National survey reveals gap in ‘uncontrolled asthma’ knowledge
WASHINGTON A new nationwide telephone survey of 1,001 patients released Wednesday found that while 66% of asthma patients considered asthma a serious condition, the majority of the 21% who reported discontinuing taking an asthma controller medicine did so because they incorrectly believed their asthma was controlled.
“This survey shows there’s an alarming divide between what people know about their asthma and the actions they take to achieve optimal control of their asthma symptoms,” stated Mike Tringale, director of external affairs for the Asthma and Allergy Foundation of America, which conducted the survey with support from AstraZeneca. “Part of the problem may be that many patients believe their asthma is under control once they’re no longer experiencing symptoms. Asthma patients can take action to better manage their asthma symptoms through appropriate treatment, tools and resources.”
People with asthma suffer from chronic lung inflammation (swelling), which, if left untreated, can lead to progressive loss of lung function and other severe consequences. Nearly 42% of patients surveyed incorrectly believe that when asthma symptoms subside, their controller medicine can be taken less regularly. For those with persistent asthma, a controller, or maintenance medication, helps manage chronic lung inflammation. When taken over the long-term, asthma controller medications are shown to not only help control asthma symptoms, but also help to improve lung function. Of the patients taking a controller medication, nearly all (93%) of patients indicate that controller medications work best when taken every day.
The survey also found that 87% of physicians think their patients stop their asthma controller medications without their advice.
“There is a clear need for more physician-to-patient education about asthma control and appropriate therapies,” stated Reynold Panettieri from the University of Pennsylvania and an author of the study. “The first step to asthma control is for patients and physicians to create an asthma action plan, which may include a controller therapy.”
Asthma, considered one of the most serious chronic diseases in the United States, affects more than 22 million Americans. In 2004, sudden uncontrolled asthma episodes accounted for an estimated 1.8 million emergency room visits and nearly 500,000 hospitalizations. Current asthma management guidelines from the National Heart, Lung and Blood Institute note that properly controlled asthma is marked by patients being able to carry out all normal day-to-day activities, a decrease in weekly symptoms (no more than two times per week) and a decrease in yearly asthma attacks (no more than one attack per year which required oral corticosteroid therapy).
Study reveals that fetuses lacking nutrition genetically adapt to poor health when born
BETHESDA, Md. You are what your mother did not eat during pregnancy.
A recently published report in the FASEB Journal, the medical journal for the Federation of American Societies for Experimental Biology, reported that scientists from the University of Utah have found that rat fetuses receiving poor nutrition in the womb become genetically primed to be born into an environment lacking proper nutrition.
As a result of this genetic adaptation, the rats were likely to grow to smaller sizes than their normal counterparts. At the same time, they were also at higher risk for a host of such health problems throughout their lives as diabetes, growth retardation, cardiovascular disease, obesity, and neurodevelopmental delays.
“Our study emphasizes that maternal–fetal health influences multiple healthcare issues across generations,” stated Robert Lane, professor of pediatric neonatology at the University of Utah, and one of the senior researchers involved in the study. “To reduce adult diseases such as diabetes, obesity and cardiovascular disease, we need to understand how the maternal–fetal environment influences the health of offspring.”
Although the study involved rats, the genes and cellular mechanisms involved are the same as those in humans.
“The new ‘epigenetics’ has taught us how nature is changed by nurture,” stated Gerald Weissmann, editor-in-chief of The FASEB Journal. “The jury’s in and, yes, expectant moms really are eating for two. This study shows not only that we need to address problems such as preeclampsia during pregnancy, but also that prenatal care is far more important than anyone could have imagined a decade ago.”
Low blood sugar events increase dementia risk in elderly patients with Type 2 diabetes, study finds
OAKLAND, Calif. Hypoglycemic episodes that require a visit to the hospital are associated with increased risk of dementia in elderly patients with Type 2 diabetes mellitus, according to a Kaiser Permanente Division of Research study in the Journal of the American Medical Association.
Though not a randomized clinical trial, this study provides additional information for the debate about how tightly blood sugar should be controlled in patients with Type 2 diabetes, particularly in elderly patients, the researchers reported. The study appears in the current diabetes mellitus themed issue of JAMA.
While several studies have shown low blood sugar to affect cognitive function in children with Type 1 diabetes, this is the first study to evaluate the association in older patients with diabetes.
“We know that the brain becomes more vulnerable with age, and we need a better understanding of how glycemic control can affect brain health over the long term,” said the study’s principal investigator, Rachel A. Whitmer, Ph.D., a research scientist with the Kaiser Permanente Division of Research. “This study adds to the evidence base that perhaps we should rethink the notion of very tight glycemic control for our elderly patients with diabetes mellitus.”
The study looked at 16,667 elderly patients with Type 2 diabetes from the Kaiser Permanente Northern California Diabetes Registry. The average age for the study population was 66 years; 55% were male and 60% were white. The researchers identified 1,465 patients in the cohort that were hospitalized or had emergency room admittance at least once for hypoglycemia from 1980 to the end of 2002.
Compared with those with no hypoglycemic episodes, patients with one hypoglycemic episode had a 45% increased risk of being diagnosed with dementia after 2003, the study revealed. Those with two episodes had a 115% increased risk, and those with three or more episodes had a 160% increased risk of dementia. Adjustments were made for age, body mass index, race, education, gender, and duration of diabetes. The effect remained after further adjustments for hypertension, stroke, cardiovascular disease, end-stage renal disease, glycosylated hemoglobin levels, and treatment for diabetes.
Compared with those with no hypoglycemic episodes, those with one or more episode had a 32% greater risk of dementia (adjusted for age, body mass index, education, gender, duration of diabetes, co-morbidities, glycosylated hemoglobin and treatment for diabetes).
“Our findings suggest that pursuit of ‘tight’ glycemic control (i.e. to hemoglobin A1c levels less than 7%) may be inadvisable in older patients with Type 2 diabetes if required treatment is causing hypoglycemia,” said Joe Selby, MD, MPH, a co-author on this study and the director of the Kaiser Permanente Division of Research.
In view of these three trials, recent recommendations from the American Heart Association and the American College of Cardiology have urged that treatment be individualized and that caution be exercised to prevent severe hypoglycemia. The guidelines further emphasize the critical importance of blood pressure control, lipid or cholesterol control, smoking cessation, and use of aspirin, Selby said.