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Asthma Linked With Shingles

Asthma Linked With Shingles

Previous research has suggested that children with asthma are at increased risk for developing herpes zoster (shingles or zoster), but this association has not been assessed in adults. Recent estimates show that asthma affects up to 17% of the United States population, and shingles affects nearly 1 million Americans every year, particularly the older adult population. For a study published in the Journal of Allergy and Clinical Immunology, Young J. Juhn, MD, MPH, and colleagues sought to determine whether or not asthma is associated with an increased risk of zoster in older adults.   Making the Link Prior to the current study, Dr. Juhn and colleagues found that asthma was linked to an increased risk of various respiratory infections, including community-acquired pneumonia, whooping cough, and ear infections. “Although this research was helpful, it didn’t explain whether the associations were due to airway structure or issues surrounding immune function,” says Dr. Juhn. “For the new study, we analyzed the association between asthma and zoster, which is not an airway infection, in order to help determine the epidemiologic relationship between asthma and the risk of zoster.” For the analysis, researchers compared the frequency of asthma among adults aged 50 or older with zoster with that of age- and gender-matched controls who did not have a history of zoster. Asthma status was based upon predetermined criteria rather than having physicians diagnose the disease using ICD-9 codes or self-reported asthma status, according to Dr. Juhn. Of the 371 patients with shingles, 23% had a history of asthma, compared with a rate of 15% that was observed among the 742 control subjects, Dr. Juhn...
CME: The Increasing Costs of COPD

CME: The Increasing Costs of COPD

Chronic lower respiratory disease—the large majority of which is COPD—currently ranks as the third leading cause of mortality in the United States. Recent estimates of the costs associated with chronic lower respiratory disease have presented asthma and COPD together, which does not allow for a true understanding of the costs of COPD to the national healthcare system. Fur-ther complicating available data is the fact that patients with COPD often have a multitude of comorbidities. “Most COPD is attributable to smoking, which can also cause heart disease, cancer, and many other conditions,” explains Earl S. Ford, MD, MPH. “This makes it difficult to understand what costs are directly attributable to COPD and what costs are actually attributable to conditions that co-exist with COPD. Some of the previous studies looking at the costs of COPD have likely included ‘double counting’ from not factoring in costs that are actually attributable to these comorbidities.” A Thorough Analysis For a study published in Chest, Dr. Ford and colleagues estimated national and state-specific COPD-attributable annual medical costs by payer and absenteeism in 2010 and projected medical costs through 2020. The team used the 2006 to 2010 Medical Expenditure Panel Survey, 2004 National Nursing Home Survey, and 2010 CMS data to generate cost estimates and 2010 census data to project medical costs through 2020. “We felt that the most presentable costs were those that were estimated after accounting for 11 comorbidities, including heart disease, pneumonia, diabetes, asthma, and depression,” adds Dr. Ford. After accounting for these other comorbidities, the researchers estimated that the 2010 costs attributable to COPD and its sequelae were $32.1 billion (Figure). By...
The Increasing Costs of COPD

The Increasing Costs of COPD

Chronic lower respiratory disease—the large majority of which is COPD—currently ranks as the third leading cause of mortality in the United States. Recent estimates of the costs associated with chronic lower respiratory disease have presented asthma and COPD together, which does not allow for a true understanding of the costs of COPD to the national healthcare system. Fur-ther complicating available data is the fact that patients with COPD often have a multitude of comorbidities. “Most COPD is attributable to smoking, which can also cause heart disease, cancer, and many other conditions,” explains Earl S. Ford, MD, MPH. “This makes it difficult to understand what costs are directly attributable to COPD and what costs are actually attributable to conditions that co-exist with COPD. Some of the previous studies looking at the costs of COPD have likely included ‘double counting’ from not factoring in costs that are actually attributable to these comorbidities.” A Thorough Analysis For a study published in Chest, Dr. Ford and colleagues estimated national and state-specific COPD-attributable annual medical costs by payer and absenteeism in 2010 and projected medical costs through 2020. The team used the 2006 to 2010 Medical Expenditure Panel Survey, 2004 National Nursing Home Survey, and 2010 CMS data to generate cost estimates and 2010 census data to project medical costs through 2020. “We felt that the most presentable costs were those that were estimated after accounting for 11 comorbidities, including heart disease, pneumonia, diabetes, asthma, and depression,” adds Dr. Ford. After accounting for these other comorbidities, the researchers estimated that the 2010 costs attributable to COPD and its sequelae were $32.1 billion (Figure). By...
Previous Respiratory Disease & Lung Cancer

Previous Respiratory Disease & Lung Cancer

Studies have suggested a relationship between previous respiratory diseases and a lung cancer diagnosis. Most of this research has been conducted in Asian populations and does not account for the high level of co-occurrence that has been observed among different respiratory diseases. To better understand the relationship between multiple previous respiratory diseases and lung cancer risk, Paolo Boffetta, MD, MPH, and colleagues pooled data from a consortium of seven case-control studies as part of the SYNERGY project, which provided detailed information on smoking habits in European and North American populations. New Findings Data on five previous respiratory diseases—chronic bronchitis, emphysema, tuberculosis, pneumonia, and asthma—were collected by self-report for the study, which was published in the American Journal of Respiratory and Critical Care Medicine. Analyses were stratified by gender and adjusted for study center, age, employment in an occupation with an excess risk of lung cancer, level of education, smoking status, cigarette pack-years, and time since quitting smoking. According to the results, patients with chronic bronchitis, emphysema, and pneumonia were at higher risk of lung cancer when compared with those who had no previous respiratory disease diagnoses. In men, chronic bronchitis and emphysema were associated with odds ratios (ORs) of 1.33 and 1.50, respectively, for lung cancer. Men who were diagnosed with pneumonia 2 or fewer years prior to lung cancer were also at greater risk of lung cancer (OR, 3.31), but this correlation leveled off when a pneumonia diagnosis was made after the 2-year threshold. Patients with co-occurring chronic bronchitis, emphysema, and pneumonia had a higher risk of lung cancer than those who had any of these conditions alone....
Assessing Asthma Control

Assessing Asthma Control

The Asthma Control Test (ACT) has long been used as a quick survey to assess how well asthma symptoms are controlled among patients aged 12 and older, while the Childhood ACT (CACT) is used for such testing in younger children. More recently, the Asthma APGAR system has emerged as an alternative to ACT/CACT because of an implied ability to assess asthma control and reasons for inadequate control. However, little is known about how the Asthma APGAR system compares with ACT/CACT in the assessment of asthma control. Comparing Tests For a study published in Mayo Clinic Proceedings, Barbara P. Yawn, MD, MSc, MSPH, and colleagues sought to compare the impact of the Asthma APGAR system versus that of ACT/CACT on patient outcomes. Participants required daily asthma therapy and were asked to complete ACT in written form, several other asthma-related questions, and then the Asthma APGAR test. Children aged 5 to 11 completed the CACT, often with help from a parent. “The ACT and APGAR tests are highly comparable,” says Dr. Yawn, whose study results showed an overall agreement of 84.4% between the tests. “However, ACT doesn’t identify factors that may contribute to poorly controlled asthma. In contrast, the APGAR test was able to identify an actionable item for asthma control in more than three-quarters of cases. For pulmonologists, this can help speed up care by informing us about where to look for problems. The Asthma APGAR system was designed to not only help identify poor or inadequate control, but also to highlight the most common reasons why it isn’t under control. Our study demonstrated that the Asthma APGAR system could...
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