Asthma at the 2012 American Thoracic Society Meeting
Although the ATS is not the primary asthma-related US meeting, more than 100 studies on asthma will be presented there next week. One that should interest family practitioners and pediatricians is a longitudinal study that followed a cohort of nearly 500 newborns up to age 23. The researchers found a correlation between the timing of solid food introduction and the risk of wheezing at age 23. Infants who received solid food by 8 or 10 weeks of age, regardless of the type of food, were 84% and 122% more likely to be wheezing by age 23.
However, researchers found no increased risk of wheezing in infants who were introduced to solid food at 16 weeks. The study echoes other research showing that introducing solid food before the generally recommended age of 4 to 6 months can increase the risk of eczema. It also provides additional support to another birth cohort study that found that later introduction of solid food had little effect on the risk of developing atopic disease.21,22
Other asthma-related presentations of interest to primary care clinicians:
• Obesity and exercise-induced bronchospasm. Obese children are more likely to have exercise-induced bronchospasm if they have asthma, and worsening lung function is correlated with increasing body mass index (BMI). Researchers found a substantial decrease in FEV1 in obese children without asthma (25%) compared to 18% in those with asthma. Based on their findings, the authors recommended that clinicians screen obese children for pre- and post exercise pulmonary function, whether or not they have asthma.23
• Inhaler technique. One of the major contributors to poor clinical outcomes in asthma patients is poor inhaler technique. Yet physicians often prescribe inhalers without providing adequate instruction on their use. A study that will be presented at ATS evaluated the effects of training instruction based on the American College of Chest Physician guidelines among 69 patients randomized to either verbal training or physical demonstration with a placebo device.
All participants made at least one initial mistake in using the device, most often not breathing out through their mouth before using the inhaler and not breathing in while releasing the medication dose. Doing is learning: Although technique improved significantly after instruction in both groups, the verbal group needed a median of 3 interventions for full improvement, while the demonstration group needed only 2.24 Take-home message: It’s crucial to assure that your patients know how to use their inhalers properly. The best and quickest way to achieve this may be to demonstrate how to use the inhaler, rather than just talking about it.
• Inhaler knowledge. Another problem with devices is that there are just so many. Not just patients but also healthcare providers struggle with this variety. At the ATS meeting, a member of a research team will describe how they assessed 46 doctors, nurses, pharmacists, and respiratory therapists in their knowledge of and ability to use 4 inhaler devices (Spiriva Handihaler®, Advair Diskus®, ProAir HFA®, and Pulmicort Flexhaler®). They found knowledge scores ranging from 77% for PharmDs to 58% for physicians, and technical skill scores ranging from 84% for respiratory therapists to 60% for registered nurses.25 Take-home message: If you don’t understand how to use an inhaler, how can you explain it to your patients?
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