Chronic Heartburn Could Spur Asthma in Some Patients: MedlinePlus

Chronic Heartburn Could Spur Asthma in Some Patients: MedlinePlus

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Chronic Heartburn Could Spur Asthma in Some Patients

Study reinforces the link, and a new test might be better at spotting the problem, experts say

URL of this page: http://www.nlm.nih.gov/medlineplus/news/fullstory_133447.html (*this news item will not be available after 04/25/2013)

By Robert Preidt

Friday, January 25, 2013

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FRIDAY, Jan. 25 (HealthDay News) — Chronic heartburn is a major cause of asthma in adults, a new study suggests.
The finding could help add asthma to the known health risks — including esophageal cancer — already associated with chronic heartburn, which is formally known as gastroesophageal reflux disease (GERD) and is one of the most common digestive disorders in Western nations.
GERD occurs when a muscle at the end of the esophagus fails to close properly. This allows stomach contents to leak back (reflux) into the esophagus and irritate it. GERD symptoms include frequent heartburn, chest discomfort, dry cough, difficulty swallowing, hoarseness or sore throat, and regurgitation of food.
In this study, researchers used a new, specially designed catheter that measures levels of acid reflux exposure within the patient’s airway. They believe that this new method (known by the acronym HMII) was much more effective than conventional techniques in identifying patients with GERD-induced asthma.
The researchers also found that for the majority of patients, asthma symptoms eased after they underwent surgery for GERD, according to the study published Jan. 23 in the journal JAMA Surgery.
“We have observed for some time a strong association between GERD and certain pulmonary [lung] diseases, including adult-onset asthma,” study author Dr. Blair Jobe, director of the Institute for the Treatment of Esophageal and Thoracic Disease at the West Penn Allegheny Health System, said in a health system news release.
“The real challenge, however, has been our limited ability to effectively diagnose these patients and determine who precisely may benefit from surgical intervention,” he added. According to Jobe, the newly devised test “is much more sensitive as means of detecting GERD in asthmatic patients than what we have traditionally relied upon.”
The findings are strong enough to warrant consideration of HMII testing in adults with asthma that is not responding to asthma medications or in those who also have GERD symptoms, he said.
One expert wasn’t surprised by the findings.
“GERD is a common condition affecting millions of Americans,” noted Dr. David Bernstein, gastroenterologist and chief of the division of hepatology at North Shore University Hospital in Manhasset, N.Y. He said that “reflux of gastric acid through the esophagus and into the lungs is a common cause of chronic cough and asthma.”
But it may be too early to advocate for widespread diagnostic testing using the new method, he added.
“This new technique is interesting and needs to be further evaluated before it can replace currently accepted diagnostic techniques,” Bernstein said.
However, he believes that surgery is not always warranted for patients with reflux-linked asthma symptoms.
“Surgery for GERD-induced asthma is seldom necessary due to the ability of high-dose anti-acid medications in controlling the vast majority of reflux cases,” Bernstein contends. “It is premature to recommend anti-reflux surgery without an adequate trial of anti-acid medications.”

SOURCES: David Bernstein, M.D., gastroenterologist and chief, division of hepatology, North Shore University Hospital, Manhasset, N.Y; West Penn Allegheny Health System, news release, Jan. 23, 2013

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Combo Inhaler May Give Better Relief for Some With Asthma: MedlinePlus

Combo Inhaler May Give Better Relief for Some With Asthma: MedlinePlus

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Combo Inhaler May Give Better Relief for Some With Asthma

Inhalers containing both rescue and preventive drugs helped patients with moderate to severe condition in studies

URL of this page: http://www.nlm.nih.gov/medlineplus/news/fullstory_134552.html

(*this news item will not be available after 06/02/2013)

Monday, March 4, 2013

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MONDAY, March 4 (HealthDay News) — Asthma patients typically use two inhaled drugs — one a fast-acting “rescue inhaler” to stem attacks and another long-lasting one to prevent them.
However, combining both in one inhaler may be best for some patients, two new studies suggest.
Patients with moderate to severe asthma who used a combination inhaler had fewer attacks than those on two separate inhalers, researchers report. Both studies tested the so-called SMART (single maintenance and reliever therapy) protocol.
“The SMART regime was more effective as a treatment for asthma than the conventional treatment, where you just use a inhaler at a fixed maintenance dose and a short-acting inhaler for the relief of symptoms,” said Dr. Richard Beasley, director of the Medical Research Institute of New Zealand in Wellington and lead researcher of one of the studies.
These drugs are a combination of a corticosteroid (such as budesonide or fluticasone) and a long-acting beta-2 agonist (such as salmeterol or formoterol) and are sold under various brand names including Seretide, Symbicort and Advair.
In asthma, treatment increases as the severity of the condition does, Beasley said. So, this combination therapy isn’t the first choice. When the asthma is difficult to control with other methods, “we are now recommending the SMART regime,” he said.
“You treat the patients according to their needs,” Beasley said. “This is certainly not what you start them on — it is something you would use on moderate to severe patients.”
In the United States, use of these combination inhalers is also not considered first-line therapy for asthma, according to Dr. Len Horovitz, a pulmonary specialist at Lenox Hill Hospital in New York City.
“Patients, however, are currently using these combination inhalers,” he said. If the asthma is moderate to severe, then a combination inhaler is appropriate, said Horovitz, who was not involved with either new study.
The reports were published in the March issue of the journal Lancet Respiratory Medicine.
One study was funded by Italian pharmaceutical company Chiesi Farmaceutici, whose products include asthma medications. The multi-center European study was led by Dr. Klaus Rabe, a professor of pulmonary medicine at the University of Kiel, in Germany.
The study included more than 1,700 patients with moderate asthma. Researchers found that participants using the single, combination inhaler had significantly fewer severe asthma attacks and were seen at a hospital or urgent medical facility less than those patients using the two inhalers.
Rabe and colleagues wrote that although drugs like Symbicort (the specific budesonide/formoterol combination used in the study) can be more expensive than separate inhalers, the ability to prevent asthma attacks and reduce hospital and emergency room visits may be cost-saving in the end.
In the second trial, funded by the Health Research Council of New Zealand, Beasley’s team randomly assigned 303 patients to the single-inhaler protocol or to usual care with two inhalers. Over six months, the researchers found that those using Symbicort had fewer severe asthma attacks.
One concern had been that patients using the combination inhaler would get overexposed to corticosteroid or would overuse the inhaler, Beasley said.
They found, however, that patients using the combination inhaler reduced their overuse of corticosteroid by 40 percent, compared to those using separate inhalers.
While those in the SMART program took in more corticosteroids a day, they had fewer asthma attacks so their overall exposure to corticosteroid was the same as for people in the two-inhaler group, the New Zealand researchers explained.

SOURCES: Richard Beasley, M.B., director, Medical Research Institute of New Zealand, Wellington; Len Horovitz, M.D., pulmonary specialist, Lenox Hill Hospital, New York City; March 2013 Lancet Respiratory Medicine

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