Asthma continues to be one of the most prevalent chronic lung diseases and growing health concerns in the state of Texas. Asthma, a potentially deadly illness, affects the lungs and causes the airways to become inflamed and swollen, and surrounding muscles to tighten. Symptoms include episodes of coughing, chest tightness, wheezing and shortness of breath.
According to the Texas Behavioral Risk Factor Surveillance System in 2005, an estimated 1.5 million (6.8 percent) adult Texans and 458 thousand (7.3 percent) children 0-17 years of age currently report having asthma. Also, an estimated 2.5 million (11.1 percent) adult Texans and 728 thousand (11.6 percent) children report having had asthma during their lifetime.
In addition, asthma has had a significant economic impact on the state of Texas. According to the Texas Health Care Information Collection in 2004, hospital discharges listing asthma as the principle diagnosis and other diagnoses account for about $353 million in total charges.
The Texas Asthma Plan serves as a planning tool to initiate asthma activities in the state of Texas. The 2007-2010 Edition contains issue items with updated goals and action steps specific to regional areas throughout Texas.
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Asthma medications should be available for over-the-counter use: con.
Ann Am Thorac Soc. 2014 Jul;11(6):975-9
Authors: Milgram LJ
The United States Food and Drug Administration recently considered a policy to transfer inhaled short-acting bronchodilators to over-the-counter status if conditions of safe use can be established. The American Thoracic Society filed a comment in opposition to the proposal. This article examines the negative consequences that might result from allowing nonprescription access to bronchodilators and other inhaled asthma medications. Such a proposed policy change conflicts directly with current guidelines for asthma management and would undermine efforts to achieve adequate asthma control in patients. In addition, a policy change to convert asthma medications to over-the-counter status could result in increased costs to patients as well as increased health care costs to society overall due to a worsening of asthma control in the population.
PMID: 24964175 [PubMed - indexed for MEDLINE]
Asthma medications should be available for over-the-counter use: pro.
Ann Am Thorac Soc. 2014 Jul;11(6):969-74
Authors: Gerald JK, Wechsler ME, Martinez FD
Medications that provide quick relief of symptoms and that control airway inflammation are the mainstays of asthma treatment. However, adherence to these medications is suboptimal. The inconvenience and costs associated with obtaining these prescription-only medications are factors that contribute to poor adherence. The Food and Drug Administration recently requested public comment on a new paradigm whereby specific prescription-only medications could be made available over the counter, provided that conditions for their safe use could be established. Many organizations expressed opposition, including the American Thoracic Society and other societies representing patients with respiratory diseases. These organizations cited unsubstantiated benefits and unnecessary risks as reasons to oppose greater over-the-counter availability of current prescription-only medications. This article examines the rationale for, and potential ramifications of, making asthma medications available for nonprescription use.
PMID: 24964037 [PubMed - indexed for MEDLINE]
Role of anticholinergics in asthma management: recent evidence and future needs.
Curr Opin Pulm Med. 2015 Jan;21(1):103-8
Authors: Rogers L, Hanania NA
PURPOSE OF REVIEW: Anticholinergic antimuscarinic bronchodilators play a major role in the treatment of chronic obstructive pulmonary disease, but their role in asthma has long been limited to acute management. More recently, the role of long-acting antimuscarinic bronchodilators (LAMAs) in chronic asthma management has been explored. This review will examine the pharmacological rationale for use of inhaled anticholinergics in the treatment of asthma, and provide an overview of the current literature supporting this use, as well as describe future research needs in this area.
RECENT FINDINGS: Short-acting anticholinergic bronchodilators have a role as add-on agents in the treatment of acute asthma. Preliminary clinical studies suggest that inhaled LAMAs may be comparable to long-acting beta2-agonists (LABAs) as an add-on therapy in patients not controlled by inhaled corticosteroids (ICS) alone, and may also have added benefit in patients not controlled on combined ICS-LABA. Mechanistic studies suggest that apart from their bronchodilator activity, LAMAs may have anti-inflammatory and antiremodeling influences on the airways. Further research is needed to clarify the clinical relevance of these experimental observations.
SUMMARY: Accumulating evidence supports the use of inhaled LAMAs as an add-on therapy in patients with asthma, who remain symptomatic despite guideline-based therapy with ICS with or without LABAs. Further studies are warranted to help define mechanisms of action of LAMAs, apart from their role as bronchodilators, and determine how these other actions impact asthma outcomes over time. Furthermore, future studies need to examine the long-term efficacy and safety of LAMAs in asthma and identify a subgroup of patients who would benefit from such therapies to facilitate early, personalized therapy.
PMID: 25415409 [PubMed - indexed for MEDLINE]
The respiratory microbiome and innate immunity in asthma.
Curr Opin Pulm Med. 2015 Jan;21(1):27-32
Authors: Huang YJ
PURPOSE OF REVIEW: The purpose of this study is to summarize recent studies of the lower respiratory microbiome in asthma, the role of innate immunity in asthma and strategies to understand complex microbiome-immune interactions in asthma.
RECENT FINDINGS: Recent evidence indicates that the composition of lower respiratory microbiota in asthmatic individuals, across a spectrum of disease severity, is altered compared with healthy individuals. Attributes of this altered airway microbiome have been linked to clinical and inflammatory features of asthma. The importance of innate immune cells and mucosal defense systems in asthma is increasingly appreciated and may be dysregulated in the disease.
SUMMARY: Interactions between the respiratory microbiome and innate mucosal immunity in asthma are complex and a challenge to dissect. Multiple avenues of investigation, leveraging a variety of methodologies, will need to be pursued to understand functional relationships to clinical and inflammatory phenotypes seen in asthma.
PMID: 25405668 [PubMed - indexed for MEDLINE]
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