Defanging Asthma

Ask anyone who has it: asthma is no fun.  Probably few sensations are as unsettling as not being able to breath, and that’s what happens to those with asthma.  Now imagine being a kid with asthma, as an increasing number of children worldwide are.  Not only is breathing sometimes almost impossible, the condition may seriously impair one's ability to participate in sports, can strike with apparent randomness, resulting in hospitalization, and may even cause death.  Can use of an antibody medication help?  That’s in the current issue of NEJM and provides fodder for discussion in this week’s podcast.

This study enrolled 419 inner city children 6-20 years of age, who had had at least one asthma attack requiring an emergency department visit or hospitalization in the previous 6 to 12 months to study entry, despite use of an asthma control regimen.  I think it is sobering to reflect on the fact that asthma in general is much more severe among our youngest residents of inner cities due to their exposure to allergens like cockroach dander.

All of the study subjects were brought up to speed on managing their asthma with medications and other measures such as bedding covering, then half were randomized to receive subcutaneous injections of the antibody every two or four weeks, or placebo. The study continued for a year.

Use of the antibody, called 'omalizumab,' resulted in about a one-quarter reduction in symptoms, but hospitalizations due to an acute exacerbation of asthma were 6.3% in the placebo group versus 1.5% in the treated group.  That's huge.  And side effects of treatment for the duration of this study were minimal.

A couple of points I raise in the podcast:  this medication is expensive, and represents a bit of an inconvenience since it's an injection.  I also feel obliged to bring up FDA imposed 'black box' warnings regarding use of this medication.  There is a risk of a severe allergic reaction when the antibody is injected, so it must always be done in a physician's office.  Additionally, when the medication is used long term there may be an increased risk of certain types of cancer.  Finally, right now the drug is not approved for use in children younger than 12 years of age, although the average age of participants in this study was about 10.  We don't know what impact the drug might have when therapy is begun so early in life and prior to adolescence.  Rick's point is well-taken:  this therapy should be reserved for children with asthma who, despite the best medications and strategies to keep their condition controlled, continue to experience acute exacerbations.  For those who do, however, it offers hope.

Other topics this week include two others from NEJM: a novel 'bunyavirus' identified in China, and stents versus bypass surgery for quality of life issues.  Finally in JAMA, use of high dose clopidogrel isn't helpful for people at risk of forming clots after they have a stent placed in one of the heart's arteries.  Until next week, y'all live well.

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What Is Acute Exacerbation Of Asthma | Asthma Education Site
July 25, 2012 at 1:20 pm

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asim July 10, 2013 at 6:36 am

My son has been suffering from chronic asthma since childhood. An important preventive measure that I take is installing air purifiers in his room. Allergens and air contaminants can induce an asthma bout. Air purifiers aid to keep the room clean and free of impurities.


Richard Friedel January 5, 2012 at 4:34 am

A shameful lack of research
The mention of asthma as a purportedly scientifically understood and treated disease shows the reliance on a how many angels on the head of a pin type of surrealistic argument here, betraying the aims of the authors to confirm the medical wisdom on the disease.. The extensive scientific writings on inspiratory muscle training and the widespread use of the respective appliances clearly indicates not only that asthma symptoms may be eliminated by such training but also that the muscle deconditioning effects of asthma drugs must be responsible for the epidemic. Furthermore all too relevant is the shameful utter absence of any serious enquiry about causation due to treatment even despite the alarming increase in asthma morbidity. Obviously anyone afflicted by the disorder should consult a physician aware of the developments. RF


Kathy November 3, 2011 at 11:27 pm

I agree allergies affect asthma but they say the cause is unknown. My family has a history of asthma. I had the yearly bout of Bronchitis but was not experiencing asthma. I worked outdoors as a Letter Carrier for 10 years. Then the Perfect Storm happened. At the age of about 46 I had a back injury causing a lot of pain, controlled with medication. Shortly afterwards I had new wall to wall carpet installed throughout my house. A chemical smell was in the air. That very week I had a lumbar flare up and I had an immediate asthma attack, my first. I was under the care of an Allergy doctor. I received 5 years of shots, multiple inhalers, steroids on occasion & a complete new air conditioning system including new duct work, all helped. I eventually had all my carpeting removed. I replaced my flooring with ceramic tile. I have not had any asthma problems since then, no inhalers. That was at least eight years ago. The big name carpet manufacturer never admitted liability but they did pay to have the new carpet steam cleaned at the time. I have no doubt that the stress of the pain triggered the chemical irritants that were in my bronchi and lungs. My advise is to keep away from or get rid of carpeting because of the chemicals and dust that is easily trapped. I regret not doing so sooner despite the cost.


jade smith March 19, 2011 at 12:35 am

Asthma is very danger problem. People who are suffering with this problem sometimes they are not able to do breathing and they can suffer with attack. Allergy is the cause of asthma. They need fresh air to live healthy. Today some medicines are available in the market to handle this problem.


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