New asthma research presented at CHEST 2009

Zinc deficiency may play a role in the development of extrinsic or allergic asthma. Researchers from India evaluated serum zinc levels and absolute eosinophil count in 96 cases of asthma (61 patients had intrinsic asthma and 35 had extrinsic asthma). Patients who suffered from any comorbid illness were excluded from the study. Results showed that serum zinc levels in the extrinsic asthma group were significantly lower than in the intrinsic asthma group, but the difference in eosinophil count was not significant. Researchers conclude that additional studies are needed to reach a definite conclusion.

Air Pollution Major Factor in Fresno Health
(#8164, Tuesday, November 3, 3:45 PM ET)

Air pollution is a major health risk for patients in Fresno, CA, who suffer from chronic lung diseases. Researchers from the University of California, San Francisco, Fresno compared the weekly rates of those admitted to the ER with asthma or chronic obstructive pulmonary disease (COPD) with air pollution indices for corresponding weeks. There were 1,184 ER visits in total, predominantly by female patients (60 percent). Of the total ER visits, 932 (79 percent) patients were admitted and 24 (2.0 percent) were ICU admissions. Results showed that an increased ambient particulate matter 2.5 (PM-2.5) level was associated with an increase in weekly ER visits; however, there was no association between ambient ozone level and weekly ER visits from respiratory illness. Researchers conclude that air pollution, as measured by particulate matter, has a greater impact on patients with chronic airway disease than ambient ozone level.

Electrical Stimulation May Help in Acute Asthma Situations
(#8161, Tuesday, November 3, 3:45 PM ET)

Patients with acute asthma who have failed conventional asthma therapy may benefit from electrical stimulation as a means to induce bronchodilation. Researchers from five US institutions, including Rush University Medical Center in Illinois and Johns Hopkins Medical Institutions in Maryland, assessed the outcomes of percutaneous electrical stimulation on four adult patients with moderately severe asthma who had failed conventional pharmacologic therapy. The minimally invasive procedure was conducted in fully conscious and responsive patients using local anesthesia at the insertion site. Treatment consisted of up to 180 minutes of continuous electrical stimulation at 25 Hz and a 200-ms pulse width at an amplitude ranging between 1 and 12 volts. During treatment, the % predicted FEV1 increased from 59.5±4.7 to 68.3±5.2 at 30 minutes and reached a mean peak of 75.2±5.5 (p=0.004) during the study. After completing treatment, the FEV1 remained elevated for 30 minutes. Researchers conclude that electrical stimulation may provide a nonpharmacologic- and nonairflow-dependent bronchodilation treatment for use in critical care settings.

Children With Asthma May Benefit From Reduction in Daily Steroids
(#9114, Tuesday, November 3, 3:45 PM ET)

Children with status asthmaticus, those who experience prolonged and serious asthma attacks, may safely be able to reduce their daily corticosteroid dose. Researchers from Kosair Children’s Hospital in Kentucky conducted before and after chart reviews of 292 patients younger than 18 years who were hospitalized with status asthmaticus. Eligible patients had received methylprednisolone, prednisolone, or prednisone. Steroid dosing for group 1 (152 patients) was 1 mg/kg/dose every 6 hours (maximum of 240 mg/day) and 0.5 to 1 mg/kg/dose every 12 hours (maximum of 60 mg/day) for group 2 (141 patients). The average length of hospital stay for was 2.01 days for group 1 and 1.98 days for group 2, suggesting there was no effect on length of stay. Researchers conclude that decreasing the daily dose of systemic corticosteroids for status asthmaticus does not affect the length of hospital stay.

High-Dose Inhaled Albuterol Associated With Metabolic Acidosis
(#8423, Tuesday, November 3, 3:45 PM ET)

Patients with severe acute asthma may be at a higher risk of developing metabolic acidosis, an excess of acid in the blood. In a retrospective analysis, researchers from Yale School of Medicine reviewed demographic and physiologic data of 201 pediatric patients (younger than18 years) admitted to the pediatric ICU with a diagnosis of severe acute asthma. Results showed that heart rate and respiratory rate were higher in patients receiving high-dose albuterol (>10 mg/h), and 14 patients (33 percent) developed metabolic acidosis. In addition, 13 patients (43.3 percent) receiving high-dose albuterol developed metabolic acidosis compared with one patient (8.3 percent) receiving low-dose (

<10 mg/h) inhaled albuterol. There was no difference between age, gender, duration of symptoms before hospital presentation, and pediatric risk of mortality score between patients on high-dose and low-dose albuterol.


Contact: Jennifer Stawarz
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American College of Chest Physicians

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