The number of asthma exacerbations was cut in half among pregnant women when treatment decisions were guided by measurements of their fraction of exhaled nitric oxide (FENO), a randomized trial found. The rate of exacerbations was 0.288 per pregnancy in a group of women who had routine testing of FENO, and doses of inhaled steroids and long-acting β-agonists adjusted according to the results, reported Peter G. Gibson, MBBS, of the University of Newcastle in New South Wales, Australia, and colleagues. In contrast, women in a control group whose treatment was guided by clinical symptoms had 0.615 exacerbations per pregnancy, giving an incidence rate ratio of 0.496 (95% CI 0.325 to 0.755, P=0.001), the group reported in the Sept. 10 issue of The Lancet. Action Points  

• Explain that the number of asthma exacerbations was halved among pregnant women when treatment decisions were guided by measurements of their fraction of exhaled nitric oxide (FENO).
• Note that the number needed to treat using the FENO-based algorithm was six to prevent one woman from having an exacerbation.

Disease exacerbations in pregnant women can have deleterious effects on both mother and baby, leading to increased healthcare use and low birth weight.

Patients with asthma have higher levels of exhaled nitric oxide, reflecting an inflammatory state in the airways.

Previous studies evaluating FENO for asthma management have had inconsistent results, which may have related to the overall complexity of treatment algorithms.

So Gibson and colleagues designed an asthma treatment algorithm specific for use in pregnancy, testing it in a double-blind trial that enrolled 220 women before 22 weeks of gestation.

The treatment algorithm involved using FENO concentration to determine the dose of inhaled budesonide, with dose lowering when the concentration of nitric oxide fell below 16 parts per billion, and upward titration if the concentration exceeded 29 parts per billion.

The steroid dose could be adjusted up from 100 μg twice per day to 800 μg twice per day, with a long-acting β-agonist added. Doses increased depending on symptom scores on an asthma control questionnaire.

Scores on this questionnaire below 0.75 represented well controlled asthma and scores above 1.5 indicated uncontrolled asthma.

At baseline, participants’ mean age was 28, and median symptom score was 0.85.

Their mean forced expiratory volume in one second (FEV1) was approximately 95% of predicted, with a ratio of FEV1 to forced vital capacity of just under 80%.

During the two years prior to their pregnancy, 11% of the women had needed emergency department care and 19% had required oral corticosteroid treatment.

A total of 42% were using inhaled steroids at baseline.

Exacerbations occurred in 25% of women in the active treatment group and in 41% of controls (P=0.011). The number needed to treat was six to prevent one woman from having an exacerbation.

In general, the exacerbations were moderate in severity, with mean symptom scores rising to 2.02 and 1.97 in the treatment and control groups, respectively.

Patients in the active treatment group made fewer unplanned physician visits (P=0.002), fewer needed oral corticosteroids (P=0.042), none required hospital admission (P=1.0), and fewer made a visit to the ER (P=0.399).

In contrast, control patients used short-acting β2-agonists more often (one day per week versus zero, P=0.024).

Adjusted health-related quality of life by the end of the study, as measured on the Short Form-12 mental summary, was significantly higher in the FENO group (P=0.037).

Asthma-specific quality of life scores were low in both groups by the end of the study.

The treatment algorithm based on FENO measurement led to a markedly different treatment pattern, according to the researchers, with more women using inhaled steroids — but at lower doses — and often in conjunction with a long-acting β-agonist.

Mean dose of the inhaled steroid was 200 μg per day in the FENO group, with a range of zero to 400 μg, compared with a mean of zero in the control group and a range of zero to 800 μg.

Substantially more of the FENO group used inhaled steroids (68.5% versus 42.2%, P<0.001) and long-acting β-agonists (40.5% versus 17.4%, P<0.0001) by the end of the study period.

“This different treatment profile is consistent with present advice in asthma management guidelines that promote greater use of inhaled corticosteroid, at lower doses, and the earlier introduction of a long-acting β2-agonist,” wrote Gibson and colleagues.

The study was not powered to detect differences in perinatal outcomes, but median birth weights were higher in the active treatment group (3,520 g versus 3,460 g) and there were six preterm deliveries compared with nine in the control group.

Moreover, there were significantly fewer neonatal hospitalizations with FENO-based management (8% versus 18%, P=0.046).

In a comment accompanying the study, Stanley J. Szefler, MD, of the University of Colorado in Denver, described the findings as “remarkable.”

The study, wrote Szefler, “should prompt a reassessment of the conventional approach to management of asthma in pregnancy and a reassessment of techniques to apply exhaled nitric oxide measurements to clinical practice.”

The study was funded by the National Health and Medical Research Council of Australia.

One author disclosed receiving travel reimbursements from GlaxoSmithKline, AstraZeneca, Novartis, and Boehringer Ingelheim. A second author has received lecture fees from Aerocrine AB.

I have Ulcerative Colitis and last thursday my doctor started me on antibiotics. Saturday before last, however, I had sex for the first time -without a condom (stupid I know) for only about 10 seconds before I chickened out. ever since then, I've been feeling bloated and my period is supposed to come today but it hasn't arrived yet. I've been stressing out ever since.

What I want to know is: am I pregnant or am I suffering common symptoms of UC

Note: I am taking Lialda – 2 tabs daily, Metronidazole (the antibiotic) and Rowasa enemas.

HELP PLEASE!?

Some women do experience symptoms that early in pregnancy but, given your history, there is a chance that it's an exacerbation of your ulcerative colitis. it could also be a side effect of the Metronidazole, it's really impossible to know for sure. I'd give it a few days, your period could just be late. If you still don't have your period, there's a good choice of simple urine pregnancy tests you can buy from any chemist, or see your GP.

Asthma is really a serious condition that has a big effect to affected individual. Fortunately, nowadays there are many drugs available that may help you managed asthma attacks. and yes it is useful for treating chronic bronchitis, emphysema, and chronic obstructive pulmonary disease (COPD). this article discuss a little more about how can we prevent it and what drug can best assist you to.

Asthma causes recurring airway obstructions. it is a chronic inflammatory disease that could be caused by environmental triggers, or it may use a genetic background. Asthma causes wheezing, coughing, breathlessness, and chest tightness. Sufferers could possibly avoid the environmental triggers to reduce some occurrences of asthma attacks.

COPD is really a chronic pulmonary disease that includes bronchitis and emphysema. Chronic only denotes that it’s a thing that has affected one’s health for some time. these diseases create a blockage inside the airways of the lungs. it is difficult to get enough oxygen to perform the simplest of daily functions. Exacerbation can be a sudden worsening of symptoms that may last a day or two, and often require antibiotics, steroids, and perhaps hospitalization.

Seasonal allergies are related to pollens which are produced with the year. Spring offers pollens released through the trees because they get up after the winter. Summertime release both grass and weed allergens. inside the fall, ragweed is prominent. Seasonal allergies modify the lining with the nose, eyes, and even the lungs in individuals who suffer from asthma.

Cystic fibrosis causes excess mucus to build up inside a person’s pancreas, digestive tract, and the lungs. it prevents a body to effectively break down and absorb food. It’s a common lung disease in young adults and youngsters which can be probably an inherited disease that often leads to death when young.

Sarcoidosis is a disease that can appear and disappear on and off within a person’s everyday life. it causes an inflammatory reaction of the tissues in your body, and may affect nearly any organ. Generally, it boils down to the lungs or even the lymph nodes.

To wind down the muscles surrounding the airways, Spiriva may be used to make breathing less complicated. Much more, it may also decrease the inflammation of airways. Patients that are in the middle of creating a severe asthma attack should not use this medicine. Doctors should be consulted prior to beginning the use of any medication. People accept severe airway inflammations and obstructions and may get rest from the usage of this medication.

Blazhe Ilijaoturay knows pretty much all healthcare remedies on the market, and seems to have diligently weighed the substantial benefits and drawbacks connected with Spiriva and trust it to be the first currently available. In case you wants to get more info, keep reading.

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