Inhaled corticosteroid-phobia and childhood asthma: Current understanding and management implications

β2-Adrenoreceptor Agonists, Montelukast, and Parkinson Disease Risk

OBJECTIVE

This study was undertaken to examine the association between montelukast use, β2-adrenoreceptor (β2AR) agonist use, and later Parkinson disease (PD).

METHODS

We ascertained use of β2AR agonists (430,885 individuals) and montelukast (23,315 individuals) from July 1, 2005 to June 30, 2007, and followed 5,186,886 PD-free individuals from July 1, 2007 to December 31, 2013 for incident PD diagnosis. We estimated hazard ratios and 95% confidence intervals using Cox regressions.

RESULTS

We observed 16,383 PD cases during on average 6.1 years of follow-up. Overall, use of β2AR agonists and montelukast were not related to PD incidence. A 38% lower PD incidence was noted among high-dose montelukast users when restricted to PD registered as the primary diagnosis.

INTERPRETATION

Overall, our data do not support inverse associations between β2AR agonists, montelukast, and PD. The prospect of lower PD incidence with high-dose montelukast exposure warrants further investigation, especially with adjustment for high-quality data on smoking. ANN NEUROL 2023;93:1023-1028.

Are we overcoming our inability to have pediatric patients properly use inhaled corticosteroids by inappropriately escalating their therapy?

OBJECTIVE

To perform a narrative review to describe and discuss potential methods and strategies for effectively assessing and dealing with poor adherence and/or misuse of inhalers in difficult-to-treat pediatric asthmatic patients.

DATA SOURCES

Articles available in electronic databases, published from inception to April 2021.

STUDY SELECTIONS

Relevant articles in the literature that discuss and analyze potential methods and strategies for effectively assessing and dealing with poor adherence and/or misuse of inhalers in difficult-to-treat pediatric asthmatic patients.

RESULTS

Validated self-reported questionnaires, weighing inhaler canisters, and pharmacy records might be the most suitable methods for assessing adherence to inhaled controller therapy in clinical practice. Additionally, validated instruments could be used as an objective measurement of the adequacy of inhaler technique. Finally, empathy and a true and strong physician-parent/patient partnership have a more powerful influence on adherence than almost any other factor, and they are probably the most cost-effective methods not only for detecting poor adherence to controller therapy but also for dealing with and improving it.

CONCLUSIONS

Failure to detect or effectively handle nonadherence and/or inhaler misuse in a patient with uncontrolled asthma can mislead clinicians into thinking that the patient is nonresponsive to the original less-intensive therapy, resulting in unneeded dosage increases and/or escalation of controller therapy to more costly medications, in some cases reaching the level of biologic therapy.

When adherence and inhalation technique matter: Difficult-to-control pediatric asthma in low- to middle-income countries

Despite relatively recent advances in our understanding of the physiopathology of asthma and the availability of highly effective controller medications, such as inhaled corticosteroids (ICS), currently many pediatric patients fail to control their asthma, especially in low- and middle-income countries (LMICs). Although some of these difficult-to-control asthmatic children have severe therapy-resistant asthma, most of them experience poor asthma control due to various modifiable factors, among which poor adherence to inhaled controller therapy and inadequate inhaler technique are the most common. Although electronic monitoring devices have been considered to be essential tools in identifying patients with severe therapy-resistant asthma, their high cost and low availability have currently limited their use in clinical practice. For these reasons, clinicians might consider using validated self-reported questionnaires and the weight of inhaler canisters and as alternative and valid options for assessing adherence to inhaled controller therapy. Furthermore, clinicians might consider adopting validated instruments as an objective measurement of the adequacy of inhaler technique. Although recognizing poor adherence does not automatically lead to improved adherence, it is usually an essential first step in effectively targeting adherence behavior, especially if the reasons for low or erratic compliance are explored by means of non-judgmental doctor-patient communication. These recommendations could assist in overcoming our inability to have pediatric asthmatic patients use ICS and in avoiding escalating their controller therapy toward more expensive medications, eventually reaching the use biologics. Promoting the rational and cost-effective use of asthma controller therapy could help to optimize the limited health resources in many LMICs.

Overweight Proxies Are Associated with Atopic Asthma: A Matched Case-Control Study

BACKGROUND

Many studies have documented a link between overweight and asthma in children with contradictory results regarding the best way to measure overweight. Moreover, often, the dynamic development of atopy, overweight, and asthma is controlled for age dependency insufficiently.

OBJECTIVE

This study assesses and compares the associations of overweight measured as waist circumference, waist to height ratio (WHtR), neck circumference, and body mass index with the occurrence of asthma - best possibly controlling for age-dependencies of these parameters.

METHODS

From a sample of 2,511 children aged 6-17 years, we matched 157 children with asthma with 2 controls (n = 471) according to age and atopy status and performed conditional logistic regression analyses. We further investigated the role of known influencing factors of asthma occurrence.

RESULTS

In children with atopy, all overweight proxies were consistently positively associated with asthma. Statistical significance was reached for WHtR-SD score (OR 1.26, 95% CI 1.03-1.54, p = 0.025) and persisted when further covariates, such as birth weight or social status, were added to the model. Groups of atopic versus nonatopic participants do not differ in levels of interleukin-6 or high-sensitivity C-reactive protein.

CONCLUSION

In our cohort, overweight seems to carry a risk for asthma only if accompanied with atopy. We call for more strict age matching in pediatric cohort studies and longitudinal studies for a better understanding for causal links of overweight, atopy, and asthma.