The two-month rifampin/pyrazinamide (RIF/PZA) regimen recommended for latent tuberculosis (TB) can be a useful treatment in high-risk, non-adherent groups, but researchers warn that physicians should regularly monitor these patients for potential liver toxicity. Investigators studied 114 persons, many of whom were homeless, who received RIF/PZA over two months for treatment of latent tuberculosis. Numerous patients were at high risk for both liver disease and non-adherence to treatment. All patients had a positive TB skin test, but none had evidence of actual disease. Nine patients showed elevation of hepatic enzymes into the confirmed hepatitis zone, and 6 had symptoms of the disease. The final rate of hepatitis for this study group was 5.3 percent or 6 persons confirmed or suspected. The research said that the completion rate for treatment was 67 percent with RIF/PZA in this high-risk population. That rate compared very favorably with completion rates of 22 to 49 percent described in other studies lasting 6 months for isoniazid in cohorts of homeless persons who were being treated for latent TB. The study appears in the second issue for March 2003 of the American Thoracic Society's peer-reviewed American Journal of Respiratory and Critical Care Medicine.
EXPOSURE IN THE WOMB TO SMOKING PLUS EARLY ASTHMA ONSET CAUSE LUNG FUNCTION DEFICITS
Exposure in the womb to maternal smoking and early onset of asthma were associated with large deficits in children's lung function. Investigators looked at data on medical history, tobacco smoke exposure, and lung function among 5,933 participants in the Children's Health Study. The researchers pointed out that children exposed in utero to smoke who had late onset of asthma (after age 5) showed a different pattern than did exposed children with early onset of asthma (before age 5). The youngsters in the former category showed deficits in lung function that were smaller at age 10 and decreased by age 15. The lead researcher noted their findings supported the hypothesis that in utero exposure and early onset of asthma were synergistically associated with persistent deficits in lung function. The authors conclude that children with early onset asthma may be a high-risk group for subsequent adverse respiratory outcomes during their life course. The researchers did not observe any independent effect of only environmental tobacco smoke (ETS) exposure on the children's lung function. Almost 19 percent were exposed in utero to maternal smoking and 32 percent had received lifetime ETS exposure. The study was published in the second issue for March 2003 of the American Thoracic Society's peer-reviewed American Journal of Respiratory and Critical Care Medicine.
LUNG FUNCTION AND ELEVATED BLOOD GLUCOSE LEVELS
Both the diagnosis of diabetes and a higher level of fasting blood glucose were associated with lower than predicted levels of pulmonary function in tests involving 3,223 members of the Framingham Offspring Cohort. The researchers pointed out that the diagnosis of diabetes mellitus was associated with lower lung function results on two major lung function tests. They said that there was a progressive fall in residual pulmonary function across quartiles of fasting blood glucose. According to the authors, diabetes has been associated with markers of systemic inflammation and with increased risk of other disease in which inflammation plays a role, such as cardiovascular disease. Although several studies have suggested that diabetes is associated with impaired pulmonary function, the results of these studies about this relationship have been inconsistent. Consequently, the investigators decided to use the Offspring Cohort of the Framingham Heart Study to examine the cross-sectional relationship of pulmonary function to diabetes and the level of fasting blood glucose. The study appears in the second issue for March 2003 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 mailing 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