American Thoracic Society News Tips for April

AMERICAN THORACIC SOCIETY NEWS TIPS FOR APRIL

SEVERE ASTHMATICS WITH PSYCHOPATHOLOGY CAUSE INCREASED HEALTH CARE COSTS

A study of severe asthmatics who also suffered from psychological dysfunction showed they had more visits to the doctor, frequent emergency room trips and hospitalizations, and recurrent exacerbations of the disease. The research is the first of its kind to connect psychopathology with increased health care utilization in a group of regularly supervised patients suffering from severe asthma, according to Dutch investigators. They studied 98 patients with severe asthma. Of this group, 21 were considered also to be psychiatric cases after testing.

With respect to demographics and objective disease characteristics, there were no significant differences between the psychiatric cases and the 77 non-psychiatric cases. However, those with psychological dysfunction had almost a 11-fold increased risk for two or more asthma exacerbations and almost a five-fold increased risk for two or more hospitalizations during the prior year. The findings appear in the April issue of the American Journal of Respiratory and Critical Care Medicine.

CHRONIC INFECTION LINKED TO ASTHMA

Chronic infection with Chlamydia pneumoniae is linked to asthma, according to investigators who studied the serology of 33 asthmatics and 33 healthy control subjects. Although no asthmatics or control subjects had current acute infection, evidence of past infection was detected in 17 (52%) of the 33 patients with asthma and only five (15%) of the healthy control subjects. The infectious agent is a common respiratory pathogen worldwide. Most persons become infected with it at least twice during their lifetime. The study group of 33 nonsmoking subjects with asthma included 20 males (average age 45-1/2) and 13 females (average age almost 48). The sera for the 33 health controls, who constituted a group similar to the subjects, came from a blood donor center. The study appears in the April issue of the American Journal of Respiratory and Critical Care Medicine.

"GOLD" REPORT DETAILS LATEST INFORMATION ON CHRONIC OBSTRUCTIVE PULMONARY DISEASE

An executive summary of the best validated current concepts of disease management for chronic obstructive pulmonary disease (COPD) is published in the April issue of the American Journal of Respiratory and Critical Care Medicine. The summary, which sprang from the Global Initiative for Chronic Obstructive Lung Disease (GOLD), sponsored by the World Health Organization (WHO) and the U.S. National Heart, Lung, Blood Institute, is designed to focus on the problem of COPD management through four main sections. The sections are: Assessing and Monitoring the Disease; Reducing Risk Factors; Managing Stable COPD; and Managing Exacerbations.

Diagnosis of the disease is based on a history of risk factor exposure and the presence of airflow limitation as expressed by lung function test values. COPD is usually not diagnosed until it is clinically advanced. In a study by the WHO and the World Bank, the worldwide prevalence of COPD in 1990 was estimated to be 9.34 cases per 1,000 men and 7.33 cases per 1,000 women. However, the ATS summary notes that these figures under-estimate the true prevalence since they include all ages and do not focus on the actual prevalence in older adults.

COPD death rates are very low among persons younger than 45. Obstructive lung disease prevalence is highest in those countries where cigarette smoking is common. Cigarette smokers have a higher prevalence of lung function abnormalities and respiratory symptoms, a greater annual decline in lung function, and higher death rates from COPD.

For the complete text of these articles, please see the ATS Journal Online Website at http://www.atsjournals.org. To request a complimentary journalist subscription to ATS journals online, or if you would like to add your name to the monthly mailing list, contact Chris Shepherd at (212) 315-6441, by fax at (212) 315-6456, or by e-mail at [email protected]

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