using anti‐asthmatic drug prescription data to identify children with asthma and assessed medication patterns in children with and without confirmed asthma.MethodsWe used population‐based Danish prescription data and hospital discharge registries to identify all children aged 0 to 14 years who had redeemed at least one prescription for an inhaled anti‐asthmatic drug. Individual asthma cases were validated by hospital discharge information and by their treating general practitioners according to international asthma guidelines.ResultsIn total, 2053 children, out of a population of 20181, had redeemed at least one prescription of any inhaled anti‐asthmatic drug. The positive predictive value (PPV) of having two different asthma medications prescribed in 1 year was 80.2% for presence of true asthma, with a sensitivity of 59%. Corresponding estimates of PPV/sensitivity of at least one prescription for an inhaled corticosteroid (ICS) were 79% and 58%, respectively, while the true asthma PPV with at least one LABA prescription increased to 97%. Among children with confirmed asthma, one‐third had not used Beta2‐agonist therapy as part of their treatment. Conversely, among children without confirmed asthma, 40% were prescribed a minimum of two prescriptions for any kind of inhaled anti‐asthmatic drug, and 12% and 9% used an ICS or Leukotriene receptor antagonist, respectively.ConclusionsAnti‐asthmatic drug prescription data could be used to identify children with true asthma, with reasonable accuracy. The observed pattern of anti‐asthmatic medication usage among children with and without confirmed asthma suggests that there is room for therapeutic improvement.

Fibromyalgia as a cause of uncontrolled asthma: a case–control multicenter study

Background: Fibromyalgia can affect the control of asthma when both diseases are present in a single patient.Objectives: To characterize asthma in patients with concomitant fibromyalgia to assess whether fibromyalgia is an independent factor of asthma severity that influences poor asthma control. We also evaluated how dyspnea is perceived by patients in order to demonstrate that alterations in the perception of airway obstruction may be responsible for poor asthma control.Methods: This was a cross-sectional case–control multicenter study, in which 56 patients in the asthma and fibromyalgia group were matched to 36 asthmatics by sex, approximate age, and asthma severity level. All patients were women. Study variables included the Asthma Control Test (ACT), the Mini Asthma Quality of Life Questionnaire (MiniAQLQ), the Nijmegen hyperventilation syndrome questionnaire, the Hospital Anxiety and Depression Scale, and perception of dyspnea after acute bronchoconstriction.Results: Although patients in both study groups showed similar asthma severity and use of anti-asthmatic drugs, patients in the asthma and fibromyalgia group showed lower scores on the ACT and MiniAQLQ questionnaires, and higher scores of anxiety and depression as well as hyperventilation compared to asthma patients without fibromyalgia. All these differences were statistically significant.Conclusions: Fibromyalgia in patients with asthma influences poor control of the respiratory disease and is associated with altered perception of dyspnea, hyperventilation syndrome, high prevalence of depression and anxiety, and impaired quality of life.Clinical implications: Fibromyalgia may be considered a risk factor for uncontrolled asthma in patients suffering from asthma and fibromyalgia concomitantly.

Prescribing pattern in patients of asthma visiting outpatient departments of a tertiary care hospital: a cross-sectional, observational study

Background: Objective of the study was to evaluate the prescribing pattern in patients of asthma visiting outpatient departments.Methods: Collected prescriptions were analyzed for demographic variables, proportions of various comorbid conditions, average number of drugs per prescription, average number of anti-asthmatic drugs per prescription, proportion of prescription with antibiotics, fixed dose combinations, and generic/brand names, proportion of formulations utilized, proportion of concomitant medications and possible drug interactions, average cost per prescription, average cost of antiasthmatic drugs per prescription, proportion of irrational prescription and adverse drug reactions.Results: Total 139 prescriptions were evaluated. Deriphyllin was the most commonly prescribed anti-asthmatic drug followed by beta agonist- steroid combination. Majority drugs were prescribed by inhalational route. Deriphyllin, and dexamethasone were prescribed by oral route and salbutamol was by both oral and inhalational route of administration. Antibiotics were prescribed to 24 patients. Possible drug interaction with deriphyllin was found in 15 prescriptions. Average cost per prescription was Rs. 193.4 (95%CI: 171.6-215.3).Conclusions: Prescribing pattern of asthma in our hospital shows more use of anti-asthmatic drugs. Standard treatment guideline should be followed. Role of methylxanthine in long term management of asthma should be justified.

Variabilidad e idoneidad del tratamiento antiasmático en pediatría de atención primaria

ObjectiveTo analyse the use patterns and the characteristics of anti-asmathic prescriptions in pediatric primary health care. DesignObservational and retrospective study. LocationPediatric primary health care, Asturias, Spain. ParticipantsDrug prescriptions in respiratory diseases in children (<14years old) during 2011. Principal measurementsData obtained from the billing database of the Regional Health Service of Asturias and analysed by sanitary district and primary health centres, calculating the number of DDD/1.000 children/day (DHD). Clinical records audit in 6 paediatric surgeries of sanitary district V to evaluate the suitability of the drug prescriptions to the current recommendations. ResultsThe main group were bronchodilators (17.14DHD) with predominance of the inhaled route (14DHD). We observe more use of inhaled corticoids (4.83DHD), with an important use of fluticasone. We considered un-suitable 94.3% oral bronchodilators, and >50% of mepiramine prescriptions. We registered off-label prescriptions, 17.8% of them were about oral salbutamol, being used in children <2years old. ConclusionsThe use of anti-asthmatic drugs in our region is high, maybe it's related to the asthma prevalence. We observed variability between sanitary districts and health centres. The prescription patterns are closed to the current recommendation, except in the case of oral bronchodilators.

Determinants of angiotensin-converting enzyme inhibitor (ACEI) intolerance and angioedema in the UK Clinical Practice Research Datalink.

The aim of the present study was to describe the occurrence and determinants of angiotensin-converting enzyme (ACE) inhibitor (ACEI) intolerance and angioedema (AE) among patients initiating ACEI therapy in a real-world primary care population. Two nested case-control studies were conducted in a cohort of 276 977 patients aged ≥45years initiating ACEIs from 2007 to 2014 in the UK Clinical Practice Research Datalink (CPRD). Cases of AE occurring for the first time during ACEI therapy (n = 416) were matched with AE-free controls (n = 4335) on the duration of ACEI treatment. Documented switches to angiotensin-II receptor blockers in the prescription records were used to identify ACEI-intolerance cases (n = 24 709), and these were matched with continuous ACEI users (n = 84 238) on the duration of ACEI therapy. Conditional logistic regression was used to assess the associations of demographic factors, comorbidities and comedication with AE and ACEI intolerance. AE during ACEI therapy was associated with age over 65years [odds ratio (OR) 1.36, 95% confidence interval (CI) 1.07, 1.73], history of allergy (OR 1.53, 95% CI 1.19, 1.96), use of calcium channel blockers (OR 1.57, 95% CI 1.23; 2.01), use of antihistamines (OR 21.25, 95% CI 16.44, 27.46) and use of systemic corticosteroids (OR 4.52, 95% CI 3.26, 6.27). ACEI intolerance was significantly associated with more comorbidities and comedication compared with AE, including allergy (OR 2.02, 95% CI 1.96, 2.09), use of antiasthmatic drugs (OR 1.51, 95% CI 1.42, 1.61) and use of antihistamines (OR 1.53, 95% CI 1.43, 1.63). Among ACEI users developing AE or ACEI intolerance, several comorbidities and comedication classes were significantly more prevalent compared with ACEI users not developing these adverse reactions.

A systematic review of fractional exhaled nitric oxide in the routine management of childhood asthma.

Fractional exhaled nitric oxide (FeNO) is a non-invasive biomarker of eosinophilic inflammation which may be used to guide the management of asthma in childhood. To synthesise the available evidence on the efficacy of FeNO-guided management of childhood asthma. Databases including MEDLINE and the Cochrane Library were searched, and randomised controlled trials (RCTs) comparing FeNO-guided management with any other monitoring strategy were included. Study quality was assessed using the Cochrane risk of bias tool for RCTs, and a number of outcomes were examined, including: exacerbations, medication use, quality of life, adverse events, and other markers of asthma control. Meta-analyses were planned if multiple studies with suitable heterogeneity were available. However, due to wide variations in study characteristics, meta-analysis was not possible. Seven RCTs were identified. There was some evidence that FeNO-guided monitoring results in improved asthma control during the first year of management, although few results attained statistical significance. The impact on severe exacerbations was unclear. Similarly, the impact on use of anti-asthmatic drugs was unclear, and appears to depend on the step up/down protocols, and the clinical characteristics of patients. The potential benefit of FeNO monitoring is equivocal. Trends toward reduced exacerbation and increased medication use were seen, but typically failed to reach statistical significance. There are a number of issues that complicate data interpretation, including differences in the likely severity of included cohorts and variations in treatment algorithms. Further work is needed to systematically explore the impact of these parameters.

Prevalence of over-/misdiagnosis of asthma in patients referred to an allergy clinic

Objective: Increasing asthma incidence may be due to an overall increase in asthma awareness by physicians, potentially resulting in overdiagnosis. One of the unique features of asthma is bronchial hyperresponsiveness, which can be assessed by methacholine bronchial challenge (MBC). Overdiagnosis may result in over- or mistreatment. The aims of this study were to describe the prevalence of the over-/misdiagnosis of asthma and the use of anti-asthmatic drugs in patients with asthma-like symptoms who had not yet undergone a respiratory function assessment to confirm the diagnosis of asthma. Methods: This was a retrospective study analyzing all MBCs performed by our Outpatient Allergy Clinic in a two-year period to confirm/exclude the diagnosis of asthma in patients referred by general practitioners and complaining of asthma-like symptoms. Anti-asthmatic medications used by the patients until the MBC date were recorded. Results: 43.8% of the reviewed MBCs were positive and 37.4% of the patients with a positive MBC were previously taking anti-asthmatic drugs (568.8 ± 76.4 mcg mean beclomethasone equivalents), compared to 51.2% of those patients with a negative MBC (464.8 ± 57.8 mcg). No differences were found in the daily doses of inhaled corticosteroids or other anti-asthmatic drugs, or in the duration of treatment before the assessment of bronchial hyperresponsiveness. Conclusions: A sizeable percentage of subjects who reported physician-diagnosed asthma had a negative MBC. Nevertheless, a greater proportion of negative MBC patients were taking anti-asthmatic drugs compared to those with a confirmed diagnosis of asthma, illustrating that the overdiagnosis of asthma may lead to over- and mistreatment of respiratory symptoms.

Use of Antiasthmatic Drugs during Pregnancy after the First Trimester and Maternal and Neonatal Outcomes

Background. Women with asthma using antiasthmatics during the later part of the pregnancy have an increased risk for obstetric complications and their infants of neonatal complications. Material and Methods. The study is based on a linkage between the Swedish Medical Birth Register and a register of prescribed drugs in Sweden for the years 2009–2011, identifying women who had filled prescriptions for antiasthmatics after the first trimester. Their characteristics, their obstetric history, and the neonatal conditions of their infants were compared with all other women who gave birth. Adjusted Mantel-Haenszel odds ratios were determined. Results. We found an increased risk for a number of maternal conditions but no risk increase for gestational diabetes (after adjustment for body mass index) or for premature rupture of membranes. There was an increase in preterm births for some drugs used at severe asthma and of low birth weight and small for gestational age for most drug combinations. An increased risk was seen for neonatal hypoglycemia, respiratory problems, and low Apgar score. Conclusions. There are many hazards associated with maternal asthma and use of antiasthmatic drugs. Most evidence suggests a disease effect. A careful control of the asthma during pregnancy is important.

Maternal Asthma and Use of Antiasthmatic Drugs in Early Pregnancy and Congenital Malformations in the Offspring

Objectives: To investigate the risk of congenital malformations in infants born of women who had used antiasthmatic drugs in early pregnancy. Methods: Data were obtained from the Swedish Medical Birth Register for 1996-2011. Information on drug use was based on midwife interviews towards the end of the first trimester. Presence of congenital malformations was ascertained from three national health registers. Risk estimates were made with Mantel-Haenszel odds ratios after adjustment for delivery year, maternal age, parity, smoking, and body mass index. Consideration was taken to concomitantly used drugs. Results: Among more than 1.5 million women who gave birth, 2.9% reported the use of antiasthmatics. These women had characteristics which distinguished them from other women who gave birth and they more often than these used other drugs than antiasthmatics. These differences seemed to affect malformation risk only little. The risk for a major malformation was slightly but significantly increased (odds ratio=1.09, 95% confidence interval 1.03-1.12), specifically this was seen for cardiovascular defects, median cleft palate, and pyloric stenosis. There was no specific association with specific drugs or drug groups, the highest risk estimate was seen for women who used only one drug and notably a short-acting adrenergic or used three or more antiasthmatic drug groups. Conclusion: The absolute risk for a congenital malformation in infants born of women using antiasthmatics is low and some evidence indicates that it is due to underlying asthma. A good control of asthma seems important and scare of teratogenicity of the common antiasthmatic drugs should not prevent adequate use.

Anti-IgE therapy for allergic bronchopulmonary aspergillosis

Allergic bronchopulmonary aspergillosis (ABPA) is a severe type of asthma. Some cases are resistant to treatment, even with regular use of antiasthmatic drugs and antifungal agents. The diagnosis of ABPA was made in a 40-year-old patient with ABPA according to the Rosenberg-Patterson criteria. Symptoms were not controlled despite regular use of antiasthmatic drugs, daily systemic steroids, and antifungal agents. Omalizumab, administered in an attempt to stabilize these uncontrolled symptoms, was effective with no adverse events. Our experience suggests omalizumab is a potential candidate drug for controlling steroid-dependent ABPA.

The term “asthma” should be avoided in describing the chronic pulmonary disease of prematurity

To the Editor : We read with interest the report from Kallen et al . [1] that preterm birth and (to a lesser extent) restricted intrauterine growth both substantially increase the risk of developing “childhood asthma”. Their data are interesting, and several plausible hypotheses are advanced to explain the correlation between prematurity (and intrauterine growth restriction) and the development of asthma later on. As in numerous other studies [2–4], cases of asthma were identified on the strength of anti-asthma drug prescriptions. Rightly enough, a persistent use of anti-asthma drugs (at least five prescriptions) was required to minimise the inclusion of non-asthmatic cases [1]. …

Aukning öndunarfæraeinkenna og notkunar astmalyfja meðal Íslendinga á aldrinum 20-44 ára

In the year 1990 the European Community Respiratory Health Survey I (ECRHS I) demonstrated that the prevalence of these diseases was lowest in Iceland (www.ecrhs.org). In order to compare the prevalence of respiratory symptoms in Reykjavik over time, a new identical cross-sectional study was performed seventeen years later. Both cohorts, were in the age group 20-44 years and randomly selected from the population in Reykjavik and suburbs. Both answered questionnaires about respiratory symptoms, nasal allergy and use of anti-asthmatic drugs. The second cohort was part of the EuroPrevall study (www.europrevall.org) performed in 2007. Response rate was lower in 2007 (999 or 43.2%) than in 1990 (2.903 or 80.6%).The prevalence of attacks of asthma increased over time from 2.2% to 6.7% (p<0.0001), use of anti-asthmatic drugs increased from 2.4% to 7.2% (p<0.0001) and nasal allergy symptoms from 17.8% to 29.3% (p< 0.0001). There was an increase of all respiratory symptoms except wheezing or whistling, where the prevalence dropped from 18.0% to 14.4% (p<0.01). In the year 2007 women had more often been woken by attacks of coughing (p<0.0001), had more often attacks of asthma (p<0.05) and were more likely to use anti-asthmatic drugs (p<0.05) than men. Attacks of asthma and the use of anti-asthmatic drugs were more common among the younger age group in the year 2007. That was not seen in the year 1990. This study provides evidence of an increase in respiratory symptoms and use of anti-asthmatic drugs over a period of 17 years from 1990 among young adult Icelanders.

Pattern of asthma medication use among children from a large urban center in Brazil

PurposeDespite the advances in asthma therapeutics, there are few data on the use and determinants of anti-asthmatic drugs in the general population of children. This study describes the use of asthma medications among children in the general population and in children with current asthma, living in a large urban center in Brazil.MethodsA population-based cross-sectional survey, aimed at analyzing asthma determinants, was conducted with 1,382 children aged 4–11 years, between February and May 2006, in Salvador, Brazil. At baseline, an extensive questionnaire was applied, including questions about the use of asthma medications in the last 12 months.ResultsIn all studied children (n = 1,382) aged 4–11 years, oral beta2-agonists were the drugs most frequently used (9.8%), followed by short-acting inhaled beta2-agonists (4.3%) and systemic corticosteroids (1.6%). Anti-asthmatic drug use was higher among males than females, and it significantly decreased with age in both genders. A total of 312 children (22.6%) reported current asthma, and 62% of them were not being treated with any anti-asthmatic drugs. Of all those who reported following a certain type of treatment, 20% used oral beta2-agonists alone; 6.1%, short-acting inhaled beta2-agonists alone; and 4.8%, a combination of both drugs. Anti-asthmatic drug use did not differ according to socioeconomic status, except for the use of inhaled beta2-agonists and systemic corticosteroids.ConclusionsAn overwhelming majority of asthmatic children were not using long-term medications for asthma, in particular inhaled corticosteroids, regardless of the severity of their disease. This result points to the deficiencies of the Brazilian public health system in recognizing this important pharmacological need for child care and thereby limiting the access of these children to a group of efficacious, available, and low risk therapeutic medications.