April 2003 JACI Highlights

Asthma treatment over the past decade is increasingly consistent with current asthma guidelines, leading to improved asthma control, according to a study in the April 2003 Journal of Allergy and Clinical Immunology (JACI).

Asthma is a chronic disease that affects more than 17 million people in the United States. Current asthma guidelines emphasize the importance of long term control of underlying airway inflammation in asthma treatment. Inhaled corticosteroids, either alone or in combination with long-acting inhaled β2-agonists, are recommended as the primary treatment for patients with moderate to severe asthma. Short-acting inhaled β2-agonists, once the mainstay of asthma therapy, are now only recommended for mild intermittent asthma or the prevention of exercise-induced symptoms.

In the study, Randall S. Stafford, MD, PhD, Stanford Center for Research in Disease Prevention, and colleagues analyzed 25 years of data extracted from the National Disease and Therapeutic Index (NDTI). Researchers tracked trends from 1978-2002 in the frequency of asthma visits and patterns of asthma treatment, focusing on the use of controller and reliever medications.

Researchers noted substantial changes in the number of asthma visits and in asthma treatment over the past 25 years. Among the findings:

• Asthma hospital visits doubled between 1978 8.5 million visits) and 1990 (17.7 million visits). However, the number of visits stabilized at an average of 16 million per year between 1991 and 2002.

• There is a declining trend in the number of return hospital visits for asthma, an indirect indicator of improved asthma control.

• The data indicated an increasing trend in the prescription of controller medications, particularly inhaled corticosteroids, and a decreasing trend in reliever medication use, particularly short-acting oral β2-agonists.

• In 2001, the prescription rate for asthma controller medication surpassed that of reliever medication for the first time (83% vs. 80%). The difference widened in 2002.

• Xanthines, which once dominated asthma therapy, were used in only 2% of visits in 2002.

Increases in the prescription rates of controllers reflect a rise in the use of inhaled corticosteroids, long-acting β2-agonists and leukotriene modifiers. The JACI study contributed to previous findings demonstrating that asthma treatment is evolving to be more consistent with consensus guidelines.

Inhaled Corticosteroid Therapy Safe for Pregnant Women

Asthma therapy with the inhaled corticosteroid budesonide has been shown to have no negative effects on the outcome of pregnancy, according to a study in the April 2003 Journal of Allergy and Clinical Immunology (JACI).

Asthma treatment guidelines emphasize the importance of maintaining asthma control during pregnancy because the risks of uncontrolled asthma are far greater than the risks associated with necessary asthma medications. Budesonide is one of the inhaled corticosteroids recommended for use during pregnancy. It is particularly a good choice for those women who require high-dose inhaled corticosteroids because of its ability to maximize adherence and minimize systemic effects.

To determine the effect budesonide has on pregnancy outcomes, Ensio Norjavaara, MD, PhD, Göteborg Pediatric Growth Research Centre, Sweden and colleagues compared mothers reporting usage of asthma medications with those who reported no usage. Researchers took their data from the Swedish Medical Birth Register, which includes 99% of the births in Sweden.

Among the group of mothers who reported taking asthma medication during pregnancy:

• 7,719 used asthma medications other than inhaled or oral corticosteroids
• 3,364 used only inhaled corticosteroids
• 2,968 used budesonide, 207 during the entire pregnancy
• 103 used both budesonide and an oral corticosteroid

The mothers who reported taking budesonide to control their asthma gave birth to babies of normal gestational age, birth weight and length. Those mothers also showed no increased rate of still births or multiple births as well.

The JACI study is the largest to date observing the use of inhaled corticosteroids and pregnancy outcomes. Women who are pregnant are often reluctant to take inhaled asthma medication because of the general fear of negative effects on the fetus. This may in turn increase the effect of asthma on the fetus and increase the risk of adverse outcomes such as higher rates of prematurity, lower birth weight and perinatal death. The current study reassures previous findings that inhaled corticosteroid therapy has no negative effect on the outcome of pregnancy.

The AAAAI is the largest professional medical specialty organization in the United States representing allergists, asthma specialists, clinical immunologists, allied health professionals and others with a special interest in the research and treatment of allergic disease. Allergy/immunology specialists are pediatric or internal medicine physicians who have elected an additional two years of training to become specialized in the treatment of asthma, allergy and immunologic disease. Established in 1943, the Academy has nearly 6,000 members in the United States, Canada and 60 other countries. The Academy serves as an advocate to the public by providing educational information through its Web site at http://www.aaaai.org or the toll free physician referral and information line at 1-800-822-2762.