asthma

Posted on Cardiovascular disease, Insomnia, Mental health

Frequent visits to green spaces linked to lower use of certain prescription meds

Lower use of drugs for depression, anxiety, insomnia, high blood pressure, and asthma in city dwellers. Findings independent of income and educational attainment


Frequent visits to urban green spaces, such as parks and community gardens in Finland, rather than the amount, or views of them from home, may be linked to lower use of certain prescription meds, suggests research published online in Occupational & Environmental Medicine.

The observed associations between frequent green space visits and lower use of drugs for depression, anxiety, insomnia, high blood pressure, and asthma were not dependent on socio-economic position.

Exposure to natural environments is thought to be good for health, but the evidence is inconsistent, say the researchers.

They wanted to determine if the amount of residential green and blue space (bodies of water), frequency of green space visits, and views of green and blue spaces from home might be separately associated with certain prescription meds.

They chose prescription meds as a proxy for ill health and those for anxiety and insomnia, depression, high blood pressure, and asthma, mainly because they are used to treat common and potentially severe health issues.

They drew on the responses of 16,000 randomly selected residents of Helsinki, Espoo, and Vantaa, to the Helsinki Capital Region Environmental Health Survey in 2015-16. These three cities make up the largest urban area in Finland. 

The survey gathered information on how city dwellers, aged at least 25, experience residential green and blue spaces within a 1 km radius of their homes.

Respondents were also asked to report their use of prescribed meds—drugs for anxiety, insomnia, and depression, collectively known as psychotropic drugs; high blood pressure and asthma drugs—if applicable, for periods ranging from within the past week up to more than a year ago or never.

They were also asked how often they spent time, or exercised outdoors, in green spaces, during May and September, with options ranging from never to 5 or more times a week. 

And they were asked whether they could see green or blue spaces from any of their windows at home, and, if so, how often they took in these views, with options ranging from seldom to often.

Green areas were forests, gardens, parks, castle parks, cemeteries, zoos, herbaceous vegetation associations such as natural grassland and moors, and wetlands. Blue areas were defined as seas, lakes, and rivers.

Potentially influential factors were also considered, including health behaviours, outdoor air pollution and noise, household income and educational attainment.

The final analysis included approximately 6000 participants who provided complete information.

This showed that the amount of residential green and blue spaces, or views of them from home, weren’t associated with prescription meds for mental health, insomnia, high blood pressure or asthma.

But the frequency of green space visits was. Compared with less than one weekly visit, visiting 3-4 times weekly was associated with 33% lower odds of using mental health meds, 36% lower odds of using blood pressure meds, and 26% lower odds of using asthma meds. 

The equivalent figures for visiting at least five times a week were 22%, 41%, and 24% lower.

These observed associations were weakened when weight (BMI) was factored in, particularly for asthma meds, as obesity is a known risk factor for asthma, point out the researchers. 

The effects of visiting green spaces were also stronger among those reporting the lowest annual household income ( below €30, 000). But overall, the associations found didn’t depend on household income and educational attainment.

This is an observational study, so we can’t establish cause and effect. No information was available on illness severity, and better health may enable a person to spend more time outdoors.

Finland has high forest cover, while Finnish cities are relatively green, making it easy for those willing to use green spaces to access them with minimal effort, they add. 

But they conclude: “Mounting scientific evidence supporting the health benefits of nature exposure is likely to increase the supply of high-quality green spaces in urban environments and promote their active use. This might be one way to improve health and welfare in cities.”

Leave a comment Posted on A to Z of Medical Conditions

Leicester researchers identify common biological features of different types of asthma




Asthma

Asthma

A team of researchers from the NIHR Leicester Biomedical Research Centre – a partnership between Leicester’s Hospitals, the University of Leicester and Loughborough University – has identified biological variations in lung tissue samples that for the first time can help identify people with mild asthma from those with moderate or severe asthma.




The team led by Professors Salman Siddiqui and Peter Bradding used state-of-the-art statistical methods involving visualisation approaches, to perform the largest comprehensive analysis of common pathological features in the airways of people with asthma of different severities. They also investigated the clinical features of these subtypes and whether there is any association with changes in genes and decline in lung function.

Professor Siddiqui and his team identified multiple biological ‘micro-clusters’ which means that there are different combinations of active genes in each of the reported subtypes of asthma.

Professor Bradding, who is a Professor of Respiratory Medicine at the University of Leicester and Consultant Respiratory Physician at Leicester’s Hospitals, said: “The most exciting thing about finding these biological variations underpinning the differences between mild asthma and moderate and severe asthma is that the statistical methods if further developed could lead to the development of new, targeted treatments for subtypes of asthma, thus allowing the right asthma treatments to be matched to different patients. In this scenario, patients would benefit because they would be offered more personalised, and therefore more effective, care to manage their asthma.”

Professor Siddiqui, Professor of Airway Diseases at the University of Leicester and Consultant Respiratory Physician at Leicester’s Hospitals, added: “Further research is now underway to understand how to use these statistical approaches to combine complex information in asthma patients and make personalised treatment decisions.”

Dr Samantha Walker, Director of Research and Policy at Asthma UK, which funded the study, said: “For a long time, asthma has been considered as one condition, but this research illustrates the growing understanding that the term ‘asthma’ is in fact an umbrella term for different lung conditions. There needs to be a much better understanding of how to identify different types of asthma so that treatment can be tailored to prevent asthma attacks and keep people out of hospital. We are calling for more research into asthma, particularly into improving and developing diagnostic tools so that people can be diagnosed and treated quickly and effectively.”




This research was supported by Ayasdi machine intelligence, a software platform that supports topological data analysis of high dimensional data.

The research appears in an article, “Airway Pathological Heterogeneity in Asthma: Visualisation of Disease Micro-Clusters using Topological Data Analysis”, was published in the Journal of Allergy and Clinical Immunology. For the full article: http://www.jacionline.org/article/S0091-6749(18)30039-3/fulltext

Leave a comment Posted on Patient Talk, Vitamins

Vitamin D may prevent asthma worsening for some




Vitamin D

Vitamin D

“Vitamin D supplements protect against severe asthma attacks,” The Daily Telegraph reports.

The headline was prompted by a review that pooled data from seven trials comparing taking vitamin D supplements with a placebo in people with asthma.




The researchers wanted to see whether vitamin D reduced the risk of severe asthma episodes that needed hospitalisation or treatment with oral steroids, referred to as “asthma exacerbations”.

Overall, the researchers found vitamin D supplements reduced the risk of asthma exacerbations by 26%. Further analysis found the protective effect was only seen in people who were vitamin D deficient to start with.

But the main limitation of this evidence is the small number of exacerbations that occurred. For example, in two trials there were no asthma exacerbations, in another only a single event.

And only 92 people from the data were vitamin D deficient at the start. This means the risk estimates are based on small numbers, which may make them less accurate.

It’s currently recommended that certain groups, including those at risk of vitamin D deficiency and children aged one to four, take vitamin D supplements all year round.

All adults and children are advised to consider taking 10 micrograms (mcg) a day of vitamin D during the autumn and winter months, when there is less sunlight.

Find out what to do during an asthma attack.

 

Where did the story come from?

The study was carried out by researchers from Barts and The London School of Medicine and Dentistry, Queen Mary University of London, and other institutions in the UK, US, Ireland, Poland and Japan.

Funding was provided by the Health Technology Assessment Programme, which is run by the UK’s National Institute for Health Research (NIHR).

The study was published in the peer-reviewed journal The Lancet: Respiratory Medicine.




The UK media’s reporting is generally accurate, but official guidelines haven’t changed on the basis of the results of this study.

 

What kind of research was this?

This systematic review and meta-analysis pooled data from people with asthma taking part in randomised controlled trials that compared vitamin D supplementation with an inactive placebo.

Previous meta-analysis of trial data has suggested that vitamin D may reduce the risk of asthma attacks and exacerbations of asthma.

But it’s not known whether this effect is influenced by the person’s vitamin D level to start with, so the researchers set out to investigate this.

A systematic review of randomised controlled trials (RCTs) is the best way of gathering the available evidence on the effects of an intervention.

But when it comes to trials on nutritional supplements, RCTs can vary considerably in how the treatment is given. And when the outcome of interest is relatively rare – in this case, asthma exacerbations – it can be difficult to be sure how much of the effect is down to the intervention.

 

What did the research involve?

The reviewers identified placebo-controlled trials of vitamin D supplementation (D2 or D3) in people with asthma that reported incidence of asthma exacerbations as an outcome.

The trials included had to be double-blinded in design, where neither the participants nor the assessors knew if a person was taking vitamin D or a placebo.

The reviewers collected individual patient data from the trials, contacting study investigators for clarity or to gather missing data.

They also collected information on participants’ age, gender, ethnicity, BMI, blood vitamin D concentration at the start of the study, and any other factors that might influence the results (confounders).

The main outcome of interest was incidence of asthma exacerbations needing treatment with oral steroids. They also looked at emergency hospital attendance or admissions and any adverse effects associated with supplementation.

Eight trials were eligible for inclusion, but patient data couldn’t be obtained for one, leaving a total of seven studies and 978 participants available for analysis. Trials came from six different countries (one from the UK), and about a third of the participants were children.

Vitamin D dosing varied from a single dose (an injection or infusion) every two months (100,000 international units, IU) to daily dosing (500 to 2,000 IU per day) or a mixture of the two. Treatment duration ranged from 15 weeks to one year.

Baseline blood vitamin D levels ranged from undetectable to 187nmol/L. Vitamin D deficiency is generally accepted to be less than 25nmol/L, so this threshold was used in the study.

 

What were the basic results?

Asthma exacerbations needing oral steroid treatment were rare. In two trials there were no exacerbations, and in another there was only one.

When pooling the participants, in all seven studies vitamin D supplementation was associated with a 26% reduced risk of asthma exacerbation needing steroid treatment (relative risk (RR) 0.74, 95% confidence interval (CI) 0.56 to 0.97).

A similar risk reduction was found when researchers just looked at the four individual studies with several exacerbations.

There was no difference between groups in the proportion of people having at least one exacerbation, but vitamin D helped reduce the risk of multiple exacerbations.

Vitamin D supplements reduced the rate of exacerbations in people with vitamin D levels less than 25nmol/l (0.33, 95% CI 0.11 to 0.98), but this was based on data from only 92 participants.

Among the 764 participants who weren’t vitamin D deficient, there was no significant effect, regardless of their age, gender and ethnicity.

Vitamin D didn’t increase the risk of serious adverse events, and there were no cases of high blood calcium or kidney stones reported.

 

How did the researchers interpret the results?

The researchers concluded: “Vitamin D supplementation reduced the rate of asthma exacerbations requiring treatment with systemic corticosteroids overall.

“We did not find definitive evidence that effects of this intervention differed across subgroups of patients.”

 

Conclusion

This review gathers the available trial evidence to address the specific question of whether giving people with asthma vitamin D supplements could have an effect on how many asthma exacerbations they have.

The review has many strengths. It only included double-blind trials, where participants and assessors didn’t know if people were taking vitamin D or a placebo.

Researchers also made careful attempts to gather all relevant data and information on confounding factors, and all but one trial had a low risk of bias.

But there are some limitations to bear in mind:

With the relatively small number of trials and participants, the outcome of interest – exacerbations needing steroid treatment – was quite rare. Three trials recorded no exacerbations, and a third only one. Analyses based on a small number of events can give less precise risk estimates.

The main aim was to see whether a person’s vitamin D levels to begin with had an effect. The researchers found there was: the benefit was only seen in people who were vitamin D deficient to start with. But only 92 people fell into this category, so again the small number of events in this sample may give a less reliable result.

The dosing and duration of treatment varied from study to study. Along with the small sample and low number of events, this makes it difficult to know what could be an optimal dose for children or adults to take.

This study, and the research it’s based on, isn’t able to tell us whether there should be a change in guidelines for people with asthma. It’s too soon to recommend they take vitamin D supplements, regardless of whether or not they’re deficient.

Current guidelines recommend everyone should consider taking a vitamin D supplement of 10mcg a day in the autumn and winter months, when there is less sunlight. People can get all the vitamin D they need from sunlight and some dietary sources in the spring and summer.

Babies who are breastfed, all children aged one to four years, pregnant and breastfeeding women, and people at risk (such as those who are indoors a lot) are advised to take a supplement all year round.

Vitamin D supplements are available from most pharmacists and are usually safe to take as long as you don’t regularly take more than 100mcg (4,000 IU) a day.

Children under 10 years should not take more than 50mcg a day, and babies under one year should not take more than 25mcg a day.

Leave a comment Posted on COPD

Majority of the nation’s asthma are incorrectly disposing of their inhalers




Inhaler

Inhaler

Most of the nation’s asthma sufferers are incorrectly disposing of their inhalers and unintentionally contributing to carbon emissions increase, a new research reveals.

While most local authorities can recycle certain plastics, some inhalers contain plastics and glasses that are not easily recyclable.




A recent research from pharmaceutical company GSK uncovered that over half of the Brits suffering from asthma surveyed were simply disposing of their inhalers in the general waste. A third were using their kerbside recycling service, wrongly thinking they will be recycled.

Progress has been made in the recycling of respiratory inhalers, with over one million being recycled over the last five years as part of a national scheme. However, as the research shows, there is still far to go when it comes to correctly disposing of them.

To ensure respiratory inhalers are recovered and recycled correctly, the pharmaceutical company launched a scheme which allows people to bring their used inhalers into a pharmacy for recovery.

By taking an inhaler to a local participating pharmacy, the plastic and aluminum parts can be used in other products, and any potentially harmful greenhouse gasses can be collected and reused elsewhere, for example in car air conditioners.

Matt Wilson, GSK’s Head of Global Environmental Sustainability, explains: “The great thing about the scheme is that anyone can walk into a participating pharmacy, hand in their inhaler and know that it will go off to be recovered, reused and recycled in a responsible way.”

A further added benefit of the scheme is that it encourages patients to visit their pharmacy, giving them the opportunity to seek advice directly from a pharmacist to better understand their condition, improve their inhaler technique and get the best benefits from their medicine.
Around 73 million inhalers are being used every year in the UK.