Patient Care - Allergy & Immunology - October 2007 - (Page 26)

ClinicalClips JOHN J. RUSSELL, MD, Contributing Editor Associate Director, Family Medicine Residency, Abington Memorial Hospital, Abington, Pa. Dr Russell and colleagues abstract current reports and studies from evidence-based medical literature and provide commentary relevant to primary care. I More on the asthma-obesity link Varga PA, Perry T T, Robles E, et al. Relationship of body mass index with asthma indicators in Head Start children. Ann Allergy Asthma Immunol. 2007;99(1):22-28. problem should be further addressed. Though the relationship must be clarified, weight management should be part of asthma management. To examine the relationship of body mass index (BMI) and asthma indicators on young children, the investigators performed a cross-sectional study of children aged 3 to 5 years with asthma who were enrolled in a Head Start (HS) program. They compared the BMI data from these children with that of 2 other groups. The first consisted of peer control subjects sampled from the National Health and Nutrition Examination Survey (NHANES), and the second comprised children in prekindergarten in Arkansas public schools. Indicators of asthma morbidity were reported by the parents; they included asthma symptoms, medication use, and school days missed. They found that the HS children’s prevalence of overweight ( 95th percentile) was significantly higher than that of the other 2 groups. In addition, compared to HS children in the lower percentile for BMI, the HS children with asthma plus a BMI in the 85th percentile or higher missed more days of school, had more emergency department visits and lifetime hospitalizations, more daytime symptoms, lower quality of life, and greater limitation of activity. Although this group had fewer oral corticosteroid bursts, no differences were observed in rescue or controller medications or nighttime symptoms. Impact for clinicians The researchers concluded that an increased BMI was associated with higher asthma morbidity, that it significantly affects the well-being of young asthmatic patients, and that the I Discriminating between moderate and severe allergic rhinitis Valero A, Ferrer M, Sastre J, et al. A new criterion by which to discriminate between patients with moderate allergic rhinitis and patients with severe allergic rhinitis based on the Allergic Rhinitis and its Impact on Asthma severity items. J Allergy Clin Immunol. 2007;20(2):359-365. The investigators sought to determine if the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines—now successfully being used to discriminate between mild and moderate/severe allergic rhinitis (AR)—can be used to differentiate between moderate to severe AR. In this observational, cross-sectional study, untreated patients with moderate to severe AR were assessed for clinical characteristics, nasal symptoms, and healthrelated quality of life. Impact for clinicians The researchers concluded that ARIA guidelines can be used to effectively differentiate between mild, moderate, and severe AR. Deriving the severity categories may help primary care physicians make treatment decisions. However, AR severity scores have limitations, and an AR control test might actually be more useful. Matthew Mintz, MD George Washington University Medical Center Washington, DC Clinical Clips is adapted from Clinical Update, which is formatted for Palm OS devices and delivered electronically. Contact the publisher at http://www.redi-reference.com/ beweek.htm for information on how to subscribe. Clinical Clips Panel Jonathan D. Beck, MD Christopher V. Chambers, MD Jeff Kirchner, DO Matthew Mintz, MD David Nicklin, MD S. Scott Paist, MD Charles A. Pohl, MD 26 PATIENT CARE ALLERGY & IMMUNOLOGY www.patientcareonline.com http://www.redi-reference.com/beweek.htm http://www.redi-reference.com/beweek.htm http://www.patientcareonline.com

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Patient Care - Allergy & Immunology - October 2007 Research Digest Contents Medicine in the News When to Suspect Celiac Disease and How to Proceed From There Averting Angioedema’s Potentially Dire Consequences Is There a Role for Leukotriene Receptor Antagonists in Treating Allergic rhinitis? Clinical Clips Dermatology Case Challenge Classified Advertising

Patient Care - Allergy & Immunology - October 2007

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