Respiratory Care Currents
By Debbie Bunch
Biologic Allows Some Severe Asthma Patients to Forego High-Dose Inhaled Steroids
British researchers publishing in The Lancet have found that many patients with severe asthma can to be treated with biologic therapies without the addition of high-dose inhaled steroids.
Results from the multinational SHAMAL study, which took place at 22 sites in the U.K., France, Italy, and Germany, showed 92% of patients taking the biologic benralizumabwere able to safely reduce their dose of inhaled steroids and 60% were able to stop using them altogether.
The 208 patients in the study were randomly assigned to taper their high-dose inhaled steroid by varying amounts over 32 weeks, followed by a 16 week maintenance period. In 90% of the patients, asthma symptoms did not worsen, and no exacerbations occurred during the 48 weeks of the trial.
“Biological therapies such as benralizumab have revolutionized severe asthma care in many ways, and the results of this study show for the first time that steroid related harm can be avoided for the majority of patients using this therapy,” said study author David Jackson, from Guy’s and St. Thomas’ and King’s College London.
Adverse side effects from high dose inhaled steroids can include osteoporosis, diabetes, and cataracts.
Another Good Reason for Your Patients to Kick the Habit
Quitting smoking is hard, and people need all the reasons to kick the habit that you can give them. Here’s another one from investigators at Washington University School of Medicine in St. Louis – smoking shrinks the brain, putting smokers at increased risk for dementia.
The researchers note scientists have long known that people who smoke have smaller brain volumes, but they were never certain which factor caused which. To find out, these investigators analyzed data on 32,094 people mostly of European descent from a publicly available database who had undergone brain imaging and provided genetic, health, and behavioral information. They found relationships between a history of smoking and brain volume, genetic risk for smoking and a history of smoking, and genetic risk for smoking and brain volume.
For the association between smoking and brain volume they found the more packs a person smoked per day, the smaller their brain volume.
Further analysis found that when all three factors were considered together, the association between genetic risk for smoking and brain volume disappeared, but the link between each of those factors and smoking behaviors remained. A statistical approach known as mediation analysis revealed this sequence of events: genetic predisposition leads to smoking, which leads to decreased brain volume.
Can brain volume be recovered if someone quits smoking? Unfortunately, no, say the investigators. When analyzing data on people who had quit long ago they found the shrinkage remained. The good news is, quitting smoking now can stop the brain from shrinking further.
“You can’t undo the damage that has already been done, but you can avoid causing further damage,” said study author Yoonhoo Chang. “Smoking is a modifiable risk factor. There’s one thing you can change to stop aging your brain and putting yourself at increased risk of dementia, and that’s to quit smoking.” The study was published by Biological Psychiatry Global Open Science. Read More
Asthma Exacerbations, ED Visits Declined in Blacks During Pandemic
According to researchers from Harvard Medical School/Cambridge Health Alliance, asthma outcomes improved in black adults and children during the COVID-19 pandemic when compared to white adults and children.
The finding comes from their analysis of data from the National Health Interview Survey from 2019 to 2022. While the overall results showed a slight increase in asthma prevalence in 2022, that increase was driven by whites. The lowest prevalence was seen in Hispanic adults and the highest prevalence was seen in black adults, but the adjusted difference between blacks and whites decreased over time.
Black children consistently had the highest asthma prevalence among children, but the asthma prevalence among children overall remained stable.
Asthma attack rates in whites remained stable as well, but among black adults they went from 29.3% in 2019 to 22.1% in 2022. ED visits declined in adults and children during the same time period, but a particularly large decline was seen among blacks. Disparities in ED visit rates between black and Hispanic children and their white counterparts narrowed during the years of the pandemic too,
The authors believe these findings can be used to address the multitude of factors involved in driving asthma pathogenesis and exacerbations, including improving environmental conditions and the equitable delivery of vaccines against common respiratory pathogens. The study was published by the Annals of Internal Medicine. Read More
