Patients with chronic obstructive pulmonary disease (COPD) who were current high-dose users of inhaled corticosteroids (ICS) had an increased risk of nonvertebral fractures compared with those who had no exposure, according to a study in the American Thoracic Society's peer-reviewed American Journal of Respiratory and Critical Care Medicine. The researchers looked at 1,708 COPD patients with a nonvertebral fracture who were matched with 6,817 COPD control subjects without a fracture. (In COPD, patients have persistent obstruction of the airways, associated with either severe emphysema or chronic bronchitis. Most such illnesses result from years of cigarette smoking.) Treatment with the inhaled form of corticosteroids is intended to deliver medication directly to the lungs (involved site) and to limit any systemic effects. Patients classified as current users who were exposed to ICS at high daily doses were at the highest risk for nonvertebral fractures. In the highest dose category, the average daily dose was 1,616 micrograms per day. The investigators point out that the increase in fracture risk associated with ICS use did not by itself warrant stoppage of treatment in patients with COPD. Rather, the risk of fractures indicated that physicians should consider prescribing the lowest effective dose of ICS in the management of COPD. Also, they pointed out that the frail nature of many COPD patients who have various chronic diseases makes them even more impacted by ICS use.
GREATER ACETAMINOPHEN USE CAN LEAD TO NEWLY DIAGNOSED ASTHMA IN WOMEN
During 6 years of follow-up of participants in the Nurses Health Study, investigators found that greater use of the analgesic acetaminophen was prospectively associated with an increased rate of new physician diagnosis of adult-onset asthma. Acetaminophen is a widely used nonprescription analgesic sold under various brand names. It relieves mild to moderate pain and reduces fever. Often, it is taken in place of aspirin because it has fewer gastrointestinal side effects. According to the authors, acetaminophen increases glutathione levels in the lung, which may predispose persons to oxidative injury and bronchospasm. Acetaminophen has been associated with asthma in cross-sectional studies and a birth cohort. Among 299 newly diagnosed cases of asthma in the Nurses Health Study between 1990 and 1996, 108 used no acetaminophen, 112 used it from 1 to 4 times per month, 41 ingested it 5 to 14 times per month, 16 took the compound 15 to 21 times per month, and 22 used the nonprescription medication more than 22 times per month. The investigators also said that acetaminophen-related bronchospasm had been demonstrated in some patients who had no history of aspirin-sensitive asthma. The study appears in the first issue for April 2004 of the American Thoracic Society's peer-reviewed American Journal of Respiratory and Critical Care Medicine.
AIR POLLUTION LEADS TO EXACERBATIONS IN CYSTIC FIBROSIS PATIENTS
In a study of 11,481 cystic fibrosis (CF) patients who breathed urban air pollutants, investigators found that exposure to two types of tiny particulate matter and to ozone was associated with increased odds of suffering two or more pulmonary exacerbations that required either hospitalization or administration of intravenous antibiotics at home. Of the study group, 3,322 patients had two or more exacerbations. The researchers found that small rise in two different sizes of particulate matter (PM2.5 and PM10) was associated with an 8 percent and 21 percent increase, respectively, in the odds for two or more patient exacerbations. A 10 parts per billion rise in ozone was associated with a 10 percent increase in exacerbations. (CF is a common inherited disease, occurring in 1 in every 2,500 white babies. A missing gene leads to the production of very sticky secretions which, among other organs affected, can clog the airways of the lung.) The investigators point out that CF patients have evidence of airway infection, inflammation, and products from tissue destruction even when they have no symptoms. They noted that within the setting of excessive oxidation and inflammation in the patients, air pollution can lead to further airway irritation and injury, which, in turn, could affect the rate and extent of airway infections. The study appears in the first issue for April 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
Journal
American Journal of Respiratory and Critical Care Medicine