Childhood Asthma Treatment: Not One-Size-Fits-All

A new study has found the addition of long-acting beta-agonist therapy to be the most effective of three step-up, or supplemental, treatments for children whose asthma is not well controlled on low doses of inhaled corticosteroids alone.

The study was designed to provide needed evidence for selecting step-up care for such children and was supported by the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health. Researchers also identified patient characteristics, such as race, that can help predict which step-up therapy is more likely to be the most effective for a child with persistent asthma.

The study found that almost all of its participants had a different response to the three different treatments. Although adding the long acting beta-agonist step-up was one and one-half times more likely to be the best treatment for most of the study group, many children responded best to other two treatments instead.

The results were presented March 2 at the American Academy of Asthma, Allergy and Immunology 2010 Annual Meeting in New Orleans and are published online in the New England Journal of Medicine.

Saline Nasal Irrigation More Effective than Spray for Chronic Sinus Symptoms

According to a new study in the latest issue of the Archives of Otolaryngology — Head & Neck Surgery, saline irrigation treatments show greater efficacy versus saline spray for providing short-term relief of chronic nasal and sinus symptoms.

In the United States, 29.5 million people 18 years of age and older are affected by sinusitis [1]. Millions more are affected by other types of allergic and non-allergic rhinitis (meaning irritation and inflammation of the mucosal membrane of the nose). Some people can reduce symptom severity using medication, including antihistamines and anti-inflammatory drugs. Antibiotics are frequently prescribed for acute and chronic sinusitis. However, their use far outweighs the predicted incidence of bacterial infection, suggesting that antibiotics are overprescribed for sinus infections. Regardless of the medication used however, for many patients, symptoms persist.

Alternative Ethanol Fuel Won’t Improve Future Air Quality

Ethanol is produced biologically by fermenting sugar with Saccharomyces yeasts. Under anaerobic (meaning in the absence of oxygen) conditions, when yeast metabolize sugar, they produce ethanol and carbon dioxide. Bioethanol (meaning ethanol production derived from crops) is the most common renewable fuel today and is derived from corn grain (starch) and sugar cane (sucrose) [1]. Thus, ethanol is an inherently renewable eco-friendly resource, contributing nothing in itself to greenhouse gases. However, a study published in the journal Environmental Science & Technology (ES&T) concludes that if every vehicle in the U.S. ran on ethanol-based fuel, the number of respiratory-related deaths and hospitalizations would likely increase.

You read that right, widespread use of E85 would likely result in an increase in respiratory-related deaths and hospitalizations.

Antibiotics Overprescribed for Sinus Infections

Healthcare use of antibiotics far outweighs the predicted incidence of bacterial causes of acute and chronic sinusitis. That’s the conclusion of a new study published in the March 2007 issue of Archives of Otolaryngology – Head and Neck Surgery [1].

Antibiotics are only effective against bacterial infection. Many sinus infections are due to viral infection, allergies or hormonal changes. Physicians try to avoid antibiotic use to reduce the emergence of dangerous resistant bacterial strains, such as methicillin-resistant Staphylococcus aureus. However, most patients with sinus congestion want immediate relief and, because more effective drugs for chronic sinusitis are lacking, demand antibiotics.

Penicillin

The four-year prospective study found Americans made on average 4.25 million visits to healthcare facilities per year for sinus infection between 1999 and 2002. At least one antibiotic was prescribed in nearly 83% of cases of acute sinusitis and 70% of cases of chronic sinusitis. Antibiotics were prescribed more often than antihistamines, nasal decongestants, corticosteroids, and antitussive, expectorant, and mucolytic agents (order reflects the frequency of recommended medication).

Sinus Congestion

The sinuses are hollow spaces located inside the bones in the skull to either side of the nose, behind and in between the eyes, in the forehead and at the back of the nasal cavity. The sinuses are lined with a moist, thin layer of tissue called a mucous membrane, which not only humidifies the air as you breathe it in, but also produces mucus to trap irritants such as dust, pollen and bacteria. The sinuses are lined with microscopic hairs called cilia. The function of cilia is to move mucus to flush the sinuses and nasal passageways of trapped irritants.

Sinus congestion is the blockage of one or more of the nasal passageways as a result of inflammation and swelling of the sinus tissues, secretion of mucus or a deviated septum (meaning obstruction of the nasal passage by the membranous ridge of cartilage in the nose that separates the nasal cavity into the two nostrils). Sinus congestion leads to impaired flow of mucus out of the sinuses. The build up of mucus in the sinuses causes increased pressure. Also, bacteria can become trapped and infect the mucous membrane, a condition termed sinusitis.