Pregnancy is an exciting time in a woman's life. Changes in your body may be matched by changes in your emotions. You don't know what to expect from day to day. You may feel tired, uncomfortable, or cranky one day and energetic, healthy, and happy the next. The last thing you need is an asthma attack.
Asthma is one of the most common medical conditions in the US and other developed countries. If you have asthma, you know what it means to have an exacerbation (attack). You may wheeze, cough, or have difficulty breathing. Remember that the fetus (developing baby) in your uterus (womb) depends on the air you breathe for its oxygen. When you have an asthma attack, the fetus may not get enough oxygen. This can put the fetus in great danger.
Symptoms of asthma during pregnancy are the same as those of asthma at any other time. However, each woman with asthma responds differently to pregnancy. You may have milder symptoms or more severe symptoms, or your symptoms may be pretty much what they are when you aren't pregnant.
In general, asthma triggers are the same during pregnancy as at any other time. Like the situation with asthma symptoms, during pregnancy sensitivity to triggers may be increased, decreased, or stay about the same. These differences are attributed to changes in hormones during pregnancy.
Common triggers of asthma attacks include respiratory infections such as a cold, flu, bronchitis, and sinusitis: Both bacterial and viral infections can trigger an asthma attack, cigarette smoke (firsthand or secondhand), gastroesophageal reflux disease (GERD), or regurgitation of stomach contents up the esophagus or "food pipe" , smoke from cooking or wood fires, emotional upset, food allergies, allergic rhinitis (hay fever or seasonal allergies).
Changes in weather, especially cold, dry air, exercise, strong smells, sprays, perfumes, allergic reactions to certain chemicals, allergic reaction to cosmetics, soaps, shampoos, Allergic reaction to irritants, such as dust/dust mites, molds, feathers, pet dander, etc. also trigger asthma attack.
If you took medication for your asthma before you became pregnant, especially if your asthma was well controlled, you may be tempted to stop taking your medication out of fear that it might harm the fetus. That would be a mistake without the advice of your health care provider. The risk to the fetus from most asthma medications is tiny compared to the risk from a severe asthma attack.
Moreover, women with asthma that is uncontrolled are more likely to have complications during pregnancy. Their babies are more likely to be born preterm (premature), to be small or underweight at birth, and to require longer hospitalization after birth. The more severe the asthma, the greater the risk to the fetus. In rare cases, the fetus can even die from oxygen deprivation.
How pregnancy may affect your asthma is unpredictable. About one third of women with asthma experience improvement while they are pregnant, about one third get worse, and the other third stay about the same. The milder your asthma was before pregnancy, and the better it is controlled during pregnancy, the better your chances of having few or no asthma symptoms during pregnancy.
If asthma control deteriorates during pregnancy, the symptoms tend to be at their worst during weeks 24-36 (months 6-8). Most women experience the same level of asthmatic symptoms in all their pregnancies. It is rare to have an asthma attack during delivery (10%). In most cases, symptoms return to "normal" within 3 months after delivery.
The important thing to remember is that your asthma can be controlled during pregnancy. If your asthma is controlled, you have just as much chance of a healthy, normal pregnancy and delivery as a woman who does not have asthma.
The best way to treat asthma is to avoid having an attack in the first place. Avoid exposure to your asthma triggers. This might improve your symptoms and reduce the amount of medication you have to take.
If you smoke, quit. Smoking can harm you and your fetus. Avoid being around others who are smoking; secondhand smoke can trigger an asthma attack. Secondhand smoke also can cause asthma and other health problems in your children.
If you have symptoms of gastroesophageal reflux (for example, heartburn), avoid eating large meals or lying down after eating. Stay away from people who have a cold, the flu, or other infection. Avoid things you are allergic to. Remove contaminants and irritants from your home. Also, avoid your known personal triggers (cat dander, exercise, whatever sets you off).
Asthma medications usually are taken in the same stepwise sequence you would take them in before pregnancy. During pregnancy, inhaled corticosteroids are the mainstay for long-term control. Long-term medications are sometimes combined into single preparations, such as an inhaled steroid and a long-acting beta-agonist.
Rescue medications are taken only when symptoms appear. Inhaled short-acting beta-agonists are usually the first choice for fast relief of symptoms.
If possible, avoid regular use of epinephrine and other related medication (alpha-adrenergics) as they may pose a higher risk to the fetus. Epinephrine may be given as an injection to treat a severe asthma attack or a life-threatening allergic response. If this situation occurs, treating your reaction effectively and quickly is important to decrease the risk of oxygen deprivation to the fetus.
Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs): These medications are used to relieve headaches, muscle pain, inflammation, and fever. They are not recommended during late-term pregnancy.
If medications are needed to control GERD (heartburn), avoid regular use of antacids that contain bicarbonate and magnesium.
Jigfo.com is a global platform for sharing and learning knowledge. For more information on this article topics visit: http://www.jigfo.com http://asthmatic.jigfo.com/ http://allergicasthma.jigfo.com/ http://immunizationduringpregnancy.jigfo.com/ http://trimester.jigfo.com/
Showing posts with label Allergy. Show all posts
Showing posts with label Allergy. Show all posts
Monday, September 8, 2008
Wednesday, April 16, 2008
New Understanding Of Immune System Creates Unexpected Links In Medicine
Based on experiments with worms similar to those that infest millions of children in the tropics, researchers see potential for a new way to treat asthma. Parasitic infections and asthma may cause the human immune system to react in some of the same ways, and may one day be cured by manipulating some of the same proteins, according to research published in the journal Science.
To be effective, the immune system must "decide" which cells and chemicals need to be ramped up to best destroy the invader at hand, be it bacterium, virus or worm. In 1986, Tim Mosmann, Ph.D., now director of the David H. Smith Center for Vaccine Biology and Immunology at the University of Rochester Medical Center, led a team that first described a new concept for how the immune system might make such choices: the Th1/Th2 Model. A landmark in immunology, it was a major step toward unraveling the systemвTMs complexities. TodayвTMs study results show how the model continues to define new players in the immune system and to suggest new treatment approaches.
"The point of the study is that each new detail in our understanding of the immune system creates opportunities to make changes that counter disease," said Mosmann. "These results, while early, suggest that helping the body make more of a newly defined immune chemical may prevent roundworm infection, and that shutting it down may reduce lung damage in asthma."
Part of the immune system is adaptive, pumping out vast numbers of immune cells on the hope that one will be the right shape to link up with, and become activated by, any invader encountered. When one of those immune cells recognizes an invader, it expands into an army of clones specifically selected to attack that organism. One workhorse of the adaptive system is the helper T cell, a white blood cell that secretes protein messengers called cytokines to accelerate the immune response.
According to MosmannвTMs model, T cells differentiate into two major sets of helper T cells, Type 1 (Th1) and Type 2 (Th2), each defined by the cytokines they produce. Each profile is more effective at attacking certain invaders, with Th1 responses, for example, better against bacteria that live inside cells. Th2 cytokines include interleukin-4 (IL-4), interleukin-5 (IL-5) and interleukin-13 (IL-13), all of which are useful in immune responses against worms. In a clue to the worm/asthma link, IL-4, IL-5 and IL-13 also trigger mechanisms that cause irreversible damage to the lungs of asthmatic patients.
Study Details
How the mouse immune system reacts to the worms is central to MosmannвTMs research because mice and humans share the Th1/Th2 immune system divide, because mouse and human roundworm parasites are relatives, and because roundworm infection remains a major threat in the developing world. His basic research on T cell subsets was funded by the National Institute of Allergy and Infectious Diseases.
More than 15,000 species of parasitic roundworms infect everything from grapes to wasps to cattle. In humans, infection is usually caused by eating undercooked pork or wild game, or by poor hygiene, and brings repeated episodes of diarrhea, anemia and malnutrition. Stranded soldiers were once advised by field manuals to eat a cigarette or drink a tablespoon of kerosene to stun the worms, but modern antihelminthic drugs (e.g. Albendazole, Ivermectin, Thiabendazole) are effective and much safer. Drug treatments, however, do not reach many living in the worst conditions nor do they prevent patients from becoming re-infected. MosmannвTMs work could conceivably lead to a vaccine that would confer permanent immunity to worm infection, but such research remains in the future.
Having been exposed to bacteria and parasites since early in evolution, tissues lining the gut and lungs of mice and humans have developed ways to prevent invaders from entering the body. Tissues lining the gut, for example, shed their outer cell layers when exposed to worms. Helper T cells release chemicals that cause gut cells to rapidly divide and reproduce (grow). As new cells are created, older, outer, infested layers die, fall off (shed) and are expelled from the body with solid waste.
Using molecular biology techniques, MosmannвTMs team found that roundworm infection led Th2 helper T cells, more than other T cell types, to produce greater amounts of a growth factor, amphiregulin, which triggers cells to divide and grow. The current results define amphiregulin for the first time as an important new player in the immune system, in the Th2 immune profile and perhaps in the many disease processes touched by it.
In the current study, mice were infected with the nematode parasite, Trichuris muris, a relative of the worm that causes trichinosis in humans. After 14 days of infection, the study found increased expression of amphiregulin along with higher levels of Th2 cytokines IL-4 and IL-13.
Researchers confirmed the relevance of amphiregulin in immune responses to the parasites by comparing worm counts in normal mice against mice that had been genetically engineered not to produce amphiregulin. Similar numbers of worm larvae were detected after ten days in both groups, and all mice cleared the parasite by day 19. Worm clearance at day 14, however, was significantly delayed in amphiregulin-deficient mice, as was the shed rate in their gut cells.
More immediate than the potential for an anti-worm vaccine, authors said, is the studyвTMs finding for the first time that amphiregulin is a product of Th2 cells, which are known to play key roles in asthma, the chronic disorder that blocks and damages air passages in the lungs of 20 million Americans.
Researchers believe airborne irritants cause Th2 cells to release interleukins, which in turn leads to the release of toxic granules that cause direct tissue damage in the lungs. As the lung tries to heal the damage, growth factors cause the airway walls to thicken, by as much as 300 percent in severe cases. Could amphiregulin be the growth factor that causes permanent thickening of asthmatic airways, restricting airflow more and more as time goes by"
MosmannвTMs team has already begun experiments to determine if the production of amphiregulin by the Th2 response in mice also occurs in human helper T cells. After that, researchers are interested in comparing amphiregulin expression levels in the cells of healthy versus asthmatic lungs.
###
Contact: Greg Williams
University of Rochester Medical Center
To be effective, the immune system must "decide" which cells and chemicals need to be ramped up to best destroy the invader at hand, be it bacterium, virus or worm. In 1986, Tim Mosmann, Ph.D., now director of the David H. Smith Center for Vaccine Biology and Immunology at the University of Rochester Medical Center, led a team that first described a new concept for how the immune system might make such choices: the Th1/Th2 Model. A landmark in immunology, it was a major step toward unraveling the systemвTMs complexities. TodayвTMs study results show how the model continues to define new players in the immune system and to suggest new treatment approaches.
"The point of the study is that each new detail in our understanding of the immune system creates opportunities to make changes that counter disease," said Mosmann. "These results, while early, suggest that helping the body make more of a newly defined immune chemical may prevent roundworm infection, and that shutting it down may reduce lung damage in asthma."
Part of the immune system is adaptive, pumping out vast numbers of immune cells on the hope that one will be the right shape to link up with, and become activated by, any invader encountered. When one of those immune cells recognizes an invader, it expands into an army of clones specifically selected to attack that organism. One workhorse of the adaptive system is the helper T cell, a white blood cell that secretes protein messengers called cytokines to accelerate the immune response.
According to MosmannвTMs model, T cells differentiate into two major sets of helper T cells, Type 1 (Th1) and Type 2 (Th2), each defined by the cytokines they produce. Each profile is more effective at attacking certain invaders, with Th1 responses, for example, better against bacteria that live inside cells. Th2 cytokines include interleukin-4 (IL-4), interleukin-5 (IL-5) and interleukin-13 (IL-13), all of which are useful in immune responses against worms. In a clue to the worm/asthma link, IL-4, IL-5 and IL-13 also trigger mechanisms that cause irreversible damage to the lungs of asthmatic patients.
Study Details
How the mouse immune system reacts to the worms is central to MosmannвTMs research because mice and humans share the Th1/Th2 immune system divide, because mouse and human roundworm parasites are relatives, and because roundworm infection remains a major threat in the developing world. His basic research on T cell subsets was funded by the National Institute of Allergy and Infectious Diseases.
More than 15,000 species of parasitic roundworms infect everything from grapes to wasps to cattle. In humans, infection is usually caused by eating undercooked pork or wild game, or by poor hygiene, and brings repeated episodes of diarrhea, anemia and malnutrition. Stranded soldiers were once advised by field manuals to eat a cigarette or drink a tablespoon of kerosene to stun the worms, but modern antihelminthic drugs (e.g. Albendazole, Ivermectin, Thiabendazole) are effective and much safer. Drug treatments, however, do not reach many living in the worst conditions nor do they prevent patients from becoming re-infected. MosmannвTMs work could conceivably lead to a vaccine that would confer permanent immunity to worm infection, but such research remains in the future.
Having been exposed to bacteria and parasites since early in evolution, tissues lining the gut and lungs of mice and humans have developed ways to prevent invaders from entering the body. Tissues lining the gut, for example, shed their outer cell layers when exposed to worms. Helper T cells release chemicals that cause gut cells to rapidly divide and reproduce (grow). As new cells are created, older, outer, infested layers die, fall off (shed) and are expelled from the body with solid waste.
Using molecular biology techniques, MosmannвTMs team found that roundworm infection led Th2 helper T cells, more than other T cell types, to produce greater amounts of a growth factor, amphiregulin, which triggers cells to divide and grow. The current results define amphiregulin for the first time as an important new player in the immune system, in the Th2 immune profile and perhaps in the many disease processes touched by it.
In the current study, mice were infected with the nematode parasite, Trichuris muris, a relative of the worm that causes trichinosis in humans. After 14 days of infection, the study found increased expression of amphiregulin along with higher levels of Th2 cytokines IL-4 and IL-13.
Researchers confirmed the relevance of amphiregulin in immune responses to the parasites by comparing worm counts in normal mice against mice that had been genetically engineered not to produce amphiregulin. Similar numbers of worm larvae were detected after ten days in both groups, and all mice cleared the parasite by day 19. Worm clearance at day 14, however, was significantly delayed in amphiregulin-deficient mice, as was the shed rate in their gut cells.
More immediate than the potential for an anti-worm vaccine, authors said, is the studyвTMs finding for the first time that amphiregulin is a product of Th2 cells, which are known to play key roles in asthma, the chronic disorder that blocks and damages air passages in the lungs of 20 million Americans.
Researchers believe airborne irritants cause Th2 cells to release interleukins, which in turn leads to the release of toxic granules that cause direct tissue damage in the lungs. As the lung tries to heal the damage, growth factors cause the airway walls to thicken, by as much as 300 percent in severe cases. Could amphiregulin be the growth factor that causes permanent thickening of asthmatic airways, restricting airflow more and more as time goes by"
MosmannвTMs team has already begun experiments to determine if the production of amphiregulin by the Th2 response in mice also occurs in human helper T cells. After that, researchers are interested in comparing amphiregulin expression levels in the cells of healthy versus asthmatic lungs.
###
Contact: Greg Williams
University of Rochester Medical Center
Tuesday, April 15, 2008
The Future Of Asthma Research
Asthma UK and the Royal Society of Medicine are offering people with asthma a unique opportunity to influence the future of asthma research.
Medicine and Me: Asthma Research will bring people with asthma, their families and carers, together with researchers and health professionals to exchange their views on the key challenges in basic asthma research.
The event aims to make science more accessible to people with asthma and ensure the strategy reflects their needs. It takes place on 19 February at the Royal Society of Medicine, London. Supported by AstraZeneca, it will include a mix of presentations and discussions, followed by an evening reception.
Medicine and Me: Asthma Research follows the hugely successful event, Medicine and Me: Asthma, which was held in 2004. It aims to provide a platform for Asthma UK to discuss its five-year Basic Asthma Research Strategy update (BARS II). The strategy was written after extensive consultation with expert asthma researchers and people with asthma over the last year and it is hoped this dialogue will have a direct impact on future research strategies.
The key areas identified in asthma research to be explored at the event are:
-- Genetics
-- Early Life and Environment
-- Immunology and Infection
-- Inflammation and Airway remodelling
People with asthma and researchers will discuss their views on how research can progress towards Asthma UK's vision of "control over asthma today, freedom from asthma tomorrow".
Donna Covey, Chief Executive of Asthma UK, said: "This is an excellent way to make medical science more accessible to people with asthma and help researchers understand the needs of people with asthma too. Asthma UK continues to increase the understanding of asthma, its causes and effects, and raise awareness of the needs of the 5.2 million people living with asthma."
Professor Tak Lee, Asthma UK Professor and Director of the MRC-Asthma UK Centre in Allergic Mechanisms of Asthma, chaired the BARS II consultation on behalf of Asthma UK said: "The key questions that have to be addressed to find a cure for asthma have now been identified. It is essential for funders to provide adequate support to researchers so these critical questions can be answered."
http://www.asthma.org.uk
Medicine and Me: Asthma Research will bring people with asthma, their families and carers, together with researchers and health professionals to exchange their views on the key challenges in basic asthma research.
The event aims to make science more accessible to people with asthma and ensure the strategy reflects their needs. It takes place on 19 February at the Royal Society of Medicine, London. Supported by AstraZeneca, it will include a mix of presentations and discussions, followed by an evening reception.
Medicine and Me: Asthma Research follows the hugely successful event, Medicine and Me: Asthma, which was held in 2004. It aims to provide a platform for Asthma UK to discuss its five-year Basic Asthma Research Strategy update (BARS II). The strategy was written after extensive consultation with expert asthma researchers and people with asthma over the last year and it is hoped this dialogue will have a direct impact on future research strategies.
The key areas identified in asthma research to be explored at the event are:
-- Genetics
-- Early Life and Environment
-- Immunology and Infection
-- Inflammation and Airway remodelling
People with asthma and researchers will discuss their views on how research can progress towards Asthma UK's vision of "control over asthma today, freedom from asthma tomorrow".
Donna Covey, Chief Executive of Asthma UK, said: "This is an excellent way to make medical science more accessible to people with asthma and help researchers understand the needs of people with asthma too. Asthma UK continues to increase the understanding of asthma, its causes and effects, and raise awareness of the needs of the 5.2 million people living with asthma."
Professor Tak Lee, Asthma UK Professor and Director of the MRC-Asthma UK Centre in Allergic Mechanisms of Asthma, chaired the BARS II consultation on behalf of Asthma UK said: "The key questions that have to be addressed to find a cure for asthma have now been identified. It is essential for funders to provide adequate support to researchers so these critical questions can be answered."
http://www.asthma.org.uk
EU Prioritises Allergic Diseases In The Seventh Framework Programme For Research
GAВLEN welcomes the vote of the European Parliament on the Seventh Framework Programme (FP7) on 30 November that acknowledges allergic diseases as major chronic diseases to be addressed in European research during the coming 7 years (2007 - 2013).
The European Parliament adopted the report of Prof. Jerzy Buzek that recognises вrespiratory diseases including those induced by allergiesв as health priorities to be addressed by translational research. This will allow respiratory allergic diseases (including asthma) to be covered by the research programme under the health theme.
In the first drafts, only food allergies (8% of all allergies) were covered. Allergic diseases will now be tackled under both the health and food themes of the research programme which should allow scientists to progress towards the overall understanding that is needed to help control this epidemic through effective prevention and treatment.
вAllergic diseasesв in all their different aspects - from hay fever to fatal attacks of asthma or reactions to peanuts - are taking lives daily and creating huge financial costs. According to the World Health Organization, asthma kills someone in Europe every hour. One child in three is allergic today and by 2015, half of the European population may be suffering from one or more allergic condition.
The European UnionвTMs next research programme known as the Seventh Framework Programme (FP7) begins on 1st January 2007 and will run for seven years until 2013 with a total budget of в'not54.6 billion.
GAВLEN - the Global Allergy and Asthma European Network is a вNetwork of Excellenceв funded by the European Union 6th Research Framework Programme (FP6). It consists of 26 research centres spread throughout Europe, as well as the European Academy of Allergology and Clinical Immunology (EAACI) and the European Federation of Allergy and Airways Diseases Patients Associations (EFA). Close to 50 collaborating centres have joined the network since its launch in 2004.
http://www.ga2len.net
World Health Report 2003, вShaping the Futureв. World Health Organization
The European Parliament adopted the report of Prof. Jerzy Buzek that recognises вrespiratory diseases including those induced by allergiesв as health priorities to be addressed by translational research. This will allow respiratory allergic diseases (including asthma) to be covered by the research programme under the health theme.
In the first drafts, only food allergies (8% of all allergies) were covered. Allergic diseases will now be tackled under both the health and food themes of the research programme which should allow scientists to progress towards the overall understanding that is needed to help control this epidemic through effective prevention and treatment.
вAllergic diseasesв in all their different aspects - from hay fever to fatal attacks of asthma or reactions to peanuts - are taking lives daily and creating huge financial costs. According to the World Health Organization, asthma kills someone in Europe every hour. One child in three is allergic today and by 2015, half of the European population may be suffering from one or more allergic condition.
The European UnionвTMs next research programme known as the Seventh Framework Programme (FP7) begins on 1st January 2007 and will run for seven years until 2013 with a total budget of в'not54.6 billion.
GAВLEN - the Global Allergy and Asthma European Network is a вNetwork of Excellenceв funded by the European Union 6th Research Framework Programme (FP6). It consists of 26 research centres spread throughout Europe, as well as the European Academy of Allergology and Clinical Immunology (EAACI) and the European Federation of Allergy and Airways Diseases Patients Associations (EFA). Close to 50 collaborating centres have joined the network since its launch in 2004.
http://www.ga2len.net
World Health Report 2003, вShaping the Futureв. World Health Organization
Vietnam Study Probes The Role Of Gut Worms In Allergies
Gut parasites could hold the key to increasingly common conditions such as eczema, asthma and hay fever, according to scientists at The University of Nottingham.
Gut parasites, such as hookworm, have evolved together with their human hosts for millions of years. Over time, these parasites have developed ways of surviving in the human gut by 'turning down' the immune response directed against them, prolonging their survival inside the host.
This reduction in immune response may also have the effect of reducing allergic tissue reactions that characterise asthma and other allergic conditions.
The latest study in this area of research is led by Dr Carsten Flohr, a clinical scientist from The University of Nottingham and Dr Luc Nguyen Tuyen, from the Khanh Hoa Provincial Health Service in central Vietnam. This work was supported through research grants from Asthma UK, the Bastow Award from the Special Trustees for Nottingham University Hospitals and a Fellowship from University College, University of Oxford.
Dr Flohr has examined the links between worms and allergic diseases in Vietnamese children and found that those with the highest level of hookworm infestation were the least likely to have an allergic response to house dust mites.
These findings support the hypothesis that gastrointestinal infection with either hookworms or other micro-organisms protects against allergy and add further weight to the so-called вhygiene hypothesisвTM.
Dr Lyn Smurthwaite, Research Development Manager for Asthma UK said: вThe вhygiene hypothesisвTM suggests that high rates of allergies and asthma in developed countries are a result of our immune systems becoming unbalanced due to improved sanitation and hygienic lifestyles that no longer expose us to the same array of bacteria, viruses or parasites. We look forward to future results in this area.в
The study involved 1,600 children aged six to 18, in four neighbouring rural communities in Khanh Hoa province, central Vietnam. Their lifestyles were studied, along with their sensitivity to common allergens and their level of infestation with hookworm and other parasites.
Following on from the study just reported online in the Journal of Allergy and Clinical Immunology, Dr Flohr and his colleagues in Vietnam have conducted an intervention study in the same population during which they regularly de-wormed schoolchildren to see whether this increased the prevalence of allergic diseases. This second study is now coming to a close and the results will be published early next year.
Dr Flohr said: вThe results from such an intervention study will allow us to draw firmer conclusions as to whether gut worm infestation truly protects against allergic disease and sensitisation.в
Co-applicants on the Asthma UK research grant that is funding the work were Professors John Britton, David Pritchard, and Hywel Williams. The Nottingham team is collaborating with researchers from the Wellcome Trust Major Overseas Programme at the Oxford University Clinical Research Unit Hospital for Tropical Diseases in Ho Chi Minh City, where Dr Flohr has been based for his field work.
The University of Nottingham is leading the way in the investigation of links between hookworm infestation в" or lack of it в" and human illness. Two further currently ongoing trials are looking at the possibility that hookworm infection may alleviate symptoms of hay fever and CrohnвTMs Disease.
If these studies show positive results, future drugs that mimic the immunological effects of hookworm infection could provide promising therapeutic options for patients with allergic and other autoimmune diseases.
The University of Nottingham is Britain's University of the Year (The Times Higher Awards 2006). It undertakes world-changing research, provides innovative teaching and a student experience of the highest quality. Ranked by Newsweek in the world's Top 75 universities, its academics have won two Nobel Prizes since 2003. The University is an international institution with campuses in the United Kingdom, Malaysia and China.
Asthma UK is the charity dedicated to improving the health and well-being of the 5.2 million people in the UK whose lives are affected by asthma. It works together with people with asthma, health professionals and researchers to develop and share expertise to help people increase their understanding and reduce the effect of asthma on their lives.
The University of Nottingham
Gut parasites, such as hookworm, have evolved together with their human hosts for millions of years. Over time, these parasites have developed ways of surviving in the human gut by 'turning down' the immune response directed against them, prolonging their survival inside the host.
This reduction in immune response may also have the effect of reducing allergic tissue reactions that characterise asthma and other allergic conditions.
The latest study in this area of research is led by Dr Carsten Flohr, a clinical scientist from The University of Nottingham and Dr Luc Nguyen Tuyen, from the Khanh Hoa Provincial Health Service in central Vietnam. This work was supported through research grants from Asthma UK, the Bastow Award from the Special Trustees for Nottingham University Hospitals and a Fellowship from University College, University of Oxford.
Dr Flohr has examined the links between worms and allergic diseases in Vietnamese children and found that those with the highest level of hookworm infestation were the least likely to have an allergic response to house dust mites.
These findings support the hypothesis that gastrointestinal infection with either hookworms or other micro-organisms protects against allergy and add further weight to the so-called вhygiene hypothesisвTM.
Dr Lyn Smurthwaite, Research Development Manager for Asthma UK said: вThe вhygiene hypothesisвTM suggests that high rates of allergies and asthma in developed countries are a result of our immune systems becoming unbalanced due to improved sanitation and hygienic lifestyles that no longer expose us to the same array of bacteria, viruses or parasites. We look forward to future results in this area.в
The study involved 1,600 children aged six to 18, in four neighbouring rural communities in Khanh Hoa province, central Vietnam. Their lifestyles were studied, along with their sensitivity to common allergens and their level of infestation with hookworm and other parasites.
Following on from the study just reported online in the Journal of Allergy and Clinical Immunology, Dr Flohr and his colleagues in Vietnam have conducted an intervention study in the same population during which they regularly de-wormed schoolchildren to see whether this increased the prevalence of allergic diseases. This second study is now coming to a close and the results will be published early next year.
Dr Flohr said: вThe results from such an intervention study will allow us to draw firmer conclusions as to whether gut worm infestation truly protects against allergic disease and sensitisation.в
Co-applicants on the Asthma UK research grant that is funding the work were Professors John Britton, David Pritchard, and Hywel Williams. The Nottingham team is collaborating with researchers from the Wellcome Trust Major Overseas Programme at the Oxford University Clinical Research Unit Hospital for Tropical Diseases in Ho Chi Minh City, where Dr Flohr has been based for his field work.
The University of Nottingham is leading the way in the investigation of links between hookworm infestation в" or lack of it в" and human illness. Two further currently ongoing trials are looking at the possibility that hookworm infection may alleviate symptoms of hay fever and CrohnвTMs Disease.
If these studies show positive results, future drugs that mimic the immunological effects of hookworm infection could provide promising therapeutic options for patients with allergic and other autoimmune diseases.
The University of Nottingham is Britain's University of the Year (The Times Higher Awards 2006). It undertakes world-changing research, provides innovative teaching and a student experience of the highest quality. Ranked by Newsweek in the world's Top 75 universities, its academics have won two Nobel Prizes since 2003. The University is an international institution with campuses in the United Kingdom, Malaysia and China.
Asthma UK is the charity dedicated to improving the health and well-being of the 5.2 million people in the UK whose lives are affected by asthma. It works together with people with asthma, health professionals and researchers to develop and share expertise to help people increase their understanding and reduce the effect of asthma on their lives.
The University of Nottingham
Race To Accelerate TB Drug Development
Each year, tuberculosis kills nearly two million people while an estimated nine million develop the disease - with the hardest-hit areas in AIDS-afflicted developing nations. One of the most pressing challenges is the increase in drug-resistant TB. "No Time to Wait: Overcoming Gaps in TB Drug R&D," a symposium -В organized by the international medical humanitarian organization Doctors Without Borders/MГ(c)decins Sans FrontiГЁres (MSF) and supported by Howard P. Milstein and Weill Cornell Medical College's Abby and Howard P. Milstein Program in Chemical Biology - will bring together a wide range of infectious disease experts and organizations to discuss practical ways of overcoming the current bottlenecks in TB drug research and development.
В В В В В The event takes place today and tomorrow at the Cornell Club in Manhattan and will feature an introductory address by Howard P. Milstein, a member of the Board of Overseers of Weill Cornell Medical College and trustee emeritus and presidential councilor of Cornell University.
В В В В В В В В "An additional 450,000 new cases of multidrug-resistant TB are seen every year, including people recently diagnosed with particularly lethal new resistant strains," says Mr. Milstein. "We must urgently find new ways of developing new treatments, including fast-tracking clinical trials of promising anti-TB compounds as well as funding strategies for TB research and development initiatives."
В В В В В The drugs in today's standard TB treatment were developed in the 1950s and 1960s, and the most commonly used TB test - developed more than a century ago - manages to detect TB in only about half of the cases. Existing TB drugs and tests are even less adapted for use in people who also have HIV/AIDS. To respond to the devastating impact of TB, especially in developing countries, newer medicines will urgently need to get to patients by working with regulatory agencies, drug development initiatives and pharmaceutical companies to ensure fast-track clinical development and availability of new drugs.
В В В В В Other participating institutions and government agencies include the World Health Organization, National Institute of Allergy and Infectious Diseases (NIAID) /National Institutes of Health (NIH), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDC), GlaxoSmithKline, Novartis AG, Johns Hopkins University Bloomberg School of Public Health, Bill and Melinda Gates Foundation, Columbia University, Rockefeller Foundation, European and Developing Countries Clinical Trials Partnership (EDCTP), Brazilian Society of Respiratory Diseases, St. George's Hospital Medical School of London, Global Alliance for TB Drug Development, University of Illinois at Chicago, Institute for Tuberculosis Research University of Illinois at Chicago, Yale Law School, Drugs for Neglected Diseases Initiative (DNDi), Tibotec, Denver Health and Hospitals, Treatment Action Group, and the Consumer Project on Technology.
В В В В В In June 2006, the Milsteins donated $7.25 million to Weill Cornell Medical College to establish the Abby and Howard P. Milstein Chemistry Core Facility and the Abby and Howard P. Milstein Program in Chemical Biology of Infectious Disease.
В В В В В Howard Milstein is Chairman of New York Private Bank and Trust, as well as Co-Chairman, President and CEO of Emigrant Savings Bank. He serves as a Trustee of Cornell University, where he received his undergraduate degree in 1973. He has been a member of the Board of Overseers of Weill Cornell Medical College since 1989. The Milstein family has a long history of generosity in support of Weill Cornell. Over the years, Mr. Milstein has been a strong supporter of the Medical Center's neuroscience initiatives and its Cabaret! benefit events.
The Joan and Sanford I. Weill Medical College
The Joan and Sanford I. Weill Medical College - located in New York City - is committed to excellence in research, teaching, patient care and the advancement of the art and science of medicine. The Medical College, which is a principal academic affiliate of NewYork-Presbyterian Hospital, offers an innovative curriculum that integrates the teaching of basic and clinical sciences, problem-based learning, office-based preceptorships, and primary care and doctoring courses. Physicians and scientists of Weill Cornell Medical College are engaged in cutting-edge research in such areas as stem cells, genetics and gene therapy, geriatrics, neuroscience, structural biology, cardiovascular medicine, AIDS, obesity, cancer and psychiatry - and continue to delve ever deeper into the molecular basis of disease in an effort to unlock the mysteries behind the human body and the malfunctions that result in serious medical disorders. Weill Cornell Medical College is the birthplace of many medical advances - from the development of the Pap test for cervical cancer to the synthesis of penicillin, the first successful embryo-biopsy pregnancy and birth in the U.S., and most recently, the world's first clinical trial for gene therapy for Parkinson's disease. Weill Cornell's Physician Organization includes 650 clinical faculty, who provide the highest quality of care to their patients.
Joan and Sanford I. Weill Cornell Medical College
525 East 68th Street, Box 144
New York, NY 10021
http://www.med.cornell.edu
http://www.nyp.org
В В В В В The event takes place today and tomorrow at the Cornell Club in Manhattan and will feature an introductory address by Howard P. Milstein, a member of the Board of Overseers of Weill Cornell Medical College and trustee emeritus and presidential councilor of Cornell University.
В В В В В В В В "An additional 450,000 new cases of multidrug-resistant TB are seen every year, including people recently diagnosed with particularly lethal new resistant strains," says Mr. Milstein. "We must urgently find new ways of developing new treatments, including fast-tracking clinical trials of promising anti-TB compounds as well as funding strategies for TB research and development initiatives."
В В В В В The drugs in today's standard TB treatment were developed in the 1950s and 1960s, and the most commonly used TB test - developed more than a century ago - manages to detect TB in only about half of the cases. Existing TB drugs and tests are even less adapted for use in people who also have HIV/AIDS. To respond to the devastating impact of TB, especially in developing countries, newer medicines will urgently need to get to patients by working with regulatory agencies, drug development initiatives and pharmaceutical companies to ensure fast-track clinical development and availability of new drugs.
В В В В В Other participating institutions and government agencies include the World Health Organization, National Institute of Allergy and Infectious Diseases (NIAID) /National Institutes of Health (NIH), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDC), GlaxoSmithKline, Novartis AG, Johns Hopkins University Bloomberg School of Public Health, Bill and Melinda Gates Foundation, Columbia University, Rockefeller Foundation, European and Developing Countries Clinical Trials Partnership (EDCTP), Brazilian Society of Respiratory Diseases, St. George's Hospital Medical School of London, Global Alliance for TB Drug Development, University of Illinois at Chicago, Institute for Tuberculosis Research University of Illinois at Chicago, Yale Law School, Drugs for Neglected Diseases Initiative (DNDi), Tibotec, Denver Health and Hospitals, Treatment Action Group, and the Consumer Project on Technology.
В В В В В In June 2006, the Milsteins donated $7.25 million to Weill Cornell Medical College to establish the Abby and Howard P. Milstein Chemistry Core Facility and the Abby and Howard P. Milstein Program in Chemical Biology of Infectious Disease.
В В В В В Howard Milstein is Chairman of New York Private Bank and Trust, as well as Co-Chairman, President and CEO of Emigrant Savings Bank. He serves as a Trustee of Cornell University, where he received his undergraduate degree in 1973. He has been a member of the Board of Overseers of Weill Cornell Medical College since 1989. The Milstein family has a long history of generosity in support of Weill Cornell. Over the years, Mr. Milstein has been a strong supporter of the Medical Center's neuroscience initiatives and its Cabaret! benefit events.
The Joan and Sanford I. Weill Medical College
The Joan and Sanford I. Weill Medical College - located in New York City - is committed to excellence in research, teaching, patient care and the advancement of the art and science of medicine. The Medical College, which is a principal academic affiliate of NewYork-Presbyterian Hospital, offers an innovative curriculum that integrates the teaching of basic and clinical sciences, problem-based learning, office-based preceptorships, and primary care and doctoring courses. Physicians and scientists of Weill Cornell Medical College are engaged in cutting-edge research in such areas as stem cells, genetics and gene therapy, geriatrics, neuroscience, structural biology, cardiovascular medicine, AIDS, obesity, cancer and psychiatry - and continue to delve ever deeper into the molecular basis of disease in an effort to unlock the mysteries behind the human body and the malfunctions that result in serious medical disorders. Weill Cornell Medical College is the birthplace of many medical advances - from the development of the Pap test for cervical cancer to the synthesis of penicillin, the first successful embryo-biopsy pregnancy and birth in the U.S., and most recently, the world's first clinical trial for gene therapy for Parkinson's disease. Weill Cornell's Physician Organization includes 650 clinical faculty, who provide the highest quality of care to their patients.
Joan and Sanford I. Weill Cornell Medical College
525 East 68th Street, Box 144
New York, NY 10021
http://www.med.cornell.edu
http://www.nyp.org
Wednesday, March 12, 2008
Asthma Blog Carnival
Registered Nurses posted at http://arizonajobsandemployment.com
Allergic Asthma Treatment posted at http://www.allergyabc.com/blog
benefits of correct breathing posted at http://www.asthmacare.ie/blog
hyperventilation chronic or acute? posted at http://www.asthmacare.ie/blog
Wednesday, March 5, 2008
Race To Accelerate TB Drug Development
Each year, tuberculosis kills nearly two million people while an estimated nine million develop the disease - with the hardest-hit areas in AIDS-afflicted developing nations. One of the most pressing challenges is the increase in drug-resistant TB. "No Time to Wait: Overcoming Gaps in TB Drug R&D," a symposium -В organized by the international medical humanitarian organization Doctors Without Borders/MГ(c)decins Sans FrontiГЁres (MSF) and supported by Howard P. Milstein and Weill Cornell Medical College's Abby and Howard P. Milstein Program in Chemical Biology - will bring together a wide range of infectious disease experts and organizations to discuss practical ways of overcoming the current bottlenecks in TB drug research and development.
В В В В В The event takes place today and tomorrow at the Cornell Club in Manhattan and will feature an introductory address by Howard P. Milstein, a member of the Board of Overseers of Weill Cornell Medical College and trustee emeritus and presidential councilor of Cornell University.
В В В В В В В В "An additional 450,000 new cases of multidrug-resistant TB are seen every year, including people recently diagnosed with particularly lethal new resistant strains," says Mr. Milstein. "We must urgently find new ways of developing new treatments, including fast-tracking clinical trials of promising anti-TB compounds as well as funding strategies for TB research and development initiatives."
В В В В В The drugs in today's standard TB treatment were developed in the 1950s and 1960s, and the most commonly used TB test - developed more than a century ago - manages to detect TB in only about half of the cases. Existing TB drugs and tests are even less adapted for use in people who also have HIV/AIDS. To respond to the devastating impact of TB, especially in developing countries, newer medicines will urgently need to get to patients by working with regulatory agencies, drug development initiatives and pharmaceutical companies to ensure fast-track clinical development and availability of new drugs.
В В В В В Other participating institutions and government agencies include the World Health Organization, National Institute of Allergy and Infectious Diseases (NIAID) /National Institutes of Health (NIH), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDC), GlaxoSmithKline, Novartis AG, Johns Hopkins University Bloomberg School of Public Health, Bill and Melinda Gates Foundation, Columbia University, Rockefeller Foundation, European and Developing Countries Clinical Trials Partnership (EDCTP), Brazilian Society of Respiratory Diseases, St. George's Hospital Medical School of London, Global Alliance for TB Drug Development, University of Illinois at Chicago, Institute for Tuberculosis Research University of Illinois at Chicago, Yale Law School, Drugs for Neglected Diseases Initiative (DNDi), Tibotec, Denver Health and Hospitals, Treatment Action Group, and the Consumer Project on Technology.
В В В В В In June 2006, the Milsteins donated $7.25 million to Weill Cornell Medical College to establish the Abby and Howard P. Milstein Chemistry Core Facility and the Abby and Howard P. Milstein Program in Chemical Biology of Infectious Disease.
В В В В В Howard Milstein is Chairman of New York Private Bank and Trust, as well as Co-Chairman, President and CEO of Emigrant Savings Bank. He serves as a Trustee of Cornell University, where he received his undergraduate degree in 1973. He has been a member of the Board of Overseers of Weill Cornell Medical College since 1989. The Milstein family has a long history of generosity in support of Weill Cornell. Over the years, Mr. Milstein has been a strong supporter of the Medical Center's neuroscience initiatives and its Cabaret! benefit events.
The Joan and Sanford I. Weill Medical College
The Joan and Sanford I. Weill Medical College - located in New York City - is committed to excellence in research, teaching, patient care and the advancement of the art and science of medicine. The Medical College, which is a principal academic affiliate of NewYork-Presbyterian Hospital, offers an innovative curriculum that integrates the teaching of basic and clinical sciences, problem-based learning, office-based preceptorships, and primary care and doctoring courses. Physicians and scientists of Weill Cornell Medical College are engaged in cutting-edge research in such areas as stem cells, genetics and gene therapy, geriatrics, neuroscience, structural biology, cardiovascular medicine, AIDS, obesity, cancer and psychiatry - and continue to delve ever deeper into the molecular basis of disease in an effort to unlock the mysteries behind the human body and the malfunctions that result in serious medical disorders. Weill Cornell Medical College is the birthplace of many medical advances - from the development of the Pap test for cervical cancer to the synthesis of penicillin, the first successful embryo-biopsy pregnancy and birth in the U.S., and most recently, the world's first clinical trial for gene therapy for Parkinson's disease. Weill Cornell's Physician Organization includes 650 clinical faculty, who provide the highest quality of care to their patients.
Joan and Sanford I. Weill Cornell Medical College
525 East 68th Street, Box 144
New York, NY 10021
http://www.med.cornell.edu
http://www.nyp.org
В В В В В The event takes place today and tomorrow at the Cornell Club in Manhattan and will feature an introductory address by Howard P. Milstein, a member of the Board of Overseers of Weill Cornell Medical College and trustee emeritus and presidential councilor of Cornell University.
В В В В В В В В "An additional 450,000 new cases of multidrug-resistant TB are seen every year, including people recently diagnosed with particularly lethal new resistant strains," says Mr. Milstein. "We must urgently find new ways of developing new treatments, including fast-tracking clinical trials of promising anti-TB compounds as well as funding strategies for TB research and development initiatives."
В В В В В The drugs in today's standard TB treatment were developed in the 1950s and 1960s, and the most commonly used TB test - developed more than a century ago - manages to detect TB in only about half of the cases. Existing TB drugs and tests are even less adapted for use in people who also have HIV/AIDS. To respond to the devastating impact of TB, especially in developing countries, newer medicines will urgently need to get to patients by working with regulatory agencies, drug development initiatives and pharmaceutical companies to ensure fast-track clinical development and availability of new drugs.
В В В В В Other participating institutions and government agencies include the World Health Organization, National Institute of Allergy and Infectious Diseases (NIAID) /National Institutes of Health (NIH), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDC), GlaxoSmithKline, Novartis AG, Johns Hopkins University Bloomberg School of Public Health, Bill and Melinda Gates Foundation, Columbia University, Rockefeller Foundation, European and Developing Countries Clinical Trials Partnership (EDCTP), Brazilian Society of Respiratory Diseases, St. George's Hospital Medical School of London, Global Alliance for TB Drug Development, University of Illinois at Chicago, Institute for Tuberculosis Research University of Illinois at Chicago, Yale Law School, Drugs for Neglected Diseases Initiative (DNDi), Tibotec, Denver Health and Hospitals, Treatment Action Group, and the Consumer Project on Technology.
В В В В В In June 2006, the Milsteins donated $7.25 million to Weill Cornell Medical College to establish the Abby and Howard P. Milstein Chemistry Core Facility and the Abby and Howard P. Milstein Program in Chemical Biology of Infectious Disease.
В В В В В Howard Milstein is Chairman of New York Private Bank and Trust, as well as Co-Chairman, President and CEO of Emigrant Savings Bank. He serves as a Trustee of Cornell University, where he received his undergraduate degree in 1973. He has been a member of the Board of Overseers of Weill Cornell Medical College since 1989. The Milstein family has a long history of generosity in support of Weill Cornell. Over the years, Mr. Milstein has been a strong supporter of the Medical Center's neuroscience initiatives and its Cabaret! benefit events.
The Joan and Sanford I. Weill Medical College
The Joan and Sanford I. Weill Medical College - located in New York City - is committed to excellence in research, teaching, patient care and the advancement of the art and science of medicine. The Medical College, which is a principal academic affiliate of NewYork-Presbyterian Hospital, offers an innovative curriculum that integrates the teaching of basic and clinical sciences, problem-based learning, office-based preceptorships, and primary care and doctoring courses. Physicians and scientists of Weill Cornell Medical College are engaged in cutting-edge research in such areas as stem cells, genetics and gene therapy, geriatrics, neuroscience, structural biology, cardiovascular medicine, AIDS, obesity, cancer and psychiatry - and continue to delve ever deeper into the molecular basis of disease in an effort to unlock the mysteries behind the human body and the malfunctions that result in serious medical disorders. Weill Cornell Medical College is the birthplace of many medical advances - from the development of the Pap test for cervical cancer to the synthesis of penicillin, the first successful embryo-biopsy pregnancy and birth in the U.S., and most recently, the world's first clinical trial for gene therapy for Parkinson's disease. Weill Cornell's Physician Organization includes 650 clinical faculty, who provide the highest quality of care to their patients.
Joan and Sanford I. Weill Cornell Medical College
525 East 68th Street, Box 144
New York, NY 10021
http://www.med.cornell.edu
http://www.nyp.org
Tuesday, March 4, 2008
Exacerbations In Severe COPD Reduced By Combination Therapy
For patients with severe chronic obstructive pulmonary disease (COPD), combining a long-acting bronchodilator with an inhaled corticosteroid reduced the number of exacerbations by 35 percent.
The research appears in the second issue for January 2007 of the American Journal of Respiratory and Critical Care Medicine, published by the American Thoracic Society.
Peter Kardos, M.D., of the Respiratory Medicine Section of Maingau Hospital in Frankfurt am Main, Germany, and three associates treated patients with moderate to severe COPD from 92 respiratory centers across Germany. All had less than a 50 percent predicted lung function capability for their age group.
The researchers treated 487 patients with salmeterol, a long-acting bronchodilator, and gave 507 a combination therapy of salmeterol and fluticasone propionate, an inhaled corticosteroid. Of the total cohort, 792 patients completed all phases of the 44-week study.
In the combined therapy group, 324 patients experienced moderate to severe exacerbations, as compared to 464 in the control group. The authors believe that this reduction in exacerbations is likely of clinical importance for patients with severe COPD.
"Exacerbations are a major cause of disease-related problems," said Dr. Kardos. "In particular, they greatly contribute to the decline of the health-related quality of life, increase symptoms and breathlessness, speed progression of the disease and increase the risk of mortality. In addition, exacerbations induce enormous economic costs. They can occur at any stage of the disease, but become more frequent as lung function impairment worsens."
In the United States, COPD is the fourth leading cause of death, killing 122,283 Americans in 2003. In 2004, more than 11 million U.S. adults were estimated to suffer from the disease, which results from chronic bronchitis and emphysema, two lung diseases that frequently co-exist and interfere with normal breathing. Smoking is the primary cause of COPD.
To date, no medication has been effective in halting long-term decline in lung function, which is the hallmark of the disease. Medications can only be used to provide relief from symptoms and prevent complications.
In an editorial on the research in the same issue of the journal, Dennis E. Niewoehner, M.D., and Timothy J. Wilt, M.D., of the Veterans Affairs Medical Center and the University of Minnesota, wrote: "As in all previous large inhaled corticosteroid (ICS) trials, Dr. Kardos administered relatively high doses of flutacasone. High dose ICS causes localized adverse effects in the upper airway and on the skin, but only infrequently do these complications cause discontinuation of therapy."
"Of greater concern is the systemic absorption of small amounts of ICS and the potential for long-term sequelae, particularly involving the bones and eyes," the editorialists continued. "The largely elderly population of patients with COPD may be at greater risk, and, as discussed in a recent review, the extent of the relationship between long-term ICS and bone and eye complications has yet to be fully clarified."
"Dr. Kardos and associates identify an additional safety concern with ICS not mentioned in previous publications. Based on adverse event reporting, 23 cases of pneumonia occurred in the combined-treatment group compared with only seven in the salmeterol arm. This difference is statistically significant and represents an excess pneumonia rate of about 3 per 100 patient years in patients given fluticasone."
The authors noted that similar results were obtained in patients who received fluticasone in TOwards a Revolution in COPD Health (TORCH), a survival study that aimed to determine the impact of salmeterol/fluticasone propionate combination and the individual components on the survival of COPD patients.
"In light of the known immunosuppressive properties of corticosteroids, an excess pneumonia rate from a high local concentration of ICS is not particularly surprising," the editorialists wrote.
The authors also pointed out that only a small minority of patients treated with ICS would achieve "clinically noticeable improvement in health status."
They concluded: "Therefore, decisions to initiate ICS combined with a long-acting beta agonist should focus on severely symptomatic and exacerbation-prone patients and balance the recently demonstrated benefits against increased drug costs and adverse effects."
###
Contact for study:
Peter Kardos, M.D.,
Group Practice and Center for Respiratory and Sleep Medicine, Allergy,
Maingau Hospital,
Scheffelstrasse 33, 60318,
Frankfurt am Main,
Germany
Contact for editorial:
Dennis E. Niewoehner, M.D.,
Chief, VA Medical Center,
Pulmonary Section (111N), 1 Veterans Drive,
Minneapolis, MN 55417
Contact: Suzy Martin
American Thoracic Society
The research appears in the second issue for January 2007 of the American Journal of Respiratory and Critical Care Medicine, published by the American Thoracic Society.
Peter Kardos, M.D., of the Respiratory Medicine Section of Maingau Hospital in Frankfurt am Main, Germany, and three associates treated patients with moderate to severe COPD from 92 respiratory centers across Germany. All had less than a 50 percent predicted lung function capability for their age group.
The researchers treated 487 patients with salmeterol, a long-acting bronchodilator, and gave 507 a combination therapy of salmeterol and fluticasone propionate, an inhaled corticosteroid. Of the total cohort, 792 patients completed all phases of the 44-week study.
In the combined therapy group, 324 patients experienced moderate to severe exacerbations, as compared to 464 in the control group. The authors believe that this reduction in exacerbations is likely of clinical importance for patients with severe COPD.
"Exacerbations are a major cause of disease-related problems," said Dr. Kardos. "In particular, they greatly contribute to the decline of the health-related quality of life, increase symptoms and breathlessness, speed progression of the disease and increase the risk of mortality. In addition, exacerbations induce enormous economic costs. They can occur at any stage of the disease, but become more frequent as lung function impairment worsens."
In the United States, COPD is the fourth leading cause of death, killing 122,283 Americans in 2003. In 2004, more than 11 million U.S. adults were estimated to suffer from the disease, which results from chronic bronchitis and emphysema, two lung diseases that frequently co-exist and interfere with normal breathing. Smoking is the primary cause of COPD.
To date, no medication has been effective in halting long-term decline in lung function, which is the hallmark of the disease. Medications can only be used to provide relief from symptoms and prevent complications.
In an editorial on the research in the same issue of the journal, Dennis E. Niewoehner, M.D., and Timothy J. Wilt, M.D., of the Veterans Affairs Medical Center and the University of Minnesota, wrote: "As in all previous large inhaled corticosteroid (ICS) trials, Dr. Kardos administered relatively high doses of flutacasone. High dose ICS causes localized adverse effects in the upper airway and on the skin, but only infrequently do these complications cause discontinuation of therapy."
"Of greater concern is the systemic absorption of small amounts of ICS and the potential for long-term sequelae, particularly involving the bones and eyes," the editorialists continued. "The largely elderly population of patients with COPD may be at greater risk, and, as discussed in a recent review, the extent of the relationship between long-term ICS and bone and eye complications has yet to be fully clarified."
"Dr. Kardos and associates identify an additional safety concern with ICS not mentioned in previous publications. Based on adverse event reporting, 23 cases of pneumonia occurred in the combined-treatment group compared with only seven in the salmeterol arm. This difference is statistically significant and represents an excess pneumonia rate of about 3 per 100 patient years in patients given fluticasone."
The authors noted that similar results were obtained in patients who received fluticasone in TOwards a Revolution in COPD Health (TORCH), a survival study that aimed to determine the impact of salmeterol/fluticasone propionate combination and the individual components on the survival of COPD patients.
"In light of the known immunosuppressive properties of corticosteroids, an excess pneumonia rate from a high local concentration of ICS is not particularly surprising," the editorialists wrote.
The authors also pointed out that only a small minority of patients treated with ICS would achieve "clinically noticeable improvement in health status."
They concluded: "Therefore, decisions to initiate ICS combined with a long-acting beta agonist should focus on severely symptomatic and exacerbation-prone patients and balance the recently demonstrated benefits against increased drug costs and adverse effects."
###
Contact for study:
Peter Kardos, M.D.,
Group Practice and Center for Respiratory and Sleep Medicine, Allergy,
Maingau Hospital,
Scheffelstrasse 33, 60318,
Frankfurt am Main,
Germany
Contact for editorial:
Dennis E. Niewoehner, M.D.,
Chief, VA Medical Center,
Pulmonary Section (111N), 1 Veterans Drive,
Minneapolis, MN 55417
Contact: Suzy Martin
American Thoracic Society
Sequella Receives FDA Fast Track Status For TB Drug
Sequella, Inc., a clinical-stage biopharmaceutical company focused on commercializing improved treatment paradigms for diseases of epidemic potential, today announced it has received Fast Track designation from the U.S. Food and Drug Administration (FDA) for SQ109, the company's proprietary lead drug candidate for treatment of pulmonary tuberculosis (TB). With a mechanism of action distinct from other antibiotics used in TB therapy, SQ109 shows excellent in vitro activity against drug susceptible and drug resistant TB bacteria, including XDR-TB, as well as potent in vivo activity against pulmonary TB alone and with other TB drugs.
"This FDA Fast Track designation validates SQ109 as a potentially unique addition to the TB therapeutic armamentarium," said Dr. Carol Nacy, CEO of Sequella. "This is an important regulatory milestone and recognition that SQ109 may address unmet needs in TB therapy to improve and shorten the current treatment regimen."
According to a letter from the FDA, SQ109 received fast track designation based on the following: "SQ 109 has the potential to fulfill an unmet medical need, and the preclinical information available thus far demonstrates that SQ 109 has the potential to enhance the treatment of tuberculosis during the first two months of intensive therapy and to treat multi-drug resistant TB." The FDA letter also stated that: "In 2002 the estimated number of active cases of tuberculosis was 9 million, with approximately 2 million deaths, worldwide."
Mandated by the FDA Modernization Act of 1997, Fast Track designation expedites the development and review of a New Drug Application (NDA) for approval.
About Tuberculosis (TB)
TB is a contagious infectious disease caused by the bacterium Mycobacterium tuberculosis. TB bacteria can be inhaled into lungs and are able to avoid destruction by certain white blood cells. Without containment by immune cells, the bacteria can spread throughout the body, multiply, survive and remain dormant for years. TB is the leading cause of global deaths that result from a single-agent infectious disease. Nine million new cases of active TB disease are reported every year. The World Health Organization (WHO) estimates that one-third of the world's population is infected with TB.
About SQ109
SQ109 is an orally active small molecule antibiotic that inhibits cell wall synthesis and acts on multiple cellular pathways in a select group of microorganisms, including Mycobacterium tuberculosis, the bacteria that cause TB. SQ109 enhances, both in vitro and in vivo, the activity of the anti- tubercular drugs isoniazid and rifampin, thereby shortening by 25% the time required to cure mice of experimental TB. SQ109 is currently in Phase I clinical trials under a US IND, and could replace one or more of the current first-line anti-TB drugs, simplify therapy, and shorten the treatment regimen. Since 2000, Sequella has applied its scientific expertise in TB research and product development to identify, characterize, and complete preclinical evaluation of SQ109. SQ109 was developed in partnership with the NIH, with several grants from the National Institute of Allergy and Infectious Diseases (NIAID) and the assistance of the NIAID and the National Cancer Institute Inter-Institute Program (NCI IIP) for IND-enabling studies.
About Sequella, Inc.
Sequella is a clinical-stage biopharmaceutical company focused on commercializing improved treatment paradigms for diseases of epidemic potential. The company leverages its global influence, infectious disease expertise, and diverse product portfolio to proactively address emerging health threats with significant market opportunity. The Company's lead drug candidate SQ109, a new orally-active diamine antibiotic for the treatment of tuberculosis (TB) and other infectious diseases, is presently in Phase I clinical studies. The company's lead diagnostic product candidate, the TB Patch, is completing several international clinical trials in anticipation of world-wide product registration. For more information, please visit http://www.sequella.com.
Forward-Looking Statement
This press release contains forward-looking statements that are subject to risks and uncertainties, and includes statements that are not historical facts. Actual results could differ significantly from results discussed. Sequella disclaims any intent or obligation to update forward-looking statements, except as required by law.
Sequella, Inc.
http://www.sequella.com
"This FDA Fast Track designation validates SQ109 as a potentially unique addition to the TB therapeutic armamentarium," said Dr. Carol Nacy, CEO of Sequella. "This is an important regulatory milestone and recognition that SQ109 may address unmet needs in TB therapy to improve and shorten the current treatment regimen."
According to a letter from the FDA, SQ109 received fast track designation based on the following: "SQ 109 has the potential to fulfill an unmet medical need, and the preclinical information available thus far demonstrates that SQ 109 has the potential to enhance the treatment of tuberculosis during the first two months of intensive therapy and to treat multi-drug resistant TB." The FDA letter also stated that: "In 2002 the estimated number of active cases of tuberculosis was 9 million, with approximately 2 million deaths, worldwide."
Mandated by the FDA Modernization Act of 1997, Fast Track designation expedites the development and review of a New Drug Application (NDA) for approval.
About Tuberculosis (TB)
TB is a contagious infectious disease caused by the bacterium Mycobacterium tuberculosis. TB bacteria can be inhaled into lungs and are able to avoid destruction by certain white blood cells. Without containment by immune cells, the bacteria can spread throughout the body, multiply, survive and remain dormant for years. TB is the leading cause of global deaths that result from a single-agent infectious disease. Nine million new cases of active TB disease are reported every year. The World Health Organization (WHO) estimates that one-third of the world's population is infected with TB.
About SQ109
SQ109 is an orally active small molecule antibiotic that inhibits cell wall synthesis and acts on multiple cellular pathways in a select group of microorganisms, including Mycobacterium tuberculosis, the bacteria that cause TB. SQ109 enhances, both in vitro and in vivo, the activity of the anti- tubercular drugs isoniazid and rifampin, thereby shortening by 25% the time required to cure mice of experimental TB. SQ109 is currently in Phase I clinical trials under a US IND, and could replace one or more of the current first-line anti-TB drugs, simplify therapy, and shorten the treatment regimen. Since 2000, Sequella has applied its scientific expertise in TB research and product development to identify, characterize, and complete preclinical evaluation of SQ109. SQ109 was developed in partnership with the NIH, with several grants from the National Institute of Allergy and Infectious Diseases (NIAID) and the assistance of the NIAID and the National Cancer Institute Inter-Institute Program (NCI IIP) for IND-enabling studies.
About Sequella, Inc.
Sequella is a clinical-stage biopharmaceutical company focused on commercializing improved treatment paradigms for diseases of epidemic potential. The company leverages its global influence, infectious disease expertise, and diverse product portfolio to proactively address emerging health threats with significant market opportunity. The Company's lead drug candidate SQ109, a new orally-active diamine antibiotic for the treatment of tuberculosis (TB) and other infectious diseases, is presently in Phase I clinical studies. The company's lead diagnostic product candidate, the TB Patch, is completing several international clinical trials in anticipation of world-wide product registration. For more information, please visit http://www.sequella.com.
Forward-Looking Statement
This press release contains forward-looking statements that are subject to risks and uncertainties, and includes statements that are not historical facts. Actual results could differ significantly from results discussed. Sequella disclaims any intent or obligation to update forward-looking statements, except as required by law.
Sequella, Inc.
http://www.sequella.com
Subcutaneous Injection Of Pollen-Extract Can Ward Off Symptoms Of Hayfever
Injecting small amounts of pollen-extract just below the skin in people who have hayfever can desensitize them to the pollen and reduce their symptoms. It also reduces the amount of medication they use.
These are the conclusions from a Cochrane Review of this therapy. The review pooled data from 51 trials involving a total of 2871 patients, 1645 of whom received an active treatment, while 1226 received an inactive placebo. Treatment consisted of an average of 18 injections spread over a range of times from three days to three years.
The review found that the treatment was safe, with serious adverse reactions to the therapy occurring in only four patients; one of whom had been given a placebo. Three had an anaphylactic reaction and one had an attack of asthma. All of them recovered fully and none dropped out of the trial as a result of these side-effects.
"Because of the very low, but real, risk of an adverse reaction, this treatment should only given in facilities that have full resuscitation back up. Unfortunately, in the UK, this means that it can only be given in specialized centres, which greatly limits its use," says Review Authors Moises Calderon, a Senior Clinical Fellow in the Department of Allergy and Respiratory Medicine at the Royal Brompton Hospital, London, and Professor Aziz Sheikh, Primary Care Research and Development at the University of Edinburgh.
The risk of an adverse reaction also means that it should not be given to people who also have asthma.
The Cochrane Review concluded that injection immunotherapy is a safe and valid treatment for patients with hayfever, and particularly those who have not responded to other treatments.
Calderon MA et al. Allergen injection immunotherapy for seasonal allergic rhinitis. Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.: CD001936. DOI: 10.1002/14651858.CD001936.pub2.
###
The Cochrane Library, 2007, Issue 1
Notes
1. The Cochrane Library contains high quality health care information, including Systematic Reviews from The Cochrane Collaboration. These Reviews bring together research on the effects of health care and are considered the gold standard for determining the relative effectiveness of different interventions. The Cochrane Collaboration (http://www.cochrane.org/) is a UK registered international charity and the world's leading producer of systematic Reviews. It has been demonstrated that Cochrane Systematic Reviews are of comparable or better quality and are updated more often than the Reviews published in print journalsВ.
2. The Cochrane Library can be accessed at http://www.thecochranelibrary.com/. Guest users may access abstracts for all Reviews in the database, and members of the media may request full access to the contents of the Library. For further information, see contact details below.
3. A number of countries have national provisions by which some or all of their residents are able to access The Cochrane Library for free. These include:
Australia www.nicsl.com.au/Cochrane
All residents of Australia with access to the Internet can access The Cochrane Library for free, thanks to funding provided by the Australian Government and administered by the National Institute of Clinical Studies
Denmark www.vifab.dk or www.sundhedsportalen.dk or www.deff.dk or www.cochrane.dk All residents of Denmark (including Greenland and the Faroe Islands) can access The Cochrane Library for free, thanks to funding for a national provision from Videns-og Forskningscenter for Alternativ Behandling (ViFAB), Den fГ|lles offentlige sundhedsportal, Biblioteksstyrelsen and The Nordic Cochrane Centre.
England www.nelh.nhs.uk/cochrane.aspAll residents of England with access to the Internet can access The Cochrane Library for free, thanks to funding provided by the NHS Connecting for Health, National Library for Health.
Finland www.terveysportti.fi Access to The Cochrane Library is available in Finland for registered users of Terveysportti-portal provided by Duodecim Medical Publications Ltd.
Ireland All residents within the Island of Ireland can access The Cochrane Library for free, thanks to funding for a national provision by The Health Research Board in Dublin and The Research and Development Office in Belfast.
Latin and Central America and Carribbean http://cochrane.bireme.br All countries in Latin and Central America and Caribbean can access The Cochrane Library for free via the Virtual Health Library BIREME interface (in English, Spanish or Portugues), thanks to funding by BIREME / Pan- American Health Organisation (PAHO) / World Health Organisation (WHO)
New Zealand http://www.moh.govt.nz/cochranelibrary or http://www.nzgg.org.nz/ or http://www.cochrane.org.nz/All residents of New Zealand with access to the internet can access The Cochrane Library for free, thanks to the District Health Boards and the New Zealand Ministry of Health.
Norway www.cochrane.no All residents of Norway can access The Cochrane Library for free, thanks to funding for a national provision from The Norwegian Health Services Research Centre
Poland http://www.aotm.gov.pl All residents of Poland with access to the Internet can access The Cochrane Library for free, thanks to funding for a national provision by Agencja Oceny Technologii Medycznych
Scotland http://www.nes.scot.nhs.uk/ All residents of Scotland with access to the Internet can access The Cochrane Library for free, thanks to funding provided by the NHS Education for Scotland
Spain http://www.update-software.com/Clibplus/ClibPlus.asp
South Africa http://www.sahealthinfo.org/evidence/databases.htm. The South African Cochrane Centre (SACC) offers a limited number of free access registrations to The Cochrane Library to African residents. To apply for a sponsorship please register at: http://www.sahealthinfo.org/SAHealthInfoUtils/index.jsp.
Sweden www.sbu.se All residents of Sweden with access to the Internet can access The Cochrane Library for free, thanks to the funding provided SBU - Statens beredning fГPr medicinsk utvГ¤rdering/The Swedish Council on Technology Assessment in Health Care
Wales All residents of Wales with access to the Internet can access The Cochrane Library for free, thanks to funding provided by The Welsh Assembly Government. The Canadian Province of New Brunswick http://www.gnb.ca/0003/ Access to The Cochrane Library is available for free through the electronic resources section of the NBPLS website to all New Brunswickers who have a public library card thanks to funding provided by the partnership involving the New Brunswick Public Library Service (NBPLS), the University of New Brunswick (UNB) Libraries, and the Regional Health Authority (RHA) libraries
The Canadian Northwest Territorities, Nunavut, Yukon http://www.thecochranelibrary.comAll Northern residents with access to the Internet can access The Cochrane Library for free thanks to funding provided by the Pan-Northern Agreement and the Indian and Inuit Branch of Health Canada.
The Canadian Province of Saskatchewan www.thecochranelibrary.com All residents of Saskatchewan can access to The Cochrane Library for free by using public library facilities in the providence and remotely through their local library web site with a library card thanks to funding provided by the partnership involving the Health Quality Council, The Canadian Cochrane Network and Centre (University of Saskatchewan Site Group), the Multitype Database Licensing Program, and the Saskatchewan Provincial Library
The US State of Wyoming http://wyld.state.wy.us/dbloginform.html/ All residents can access The Cochrane Library for free at the state's Wyoming Libraries Database libraries which include public, community college and medical libraries thanks to funding provided by Wyoming State Legislature's Joint Labor, Health and Social Services Committee
4. There are also several programmes, such as the Health InterNetwork Access to Research Initiative (HINARI) that provide access in developing countries. To find out whether your country is included in any of these programmes/provisions, or to learn how to get access if you don't already have it, please visit: http://www.thecochranelibrary.com/.
В Jadad AR, Cook DJ, Jones A, Klassen TP, Tugwell P, Moher M, et al. Methodology and reports of systematic Reviews and meta-analysies: a comparison of Cochrane Reviews with articles published in paper-based journal.
Contact: Amy Molnar
John Wiley & Sons, Inc.
These are the conclusions from a Cochrane Review of this therapy. The review pooled data from 51 trials involving a total of 2871 patients, 1645 of whom received an active treatment, while 1226 received an inactive placebo. Treatment consisted of an average of 18 injections spread over a range of times from three days to three years.
The review found that the treatment was safe, with serious adverse reactions to the therapy occurring in only four patients; one of whom had been given a placebo. Three had an anaphylactic reaction and one had an attack of asthma. All of them recovered fully and none dropped out of the trial as a result of these side-effects.
"Because of the very low, but real, risk of an adverse reaction, this treatment should only given in facilities that have full resuscitation back up. Unfortunately, in the UK, this means that it can only be given in specialized centres, which greatly limits its use," says Review Authors Moises Calderon, a Senior Clinical Fellow in the Department of Allergy and Respiratory Medicine at the Royal Brompton Hospital, London, and Professor Aziz Sheikh, Primary Care Research and Development at the University of Edinburgh.
The risk of an adverse reaction also means that it should not be given to people who also have asthma.
The Cochrane Review concluded that injection immunotherapy is a safe and valid treatment for patients with hayfever, and particularly those who have not responded to other treatments.
Calderon MA et al. Allergen injection immunotherapy for seasonal allergic rhinitis. Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.: CD001936. DOI: 10.1002/14651858.CD001936.pub2.
###
The Cochrane Library, 2007, Issue 1
Notes
1. The Cochrane Library contains high quality health care information, including Systematic Reviews from The Cochrane Collaboration. These Reviews bring together research on the effects of health care and are considered the gold standard for determining the relative effectiveness of different interventions. The Cochrane Collaboration (http://www.cochrane.org/) is a UK registered international charity and the world's leading producer of systematic Reviews. It has been demonstrated that Cochrane Systematic Reviews are of comparable or better quality and are updated more often than the Reviews published in print journalsВ.
2. The Cochrane Library can be accessed at http://www.thecochranelibrary.com/. Guest users may access abstracts for all Reviews in the database, and members of the media may request full access to the contents of the Library. For further information, see contact details below.
3. A number of countries have national provisions by which some or all of their residents are able to access The Cochrane Library for free. These include:
Australia www.nicsl.com.au/Cochrane
All residents of Australia with access to the Internet can access The Cochrane Library for free, thanks to funding provided by the Australian Government and administered by the National Institute of Clinical Studies
Denmark www.vifab.dk or www.sundhedsportalen.dk or www.deff.dk or www.cochrane.dk All residents of Denmark (including Greenland and the Faroe Islands) can access The Cochrane Library for free, thanks to funding for a national provision from Videns-og Forskningscenter for Alternativ Behandling (ViFAB), Den fГ|lles offentlige sundhedsportal, Biblioteksstyrelsen and The Nordic Cochrane Centre.
England www.nelh.nhs.uk/cochrane.aspAll residents of England with access to the Internet can access The Cochrane Library for free, thanks to funding provided by the NHS Connecting for Health, National Library for Health.
Finland www.terveysportti.fi Access to The Cochrane Library is available in Finland for registered users of Terveysportti-portal provided by Duodecim Medical Publications Ltd.
Ireland All residents within the Island of Ireland can access The Cochrane Library for free, thanks to funding for a national provision by The Health Research Board in Dublin and The Research and Development Office in Belfast.
Latin and Central America and Carribbean http://cochrane.bireme.br All countries in Latin and Central America and Caribbean can access The Cochrane Library for free via the Virtual Health Library BIREME interface (in English, Spanish or Portugues), thanks to funding by BIREME / Pan- American Health Organisation (PAHO) / World Health Organisation (WHO)
New Zealand http://www.moh.govt.nz/cochranelibrary or http://www.nzgg.org.nz/ or http://www.cochrane.org.nz/All residents of New Zealand with access to the internet can access The Cochrane Library for free, thanks to the District Health Boards and the New Zealand Ministry of Health.
Norway www.cochrane.no All residents of Norway can access The Cochrane Library for free, thanks to funding for a national provision from The Norwegian Health Services Research Centre
Poland http://www.aotm.gov.pl All residents of Poland with access to the Internet can access The Cochrane Library for free, thanks to funding for a national provision by Agencja Oceny Technologii Medycznych
Scotland http://www.nes.scot.nhs.uk/ All residents of Scotland with access to the Internet can access The Cochrane Library for free, thanks to funding provided by the NHS Education for Scotland
Spain http://www.update-software.com/Clibplus/ClibPlus.asp
South Africa http://www.sahealthinfo.org/evidence/databases.htm. The South African Cochrane Centre (SACC) offers a limited number of free access registrations to The Cochrane Library to African residents. To apply for a sponsorship please register at: http://www.sahealthinfo.org/SAHealthInfoUtils/index.jsp.
Sweden www.sbu.se All residents of Sweden with access to the Internet can access The Cochrane Library for free, thanks to the funding provided SBU - Statens beredning fГPr medicinsk utvГ¤rdering/The Swedish Council on Technology Assessment in Health Care
Wales All residents of Wales with access to the Internet can access The Cochrane Library for free, thanks to funding provided by The Welsh Assembly Government. The Canadian Province of New Brunswick http://www.gnb.ca/0003/ Access to The Cochrane Library is available for free through the electronic resources section of the NBPLS website to all New Brunswickers who have a public library card thanks to funding provided by the partnership involving the New Brunswick Public Library Service (NBPLS), the University of New Brunswick (UNB) Libraries, and the Regional Health Authority (RHA) libraries
The Canadian Northwest Territorities, Nunavut, Yukon http://www.thecochranelibrary.comAll Northern residents with access to the Internet can access The Cochrane Library for free thanks to funding provided by the Pan-Northern Agreement and the Indian and Inuit Branch of Health Canada.
The Canadian Province of Saskatchewan www.thecochranelibrary.com All residents of Saskatchewan can access to The Cochrane Library for free by using public library facilities in the providence and remotely through their local library web site with a library card thanks to funding provided by the partnership involving the Health Quality Council, The Canadian Cochrane Network and Centre (University of Saskatchewan Site Group), the Multitype Database Licensing Program, and the Saskatchewan Provincial Library
The US State of Wyoming http://wyld.state.wy.us/dbloginform.html/ All residents can access The Cochrane Library for free at the state's Wyoming Libraries Database libraries which include public, community college and medical libraries thanks to funding provided by Wyoming State Legislature's Joint Labor, Health and Social Services Committee
4. There are also several programmes, such as the Health InterNetwork Access to Research Initiative (HINARI) that provide access in developing countries. To find out whether your country is included in any of these programmes/provisions, or to learn how to get access if you don't already have it, please visit: http://www.thecochranelibrary.com/.
В Jadad AR, Cook DJ, Jones A, Klassen TP, Tugwell P, Moher M, et al. Methodology and reports of systematic Reviews and meta-analysies: a comparison of Cochrane Reviews with articles published in paper-based journal.
Contact: Amy Molnar
John Wiley & Sons, Inc.
Inhaled Steroids Best Treatment For Children With Asthma
Although several medications are available to help children maintain asthma control, clinical trials directly comparing them have not been conducted. In fact, current recommendations in national and international asthma guidelines are based either on studies of single treatments compared to a placebo in children or on comparison studies in adults.
For the first time, researchers compared the effectiveness and safety of three different asthma medicines for initial daily therapy for school-aged children with mild to moderate persistent asthma: a low dose inhaled corticosteroid (200 mcg fluticasone a day); a combination of a lower dose inhaled corticosteroid and an inhaled long acting beta2 agonist (100 mcg fluticasone each morning plus 50mcg salmeterol twice daily), and a leukotriene receptor antagonist (montelukast). Studying 285 children ages 6 - 14 years, researchers in the Childhood Asthma Research and Education Network of the National Heart, Lung, and Blood Institute (NHLBI) found that after 48 weeks, inhaled corticosteroids are the most effective initial daily therapy for children with mild to moderate persistent asthma. They also found no significant adverse growth effects among any of the medicines studied.
"Long-term comparison of 3 controller regimens for mild-moderate persistent childhood asthma: The Pediatric Asthma Controller Trial," is published in this month's issue of the Journal of Allergy and Clinical Immunology (JACI). These results support the current asthma clinical guidelines, which recommend inhaled corticosteroids as the preferred initial therapy for children with mild to moderate asthma.
###
The theme of the January issue of the journal is National Institutes of Health asthma networks. The issue features review articles on several NHLBI programs - the Asthma Clinical Research Network, the Childhood Asthma Research and Education Network, the Childhood Asthma Management Program, and the Severe Asthma Research Program - as well as the Asthma and Allergic Diseases Research Centers and the Inner City Asthma Consortium of the National Institute of Allergy and Infectious Diseases (NIAID).
For more information:
* Asthma Information for Patients and the General Public
* Guidelines for the Diagnosis and Management of Asthma--Update on Selected Topics 2002
* Childhood Asthma Research and Education (CARE) Network
* Inhaled Corticosteroids Benefit Young Children with Frequent Wheezing but Do Not Prevent Development of Chronic Asthma, May 10, 2006, news release
Part of the National Institutes of Health, the National Heart, Lung, and Blood Institute (NHLBI) plans, conducts, and supports research related to the causes, prevention, diagnosis, and treatment of heart, blood vessel, lung, and blood diseases; and sleep disorders. The Institute also administers national health education campaigns on women and heart disease, healthy weight for children, and other topics. NHLBI press releases and other materials are available online at http://www.nhlbi.nih.gov/.
The National Institutes of Health (NIH) -- The Nation's Medical Research Agency -- includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit http://www.nih.gov/.
Contact: NHLBI Communications Office
NIH/National Heart, Lung, and Blood Institute
For the first time, researchers compared the effectiveness and safety of three different asthma medicines for initial daily therapy for school-aged children with mild to moderate persistent asthma: a low dose inhaled corticosteroid (200 mcg fluticasone a day); a combination of a lower dose inhaled corticosteroid and an inhaled long acting beta2 agonist (100 mcg fluticasone each morning plus 50mcg salmeterol twice daily), and a leukotriene receptor antagonist (montelukast). Studying 285 children ages 6 - 14 years, researchers in the Childhood Asthma Research and Education Network of the National Heart, Lung, and Blood Institute (NHLBI) found that after 48 weeks, inhaled corticosteroids are the most effective initial daily therapy for children with mild to moderate persistent asthma. They also found no significant adverse growth effects among any of the medicines studied.
"Long-term comparison of 3 controller regimens for mild-moderate persistent childhood asthma: The Pediatric Asthma Controller Trial," is published in this month's issue of the Journal of Allergy and Clinical Immunology (JACI). These results support the current asthma clinical guidelines, which recommend inhaled corticosteroids as the preferred initial therapy for children with mild to moderate asthma.
###
The theme of the January issue of the journal is National Institutes of Health asthma networks. The issue features review articles on several NHLBI programs - the Asthma Clinical Research Network, the Childhood Asthma Research and Education Network, the Childhood Asthma Management Program, and the Severe Asthma Research Program - as well as the Asthma and Allergic Diseases Research Centers and the Inner City Asthma Consortium of the National Institute of Allergy and Infectious Diseases (NIAID).
For more information:
* Asthma Information for Patients and the General Public
* Guidelines for the Diagnosis and Management of Asthma--Update on Selected Topics 2002
* Childhood Asthma Research and Education (CARE) Network
* Inhaled Corticosteroids Benefit Young Children with Frequent Wheezing but Do Not Prevent Development of Chronic Asthma, May 10, 2006, news release
Part of the National Institutes of Health, the National Heart, Lung, and Blood Institute (NHLBI) plans, conducts, and supports research related to the causes, prevention, diagnosis, and treatment of heart, blood vessel, lung, and blood diseases; and sleep disorders. The Institute also administers national health education campaigns on women and heart disease, healthy weight for children, and other topics. NHLBI press releases and other materials are available online at http://www.nhlbi.nih.gov/.
The National Institutes of Health (NIH) -- The Nation's Medical Research Agency -- includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit http://www.nih.gov/.
Contact: NHLBI Communications Office
NIH/National Heart, Lung, and Blood Institute
Uncontrolled Exercise-Induced Asthma Limits Physical Activity
People with exercise-induced asthma (EIA) may not be able to participate in physical activities if it is not properly controlled, according to the American Academy of Allergy, Asthma & Immunology (AAAAI).
About 20 million Americans suffer from asthma. In addition, many non- asthmatic patients, up to 13% of the population, experience asthma symptoms with exercise.
"If someone is experiencing symptoms of EIA, it is important for them to be properly diagnosed by an allergist/immunologist to make sure it is not something more serious," said Tim Craig, DO, FAAAAI, Chair of the AAAAI's Sports Medicine Committee. "The physician will be able to treat the patient's EIA with proper medications and will also address other issues to ensure the person can participate in sports and exercise to their fullest capacity."
EIA is caused by airways that are overly sensitive to sudden changes in temperature and humidity, especially when breathing colder, drier air. During physical activity, people tend to breathe through their mouths, allowing the cold, dry air to reach the lower airways without passing through the warming, humidifying effect of the nose.
Symptoms of EIA include wheezing, chest tightness, coughing, chest pain, shortness of breath and fatigue. These symptoms can be controlled with proper medication and guidance from an allergist/immunologist.
Inhaled medications taken prior to exercise are helpful in controlling and preventing exercise-induced bronchospasm. The medication of choice in preventing EIA symptoms is a short-acting beta 2 agonist bronchodilator spray used 15 minutes before exercise. These medications are effective in 80 to 90 percent of patients, have a rapid onset of action, and last for up to four to six hours. These drugs can also be used to relieve symptoms associated with EIA after they occur.
In addition to medications, a warm-up period of activity before exercise may lessen the chest tightness that occurs after exertion. A warm-down period, including stretching and jogging after strenuous activity, may prevent air in the lungs from changing rapidly from cold to warm, and may prevent EIA symptoms that occur after exercise.
When to see an allergy/asthma specialist
The AAAAI's How the Allergist/Immunologist Can Help: Consultation and Referral Guidelines Citing the Evidence provides information to assist patients and health care professionals in determining when a patient may need consultation or ongoing specialty care by the allergist/immunologist. Patients should see an allergist/immunologist if they:
-- Have exercise-induced symptoms that are unusual or do not respond well to pre-treatment with albuterol, nedocromil, or cromolyn.
-- Have had exercise-induced anaphylaxis or food-dependent exercise- induced anaphylaxis.
-- Want to SCUBA dive and have a history of asthma.
If you believe you may have EIA or have been diagnosed with EIA, talk to your allergist/immunologist about a personalized management plan for your EIA and begin exercising again. Many asthmatics have found that with proper medical treatment, they are able to reduce the symptoms of EIA.
To find an allergist/immunologist in your area or to learn more about allergies and asthma visit the AAAAI Web site at http://www.aaaai.org.
The AAAAI is the largest professional medical specialty organization in the United States representing allergists, asthma specialists, clinical immunologists, allied health professionals and others with a special interest in the research and treatment of allergic disease. Established in 1943, the AAAAI has more than 6,000 members in the United States, Canada and 60 other countries. The AAAAI serves as an advocate to the public by providing educational information through its Web site at http://www.aaaai.org.
American Academy of Allergy, Asthma & Immunology
http://www.aaaai.org
About 20 million Americans suffer from asthma. In addition, many non- asthmatic patients, up to 13% of the population, experience asthma symptoms with exercise.
"If someone is experiencing symptoms of EIA, it is important for them to be properly diagnosed by an allergist/immunologist to make sure it is not something more serious," said Tim Craig, DO, FAAAAI, Chair of the AAAAI's Sports Medicine Committee. "The physician will be able to treat the patient's EIA with proper medications and will also address other issues to ensure the person can participate in sports and exercise to their fullest capacity."
EIA is caused by airways that are overly sensitive to sudden changes in temperature and humidity, especially when breathing colder, drier air. During physical activity, people tend to breathe through their mouths, allowing the cold, dry air to reach the lower airways without passing through the warming, humidifying effect of the nose.
Symptoms of EIA include wheezing, chest tightness, coughing, chest pain, shortness of breath and fatigue. These symptoms can be controlled with proper medication and guidance from an allergist/immunologist.
Inhaled medications taken prior to exercise are helpful in controlling and preventing exercise-induced bronchospasm. The medication of choice in preventing EIA symptoms is a short-acting beta 2 agonist bronchodilator spray used 15 minutes before exercise. These medications are effective in 80 to 90 percent of patients, have a rapid onset of action, and last for up to four to six hours. These drugs can also be used to relieve symptoms associated with EIA after they occur.
In addition to medications, a warm-up period of activity before exercise may lessen the chest tightness that occurs after exertion. A warm-down period, including stretching and jogging after strenuous activity, may prevent air in the lungs from changing rapidly from cold to warm, and may prevent EIA symptoms that occur after exercise.
When to see an allergy/asthma specialist
The AAAAI's How the Allergist/Immunologist Can Help: Consultation and Referral Guidelines Citing the Evidence provides information to assist patients and health care professionals in determining when a patient may need consultation or ongoing specialty care by the allergist/immunologist. Patients should see an allergist/immunologist if they:
-- Have exercise-induced symptoms that are unusual or do not respond well to pre-treatment with albuterol, nedocromil, or cromolyn.
-- Have had exercise-induced anaphylaxis or food-dependent exercise- induced anaphylaxis.
-- Want to SCUBA dive and have a history of asthma.
If you believe you may have EIA or have been diagnosed with EIA, talk to your allergist/immunologist about a personalized management plan for your EIA and begin exercising again. Many asthmatics have found that with proper medical treatment, they are able to reduce the symptoms of EIA.
To find an allergist/immunologist in your area or to learn more about allergies and asthma visit the AAAAI Web site at http://www.aaaai.org.
The AAAAI is the largest professional medical specialty organization in the United States representing allergists, asthma specialists, clinical immunologists, allied health professionals and others with a special interest in the research and treatment of allergic disease. Established in 1943, the AAAAI has more than 6,000 members in the United States, Canada and 60 other countries. The AAAAI serves as an advocate to the public by providing educational information through its Web site at http://www.aaaai.org.
American Academy of Allergy, Asthma & Immunology
http://www.aaaai.org
Monday, March 3, 2008
Allergy Training For Nurses Improves Patients' Quality Of Life; New Research Provides The Evidence
Recent research published by Education for Health and colleagues from the University of Edinburgh, the University of Aberdeen and the London School of Hygiene and Tropical Medicine provides evidence that structured allergy training for primary care health professionals improves quality of life in patients with perennial rhinitis(1).
In this randomised, controlled trial, twenty GPs and practice nurses completed the allergy module at Education for Health over a six month period. Patients with perennial rhinitis (blocked, runny nose) from these doctors' and nurses' practices were randomly allocated to either receive care from an allergy trained doctor or nurse or from an untrained person (usual care). All patients then completed a disease-specific quality of life questionnaire which looked at the impact of their nasal symptoms on their quality of life at baseline and at 6 months.
Results showed not only that the trained nurses and doctors were more confident and competent in delivering allergy care, but that their patients' quality of life was improved compared to those patients who had continued with their usual care. This research is important on two counts, firstly, it supports the NHS agenda of improving primary care allergy services by showing that allergy training is feasible and deliverable in primary care; and secondly, that patients benefit as a result of health professional education.
Monica Fletcher, Chief Executive of Education for Health said "Most mild or moderate allergy symptoms (e.g. hayfever, allergic asthma, urticaria and some food allergy problems), can, and should, be managed successfully in primary care with appropriate training. A recent House of Commons Health Committee report on the provision of allergy services(2) echoed this view. Clinical quality markers for allergy care must be included in the GMS contract in the future. Both publications stress the importance of postgraduate training to improve allergy practice in primary care".
Allergic diseases, including hayfever (allergic rhinitis), food allergy, drug allergy and allergic asthma affect approximately 20% of the UK population and account for approximately 6% of GP consultations. Hospital admissions for severe allergic disease have increased tenfold in the last 10 years and allergy generally is associated with significant financial cost. Symptoms can be irritating, disruptive and sometimes disabling; allergic rhinitis, often trivialised by sufferers and health professionals alike, has been shown to impair concentration and learning in children.
Mark Levy, GP with interest in Respiratory diseases and Allergy said: "Despite the high prevalence and morbidity due to allergic diseases in the United Kingdom, a small minority of health professionals are trained in provision of allergy care (4, 5). Furthermore the lack of facilities for secondary and tertiary care for people with allergic conditions, coupled with the relatively small number of specialists available to teach allergy management in primary care, has resulted in patients being managed by health professionals with little formal training in this discipline (6). This study from Education for Health, offers some hope for patients and information for commissioners of health care by providing good quality evidence of the benefit for allergy sufferers in being treated by health professionals trained in this field."
Education for Health provides Allergy training at diploma and degree level.
References:
(1) Sheikh A, Khan-Wasti S, Price D, Smeeth L, Fletcher M, Walker S. Standardized training for healthcare professionals and its impact on patients with perennial rhinitis: a multi-centre randomized controlled trial. J Allergy Clin Immunol 2007; 37:90-99
(2) Department of Health. A Review of services for allergy. The epidemiology, demand for, and provision of, treatment and effectiveness of clinical interventions. http://www.dh.gov.uk. 2006
(3) Walker SM & Sheikh A. Self-reported rhinitis is a significant problem for patients with asthma: results from a national (UK) survey. Primary Care Resp J. 2005;14:83-87
(4) Mark L Levy, David Price, Xiaohong Zheng, Colin Simpson, Phil Hannaford and Aziz Sheikh. Inadequacies in UK primary care allergy services: National survey of current provisions and perceptions of need. Clinical and Experimental Allergy, 2004; 34(4): 518-519
(5) http://dx.doi.org/10.3132/pcrj.2007.00004
(6) Mark L Levy, Aziz Sheikh, Samantha Walker, Angie Woods. Should UK allergy services focus on primary care? BMJ 2006;332:1347-1348. doi:10.1136/bmj.332.7554.1347 http://bmj.bmjjournals.com/cgi/content/extract/332/7554/1347
Education for Health
The Athenaeum
10 Church Street
Warwick, CV34 4AB
UK
Switchboard Tel: +44(0)1926 493313
http://www.educationforhealth.org.uk
Facts about Education for Health:
-- Education for Health is a not for profit organisation formed by a dynamic merger in August 2005 between two of the UK's leading education organisations for health professionals: Heartsave - National Cardiovascular Training Programme, and the National Respiratory Training Centre.
-- The two partner organisations have each earned a reputation for excellence in education in their respective areas of expertise and have trained in excess of 40,000 students both nationally and internationally. Prior to the establishment of Education for Health, The National Respiratory Training Centre had been at the frontline of the battle to achieve recognition for people with lung disease since 1986.
-- Education for Health aims to provide a consistent, comprehensive and innovative approach to professional health education across the fields of cardiovascular disease, allergy, and respiratory health, with the ultimate objective of transforming lives worldwide
-- All education is evidence based and grounded in practice; fully up to date with the General Medical Services Contract; based on key national guidelines; directly linked with the competency frameworks and Knowledge and Skills Framework; and is subject to frequent, rigorous clinical and academic review. In addition, in these days of Health Service change and uncertainty, all students are fully supported throughout their studies by a team of clinical experts.
In this randomised, controlled trial, twenty GPs and practice nurses completed the allergy module at Education for Health over a six month period. Patients with perennial rhinitis (blocked, runny nose) from these doctors' and nurses' practices were randomly allocated to either receive care from an allergy trained doctor or nurse or from an untrained person (usual care). All patients then completed a disease-specific quality of life questionnaire which looked at the impact of their nasal symptoms on their quality of life at baseline and at 6 months.
Results showed not only that the trained nurses and doctors were more confident and competent in delivering allergy care, but that their patients' quality of life was improved compared to those patients who had continued with their usual care. This research is important on two counts, firstly, it supports the NHS agenda of improving primary care allergy services by showing that allergy training is feasible and deliverable in primary care; and secondly, that patients benefit as a result of health professional education.
Monica Fletcher, Chief Executive of Education for Health said "Most mild or moderate allergy symptoms (e.g. hayfever, allergic asthma, urticaria and some food allergy problems), can, and should, be managed successfully in primary care with appropriate training. A recent House of Commons Health Committee report on the provision of allergy services(2) echoed this view. Clinical quality markers for allergy care must be included in the GMS contract in the future. Both publications stress the importance of postgraduate training to improve allergy practice in primary care".
Allergic diseases, including hayfever (allergic rhinitis), food allergy, drug allergy and allergic asthma affect approximately 20% of the UK population and account for approximately 6% of GP consultations. Hospital admissions for severe allergic disease have increased tenfold in the last 10 years and allergy generally is associated with significant financial cost. Symptoms can be irritating, disruptive and sometimes disabling; allergic rhinitis, often trivialised by sufferers and health professionals alike, has been shown to impair concentration and learning in children.
Mark Levy, GP with interest in Respiratory diseases and Allergy said: "Despite the high prevalence and morbidity due to allergic diseases in the United Kingdom, a small minority of health professionals are trained in provision of allergy care (4, 5). Furthermore the lack of facilities for secondary and tertiary care for people with allergic conditions, coupled with the relatively small number of specialists available to teach allergy management in primary care, has resulted in patients being managed by health professionals with little formal training in this discipline (6). This study from Education for Health, offers some hope for patients and information for commissioners of health care by providing good quality evidence of the benefit for allergy sufferers in being treated by health professionals trained in this field."
Education for Health provides Allergy training at diploma and degree level.
References:
(1) Sheikh A, Khan-Wasti S, Price D, Smeeth L, Fletcher M, Walker S. Standardized training for healthcare professionals and its impact on patients with perennial rhinitis: a multi-centre randomized controlled trial. J Allergy Clin Immunol 2007; 37:90-99
(2) Department of Health. A Review of services for allergy. The epidemiology, demand for, and provision of, treatment and effectiveness of clinical interventions. http://www.dh.gov.uk. 2006
(3) Walker SM & Sheikh A. Self-reported rhinitis is a significant problem for patients with asthma: results from a national (UK) survey. Primary Care Resp J. 2005;14:83-87
(4) Mark L Levy, David Price, Xiaohong Zheng, Colin Simpson, Phil Hannaford and Aziz Sheikh. Inadequacies in UK primary care allergy services: National survey of current provisions and perceptions of need. Clinical and Experimental Allergy, 2004; 34(4): 518-519
(5) http://dx.doi.org/10.3132/pcrj.2007.00004
(6) Mark L Levy, Aziz Sheikh, Samantha Walker, Angie Woods. Should UK allergy services focus on primary care? BMJ 2006;332:1347-1348. doi:10.1136/bmj.332.7554.1347 http://bmj.bmjjournals.com/cgi/content/extract/332/7554/1347
Education for Health
The Athenaeum
10 Church Street
Warwick, CV34 4AB
UK
Switchboard Tel: +44(0)1926 493313
http://www.educationforhealth.org.uk
Facts about Education for Health:
-- Education for Health is a not for profit organisation formed by a dynamic merger in August 2005 between two of the UK's leading education organisations for health professionals: Heartsave - National Cardiovascular Training Programme, and the National Respiratory Training Centre.
-- The two partner organisations have each earned a reputation for excellence in education in their respective areas of expertise and have trained in excess of 40,000 students both nationally and internationally. Prior to the establishment of Education for Health, The National Respiratory Training Centre had been at the frontline of the battle to achieve recognition for people with lung disease since 1986.
-- Education for Health aims to provide a consistent, comprehensive and innovative approach to professional health education across the fields of cardiovascular disease, allergy, and respiratory health, with the ultimate objective of transforming lives worldwide
-- All education is evidence based and grounded in practice; fully up to date with the General Medical Services Contract; based on key national guidelines; directly linked with the competency frameworks and Knowledge and Skills Framework; and is subject to frequent, rigorous clinical and academic review. In addition, in these days of Health Service change and uncertainty, all students are fully supported throughout their studies by a team of clinical experts.
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