Asthma in the elderly: a double-blind, placebo-controlled study of the effect of montelukast

Juan Carlos Ivancevich Tuesday, 18 April 2017 12:10
Michele Columbo

Published: 17 April 2017

Abstract

Background

Little is known about asthma in the elderly as most studies of this condition have not included this patient group. It is unclear whether leukotriene antagonists benefit older asthmatics. We studied the effect of adding montelukast to the asthma treatment of elderly subjects.

Methods

Twenty-five subjects 65 years old and older with asthma were evaluated at week 0, 1, 5, 9, 13, and 17. Each subject received montelukast 10 mg and placebo each for 8 weeks in a cross-over design.

Results

Montelukast for 4 or 8 weeks did not significantly affect ACT, daily symptom scores, number of puffs of albuterol, spirometric values, peripheral blood eosinophils, or serum IgE vs. baseline or placebo. Similar results were obtained when analyzing subgroups of patients with lower ACT, lower FEV1, and higher eosinophils.

Conclusions

In this study of elderly asthmatics, montelukast had no effect on asthma symptoms, number of puffs of albuterol, spirometric values, peripheral blood eosinophils or serum IgE. These results will require confirmation in larger patient cohorts and in patients with uncontrolled asthmatic symptoms.

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Asthma Research and Practice - Submission guidelines

Juan Carlos Ivancevich Thursday, 09 March 2017 12:14

Submission guidelines

Our 3-step submission process

 

 

  1.  Before you submit

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    To give your manuscript the best chance of publication, follow these policies and formatting guidelines.

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Gender-specific determinants of asthma among U.S. adults

Juan Carlos Ivancevich Thursday, 02 February 2017 13:56
Rebecca Greenblatt, Omar Mansour, Edward Zhao, Michelle Ross and Blanca E Himes This email address is being protected from spambots. You need JavaScript enabled to view it.
 

Abstract

Background

Asthma, a chronic respiratory disease affecting over 18.7 million American adults, has marked disparities by gender, race/ethnicity and socioeconomic status. Our goal was to identify gender-specific demographic and socioeconomic determinants of asthma prevalence among U.S. adults using data from the Behavioral Risk Factors Surveillance System (BRFSS) and the National Health and Nutrition Examination Survey (NHANES).

Methods

Gender-specific regression analyses were performed to model the relationship between asthma prevalence with age, race/ethnicity, income, education level, smoking status, and body mass index (BMI), while taking into account the study designs.

Results

Based on BRFSS data from 1,003,894 respondents, weighted asthma prevalence was 6.2% in males and 10.6% in females. Asthma prevalence among grade 2 obese and grade 3 obese vs. not overweight or obese women was 2.5 and 3.5 times higher, respectively, while that in men was 1.7 and 2.4 times higher; asthma prevalence among current vs. never smoker women was 1.4 times higher, while that in men was 1.1 times higher. Similar results were obtained with NHANES data from 13,364 respondents: asthma prevalence among grade 2 obese and grade 3 obese vs. not overweight or obese respondents was 2.0 and 3.3 times higher for women, though there was no significant difference for men; asthma prevalence among current vs. never smokers was 1.8 times higher for women and not significantly different in men. Asthma prevalence by race/ethnicity and income levels did not differ considerably between men and women.

Conclusions

Our results underscore the importance of obesity and smoking as modifiable asthma risk factors that most strongly affect women.

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Asthma costs and social impact

Juan Carlos Ivancevich Wednesday, 01 February 2017 13:12
 
Carlos Nunes, Ana Margarida Pereira and Mário Morais-Almeida

Abstract

In recent decades, both asthma prevalence and incidence have been increasing worldwide, not only due to the genetic background, but mainly because of the effect of a wide number of environmental and lifestyle risk factors.

In many countries noncommunicable diseases, like asthma, are not yet considered a healthcare priority. This review will analyze and discuss disparities in asthma management in several countries and regions, such as access to healthcare human resources and medications, due to limited financial capacity to develop strategies to control and prevent this chronic disease.

This review tries to explore the social and economic burden of asthma impact on society. Although asthma is generally accepted as a costly illness, the total costs to society (direct, indirect and intangible asthma costs) are difficult to estimate, mainly due to different disease definitions and characterizations but also to the use of different methodologies to assess the asthma socio-economic impact in different societies.

The asthma costs are very variables from country to country, however we can estimate that a mean cost per patient per year, including all asthmatics (intermittent, mild, moderate and severe asthma) in Europe is $USD 1,900, which seems lower than USA, estimated mean $USD 3,100.

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Happy New Year 2017!!!

Juan Carlos Ivancevich Saturday, 31 December 2016 13:54

Preacutionary labelling of cross-reactive foods: The case of rapeseed

Juan Carlos Ivancevich Tuesday, 08 November 2016 13:17

Asthma Research and Practice

Alessandro Fiocchi, Lamia Dahdah, Carla Riccardi, Oscar Mazzina and Vincenzo Fierro

Abstract

Food allergic individuals are exposed to unnecessary dietary restrictions due to precautionary food allergy labelling (PFAL). Two forms of PFAL exist: type I identifies the possible presence of allergenic contaminaion in foods (‘may content…’), type II indicates as potentially dangerous ingredients or contaminants that do no belong to official list of food allergens. PFAL type II is based on the fear of cross-reactivity with foods belonging to that list. PFAL type II is less known, but may be tempting for the legal offices of food companies, for clinicians in a ‘defensive medicine’ key, and even for legislators. We identify here a case of PFAL type II, allergy to rapeseed (belonging to the family of Brassicaceae). Increasingly used for their nutritional and nutraceutic value in asthma prevention, rapeseed has been indicated by regulatory authorities in Canada and Europe as potential cross-reactor with mustard. In this review, we provide the elements for a risk assessment of cross-reactivity of rapeseed/mustard allergy in the general population both clinically and from the point of view of the molecular allergy. Three findings emerge:

1. Allergic reactions to rapeseed are exceptional

2. The allergens identified in rapeseed and mustard are similar, but not identical

3. Reactions to rapeseed have never been described in mustard-allergic patients.

On the ground of existing evidence, a precautionary labeling for rapeseed as potentially dangerous for patients allergic to mustard is not justified. In the interest of patients with multiple food allergy, PFAL type II must be avoided.

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Manifesto on small airway involvement and management in asthma and chronic obstructive pulmonary disease: an Interasma (Global Asthma Association - GAA) and World Allergy Organization (WAO) document endorsed by Allergic Rhinitis and its Impact on Asthma (

Juan Carlos Ivancevich Monday, 31 October 2016 15:19
F. Braido, N. Scichilone, F. Lavorini, O. S. Usmani, L. Dubuske, L. P. Boulet, R. Mosges, C. Nunes, M. Sánchez-Borges, I. J. Ansotegui, M. Ebisawa, F. Levi-Schaffer, L. J Rosenwasser, J. Bousquet, T. Zuberbier, G. Walter CanonicaEmail author, for the Interasma Executive Board, WAO Board of Directors, ARIA and GA²LEN

Abstract

Evidence that enables us to identify, assess, and access the small airways in asthma and chronic obstructive pulmonary disease (COPD) has led INTERASMA (Global Asthma Association) and WAO to take a position on the role of the small airways in these diseases.

Starting from an extensive literature review, both organizations developed, discussed, and approved the manifesto, which was subsequently approved and endorsed by the chairs of ARIA and GA2LEN. The manifesto describes the evidence gathered to date and defines and proposes issues on small airway involvement and management in asthma and COPD with the aim of challenging assumptions, fostering commitment, and bringing about change.

The small airways (defined as those with an internal diameter <2 mm) are involved in the pathogenesis of asthma and COPD and are the major determinant of airflow obstruction in these diseases. Various tests are available for the assessment of the small airways, and their results must be integrated to confirm a diagnosis of small airway dysfunction.

In asthma and COPD, the small airways play a key role in attempts to achieve disease control and better outcomes. Small-particle inhaled formulations (defined as those that, owing to their size [usually <2 μm], ensure more extensive deposition in the lung periphery than large molecules) have proved beneficial in patients with asthma and COPD, especially those in whom small airway involvement is predominant.

Functional and biological tools capable of accurately assessing the lung periphery and more intensive use of currently available tools are necessary. In patients with suspected COPD or asthma, small airway involvement must be assessed using currently available tools. In patients with subotpimal disease control and/or functional or biological signs of disease activity, the role of small airway involvement should be assessed and treatment tailored. Therefore, the choice between large- and small-particle inhaled formulations must reflect the physician’s considerations of disease features, phenotype, and response to previous therapy.

This article is being co-published in Asthma Research and Practice and the World Allergy Organization Journal.

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Asthma Research and Practice - Submission guidelines

Juan Carlos Ivancevich Friday, 14 October 2016 22:36

Asthma Research and Practice

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The official journal of Interasma

Submission guidelines

Our 3-step submission process

Before you submit

Now you’ve identified a journal to submit to, there are a few things you should be familiar with before you submit.

 Ready to submit

To give your manuscript the best chance of publication, follow these policies and formatting guidelines.

Asthma Research and Practice publishes the following article types:

Click the relevant link to find style and formatting information for the article you are going to submit.

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Interasma in Linkedin

Juan Carlos Ivancevich Monday, 26 September 2016 16:11

Follow the link to find us in Linkedin

https://www.linkedin.com/company/interasma

Asthma phenotypes: the intriguing selective intervention with Montelukast

Juan Carlos Ivancevich Wednesday, 17 August 2016 03:58

Cottini Marcello and Lombardi Carlo

Abstract

Asthma is a heterogeneous disease, usually characterized by chronic airway inflammation and a variable course associated with various underlying mechanisms that can differ between individuals. Patients with asthma can therefore exhibit different phenotypes, a term used to define the observable characteristics of an organism resulting from the interaction between its genetic makeup and the environment. The heterogeneity of asthma has received a large amount of attention in the last few years in order to better tailor treatment according to the different clinical and biological phenotypes of the disease. Specific asthma phenotypes may require an approach to treatment sometimes different from that recommended by current guidelines, so a personalized approach to asthma pharmacotherapy is recommended. Growing evidence suggests that leukotrienes play an important role in the pathogenesis of bronchial asthma. The mechanisms of action of leukotriene-receptor antagonists theoretically predict a good response in some asthma “phenotypes”.In this article we have performed an analysis of the recent literature (controlled clinical trials and real-life studies) about a possible selective intervention with Montelukast in specific asthma phenotypes.

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Editor: Juan C. Ivancevich, MD

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