Monoclonal Antibody Reduces Asthma Attacks by 27% for Select Group of Children
Black and Hispanic children and adolescents with severe asthma who were from low-income urban neighborhoods saw a reduction in asthma attacks if they took a monoclonal antibody called mepolizumab in a study published by The Lancet — but it wasn’t as large of a reduction as seen in other studies conducted among adults. The drug specifically targets immune cells known as eosinophils.
The 290 children in the trial were between the ages of six and 17. They were randomized to either an injection of mepolizumab or a placebo once every four weeks for 12 months. Asthma attacks were reduced by 27% for those in the active treatment group.
The study, which the National Institutes of Health supported, also looked closely at how the drug works. Investigators believe these results help explain why the reduction was more modest for children. Researchers analyzed gene activity in cells collected from the study participants’ nasal secretions at the trial’s beginning and end. Results showed that while the antibody tamped down the activity of three eosinophil-related gene networks associated with airway inflammation and asthma attacks, activity in six other networks remained unchanged, including those related to tissue inflammation and both eosinophil activation and overproduction of mucus.
“Asthma exacts a heavy toll, especially on disadvantaged school-aged children of color who live in urban areas,” said Anthony S. Fauci, MD, director of the National Institute of Allergy and Infectious Diseases. “The results of this study indicate that more research is needed to develop therapies that substantially reduce asthma attacks among these children.” Read More
AHA Issues Statement on SBD and Cardiac Arrhythmias
The American Heart Association (AHA) published a new statement on sleep disordered breathing (SBD) and its association with cardiac arrhythmia that suggests there may be a role for SBD treatment in people with the condition.
“Strong evidence indicates that sleep-disordered breathing can lead to severe health consequences, which can directly affect cardiac function,” said Reena Mehra, MD, director of research in the Cleveland Clinic’s Sleep Disorders Center and chair of the AHA panel that authored the guidance. “Our panel’s data synthesis is designed to increase knowledge and awareness of the existing science in this area.”
The panel looked at large retrospective and prospective trials to come up with its findings, and the statement was reviewed by outside experts in epidemiology and clinical, translational, and experimental research focused on SDB or cardiac arrhythmias.
Subtypes of SDB included in the statement are obstructive sleep apnea, central sleep apnea (CSA), and CSA-Cheyne-Stokes breathing.
The authors note that many observational studies have shown that SBD treatment can improve outcomes for people with atrial fibrillation and believe larger, randomized controlled trials should be a research priority.
The study was published by Circulation. Read More
Triple Therapy Outperforms Dual Therapy in COVID-19 Patients on HFNC
Researchers publishing in the Canadian Journal of Infectious Diseases and Medical Microbiology found that COVID-19 patients who require the high-flow nasal cannula (HFNC) have better outcomes if treated with a three-drug regimen than a two-drug regimen.
The study was conducted among 191 patients with severe COVID-19. Triple therapy consisting of dexamethasone, remdesivir, and baricitinib was administered to 81 of the participants. The rest of the patients received the dual therapy of dexamethasone and remdesivir.
The patients in the triple therapy group were significantly more likely to survive than those in the dual therapy group. No differences were seen in hospital length of stay or in days on the HFNC, but a trend toward less requirement for mechanical ventilation was noted.
According to the authors, this study is the first to show the benefit of triple therapy on patients requiring high-flow oxygen. Read More
Putting Some Numbers to the Toll Tobacco Takes
The American Cancer Society (ACS) has added new numbers to the toll that cigarette smoking takes on human life and productivity. According to the ACS —
- Nearly 30% of all U.S. cancer deaths in 2019 were from cigarette smoking. This led to more than two million Person-Years of Lost Life (PYLL) and nearly $21 billion in annual lost earnings.
- Death rates were the highest in the 13 states with generally weaker tobacco control policies and higher cigarette smoking prevalence, including Alabama, Arkansas, Indiana, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Ohio, Oklahoma, South Carolina, Tennessee, and West Virginia.
- The annual PYLL rate for these states was 46.8% higher than in other states and the District of Columbia (1,431 per 100,000 population compared to 975 per 100,000), and the lost earnings rate was 44% higher ($11.2 million per 100,000 population compared to $7.8 million per 100,000 population).
- The state with the lowest PYLL rate was Utah. If the PYLL and lost earning rates there had been achieved by all the states in 2019, then more than half of the estimated total PYLL and lost earnings would have been avoided.
- And finally, the proportion of avoidable PYLL and lost earnings by state exceeded 50% for PYLL in 39 states and the District of Columbia in 30 states for lost earnings.
“Increasing the price of cigarettes through excise taxes is the single most effective policy for reducing smoking,” said study author Dr. Ahmedin Jemal. That said, he also advocates for eliminating existing gaps in Medicaid and private insurance coverage of smoking cessation services, noting that this would open the door to greater access to smoking cessation counseling and medications for people who want to quit.
The study appeared in the International Journal of Cancer. Read More
COPD Patients Need More Help Managing Their Conditions
According to investigators publishing in the Annals of Family Medicine, COPD patients may not get the care they need at the primary care level to manage their conditions effectively.
The study involved patients from five states who were included in the COPD Optimum Patient Care DARTNet Research Database. Results showed an exacerbation prevalence of 38% in the past year, and 20% had been hospitalized. Forty-three percent of patients said COPD was having a high or very high impact on their health, and 45% reported not being able to walk at a normal pace.
Since these findings were seen despite the fact that 88% of the patients were receiving some form of maintenance therapy for the condition, the researchers speculate that many patients may not be receiving the right medications to help them cope with their COPD, or they may not be using the medications they are prescribed correctly. Since 31% of the patients were still smoking, they believe smoking cessation services may be lacking as well.
“Our findings highlight the high exacerbation, symptom, and treatment burdens experienced by COPD patients managed in U.S. primary care and the need for more real-life effectiveness trials to support decision making at the primary care level,” concluded the authors. Read More
Summer Camp Improves Quality of Life for Children on Ventilators
Respiratory therapists have long served as key volunteers at summer camps for children who require mechanical ventilation. In fact, a new study out of Lebanon Valley College shows these camps improve the quality of life for these children.
The 11 participants in the study completed the Pediatric Camp Outcome Measure survey online, which gauges the perceptions of campers on self-esteem, social functioning, emotional functioning, and physical functioning. Results showed the more years the children had attended the camp, the better their outcomes were on these measures.
“In my experience, the children who have the opportunity to attend camp develop strong connections to others experiencing similar medical and life challenges,” said study author Dr. Tonya Miller. “The connection expands well beyond the time spent at camp. Campers and volunteers become a community who are there for each other.”
The study was published by Pediatric Physical Therapy. Read More
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