Asthma subgroups

Data from a large, placebo-controlled US study that compared the safety of salmeterol or placebo added to usual asthma therapy showed a small but significant increase in asthma-related deaths in patients receiving salmeterol (13 deaths out of 13,174 patients treated for 28 weeks) vs those on placebo (4 of 13,179). Subgroup analyses suggest the risk may be greater in blacks compared with whites. 

While almost all patients that pharmacists interact with have some type of medication-related need (e.g., a drug product, advice about an adverse drug effect, etc.), not all patients may need the same level of service that pharmacists can provide to patients (Hepler and Strand, 1989). It is important for pharmacists to identify subgroups of patients who may benefit more direcdy from their services. For an asthma service, pa-... 

The isoquinoline alkaloids are the second largest group of alkaloids, numbering about 6000, and can be viewed as five subgroups—the simple tetrahydroisoquinolines, the benzylisoquinolines, the phenethylisoquinolines, the Amaryllidaceae alkaloids, and the monoterpene isoquinolines. In addition, there are a number of simple phenethylamine derivatives, including ephedrine (originally from Ephedra species, but now synthesized) and pseudoephedrine, used for asthma and nasal... 

Most people tolerate aspirin well, but not patients with asthma, of whom there is a subgroup in whom aspirin precipitates asthmatic attacks (61,62). This is a distinct clinical syndrome, called aspirin-induced asthma, which affects about 10% of adults with asthma (63). Aspirin-induced asthma is usually accompanied by naso-ocular symptoms and can be triggered not only by aspirin, but by several NSAIDs, a fact that makes immunological cross-reactivity most unlikely. The propensity of an NSAID to precipitate an attack of asthma is probably related to inhibition of COX (63). There is evidence that potent inhibitors of COX-1 (such as ibuprofen, indometacin, and naproxen) are more likely to precipitate bronchoconstriction than NSAIDs that inhibit COX-2 preferentially (such as meloxicam and nime-sulide) (64,65). A widely accepted hjrpothesis is that in patients with asthma and aspirin intolerance, NSAJD-induced COX inhibition results in increased products from the 5-lipoxygenase pathway, the leukotrienes, which are both potent bronchoconstrictors and also inducers of... 

Although predictive factors for allergic rhinitis, conjunctivitis and the IgE-associated subgroup of eczema, i.e. atopic eczema, are presented, the primary focus of this chapter is on asthma in at least 80% of children and 50% of adults, asthma is associated with an IgE sensitisation. 

Dermatitis. The umbrella term for a local inflammation of the skin should be dermatitis. What is generally known as atopic eczema/dermatitis is not one, single disease but rather an aggregation of several diseases with certain characteristics in common. A more appropriate term is eczema. The subgroup related to allergic asthma and rhinoconjunctivitis, i.e. eczema in a person of atopic constitution, should be called atopic eczema. 

From the first study in patients with local IgE against SEs [10] it appeared that the highest IgE concentrations were obtained from samples of aspirin-sensitive subjects. We therefore extended our observations in a nonallergic, but severely inflamed subgroup of patients, who also suffered from asthma. Subjects with nasal polyposis from Poland were classified as aspirin-sensitive (ASNP) or aspirin-tolerant (ATNP) asthmatics, based on a bronchial aspirin challenge test [47], Homogenates prepared from NP tissue were analyzed for concentrations of eosinophilic markers, total IgE and IgE antibodies to enterotoxins (SEA, SEC, TSST-1) [22], and compared to inferior nasal turbinates from healthy subjects. 

Subgroups of Antiasthmatic Drugs Drugs useful in asthma include bronchodilators (smooth muscle relaxants) and anti-inflammatory drugs (Figure 20-2). Leukotriene antagonists may have both bronchodilator and anti-inflammatory properties. 

On the other hand, there is a subgroup of asthmatics who clearly are made worse by acetylsalicylic acid. There have been investigations of the use of immunosuppressive agents in asthma, but the risks of these drugs likely preclude any widespread trial to ascertain possible benefits. 

Sehroos O, Lofroos AB, Pietinalho A, Riska H. Comparison of terbutaline and placebo from a pressurised metered dose inhaler and a dry powder inhaler in a subgroup of patients with asthma. Thorax 1994 49 1228-1230. 

Although the association between asthma and a distended stomach was first remarked on more than 100 years ago by Sir William Osier, it is only recently that the relationship between GERD and asthma has become well-defined. Asthmatics have an increased frequency of GERD, with a prevalence that varies between 34% and 89%. Because as many as 20% of adults may experience intermittent bronchospasm, the potential benefits of identifying a subgroup of patients whose disease is initiated by GERD is of considerable clinical relevance. 

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