American Thoracic Society Journal news tips for January 2004 (first issue)

Based on a large-scale study of data from 133,026 persons over age 65 who used certain respiratory prescriptions for 4 years or more, Canadian investigators concluded that long-term use of inhaled or nasal steroids at the usual doctor-recommended dose is not associated with a risk of fracture in patients. The case control study was nested within a population-based cohort of older persons who were dispensed various medications. After a least a 4-year follow-up, there were 9,624 new cases of fracture either of the hip or lower extremities. The study group also included 191,622 age-matched control subjects who were, on average age 81. According to the authors, the rate of fracture associated with the current use of inhaled or nasal corticosteroids, as well as to its use at any point during a 4-year time frame, was no different between those who took the medications and those who did not. (Corticosteroids are any of a group of hormones that are produced by the adrenal cortex. They can be produced synthetically for use in the treatment of many diseases, including asthma.) Safety concerns have been expressed about the long-term use of these drugs since they have been shown to cause resorption of bone. The investigators found that only high doses (more than 2,000 milligrams daily) for an average of 6 years or more was associated with extra risk of fracture. The research was published in the first issue for January 2004 of the American Thoracic Society's peer-reviewed American Journal of Respiratory and Critical Care Medicine.

RECURRENT WHEEZING HIGHER IN INFANTS WHO SHOW REDUCED INTERFERON, PLUS LESS SENTINEL MOLECULE

Among a study population of 238 infants, investigators found that impaired production of a major interferon, IFNγ, at age 3 months, plus reduced plasma levels of a sentinel molecule of the immune system, soluble CD14, at birth, increased significantly an infant's chances of developing recurrent wheezing in the first year of life. Out of the study group, 94 infants (39.5 percent) experienced wheezing episodes in their first year. Of these, 41 babies (17.21 percent) had recurrent wheezing. The investigators said that the odds of developing recurrent wheezing were 4.5 times higher in those in the lowest quartile of interferon gamma production at 3 months of age. It was 3.2 times higher for children in the lowest quartile of soluble CD14 levels at birth. (Interferon is a protein produced by cells that induces immunity to viral infection. CD14 is a sentinel molecule of the constitutive innate immune system that acts as a recognition agent for endotoxins.) Although about one-third of all children wheeze in the first year of their life, many of these conditions are transient in nature. However, for a subgroup that wheezes repeatedly, the condition is associated with subsequent development of asthma, and could result in a permanent reduction in lung function, according to the authors. The study appears in the first issue for January 2004 of the American Thoracic Society's peer-reviewed American Journal of Respiratory and Critical Care Medicine.

CHRONIC COUGH IS DUE TO ABNORMAL RELEASE OF INFLAMMATORY MEDIATORS WITHIN THE AIRWAY

Based on a study of persons with chronic cough, investigators believe that the problem is due to the abnormal release of inflammatory and potentially cough-producing substances within the airway. British investigators measured the concentration of various proinflammatory and tussive (cough-related) mediators in induced sputum from 62 persons with various types of chronic cough, along with those from 18 normal control subjects. They said that their findings were consistent with the hypothesis that chronic cough is associated with abnormal release of inflammatory mediators within the airway. All of the subjects were non-smokers. The age of the controls was approximately 48 and that of the coughers averaged 53 to 55 years. Among the subjects with cough, the duration of their problem had ranged from 2 to 5 years. The authors noted that this investigation was the first study of its type. The results appeared in the first issue for January 2004 of the American Thoracic Society's peer-reviewed American Journal of Respiratory and Critical Care Medicine.

For the complete text of these articles, please see the American Thoracic Society Online Web Site at http://www.atsjournals.org. For either contact information or to request a complimentary journalist subscription to ATS journals online, or if you would like to add your name to the Society's twice monthly journal news e-mail list, contact Cathy Carlomagno at 212-315-6442, or by e-mail at ccarlomagno@thoracic.org

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