Study Questions Mainstay Treatment For Mild Asthma

Steroid inhalers commonly used to prevent asthma attacks may not work any better than a placebo for many people with mild asthma, according to recent research.

Synthetic corticosteroids mimic the steroid hormone cortisol, reducing inflammation in the airways. But the drug targets a type of inflammation that may be found in far fewer patients than previously thought, research in a recent issue of the New England Journal of Medicine finds. Among patients age 12 and older in the study who had mild, persistent asthma, more than half did just as well, or better, on a placebo as they did on a steroid inhaler.

"We're suggesting that it's time to reevaluate what the standard recommended form of treatment is for these milder patients," says Stephen Lazarus, a pulmonologist at the University of California, San Francisco, and the study's lead author.

Since the early 1990s, the international guideline for treating patients with mild, persistent asthma has been to use a low-dose steroid inhaler twice a day. The recommendation was based mainly on studies of people with severe asthma; the thinking was that if people with mild symptoms used the steroid inhaler early on, it would prevent damage to their airways later.

But when the medications didn't seem to reduce asthma attacks, doctors blamed the patients.

"For many years, I think we've attributed their poor asthma control to the fact that they weren't taking their medicines," Lazarus says, "and it may be that many of them were taking their medicines — they just weren't working."

Lazarus and his team studied around 300 patients who had mild asthma. The vast majority — 73% — did not have Type 2 inflammation, an inflammation characterized by a high level of eosinophilic white blood cells, which are believed to be much more prevalent among asthma patients.

Of those patients, 66% did just as well, or better, on a placebo as on the steroid inhaler mometasone in terms of urgent care visits, days when they had trouble breathing or nights when they woke up because they were unable to breathe.

Merck, the drug company that makes mometasone, declined to comment on the study.

"We may be giving people steroids, subjecting them to potential adverse effects and the increased costs, without a significant clinical benefit," Lazarus says.

While inhaled steroids are generally safe, there is some risk for bone loss, cataracts, glaucoma and thinning of the skin.

Bone loss has long been a concern for...

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Study: Pediatrician Intervention to Help Parents Quit Smoking

Parents who smoke cigarettes put their children and others around them at risk for bronchitis, pneumonia and a variety of other ailments. But a new study offers another method to help them quit lighting up.

Researchers tested a smoking cessation program in five states in the South and the Midwest, finding it had success in helping some parents to kick the habit, according to research published Monday in JAMA Pediatrics.

About 58 million non-smokers in the United States take in secondhand smoke, including 14 million children between ages 3 and 11, according to the Centers for Disease Control and Prevention. And roughly one in five babiesborn to mothers who smoke while pregnant will have a low birth rate.

"The people who are most likely to have another pregnancy are the ones who already have a baby and are coming into the pediatrician's office," Emara Nabi-Burza, a researcher at Massachusetts General Hospital for Children and lead author of the study, said in a news release. "If we want to prevent smoking during pregnancy, one of the best strategies is to get parents of young children to quit."

The researchers tested an intervention called the Clinical Effort Against Secondhand Smoke Exposure to help parents quit smoking. The program included nearly 8,200 parents from Indiana, North Carolina, Ohio, Tennessee and Virginia.

After bringing their children to doctor's appointments, parents could opt to answer questions from an electronic survey about whether they wanted to quit smoking and provided their nicotine patches or gum to help with that effort.

In addition, the pediatricians offered parents a chance to enroll in their state's quitline and the national SmokeFreeTXT. Finally, parents received motivational texts from the pediatricians to quit smoking, whether they opted to participate in other aspects of the intervention or not.

Of parents who completed the survey, just over 44 percent received "meaningful treatment," with the intervention helping to reduce smoking among parents by 2.7 percent.

The researchers point to the use of electronic tablets to manage the questionnaire, which also included a motivational video customized to each parent's state and other characteristics, as a key part of the program that helped parents quit.

"We knew the pediatric visit was a teachable moment to help parents quit smoking," said Dr. Jonathan Winickoff, who also directs pediatric research at the MGH Tobacco Research and Treatment Center....

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COPD: 5 Must-Know Updates

Chronic obstructive pulmonary disease (COPD) represents a major burden to global health, and it is a leading cause of morbidity and mortality. Intense research has expanded our knowledge of pathophysiology and therapeutic targets and allowed for the personalization of treatment. The following review provides five disease-related COPD updates.

1. Bronchoscopic Lung Volume Reduction

Bronchoscopic lung volume reduction (BLVR) is accomplished by occluding airways proximal to nonfunctioning, hyperinflated areas of the lung. Several different methods, including endobronchial and intrabronchial valves, coils, and thermal ablative techniques, are used to achieve BLVR.[1] To date, data have shown benefits for symptoms and functional outcomes, but proper patient selection is critical. Head-to-head comparisons between therapies are not available, and although guidelines exist,[2] they're largely based on small trials and expert opinions.

Endobronchial coils and thermal vapor therapies are not approved for use in the United States, but the US Food and Drug Administration (FDA) approved two types of endobronchial valves in 2018: the Zephyr Endobronchial Valve (Pulmonx Corporation; Redwood City, California) and the Spiration Valve System (Olympus Respiratory America; Redmond, Washington). To date, there are more data available on Zephyr valves.[3,4,5] However, in general, both valve types improve symptoms, quality of life, and lung function for patients with COPD.[1] Patients who are most likely to benefit have evidence of air trapping on lung testing (typically a residual volume > 175% on plethysmography) and absence of collateral ventilation (CV) distal to the target area. Typically, CV is assessed using quantitative CT software or the proprietary Chartis System (Pulmonx Corporation). These valves should only be placed at centers that have the appropriate software, equipment, and expertise.[1,2]

2. Tailoring Therapies Using Eosinophil Counts

As we're learning more about COPD phenotypes, we're increasingly able to tailor therapies. Although therapy with inhaled corticosteroids (ICS) is recommended by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines,[6] its use is controversial. Several studies show an increased risk for pneumonia when patients with COPD use ICS,[7,8,9] and the 2014 WISDOM study found that discontinuing ICS did not affect exacerbation rates in patients using continued triple therapy [long-acting beta-agonist...

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What to know about stress-induced asthma
Stress is a common trigger of asthma symptoms. Stress and anxiety can also cause asthma attacks.
Asthma is a condition in which the airways become inflamed, making it difficult to breathe. Symptoms typically come and go with triggers, such as irritants, humid weather, and exercise.
According to Asthma UK, 43% of people with asthma report that stress can trigger their symptoms. Managing stress and anxiety can help minimize asthma flare-ups.
In this article, we look at the link between stress and asthma in more detail.
Stress and asthma
When a person feels stressed, they may experience more frequent and severe asthma symptoms.
When a person feels stressed, they may notice that their asthma symptoms flare up. Periods of stress can increase the severity, frequency, and duration of asthma symptoms.
Stress can cause people to become more sensitive to their asthma triggers. Common triggers include pet dander, pollen, humidity, and cold, dry air.
Stressors might include work, school, or family stress. Significant life changes and traumatic experiences can also cause stress.
Stress can make inflammation worse, and it can trigger shortness of breath or breathing difficulties, all of which can exacerbate asthma symptoms.
If a person can manage their asthma, they are less likely to experience stress or anxiety related asthma.
Stress can also indirectly cause asthma flare-ups. A person who is stressed may experience certain emotions, such as anger and irritation, more strongly. Strong emotions can trigger asthma symptoms.
A person who experiences stress for prolonged periods may feel more anxious. Anxiety can trigger panic attacks that can, in turn, cause an asthma attack.
People may also sometimes find that stress leads to unhealthful habits, such as smoking or drinking alcohol. These habits can trigger asthma.
Symptoms of stress-induced asthma
People may notice that their normal asthma symptoms worsen when they feel overly stressed or anxious. This feeling can be temporary, such as before an exam, or it can be due to chronic stress, which occurs over an extended period.
Asthma symptoms are similar regardless of the trigger. Common symptoms of asthma include:
tightness in the chest
trouble breathing
rapid breathing
shortness of breath
Managing stress with asthma
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CVS directs initiative combating youth smoking toward teen e-cigarette use

CVS Health and its foundation are directing their focus on cutting teen tobacco smoking toward a key driver of the worsening problem: e-cigarettes.

Already, CVS was in the midst of a five-year, $50 million initiative called "Be the First" in an effort to be the nation's first tobacco-free generation. Monday, the retailer announced it—along with the Aetna Foundation—will give more than $10 million to organizations around the country to support prevention and education programs with a particular focus on vaping.

“The spread of e-cigarette use among youth jeopardizes the progress made in reducing smoking over the last two decades,” said Troyen Brennan, M.D., chief medical officer for CVS Health, in a statement.  “By collaborating with experts and aggressively investing in innovative strategies, we believe that we can help reverse this disturbing trend.”

The 2018 National Youth Tobacco Survey found 3.6 million middle and high school students indicated they were current e-cigarette users. That was more than double the total number from the previous year. It represented a 78% increase among high school students and 50% increase among middle school students. 

The problem was concerning enough for former Food and Drug Administration Commissioner Scott Gottlieb to declare a youth vaping crisis when he led the agency. "All the dramatic gains we've made in reducing smoking rates in this country, particularly among young people, will be reversed as a result of these products," he warned during an event in March.

In 2014, CVS announced it would no longer sell tobacco products in its stores as its sought to ramp up its role in the U.S. healthcare marketplace. In 2018, CVS completed a $69 billion acquisitionof insurance giant Aetna.  Both companies have said the deal will generate more than $750 million in savings in the first two years by reducing medical costs, closing gaps of care, optimizing sites of care and providing localized services for patients with high-cost chronic conditions. 

Among the projects aimed at reducing teen smoking that will receive grant funding this year: 

  • The CVS Health Foundation is investing in a multiyear, multi-million dollar collaboration with Discovery Education to create and distribute education materials to help middle and high school students learn about the risks of e-cigarette use. The resources will be available at no cost to every school district in the U.S.
  • A new two-year, $2 million grant...
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Telehealth Rehabilitation Lowers Hospital Readmissions After COPD Exacerbation, Study Finds

Video telehealth rehabilitation reduced the rates that patients with chronic obstructive pulmonary disease (COPD) had to be readmitted within 30 days after they were hospitalized for a pulmonary exacerbation, according to a study.

The findings were published in the American Journal of Respiratory and Critical Care Medicine in a study titled “Video Telehealth Pulmonary Rehabilitation Intervention in COPD Reduces 30-day Readmissions.”

According to the researchers, hospitalizations as a result of exacerbations in COPD patients are linked with respiratory morbidity and high healthcare costs, and accounts for nearly two-thirds of the total COPD healthcare costs. About one in five patients with COPD are readmitted within 30 days after hospital admission.

Although several hospitals have started intervention programs to lower the number of readmissions, the attempts have had minimal to modest success. However, studies have shown that pulmonary rehabilitation (multidisciplinary services aimed at improving the quality of life in patients) managed to reduce readmissions by 56%.

Consequently, researchers at the University of Alabama at Birmingham (UAB) tested the effect of a program using video telehealth rehabilitation.

The team enrolled COPD patients that were hospitalized for acute exacerbations, and identified through a daily hospital census (hospital-admitted patients). Except for specific conditions preventing them from participating in the exercises, all patients were included regardless of disease severity.

For 12 weeks, the patients attended a real-time video-conferencing intervention with 36 exercise sessions, following guidelines for conventional pulmonary rehabilitation. A physiologist provided the exercises that were based on outpatient exercise assessments, and adapted to the patient’s baseline functions.

Through the regimen, including stretching, breathing, and aerobic exercises, the goal was to reach heart rates between 60% and 80% of the maximum baseline recorded in a six-minute walk test.

Results showed a significant decrease in the 30-day all-cause readmissions among COPD patients who participated in the telehealth intervention (6.2% readmission), compared with patients who did not participate (18.1% readmission).

“Participating in an exercise program soon after hospitalization for an acute exacerbation of COPD is associated with a substantially lower readmission rate within 30 days of discharge,” Surya P....

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Apple acquires asthma-monitoring start-up Tueo Health

Tueo Health has developed technology that can alert parents or caregivers about potential asthma-related issues in sleeping children to help better manage the child's asthma.

As part of its continuing efforts in healthcare, Apple has purchased Tueo Health, a small Redwood City based startup focused on monitoring asthma in sleeping pediatric patients.

The deal, first reported by CNBC, serves to bolster the tech giant’s intellectual property in the healthcare space as it continues to roll our more health-oriented features in its hardware products.

Tueo Health has developed technology that can alert parents or caregivers about potential asthma-related issues in sleeping children to help better manage the child’s asthma.

Other notable healthcare acquisitions by Apple include the 2016 purchase of personal health data startup Gliimpse – which led to some of the foundational technology behind its Apple Record System – and its 2017 acquisition of sleep tracking company Beddit.

As sleep becomes potentially a bigger part of the company’s health monitoring ambitions, it’s easy to see how Tueo Health technology could be incorporated into Beddit sleep monitors or new sleep tracking features in a new version of the Apple Watch.

Bloomberg reported that Apple will overhaul its Health app with hearing health and menstrual cycle tracking in its iOS 13 update, which will be announced at the company’s Worldwide Developers Conference in June.

Tueo Health was founded in 2015 and raised a $1.1 million seed round in 2017 led by Launchpad Digital Health. According to patent records, Apple acquired the company’s core technology that year and later the entire company. The company’s lead executives are listed as employees of Apple on their LinkedIn pages starting in 2018.

Pulmonary chronic disease management has seen a flurry of activity in recent years. One of the largest digital health acquisitions in the past year was ResMed’s $225 million acquisition of COPD and asthma management startup Propeller Health in 2018.


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Disease pathways lead to possible new treatment for severe asthma

Here’s a sobering thought: Nearly half of Americans with severe asthma do not respond to conventional drugs, leaving them with few ways to minimize the often-debilitating symptoms of the chronic disease. But researchers at NHLBI have developed a new treatment that has the potential to dramatically change that: A synthetic peptide that mimics the work of a protein, called apolipoprotein, that appears to reduce inflammation in the lungs and improve their ability to function normally.

The researchers made the discovery by studying the pathways of asthma, leading them to conclude that, despite the similarity in patient’s symptoms, the severe form of the disease could have several genetic root causes, each resulting in different responses to treatment.

Microscopic images of the lungs of mice.

Effect of the 5A apoA-I mimetic peptide on the lungs and the airway hyperreactivity in mice with asthma.

About 25 million people in the United States suffer from asthma, which is marked by inflammation and narrowing of the airways and causes wheezing, coughing, chest tightness and shortness of breath. It affects people of all ages, but it most often starts during childhood—seven million children have the disease—and it disproportionately affects minorities and families living at or below the poverty line. The condition can greatly reduce a person’s quality of life and is a major contributing factor to absences at school and work. Severe asthma attacks may require emergency room visits and hospitalizations, and they can be fatal.

In an effort to understand why some people respond to some asthma medications and others do not, researchers started with the basics. “By studying the pathways of the disease, we identified a new biological mechanism that leads to asthma,” explained Stewart J. Levine, M.D., Chief of the NHLBI Laboratory of Asthma and Lung Inflammation.

About half asthmatics have type 2-high asthma, while the others have type 2-low asthma. Type 2-high asthma is caused by an increase in the lungs and blood of inflammatory cells called eosinophils, Levine explained. But people with type 2-low asthma do not have these increased levels of eosinophils. This suggests, he said, that their asthma develops through other pathways—for instance, neutrophils, another type of inflammatory cell.

These differences, it turns out, have profound implications for treatment. For some patients with severe type 2-high asthma, standard medications,...

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