Highlights of the American Thoracic Society 2010 International Conference

Internet Monitoring Strategy for Severe Asthma Shown to be Effective
People with severe asthma who use an Internet-supported strategy and daily monitoring of exhaled nitric oxide (FENO) were able to control their asthma with lower overall dosing of oral corticosteroids than people who underwent usual care, according to new research.

“We know that in patients with prednisone-dependent asthma, it is important to adjust the daily dose of oral corticosteroids to the lowest possible level in order to reduce long-term side effects,” said Simone Hashimoto, md, research fellow from the department of Respiratory Medicine at the University of Amsterdam. “Our study shows that a novel Internet-supported strategy including daily measurements of an objective marker of airway inflammation, FENO, and supervision by an asthma nurse allows frequent adjustments of prednisone dose and leads to significant reduction of total corticosteroid consumption over a six months study period, as compared with people receiving usual care. This was not accompanied by deterioration of asthma control or asthma-related quality of life.”

High-Fat Meals a No-No for People with Asthma
People with asthma may be well advised to avoid heavy, high-fat meals, according to new research. Individuals with asthma who consumed a highfat meal showed increased airway inflammation just hours after the binge, according to researchers. The high-fat meal also appeared to inhibit the response to the asthma reliever medication Ventolin (albuterol).

Researchers recruited 40 asthmatic subjects who were randomized to receive either a high-fat, high-calorie “food challenge” or a low-fat, low-calorie meal. Those who consumed the high-fat meal had a marked increase in airway neutrophils and TLR4 mRNA gene expression. (TLR4 is a cell surface receptor that is activated by nutritional fatty acids.) They also had reduced bronchodilator response.

Children with Severe Asthma at Increased Risk of Developing COPD
Children with severe asthma have more than 30 times the risk of developing chronic obstructive lung disease as adults, compared to children without asthma, according to a recent study.

Subjects were recruited at age 7 and were assessed regularly until age 50. Those who were classified as having severe asthma in childhood had an adjusted COPD risk of 31.9 times that of children without asthma. Children with mild asthma were not at increased risk of developing adult obstructive lung disease.

Researchers still do not fully understand the mechanisms that link severe childhood asthma with adult COPD, but these findings suggest that appropriate treatment strategies should be instigated early in life to potentially minimize future risk.