Three factors may hurt asthma management. (GERD, VCDS, Poor Adherence).
Asthma management also can be hampered by conditions that mask or mimic asthma and by patient noncompliance, said Dr. Sue, professor of medicine at the University of California, Los Angeles.
He gave three examples:
* Gastroesophageal reflux disease (GERD). In a study that randomly assigned 107 asthma patients to receive omeprazole 40 mg/day or placebo for 8 weeks, 53% were found to have pathologic GERD. One-third of these patients had no typical reflux symptoms. Nighttime, but not daytime, asthma symptoms significantly improved in the omeprazole group, compared with the placebo group (Chest 116:1257-64, 1999).
On the basis of symptom scores, 35% of the patients were regarded as responders to omeprazole. Reflux was more severe in the responders than in the nonresponders. The authors concluded that a subset of patients with asthma might benefit from antireflux therapy.
* Vocal cord dysfunction syndrome (VCDS). This syndrome, which is caused by inappropriate adduction of the vocal cords during expiration, is often mistaken for asthma, especially asthma that does not respond to treatment, Dr. Sue noted.
In a study of 95 VCDS patients, 53 had concurrent asthma (Am. J. Respir. Crit. Care Med. 152[4, pt. 1]:1382-86, 1995).
Of the nonasthmatics--mostly young women whose VCDS had gone undiagnosed for a mean of 3.8 years--81% were regularly receiving corticosteroids for suspected asthma. These patients averaged 9.7 emergency department visits and 5.9 hospital admissions in the year prior to identification of VCDS; 28% of them had been intubated.
"They fit the criteria for having severe unremitting asthma, yet none of them had asthma," Dr. Sue said. VCDS patients might benefit from speech therapy because there is no pharmacologic treatment for the condition, he added.
* Poor adherence to inhaled corticosteroids or other controller therapy. Of 603 Canadian asthmatics surveyed, many had poor knowledge of their inhaled corticosteroids, such as whether the drug was a controller agent; had undue fears about side effects; and were reluctant to use the drugs as prescribed (Chest 113:587-92, 1998). Nearly half (43%) of those who ever used corticosteroids thought these drugs "opened the airways." Only 14% believed that corticosteroids prevented asthma attacks, and 3% thought that steroids "built up or strengthened" the lungs.
"Most patients who don't understand their asthma are likely to not understand the rationale for asthma therapy," Dr. Sue said.
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|Title Annotation:||gastroesophageal reflux disease, vocal cord dysfunction syndrome|
|Publication:||Internal Medicine News|
|Date:||May 1, 2003|
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