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Asthma Pops Up After Step Down


Exacerbations in asthma are common long after patients receive step down medications, and other respiratory disease news.

© sumroeng chinnapan/Shutterstock.com

© sumroeng chinnapan/Shutterstock.com

Many patients with asthma experience exacerbations within 2 years of receiving step down medications, new respiratory disease research shows. Another study demonstrates that mindfulness-based stress reduction (MBSR) has a positive effect on both the mood and stress levels of patients who have interstitial lung disease (ILD). And a randomized, controlled trial finds that adding exercise to pharmacological treatment might improve the main features of asthma for those who have moderate to severe disease.  

Look for the latest respiratory disease news on the pages that follow:

Asthma Exacerbations Occur in One-third of Patients

• About one-third of patients with asthma have an exacerbation within 2 years of stepping down controller medication, according to the results of new retrospective study.

• Researchers used a US claims database spanning 2000-2012 to conduct a time-to-event analysis.

• A step down event was defined by a 50% or more decrease in days-supplied of controller medications from one event to the next.

Younger, Female, African American Patients at Increased Risk

• Researchers monitored each patient for 10 consecutive 4-month intervals, 3 prior to stepping down, 1 when the step down occurred, and 6 after the step down.

• Among the 26,292 patients in the study, 32% had an asthma exacerbation in the 2-year period after step down of asthma controller medication, although only 7% visited an emergency department or were hospitalized for asthma.

• Patients at increased risk for a quicker asthma exacerbation included those aged 19 years and younger, females, and African Americans.

• Source: Rank MA, Johnson R, Branda M, et al. Long term outcomes after stepping down asthma controller medications: a claims-based, time-to-event analysis. Chest. 2015 May 21. doi:10.1378/chest.15-0301. [Epub ahead of print]

Stress Reduction Program for Interstitial Lung Disease

• Chronic, progressive respiratory symptoms are associated with a strong psychological and emotional effect in patients who have ILD.

• An MBSR program appears to be safe and feasible in patients who have ILD, according to the results of a prospective, observational pilot study.

• The researchers hypothesized that mindfulness practice might indirectly trigger a positive, measurable effect on pulmonary performance and exercise tolerance.

Mindfulness Elevates Moods and Reduces Stress in ILD

• The study included 19 patients with ILD who participated in an 8-week MBSR program and then were monitored for 12 months.

• All 17 evaluable patients who completed the study attended an average of 8 of 9 sessions.

• The results suggest a positive effect on patients’ moods and stress levels, lending support for larger controlled studies to assess the efficacy of MBSR programs for ILD.

• Source: Sgalla G, Cerri S, Ferrari R, et al. Mindfulness-based stress reduction in patients with interstitial lung diseases: a pilot, single-centre observational study on safety and efficacy. BMJ Open Respir Res. 2015;2:e000065 doi:10.1136/bmjresp-2014-000065.

Aerobic Exercise Decreases Bronchial Hyper-responsiveness in Asthma

• Patients with asthma often avoid exercise for fear of triggering symptoms.

• Aerobic exercise appears to limit the severity of asthma symptoms and improve quality of life, according to the results of a new randomized controlled trial.

• These researchers investigated the effects of aerobic training on bronchial hyper-responsiveness (BHR), serum inflammatory cytokines, clinical control, and asthma quality of life.

Exercise Leads to Better Tolerance of Trigger Factor

• The study included 58 patients with moderate to severe asthma who were randomly assigned to 30 minutes of yoga breathing twice a week or the breathing exercise plus a 35-minute indoor treadmill session twice weekly for 12 weeks.

• Among those of the 43 patients (21 in the breathing group and 22 in the breathing plus aerobic exercise group) who completed the study and were able to take the BHR test, 2 were classified as borderline hyper-responsive, 5 were classified as mildly hyper-responsive, and 29 were moderately to severely hyper-responsive.

• At the end of the study, BHR had fallen in those in the breathing plus aerobic exercise group in 1 doubling dose of histamine.

• BHR did not change in the patients in the breathing group.

Aerobic Exercise Boosts Breathing Function

• Levels of some cytokines fell significantly among those in the breathing plus aerobic exercise group, and the number of symptom-free days increased.

• Those in the breathing plus aerobic exercise group had fewer bouts of worsening symptoms than those in the breathing group.

• Quality-of-life score rose significantly in 15 patients in the breathing plus aerobic exercise group, and maximum oxygen intake and aerobic power increased.

Exercise as Adjunctive Asthma Therapy

• The effects were most noticeable in patients with higher levels of systemic inflammation and poorer symptom control.

• The researchers concluded that adding exercise as an adjunct therapy to pharmacological treatment could improve the main features of asthma.

• Source: Franca-Pinto A, Mendes FA, de Carvalho-Pinto RM, et al. Aerobic training decreases bronchial hyperresponsiveness and systemic inflammation in patients with moderate or severe asthma: a randomised controlled trial. Thorax.doi:10.1136/thoraxjnl-2014-206070.

Take-home Messages:

• About one-third of patients have an asthma exacerbation in the 2 years after a step down event.

• An MBSR program might produce a positive, lasting improvement in mood and stress in patients with ILD and appears to be safe and feasible.

• For the first time, a randomized, controlled trial provides evidence that improvement in aerobic exercise reduces bronchial hyper-responsiveness and systemic inflammation in patients with moderate to severe asthma.

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