Newsbriefs from the Journal Chest, February 2006

NEW MARKERS HELP PREDICT HEART DIEASE IN SLEEP APNEA PATIENTSTurkish researchers have identified two markers that may help predict the occurrence of cardiovascular disease among patients with sleep apnea. Researchers analyzed serum cardiac risk markers in 32 male patients with sleep apnea scores greater than five (group I), 30 male patients with scores less than five (group II), and a control group of 30 subjects without sleep apnea. Serum homocysteine and C-reactive protein (CRP) levels, markers associated with heart disease, were found to be elevated in group I compared with group II. Serum CRP values were increased in both group I and group II compared with the control group, and serum homocysteine values were higher in group I than in the control group. There were no significant differences between group I, group II, and the control group with respect to age, body mass index, and blood pressure. Researchers conclude that increased levels of homocysteine and CRP may help predict the long-term prognosis for cardiovascular disease and the treatment of sleep apnea. The study appears in the February issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians.

CHILDHOOD RISK FACTORS PREDICT ADULT ASTHMA A new study shows that the presence of certain asthma-related risk factors in childhood may increase the risk of developing asthma in adulthood. Danish researchers followed 291 patients aged 7 to 17 years at study enrollment for 12 years to determine the incidence and remission of asthma and its predictors. All participants were interviewed and underwent asthma/allergy testing at the beginning of the study and at follow-up 12 years later. The prevalence of asthma at baseline was 4.1 percent and increased to 11.6 percent at follow-up, at which point 19.6 percent had experienced asthma symptoms at some time. During follow-up, 16.1 percent of patients developed asthma, which was predicted by wheezing during childhood as well as airway hyperresponsiveness to histamine (AHR), allergic sensitization to house dust mites (HDM), and dermatitis. The presence of more than one of these risk factors was associated with a high probability of developing asthma at follow-up (61.5 percent). In patients without any risk factors, only 4 percent developed asthma during follow-up. Among patients with asthma, 40 percent remitted during follow-up. Researchers speculate that patients with known risk factors in childhood may need a more intensive interventional approach in follow-up care. The study appears in the February issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians.

ASTHMA FOLLOW-UPS INCREASE WITH PRESCHEDULED APPOINTMENT A new study finds that prescheduling an appointment with a doctor may increase the likelihood that a newly diagnosed asthma patient will seek follow-up care for his or her condition. Researchers from nine emergency departments (ED) across the United States and Canada compared the effect of ED interventions on the rates of primary care follow-up and long-term outcomes for 384 patients (ages 2 to 54 years) newly diagnosed with asthma by an ED physician. Patients received usual discharge care (group A), or free prednisone, vouchers for transport to and from a primary care visit, and either a telephone reminder to schedule an appointment (group B) or a prior scheduled appointment (group C). Results showed that primary care follow-up was higher in group C (65 percent) compared with group A (42 percent) and group B (48 percent). There were no differences in ED visits, hospitalizations, quality of life, or inhaled corticosteroid use one year after the initial ED visit. Researchers conclude that ED interventions, including appointment assistance, can significantly increase the likelihood that a discharged asthma patient will obtain primary care follow-up but does not impact long-term outcomes. The study appears in the February issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians.