Insurance Loss Hampers Young People With Asthma

MONDAY, April 22 (HealthDay News) -- The loss of health insurance is the main reason asthma care for young people deteriorates after age 18, according to a new study.

Certain social factors -- such as leaving school and no longer having adult supervision -- also contribute to the decline in care, according to Harvard Medical School researchers.

"This study suggests that expanding insurance coverage will help many young adults with asthma receive the care they need," study leader Kao-Ping Chua, a staff physician in the division of emergency medicine at Boston Children's Hospital, said in a Harvard news release. "But it also points to the importance of addressing other socially mediated factors in this population."

"Aside from the lack of financial protection, uninsurance poses fewer health risks to young adults than for older adults because they are generally healthy," study senior author J. Michael McWilliams, an assistant professor of health care policy and medicine at Harvard Medical School, said in the news release.

"But for young people with asthma -- or other conditions amenable to medical care -- it's important to understand and address the barriers to care," he added.

The researchers looked at data from nearly 2,500 asthma patients, aged 14 to 25, in order to determine if they had a regular care provider, if they visited that provider at least once a year, if they used asthma medications and if they made emergency-room visits.

Patients under age 18 were more likely to use primary care and asthma medications, while those over 18 were more likely to make emergency-room visits and have problems getting care and medications due to cost.

The loss of health insurance explained 32 percent of the decline in the use of primary care by patients over age 18 and between 47 percent and 61 percent of the increase in their cost-related problems getting care and medications, according to the study, which was published recently in the journal Pediatrics.

Under the federal Affordable Care Act, young adults whose parents have private insurance will be eligible to continue receiving coverage on their parents' policies until they are 26. But, the researchers said, since the U.S. Supreme Court ruled that states do not have to extend similar coverage to people on Medicaid, low-income young adults will be left out.

Health insurance, however, is not the only problem, they added.

"Young people with asthma need to work with their care providers to create transition plans from pediatric to adult care that take into account their medical and social history," Chua said.

-- Robert Preidt
Copyright © 2013 HealthDay. All rights reserved. SOURCE: Harvard Medical School, news release, April 22, 2013

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Insurance Loss Hampers Young People With Asthma

Harvard researchers report on impact of health insurance in youths' disease management

By Robert Preidt

HealthDay Reporter

MONDAY, April 22 (HealthDay News) -- The loss of health insurance is the main reason asthma care for young people deteriorates after age 18, according to a new study.

Certain social factors -- such as leaving school and no longer having adult supervision -- also contribute to the decline in care, according to Harvard Medical School researchers.

"This study suggests that expanding insurance coverage will help many young adults with asthma receive the care they need," study leader Kao-Ping Chua, a staff physician in the division of emergency medicine at Boston Children's Hospital, said in a Harvard news release. "But it also points to the importance of addressing other socially mediated factors in this population."

"Aside from the lack of financial protection, uninsurance poses fewer health risks to young adults than for older adults because they are generally healthy," study senior author J. Michael McWilliams, an assistant professor of health care policy and medicine at Harvard Medical School, said in the news release.

"But for young people with asthma -- or other conditions amenable to medical care -- it's important to understand and address the barriers to care," he added.

The researchers looked at data from nearly 2,500 asthma patients, aged 14 to 25, in order to determine if they had a regular care provider, if they visited that provider at least once a year, if they used asthma medications and if they made emergency-room visits.

Patients under age 18 were more likely to use primary care and asthma medications, while those over 18 were more likely to make emergency-room visits and have problems getting care and medications due to cost.

The loss of health insurance explained 32 percent of the decline in the use of primary care by patients over age 18 and between 47 percent and 61 percent of the increase in their cost-related problems getting care and medications, according to the study, which was published recently in the journal Pediatrics.

Under the federal Affordable Care Act, young adults whose parents have private insurance will be eligible to continue receiving coverage on their parents' policies until they are 26. But, the researchers said, since the U.S. Supreme Court ruled that states do not have to extend similar coverage to people on Medicaid, low-income young adults will be left out.

Health insurance, however, is not the only problem, they added.

"Young people with asthma need to work with their care providers to create transition plans from pediatric to adult care that take into account their medical and social history," Chua said.

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Genes and Early Wheezing Tied to Childhood Asthma Risk

Common cold symptom increased odds for asthma in study

By Robert Preidt

HealthDay Reporter

WEDNESDAY, March 27 (HealthDay News) -- Certain genetic factors and wheezing early in life are associated with a greatly increased risk of asthma in children, a new study says.

Researchers examined data from nearly 500 children and found that about 90 percent of those who had two copies of a common genetic variation and who also experienced wheezing when they had a cold early in life developed asthma by age 6.

These children, all from families with a history of asthma or allergies, were nearly four times more likely to develop asthma than those who did not have the genetic variation and did not wheeze, according the study in the March 28 issue of the New England Journal of Medicine.

The genetic variation is found on chromosome 17 and is common. Half of the children in the study had one copy and 25 percent had two copies. The researchers also noted that colds are extremely common and affect nearly all infants.

The increased risk is associated with wheezing during colds caused by a human rhinovirus infection, the University of Chicago Medical Center researchers said.

"We found that the interaction between this specific wheezing illness and a gene or genes on a region of chromosome 17 determines childhood asthma risk," study author Carole Ober, a professor of human genetics at the University of Chicago, said in a medical center news release. "The combination of genetic predisposition and the child's response to this infection has a huge effect."

The researchers said it is not clear how this gene variation and wheezing interact to increase the risk of developing asthma. It also should be noted that the research showed only an association between them, and not a cause-and-effect relationship.

About 25 percent of children who had no wheezing from a human rhinovirus infection developed asthma, and 40 percent of those who experienced wheezing in the first three years of life but lacked the risk-related gene variants developed asthma.

That rose to nearly 60 percent among those with one copy of the gene variant and to 90 percent for those with two copies.

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Oral Allergy Treatment May Ease Asthma, Hay Fever, Study Finds

This under-the-tongue alternative to shots is used in Europe, but not approved in U.S.

By Amy Norton

HealthDay Reporter

TUESDAY, March 26 (HealthDay News) -- Spring is here, and so are seasonal allergies. For the millions who suffer from hay fever or asthma in the United States, a new under-the-tongue treatment may hold promise.

Pills and drops designed to desensitize the immune system to allergens could bring some of these allergy patients relief, a new research review finds.

The review, published March 27 in the Journal of the American Medical Association, pulled together 63 studies on so-called sublingual immunotherapy.

The therapy, commonly used in Europe and Asia, essentially allows people to get traditional allergy shots in the form of pills or drops that dissolve under the tongue. The principle is the same: Expose the immune system to extracts of the substance causing a person's allergy -- grass pollen, for example -- until it builds up a tolerance.

Right now, no under-the-tongue allergy products are approved in the United States. But some doctors offer the therapy anyway; they take the extracts approved for allergy shots and give them to patients to use orally.

In the new review, researchers found "strong" evidence that under-the-tongue immunotherapy eased symptoms of allergy-induced asthma: In eight of 13 studies, patients saw more than a 40 percent improvement in symptoms, versus patients who either got a drug-free placebo or standard medication.

The evidence was weaker when it came to nasal allergies. Only nine of 36 studies showed a more than 40 percent drop in symptoms such as congestion, runny nose and itchy eyes.

Still, the majority of studies did show some benefit, said lead researcher Dr. Sandra Lin, an associate professor of otolaryngology at Johns Hopkins University School of Medicine in Baltimore.

Under-the-tongue products are being evaluated for approval by the U.S. Food and Drug Administration (FDA), and those results will be helpful, said Lin.

She said the results from European trials cannot be simply translated to the United States because of differences in the potency of the allergen extracts used.

"We need studies to see what are the most effective doses for U.S. patients," Lin said.

The idea of taking pills instead of getting shots definitely appeals to patients, said Dr. Harold Nelson, an allergy specialist at National Jewish Health in Denver, who wrote an editorial published with the study.

But his advice to U.S. patients was to wait for products to be approved by the FDA.

Even if your doctor offers under-the-tongue immunotherapy, "there's no guarantee" it would be the same as the products studied in clinical trials, Nelson said. He noted that U.S. doctors commonly give a patient a mix of different allergen extracts, because that's how it is done with allergy shots.

But the under-the-tongue products used in clinical trials have contained only a single allergen extract, Nelson said.

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Combo Inhaler May Give Better Relief for Some With Asthma

By Steven Reinberg

HealthDay Reporter

MONDAY, March 4 (HealthDay News) -- Asthma patients typically use two inhaled drugs -- one a fast-acting "rescue inhaler" to stem attacks and another long-lasting one to prevent them.

However, combining both in one inhaler may be best for some patients, two new studies suggest.

Patients with moderate to severe asthma who used a combination inhaler had fewer attacks than those on two separate inhalers, researchers report. Both studies tested the so-called SMART (single maintenance and reliever therapy) protocol.

"The SMART regime was more effective as a treatment for asthma than the conventional treatment, where you just use a inhaler at a fixed maintenance dose and a short-acting inhaler for the relief of symptoms," said Dr. Richard Beasley, director of the Medical Research Institute of New Zealand in Wellington and lead researcher of one of the studies.

These drugs are a combination of a corticosteroid (such as budesonide or fluticasone) and a long-acting beta-2 agonist (such as salmeterol or formoterol) and are sold under various brand names including Seretide, Symbicort and Advair.

In asthma, treatment increases as the severity of the condition does, Beasley said. So, this combination therapy isn't the first choice. When the asthma is difficult to control with other methods, "we are now recommending the SMART regime," he said.

"You treat the patients according to their needs," Beasley said. "This is certainly not what you start them on -- it is something you would use on moderate to severe patients."

In the United States, use of these combination inhalers is also not considered first-line therapy for asthma, according to Dr. Len Horovitz, a pulmonary specialist at Lenox Hill Hospital in New York City.

"Patients, however, are currently using these combination inhalers," he said. If the asthma is moderate to severe, then a combination inhaler is appropriate, said Horovitz, who was not involved with either new study.

The reports were published in the March issue of the journal Lancet Respiratory Medicine.

One study was funded by Italian pharmaceutical company Chiesi Farmaceutici, whose products include asthma medications. The multi-center European study was led by Dr. Klaus Rabe, a professor of pulmonary medicine at the University of Kiel, in Germany.

The study included more than 1,700 patients with moderate asthma. Researchers found that participants using the single, combination inhaler had significantly fewer severe asthma attacks and were seen at a hospital or urgent medical facility less than those patients using the two inhalers.

Rabe and colleagues wrote that although drugs like Symbicort (the specific budesonide/formoterol combination used in the study) can be more expensive than separate inhalers, the ability to prevent asthma attacks and reduce hospital and emergency room visits may be cost-saving in the end.

In the second trial, funded by the Health Research Council of New Zealand, Beasley's team randomly assigned 303 patients to the single-inhaler protocol or to usual care with two inhalers. Over six months, the researchers found that those using Symbicort had fewer severe asthma attacks.

One concern had been that patients using the combination inhaler would get overexposed to corticosteroid or would overuse the inhaler, Beasley said.

They found, however, that patients using the combination inhaler reduced their overuse of corticosteroid by 40 percent, compared to those using separate inhalers.

While those in the SMART program took in more corticosteroids a day, they had fewer asthma attacks so their overall exposure to corticosteroid was the same as for people in the two-inhaler group, the New Zealand researchers explained.

More information

For more about asthma, visit the U.S. National Library of Medicine.

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C-Section May Raise Child's Risk of Allergies, Asthma: Study

Title: C-Section May Raise Child's Risk of Allergies, Asthma: Study
Category: Health News
Created: 2/25/2013 6:36:00 PM
Last Editorial Review: 2/26/2013 12:00:00 AM

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