According to an article published in the November issue of CHEST, the journal of the American College of Chest Physicians, acetaminophen use in both children and adults may be associated with an increase in asthma and wheezing.

The authors reviewed 19 different studies that collected data on both asthma and wheezing as well as acetaminophen use. Patients using acetaminophen were significantly more likely to have asthma than those that did not use acetaminophen. Similarly in children, acetaminophen use was more common in children during the year preceding a diagnosis of asthma and more common during the first year of life.

Researchers have several possible, but unproven explanations related to acetaminophen's impact on the pathophysiology of asthma. First, acetaminophen lowers the levels of an antioxidant in the lung called glutathione. Antioxidants, as I have written about previously, in the diet have been associated with less development and symptoms of asthma. Likewise, acetaminophen may allow one of the key enzymes that causes inflammation in asthma, cyclooxygenase, to act unchecked. Finally, acetaminophen may cause increases in IgE levels.

As a parent, I was surprised there were enough children who had not received acetaminophen to even adequately study this. But I was also concerned given how commonly acetaminophen is used to treat fever and pain in kids. Importantly, many other common fever/ pain meds, like ibuprofen, have not been studied to see if similar relationships exist. I doubt many physicians or parents will change how they treat children's fever or pain base on this one study, but it is an interesting topic to keep your eye on.

What do you think?

What would you like to see covered on the asthma site. Let us know so we can give you the asthma information you want!

Are you zinc deficient? While not a common question, a study presented at Chest 2009, the annual meeting of the American College of Chest Physicians, found that patients with allergic asthma had significantly lower zinc levels than patients with other types of asthma.

Zinc is an antioxidant that may have anti-inflammatory properties related to the pathophysiology of asthma and is commonly found in beef, chicken, and pork. Many of the symptoms of zinc deficiency can be very non-specific-- rash, tiredness, poor appetite, and slow wound healing. As a result mild forms of zinc deficiency may be difficult to diagnose.

While the results of this small study should not make anyone  run to the health food to get zinc supplements, researchers will likely keep looking to learn more about the relationship between zinc and asthma.

First responders and other rescue and recovery workers following the 2001 World Trade Center (WTC) terrorist attacks received significant dust and pollutant exposures and have developed asthma at twice the rate of the US general population according to new research presented at CHEST 2009, the 75th annual international scientific assembly of the American College of Chest Physicians (ACCP).

According to a press release, as many as 8% of workers and volunteers participating in the rescue, recovery, and cleanup have developed some sort of asthma episode compared to 4% of the general population. Additionally, only 3% of this workers and volunteers reported asthma pre 9/11, while 16% reported having asthma between 2005 and 2007.

"Although previous WTC studies have shown significant respiratory problems, this is the first study to directly quantify the magnitude of asthma among WTC responders compared with the general US population," said Hyun Kim, ScD, Instructor of Preventive Medicine at Mount Sinai School of Medicine (MSSM), in the press release. "Six years out from 9/11, the World Trade Center Program was still observing responders affected by asthma episodes and attacks at more than double the percentage of people not exposed to World Trade Center dust."

Kalpalatha Guntupalli, MD, FCCP, President of the American College of Chest Physicians commented "Asthma and other chronic lung conditions remain a significant burden for rescue and recovery workers responding to the attacks on the World Trade Center. The significant chronic health problems associated with the World Trade Center attacks only reinforces the need for stronger disaster preparedness plans, as well as long-term medical follow-up for 9/11 responders and individuals who respond to disaster-related events."

What do you think?

With all of the debate over the weekend regarding health-care, I thought it would be interesting to see what ya'll think about payment for asthma medications.

In a previous blog I discussed results from a trial of bronchial thermoplasty, a non-drug treatment where thermal energy is delivered to airways to reduce smooth muscle that narrows airways causing asthma symptoms.

Last week, the Anesthesiology and Respiratory Therapy Devices Panel of the Medical Devices Advisory Committee to the U.S. Food and Drug Administration (FDA) recommended that the Alair^® System, a device utilized in bronchial thermoplasty for the treatment of severe persistent asthma in patients 18 years and older, was approveable with certain conditions according to a company website.

Clinical trials have demonstrated:

• Significant improvement in quality of life
• 32 percent reduction in severe asthma attacks
• 84 percent reduction in emergency room visits for respiratory symptoms
• 66 percent reduction in days lost from work/school or other activities

"The Advisory Panel's recommendation for approvable with conditions of the Alair^® System marks a major step in bringing this new and important treatment option to patients with severe asthma," said Glen French, CEO of Asthmatx in the press release. "We look forward to working with FDA through the next steps to product approval."

According to the Walmart  Pharmacy Website for their $4 prescription plan, Walmart has a HFA albuterol inhaler for sale for $9. This would be a significant cost reduction compared to currently available rescue inhalers since the CFC to HFA transition.

Have you tried to access this reduced cost inhaler?

Asthma can be very complicated and, at times, difficult to control. Whicj of the following measures do you use to help control your asthma?

Icagen, a biopharmaceutical company focused on the development of drugs that can be taken orally, has announced that it will stop development of its novel, oral asthma medication senicapoc after a clinical trial failed to deliver anticipated benefits.

Senicapoc initally demonstrated promise in animal studies where it was effective in treating the late phase of asthma. Seth V. Hetherington, M.D., SVP of Clinical Development and Regulatory Affairs of Icagen discussed the results of the senicapoc clinical trials stating in a press release stating that "we completed two small, cost-effective, proof-of-concept clinical studies testing the potential of senicapoc in the treatment of asthma. While we were encouraged by the results in our first study of allergic asthma, we were disappointed by the lack of effects in this second study of exercise-induced asthma."

An oral asthma medication in addition to currently available leukotriene modifers like Singulair, theophyillne, and oral steroids would be welcome by both patients and parents due to ease of administration compared to inhalers. What do you think?

More than 1 in 3 patients referred to a specialty asthma clinic for poorly controlled asthma did not fill inhaled steroid prescriptions appropriately more than 50% of the time according to a study published in the American Journal of Respiratory and Critical Care Medicine.

Interestingly, none of the patients were suspected by the doctors as non-compliant prior to their referral and none of the patients admitted non-compliance as the reason for their poorly controlled asthma. Non-compliance was discovered in reviewing pharmacy records in a single payer system of health care.

Medication compliance is not a one size fits all problem. Some patients have concerns about side effects and other patients have difficulties in obtaining medications. What is painfully clear from this study is that many asthmatics, even ones with really poorly controlled asthma, are not doing a good job of taking medications that are known to be beneficial.

What do you think? Why do poorly controlled asthmatics have a hard time being compliant? What do you think we can do better? Leave a comment and let the asthma community know what you think.