Heidi Splete

Major Finding: Of patients who stopped taking AEDs, 45% cited side effects as a reason; those taking two or more AEDs were less likely to be satisfied with the side effects than were those taking one AED.

Data Source: National Survey of Epilepsy, Comorbidities, and Health of 7,500 epilepsy patients and 2,500 controls.

Disclosures: The presenter is an employee of Ortho-McNeil Janssen Scientific Affairs LLC, which supported the study.

TORONTO — About 40% of epilepsy patients are bothered by side effects of their antiepileptic drugs, based on data from a survey of adults with epilepsy.

Information on the tolerability of antiepileptic drugs (AEDs) and the reasons for discontinuing treatment are limited, said George J. Wan, Ph.D., in a poster presentation at the annual meeting of the American Academy of Neurology.

To examine drug tolerability and treatment satisfaction, Dr. Wan, of Ortho-McNeil Janssen Scientific Affairs LLC, and his colleagues reviewed data from the National Survey of Epilepsy, Comorbidities, and Health Outcomes (EPIC), a large survey conducted in the United States in 2009 that included 7,500 epilepsy patients and 2,500 controls.

The researchers evaluated responses from 5,117 self-reporting epilepsy patients. A total of 2,395 respondents reported being formally diagnosed with epilepsy or a seizure disorder; of those, 1,415 (59%) were taking antiepilepsy drugs at the time of the survey. About 60% of the respondents reported taking one AED, 35% reported taking two or three, and 5% reported taking four or more. The respondents had been taking AEDs for an average of 115 months.

A total of 772 respondents said that they were “not at all” bothered by side effects from AEDs during the 4 weeks leading up to the survey. But 519 respondents reported some degree of bother: 22% were mildly bothered; 12%, moderately bothered; 5%, markedly bothered; and 1%, extremely bothered.

Overall, 72% of the respondents said they were either “somewhat satisfied” or “very satisfied” with their current AED regimens. But a total of 304 respondents said that they had discontinued their medications. Of those, 50% discontinued on their doctor's advice; 45% discontinued because of side effects; 30%, because of improvement in seizures or the disappearance of seizures; and 21%, because of inadequate seizure control. Some respondents indicated more than one reason for discontinuing their AEDs.

After controlling for baseline characteristics and lifetime seizures, patients who were taking two or more AEDs were less likely to be satisfied with the side effects compared with those who were taking one AED. The study was limited by the use of self-reports. “Further research is needed to quantify the impact of AED treatment on other patient-reported outcomes,” they said.

Major Finding: Of patients who stopped taking AEDs, 45% cited side effects as a reason; those taking two or more AEDs were less likely to be satisfied with the side effects than were those taking one AED.

Data Source: National Survey of Epilepsy, Comorbidities, and Health of 7,500 epilepsy patients and 2,500 controls.

Disclosures: The presenter is an employee of Ortho-McNeil Janssen Scientific Affairs LLC, which supported the study.

TORONTO — About 40% of epilepsy patients are bothered by side effects of their antiepileptic drugs, based on data from a survey of adults with epilepsy.

Information on the tolerability of antiepileptic drugs (AEDs) and the reasons for discontinuing treatment are limited, said George J. Wan, Ph.D., in a poster presentation at the annual meeting of the American Academy of Neurology.

To examine drug tolerability and treatment satisfaction, Dr. Wan, of Ortho-McNeil Janssen Scientific Affairs LLC, and his colleagues reviewed data from the National Survey of Epilepsy, Comorbidities, and Health Outcomes (EPIC), a large survey conducted in the United States in 2009 that included 7,500 epilepsy patients and 2,500 controls.

The researchers evaluated responses from 5,117 self-reporting epilepsy patients. A total of 2,395 respondents reported being formally diagnosed with epilepsy or a seizure disorder; of those, 1,415 (59%) were taking antiepilepsy drugs at the time of the survey. About 60% of the respondents reported taking one AED, 35% reported taking two or three, and 5% reported taking four or more. The respondents had been taking AEDs for an average of 115 months.

A total of 772 respondents said that they were “not at all” bothered by side effects from AEDs during the 4 weeks leading up to the survey. But 519 respondents reported some degree of bother: 22% were mildly bothered; 12%, moderately bothered; 5%, markedly bothered; and 1%, extremely bothered.

Overall, 72% of the respondents said they were either “somewhat satisfied” or “very satisfied” with their current AED regimens. But a total of 304 respondents said that they had discontinued their medications. Of those, 50% discontinued on their doctor's advice; 45% discontinued because of side effects; 30%, because of improvement in seizures or the disappearance of seizures; and 21%, because of inadequate seizure control. Some respondents indicated more than one reason for discontinuing their AEDs.

After controlling for baseline characteristics and lifetime seizures, patients who were taking two or more AEDs were less likely to be satisfied with the side effects compared with those who were taking one AED. The study was limited by the use of self-reports. “Further research is needed to quantify the impact of AED treatment on other patient-reported outcomes,” they said.

Major Finding: Of patients who stopped taking AEDs, 45% cited side effects as a reason; those taking two or more AEDs were less likely to be satisfied with the side effects than were those taking one AED.

Data Source: National Survey of Epilepsy, Comorbidities, and Health of 7,500 epilepsy patients and 2,500 controls.

Disclosures: The presenter is an employee of Ortho-McNeil Janssen Scientific Affairs LLC, which supported the study.

TORONTO — About 40% of epilepsy patients are bothered by side effects of their antiepileptic drugs, based on data from a survey of adults with epilepsy.

Information on the tolerability of antiepileptic drugs (AEDs) and the reasons for discontinuing treatment are limited, said George J. Wan, Ph.D., in a poster presentation at the annual meeting of the American Academy of Neurology.

To examine drug tolerability and treatment satisfaction, Dr. Wan, of Ortho-McNeil Janssen Scientific Affairs LLC, and his colleagues reviewed data from the National Survey of Epilepsy, Comorbidities, and Health Outcomes (EPIC), a large survey conducted in the United States in 2009 that included 7,500 epilepsy patients and 2,500 controls.

The researchers evaluated responses from 5,117 self-reporting epilepsy patients. A total of 2,395 respondents reported being formally diagnosed with epilepsy or a seizure disorder; of those, 1,415 (59%) were taking antiepilepsy drugs at the time of the survey. About 60% of the respondents reported taking one AED, 35% reported taking two or three, and 5% reported taking four or more. The respondents had been taking AEDs for an average of 115 months.

A total of 772 respondents said that they were “not at all” bothered by side effects from AEDs during the 4 weeks leading up to the survey. But 519 respondents reported some degree of bother: 22% were mildly bothered; 12%, moderately bothered; 5%, markedly bothered; and 1%, extremely bothered.

Overall, 72% of the respondents said they were either “somewhat satisfied” or “very satisfied” with their current AED regimens. But a total of 304 respondents said that they had discontinued their medications. Of those, 50% discontinued on their doctor's advice; 45% discontinued because of side effects; 30%, because of improvement in seizures or the disappearance of seizures; and 21%, because of inadequate seizure control. Some respondents indicated more than one reason for discontinuing their AEDs.

After controlling for baseline characteristics and lifetime seizures, patients who were taking two or more AEDs were less likely to be satisfied with the side effects compared with those who were taking one AED. The study was limited by the use of self-reports. “Further research is needed to quantify the impact of AED treatment on other patient-reported outcomes,” they said.

NEW ORLEANS — Children with severe asthma have significantly higher levels of serum IgE and exhaled nitric oxide than adults, based on data from 47 consecutive patients with severe asthma.

Severe asthma affects fewer than 10% of all asthma patients, but it accounts for a disproportionate number of all asthma-related hospitalizations and emergency department visits, said Dr. Jonathan Malka of National Jewish Health in Denver.

Few studies have examined the phenotypic differences in severe asthma based on age, and recognizing the differences and similarities could help clinicians identify severe asthmatics, Dr. Malka said.

To compare levels of impairment and inflammation in children and adults, Dr. Malka and his colleagues evaluated 23 children and 24 adults with severe asthma who presented to National Jewish Health. The average age of the children was 12 years, and the average age of the adults was 47 years. The mean asthma durations were 9 years in children and 27 years in adults. The results were presented in a poster at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

Serum IgE was significantly higher in children than in adults (about 600 IU/mL vs. about 200 IU/mL). Similarly, exhaled nitric oxide levels were significantly higher in children than in adults (about 54 parts per billion vs. about 27 parts per billion).

Children with severe asthma had significantly less lung function impairment than did adults, based on two measures of lung function. Forced vital capacity (FVC) in children was 94% of the predicted value vs. 72% in adults. Forced expiratory volume in 1 second (FEV₁) in children was 73% of the predicted value vs. 56% in adults. Children also fared better than adults in terms of the FEV₁/FVC ratio and in changes in FEV₁ after using albuterol, but those differences were not significant.

Children and adults showed no significant differences in three measures of asthma morbidity: weekly albuterol use, annual asthma exacerbations, and lifetime hospitalizations.

The study was limited by the small sample size, but the biomarker findings suggest pathophysiologic differences in asthma based on age—although adults and children alike were equally compromised, Dr. Malka said. Additional research may help clinicians adjust management of their severe asthma patients based on age, he said in an interview.

Dr. Malka had no financial conflicts to disclose.

To watch an interview of Dr. Malka, go to www.youtube.com/user/ElsGlobalMedicalNews

NEW ORLEANS — Children with severe asthma have significantly higher levels of serum IgE and exhaled nitric oxide than adults, based on data from 47 consecutive patients with severe asthma.

Severe asthma affects fewer than 10% of all asthma patients, but it accounts for a disproportionate number of all asthma-related hospitalizations and emergency department visits, said Dr. Jonathan Malka of National Jewish Health in Denver.

Few studies have examined the phenotypic differences in severe asthma based on age, and recognizing the differences and similarities could help clinicians identify severe asthmatics, Dr. Malka said.

To compare levels of impairment and inflammation in children and adults, Dr. Malka and his colleagues evaluated 23 children and 24 adults with severe asthma who presented to National Jewish Health. The average age of the children was 12 years, and the average age of the adults was 47 years. The mean asthma durations were 9 years in children and 27 years in adults. The results were presented in a poster at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

Serum IgE was significantly higher in children than in adults (about 600 IU/mL vs. about 200 IU/mL). Similarly, exhaled nitric oxide levels were significantly higher in children than in adults (about 54 parts per billion vs. about 27 parts per billion).

Children with severe asthma had significantly less lung function impairment than did adults, based on two measures of lung function. Forced vital capacity (FVC) in children was 94% of the predicted value vs. 72% in adults. Forced expiratory volume in 1 second (FEV₁) in children was 73% of the predicted value vs. 56% in adults. Children also fared better than adults in terms of the FEV₁/FVC ratio and in changes in FEV₁ after using albuterol, but those differences were not significant.

Children and adults showed no significant differences in three measures of asthma morbidity: weekly albuterol use, annual asthma exacerbations, and lifetime hospitalizations.

The study was limited by the small sample size, but the biomarker findings suggest pathophysiologic differences in asthma based on age—although adults and children alike were equally compromised, Dr. Malka said. Additional research may help clinicians adjust management of their severe asthma patients based on age, he said in an interview.

Dr. Malka had no financial conflicts to disclose.

To watch an interview of Dr. Malka, go to www.youtube.com/user/ElsGlobalMedicalNews

NEW ORLEANS — Children with severe asthma have significantly higher levels of serum IgE and exhaled nitric oxide than adults, based on data from 47 consecutive patients with severe asthma.

Severe asthma affects fewer than 10% of all asthma patients, but it accounts for a disproportionate number of all asthma-related hospitalizations and emergency department visits, said Dr. Jonathan Malka of National Jewish Health in Denver.

Few studies have examined the phenotypic differences in severe asthma based on age, and recognizing the differences and similarities could help clinicians identify severe asthmatics, Dr. Malka said.

To compare levels of impairment and inflammation in children and adults, Dr. Malka and his colleagues evaluated 23 children and 24 adults with severe asthma who presented to National Jewish Health. The average age of the children was 12 years, and the average age of the adults was 47 years. The mean asthma durations were 9 years in children and 27 years in adults. The results were presented in a poster at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

Serum IgE was significantly higher in children than in adults (about 600 IU/mL vs. about 200 IU/mL). Similarly, exhaled nitric oxide levels were significantly higher in children than in adults (about 54 parts per billion vs. about 27 parts per billion).

Children with severe asthma had significantly less lung function impairment than did adults, based on two measures of lung function. Forced vital capacity (FVC) in children was 94% of the predicted value vs. 72% in adults. Forced expiratory volume in 1 second (FEV₁) in children was 73% of the predicted value vs. 56% in adults. Children also fared better than adults in terms of the FEV₁/FVC ratio and in changes in FEV₁ after using albuterol, but those differences were not significant.

Children and adults showed no significant differences in three measures of asthma morbidity: weekly albuterol use, annual asthma exacerbations, and lifetime hospitalizations.

The study was limited by the small sample size, but the biomarker findings suggest pathophysiologic differences in asthma based on age—although adults and children alike were equally compromised, Dr. Malka said. Additional research may help clinicians adjust management of their severe asthma patients based on age, he said in an interview.

Dr. Malka had no financial conflicts to disclose.

To watch an interview of Dr. Malka, go to www.youtube.com/user/ElsGlobalMedicalNews

Major Finding: In this sample, 47% of children with allergies also were deficient in vitamin D.

Data Source: Researchers assess vitamin D levels in 99 children who had asthma, atopic dermatitis, and/or a food allergy.

Disclosures: Researchers had no financial conflicts to disclosure. The study was supported in part by a grant from the National Institutes of Health.

NEW ORLEANS — Approximately half of children with asthma were deficient in vitamin D in a study of 99 children aged 18 and younger.

Previous published studies in the literature have suggested that vitamin D insufficiency contributes to the pathophysiology of allergic disease.

However, data on vitamin D's impact on children with allergies and asthma are limited, Dr. Daniel Searing said in a poster presentation at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

In his investigation, Dr. Searing and colleagues at National Jewish Health in Denver, Colo., identified 99 children who had asthma, atopic dermatitis, and/or a food allergy.

The researchers assessed vitamin D by measuring serum 25-hydroxyvitamin D levels.

Overall, 47% of the patients had insufficient levels of vitamin D (less than 30 ng/mL). The median vitamin D level was 31 ng/mL.

To assess the impact of vitamin D on inflammation, the researchers cultured peripheral blood mononuclear cells (PBMC) from 11 patients using either 10 nM vitamin D or a placebo medium for 24 hours, and supplemented them with either 10 or 100 nM of dexamethasone for the last 3 hours of culturing.

Next, they measured mitogen-activated protein kinase phosphatase-1 (MKP-1) and interleukin-10 (IL-10).

“Vitamin D enhances glucocorticoid induction of MKP-1 and IL-10 in asthmatic PBMC in vitro,” the researchers explained.

In turn, the addition of supplemental vitamin D can enhance the activity of dexa-methasone more than 10-fold, they added.

However, “the relationship between vitamin D and corticosteroid pathways, as well as its effect on the inflammatory response, is not fully understood,” the researchers emphasized.

But the results suggest that vitamin D supplementation may enhance the anti-inflammatory function of corticosteroids in asthma patients, they noted.

Median vitamin D levels were significantly lower in children taking inhaled corticosteroids (29 ng/mL), oral corticosteroids (25 ng/mL), and long-acting beta-agonists (25 ng/mL), compared with children who were not taking inhaled corticosteroids, oral corticosteroids, or long-acting beta-agonists (35 ng/mL, 32 ng/mL, and 34 ng/mL, respectively).

In addition, median vitamin D levels were significantly lower in children with positive vs. negative aeroallergen sensitivity to dog dander (29 ng/mL vs. 35 ng/mL) and house dust mites (27 ng/mL vs. 31 ng/mL).

To watch an interview of Dr. Searing, go to www.youtube.com/user/ElsGlobalMedicalNews

Major Finding: In this sample, 47% of children with allergies also were deficient in vitamin D.

Data Source: Researchers assess vitamin D levels in 99 children who had asthma, atopic dermatitis, and/or a food allergy.

Disclosures: Researchers had no financial conflicts to disclosure. The study was supported in part by a grant from the National Institutes of Health.

NEW ORLEANS — Approximately half of children with asthma were deficient in vitamin D in a study of 99 children aged 18 and younger.

Previous published studies in the literature have suggested that vitamin D insufficiency contributes to the pathophysiology of allergic disease.

However, data on vitamin D's impact on children with allergies and asthma are limited, Dr. Daniel Searing said in a poster presentation at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

In his investigation, Dr. Searing and colleagues at National Jewish Health in Denver, Colo., identified 99 children who had asthma, atopic dermatitis, and/or a food allergy.

The researchers assessed vitamin D by measuring serum 25-hydroxyvitamin D levels.

Overall, 47% of the patients had insufficient levels of vitamin D (less than 30 ng/mL). The median vitamin D level was 31 ng/mL.

To assess the impact of vitamin D on inflammation, the researchers cultured peripheral blood mononuclear cells (PBMC) from 11 patients using either 10 nM vitamin D or a placebo medium for 24 hours, and supplemented them with either 10 or 100 nM of dexamethasone for the last 3 hours of culturing.

Next, they measured mitogen-activated protein kinase phosphatase-1 (MKP-1) and interleukin-10 (IL-10).

“Vitamin D enhances glucocorticoid induction of MKP-1 and IL-10 in asthmatic PBMC in vitro,” the researchers explained.

In turn, the addition of supplemental vitamin D can enhance the activity of dexa-methasone more than 10-fold, they added.

However, “the relationship between vitamin D and corticosteroid pathways, as well as its effect on the inflammatory response, is not fully understood,” the researchers emphasized.

But the results suggest that vitamin D supplementation may enhance the anti-inflammatory function of corticosteroids in asthma patients, they noted.

Median vitamin D levels were significantly lower in children taking inhaled corticosteroids (29 ng/mL), oral corticosteroids (25 ng/mL), and long-acting beta-agonists (25 ng/mL), compared with children who were not taking inhaled corticosteroids, oral corticosteroids, or long-acting beta-agonists (35 ng/mL, 32 ng/mL, and 34 ng/mL, respectively).

In addition, median vitamin D levels were significantly lower in children with positive vs. negative aeroallergen sensitivity to dog dander (29 ng/mL vs. 35 ng/mL) and house dust mites (27 ng/mL vs. 31 ng/mL).

To watch an interview of Dr. Searing, go to www.youtube.com/user/ElsGlobalMedicalNews

Major Finding: In this sample, 47% of children with allergies also were deficient in vitamin D.

Data Source: Researchers assess vitamin D levels in 99 children who had asthma, atopic dermatitis, and/or a food allergy.

Disclosures: Researchers had no financial conflicts to disclosure. The study was supported in part by a grant from the National Institutes of Health.

NEW ORLEANS — Approximately half of children with asthma were deficient in vitamin D in a study of 99 children aged 18 and younger.

Previous published studies in the literature have suggested that vitamin D insufficiency contributes to the pathophysiology of allergic disease.

However, data on vitamin D's impact on children with allergies and asthma are limited, Dr. Daniel Searing said in a poster presentation at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

In his investigation, Dr. Searing and colleagues at National Jewish Health in Denver, Colo., identified 99 children who had asthma, atopic dermatitis, and/or a food allergy.

The researchers assessed vitamin D by measuring serum 25-hydroxyvitamin D levels.

Overall, 47% of the patients had insufficient levels of vitamin D (less than 30 ng/mL). The median vitamin D level was 31 ng/mL.

To assess the impact of vitamin D on inflammation, the researchers cultured peripheral blood mononuclear cells (PBMC) from 11 patients using either 10 nM vitamin D or a placebo medium for 24 hours, and supplemented them with either 10 or 100 nM of dexamethasone for the last 3 hours of culturing.

Next, they measured mitogen-activated protein kinase phosphatase-1 (MKP-1) and interleukin-10 (IL-10).

“Vitamin D enhances glucocorticoid induction of MKP-1 and IL-10 in asthmatic PBMC in vitro,” the researchers explained.

In turn, the addition of supplemental vitamin D can enhance the activity of dexa-methasone more than 10-fold, they added.

However, “the relationship between vitamin D and corticosteroid pathways, as well as its effect on the inflammatory response, is not fully understood,” the researchers emphasized.

But the results suggest that vitamin D supplementation may enhance the anti-inflammatory function of corticosteroids in asthma patients, they noted.

Median vitamin D levels were significantly lower in children taking inhaled corticosteroids (29 ng/mL), oral corticosteroids (25 ng/mL), and long-acting beta-agonists (25 ng/mL), compared with children who were not taking inhaled corticosteroids, oral corticosteroids, or long-acting beta-agonists (35 ng/mL, 32 ng/mL, and 34 ng/mL, respectively).

In addition, median vitamin D levels were significantly lower in children with positive vs. negative aeroallergen sensitivity to dog dander (29 ng/mL vs. 35 ng/mL) and house dust mites (27 ng/mL vs. 31 ng/mL).

To watch an interview of Dr. Searing, go to www.youtube.com/user/ElsGlobalMedicalNews

NEW ORLEANS – Children's school absences and their parents' absences from work represented the greatest economic burden of impairment in children with severe asthma, according to data from an observational study of more than 600 children.

“Asthma costs in the United States have exceeded $10 billion,” said Dr. Stanley J. Szefler of National Jewish Health in Denver, and his colleagues at the annual meeting of the American Academy of Allergy, Asthma, and Immunology. That figure includes $4.6 billion in indirect costs, such as mortality and lost school and work days, and $6.1 billion in direct costs, such as medications and hospital stays.

Dr. Szefler and his colleagues examined whether improvements in asthma impairment in young children reduced the cost burden of asthma. The study was the first to assess the economic burden of asthma in children aged 6-12 years with severe or difficult-to-treat illness as defined by the National Heart, Lung, and Blood Institute's guidelines, the researchers said.

The study included 628 children aged 6 years and older with severe or refractory asthma. At baseline, 386 children had very poorly controlled (VPC) asthma, 219 had not well-controlled (NWC) asthma, and 23 had well-controlled (WC) asthma. The children were a subgroup of the TENOR study, a large, observational study that assessed patients with severe and difficult-to-treat asthma. A total of 62% of the children were classified as VPC, the researchers noted.

The researchers compared the cumulative costs for patients who were consistently VPC at baseline, 12 months, and 24 months with the costs for patients who improved over the 24-month study period. Primary outcomes included school days lost, cost of asthma medications, unscheduled doctor visits, overnight hospital stays, and emergency department visits.

Overall, the cost of school and work days lost in the VPC group at baseline, 12 months, and 24 months was $3,087, $3,139, and $4,277, respectively. Those costs were significantly higher than for the NWC group ($369, $251, and $478, respectively) and the WC group ($0, $166, $0, respectively). The costs of school absences were measured using gender-specific dollar amounts to represent a parent's lost work day and adjusted to 2002 dollars.

The costs of medications were the next largest contributor to cost burden. Medication costs in the VPC group at baseline ($2,117), 12 months ($2,312), and 24 months ($2,298) were significantly higher than in the NWC group ($1,949, $1,987, and $1,995, respectively) and the WC group ($1,861, $1,640, and $1,605). The costs of medications were measured using the average recommended daily dose.

“The highest costs were associated with patients whose asthma impairment status remained consistently VPC,” the researchers wrote.

The study was sponsored by Genentech Inc. Dr. Szefler received funding from several organizations that are sponsored by the National Institutes of Health, as well as from several pharmaceutical companies.

Source Elsevier Global Medical News

NEW ORLEANS – Children's school absences and their parents' absences from work represented the greatest economic burden of impairment in children with severe asthma, according to data from an observational study of more than 600 children.

“Asthma costs in the United States have exceeded $10 billion,” said Dr. Stanley J. Szefler of National Jewish Health in Denver, and his colleagues at the annual meeting of the American Academy of Allergy, Asthma, and Immunology. That figure includes $4.6 billion in indirect costs, such as mortality and lost school and work days, and $6.1 billion in direct costs, such as medications and hospital stays.

Dr. Szefler and his colleagues examined whether improvements in asthma impairment in young children reduced the cost burden of asthma. The study was the first to assess the economic burden of asthma in children aged 6-12 years with severe or difficult-to-treat illness as defined by the National Heart, Lung, and Blood Institute's guidelines, the researchers said.

The study included 628 children aged 6 years and older with severe or refractory asthma. At baseline, 386 children had very poorly controlled (VPC) asthma, 219 had not well-controlled (NWC) asthma, and 23 had well-controlled (WC) asthma. The children were a subgroup of the TENOR study, a large, observational study that assessed patients with severe and difficult-to-treat asthma. A total of 62% of the children were classified as VPC, the researchers noted.

The researchers compared the cumulative costs for patients who were consistently VPC at baseline, 12 months, and 24 months with the costs for patients who improved over the 24-month study period. Primary outcomes included school days lost, cost of asthma medications, unscheduled doctor visits, overnight hospital stays, and emergency department visits.

Overall, the cost of school and work days lost in the VPC group at baseline, 12 months, and 24 months was $3,087, $3,139, and $4,277, respectively. Those costs were significantly higher than for the NWC group ($369, $251, and $478, respectively) and the WC group ($0, $166, $0, respectively). The costs of school absences were measured using gender-specific dollar amounts to represent a parent's lost work day and adjusted to 2002 dollars.

The costs of medications were the next largest contributor to cost burden. Medication costs in the VPC group at baseline ($2,117), 12 months ($2,312), and 24 months ($2,298) were significantly higher than in the NWC group ($1,949, $1,987, and $1,995, respectively) and the WC group ($1,861, $1,640, and $1,605). The costs of medications were measured using the average recommended daily dose.

“The highest costs were associated with patients whose asthma impairment status remained consistently VPC,” the researchers wrote.

The study was sponsored by Genentech Inc. Dr. Szefler received funding from several organizations that are sponsored by the National Institutes of Health, as well as from several pharmaceutical companies.

Source Elsevier Global Medical News

NEW ORLEANS – Children's school absences and their parents' absences from work represented the greatest economic burden of impairment in children with severe asthma, according to data from an observational study of more than 600 children.

“Asthma costs in the United States have exceeded $10 billion,” said Dr. Stanley J. Szefler of National Jewish Health in Denver, and his colleagues at the annual meeting of the American Academy of Allergy, Asthma, and Immunology. That figure includes $4.6 billion in indirect costs, such as mortality and lost school and work days, and $6.1 billion in direct costs, such as medications and hospital stays.

Dr. Szefler and his colleagues examined whether improvements in asthma impairment in young children reduced the cost burden of asthma. The study was the first to assess the economic burden of asthma in children aged 6-12 years with severe or difficult-to-treat illness as defined by the National Heart, Lung, and Blood Institute's guidelines, the researchers said.

The study included 628 children aged 6 years and older with severe or refractory asthma. At baseline, 386 children had very poorly controlled (VPC) asthma, 219 had not well-controlled (NWC) asthma, and 23 had well-controlled (WC) asthma. The children were a subgroup of the TENOR study, a large, observational study that assessed patients with severe and difficult-to-treat asthma. A total of 62% of the children were classified as VPC, the researchers noted.

The researchers compared the cumulative costs for patients who were consistently VPC at baseline, 12 months, and 24 months with the costs for patients who improved over the 24-month study period. Primary outcomes included school days lost, cost of asthma medications, unscheduled doctor visits, overnight hospital stays, and emergency department visits.

Overall, the cost of school and work days lost in the VPC group at baseline, 12 months, and 24 months was $3,087, $3,139, and $4,277, respectively. Those costs were significantly higher than for the NWC group ($369, $251, and $478, respectively) and the WC group ($0, $166, $0, respectively). The costs of school absences were measured using gender-specific dollar amounts to represent a parent's lost work day and adjusted to 2002 dollars.

The costs of medications were the next largest contributor to cost burden. Medication costs in the VPC group at baseline ($2,117), 12 months ($2,312), and 24 months ($2,298) were significantly higher than in the NWC group ($1,949, $1,987, and $1,995, respectively) and the WC group ($1,861, $1,640, and $1,605). The costs of medications were measured using the average recommended daily dose.

“The highest costs were associated with patients whose asthma impairment status remained consistently VPC,” the researchers wrote.

The study was sponsored by Genentech Inc. Dr. Szefler received funding from several organizations that are sponsored by the National Institutes of Health, as well as from several pharmaceutical companies.

Source Elsevier Global Medical News

Major Finding: Patients with chronic urticaria who responded to colchicine used significantly fewer steroids after starting colchicine than before starting it.

Data Source: A review of 55 patients who were treated with colchicine for chronic urticaria.

Disclosures: Dr. Georgy had no financial conflicts to disclose.

NEW ORLEANS — Colchicine is an effective steroid-sparing agent that can be used to treat refractory chronic idiopathic urticaria, based on data from a review of adults who received colchicine for CIU from 2003 to 2008.

Colchicine has been shown to decrease mast cell degranulation, suppress leukotriene generation, and decrease leukocyte adhesiveness and migration, said Dr. Mary S. Georgy of Northwestern University, Chicago, and her associates.

To assess the agent's effectiveness in this setting, the investigators reviewed charts from 55 patients with CIU who were treated with colchicine for at least 7 days, focusing on the type of urticaria, type of response, and use of oral steroids before and after colchicine treatment.

Overall, 24 patients responded to colchicine, 2 partially responded, and 29 did not respond (44%, 4%, and 53%, respectively). The average number of steroid courses in the responders dropped significantly between the 6 months prior to and the 6 months after colchicine use (2.44 vs. 0.33). Information on the average number of steroid courses was available only for the responders. The findings were presented at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

Response was defined as subjective improvement and a decrease in the oral steroid dosage of at least 50% within 3 months of beginning colchicine. A partial response was defined as a subjective improvement with no decrease in oral steroids by 50% within 3 months of beginning colchicine.

Skin biopsies from 27 patients—14 responders, 12 nonresponders, and 1 partial responder—showed neutrophilic urticaria in 86% of responders and in 25% of nonresponders.

“Colchicine was particularly effective in patients with neutrophilic urticaria,” the researchers noted.

Overall, 10 responders, 5 nonresponders, and 1 partial responder (29% of the patients) reported gastrointestinal complaints, but the differences among the groups were not significant.

“Colchicine has a relatively safe profile in chronic idiopathic urticaria,” the researchers noted.

Major Finding: Patients with chronic urticaria who responded to colchicine used significantly fewer steroids after starting colchicine than before starting it.

Data Source: A review of 55 patients who were treated with colchicine for chronic urticaria.

Disclosures: Dr. Georgy had no financial conflicts to disclose.

NEW ORLEANS — Colchicine is an effective steroid-sparing agent that can be used to treat refractory chronic idiopathic urticaria, based on data from a review of adults who received colchicine for CIU from 2003 to 2008.

Colchicine has been shown to decrease mast cell degranulation, suppress leukotriene generation, and decrease leukocyte adhesiveness and migration, said Dr. Mary S. Georgy of Northwestern University, Chicago, and her associates.

To assess the agent's effectiveness in this setting, the investigators reviewed charts from 55 patients with CIU who were treated with colchicine for at least 7 days, focusing on the type of urticaria, type of response, and use of oral steroids before and after colchicine treatment.

Overall, 24 patients responded to colchicine, 2 partially responded, and 29 did not respond (44%, 4%, and 53%, respectively). The average number of steroid courses in the responders dropped significantly between the 6 months prior to and the 6 months after colchicine use (2.44 vs. 0.33). Information on the average number of steroid courses was available only for the responders. The findings were presented at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

Response was defined as subjective improvement and a decrease in the oral steroid dosage of at least 50% within 3 months of beginning colchicine. A partial response was defined as a subjective improvement with no decrease in oral steroids by 50% within 3 months of beginning colchicine.

Skin biopsies from 27 patients—14 responders, 12 nonresponders, and 1 partial responder—showed neutrophilic urticaria in 86% of responders and in 25% of nonresponders.

“Colchicine was particularly effective in patients with neutrophilic urticaria,” the researchers noted.

Overall, 10 responders, 5 nonresponders, and 1 partial responder (29% of the patients) reported gastrointestinal complaints, but the differences among the groups were not significant.

“Colchicine has a relatively safe profile in chronic idiopathic urticaria,” the researchers noted.

Major Finding: Patients with chronic urticaria who responded to colchicine used significantly fewer steroids after starting colchicine than before starting it.

Data Source: A review of 55 patients who were treated with colchicine for chronic urticaria.

Disclosures: Dr. Georgy had no financial conflicts to disclose.

NEW ORLEANS — Colchicine is an effective steroid-sparing agent that can be used to treat refractory chronic idiopathic urticaria, based on data from a review of adults who received colchicine for CIU from 2003 to 2008.

Colchicine has been shown to decrease mast cell degranulation, suppress leukotriene generation, and decrease leukocyte adhesiveness and migration, said Dr. Mary S. Georgy of Northwestern University, Chicago, and her associates.

To assess the agent's effectiveness in this setting, the investigators reviewed charts from 55 patients with CIU who were treated with colchicine for at least 7 days, focusing on the type of urticaria, type of response, and use of oral steroids before and after colchicine treatment.

Overall, 24 patients responded to colchicine, 2 partially responded, and 29 did not respond (44%, 4%, and 53%, respectively). The average number of steroid courses in the responders dropped significantly between the 6 months prior to and the 6 months after colchicine use (2.44 vs. 0.33). Information on the average number of steroid courses was available only for the responders. The findings were presented at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

Response was defined as subjective improvement and a decrease in the oral steroid dosage of at least 50% within 3 months of beginning colchicine. A partial response was defined as a subjective improvement with no decrease in oral steroids by 50% within 3 months of beginning colchicine.

Skin biopsies from 27 patients—14 responders, 12 nonresponders, and 1 partial responder—showed neutrophilic urticaria in 86% of responders and in 25% of nonresponders.

“Colchicine was particularly effective in patients with neutrophilic urticaria,” the researchers noted.

Overall, 10 responders, 5 nonresponders, and 1 partial responder (29% of the patients) reported gastrointestinal complaints, but the differences among the groups were not significant.

“Colchicine has a relatively safe profile in chronic idiopathic urticaria,” the researchers noted.

Major Finding: A 3.75% imiquimod cream used daily for 2 weeks yielded a median reduction in AK lesions of 82%.

Data Source: Two randomized trials including 969 patients.

Disclosures: Both studies were funded by Graceway Pharmaceuticals. Dr. Swanson, Dr. Hanke, and their coauthors have financial relationships with Graceway.

ORLANDO — Daily application of 3.75% imiquimod cream with a 2-week dosing cycle was well tolerated and effective for treating actinic keratoses in adults, based on data from two studies.

In the first study, 160 patients were randomized to 3.75% imiquimod cream (Aldara, Graceway Pharmaceuticals), 160 patients to 2.5% imiquimod cream, and 159 patients to a placebo cream. The patients, aged 18 years and older, had 5–20 clinically diagnosed actinic keratoses (AKs) on the face or balding scalp, said Dr. Neil Swanson of Oregon Health and Science University, Portland, and his colleagues in a poster at the Orlando Dermatology Aesthetic and Clinical Conference.

Both the 3.75% and 2.5% creams were significantly more effective than placebo at fully clearing AKs after 2 weeks of daily use. Overall, 36% of the 3.75% group and 31% of the 2.5% group achieved complete clearance, vs. 6% of the placebo group.

The 3.75% cream, however, was significantly better than the 2.5% cream for partial clearance and lesion reduction. Approximately 60% of the 3.75% group achieved partial clearance (defined as at least 75%), compared with 48% of the 2.5% group and 23% of the placebo group.

“Median percent lesion reduction of 81.8% was comparable to that observed for imiquimod 5% cream applied for 16 weeks,” the researchers noted. Median lesion reduction from baseline was 71.8% in the 2.5% group and 25% in the placebo group.

A companion study randomized 164 patients to a placebo cream, 164 patients to imiquimod 2.5% cream, and 162 patients to imiquimod 3.75% cream. No significant improvement was seen with either imiquimod cream, reported Dr. C. William Hanke, a dermatologic surgeon in Carmel, Ind., and his colleagues.

When both studies were evaluated together, though, “efficacy was better with imiquimod 3.75% than with 2.5%. Extending the cycle duration from 2 weeks to 3 weeks did not further increase efficacy,” Dr. Hanke and his colleagues wrote.

Major Finding: A 3.75% imiquimod cream used daily for 2 weeks yielded a median reduction in AK lesions of 82%.

Data Source: Two randomized trials including 969 patients.

Disclosures: Both studies were funded by Graceway Pharmaceuticals. Dr. Swanson, Dr. Hanke, and their coauthors have financial relationships with Graceway.

ORLANDO — Daily application of 3.75% imiquimod cream with a 2-week dosing cycle was well tolerated and effective for treating actinic keratoses in adults, based on data from two studies.

In the first study, 160 patients were randomized to 3.75% imiquimod cream (Aldara, Graceway Pharmaceuticals), 160 patients to 2.5% imiquimod cream, and 159 patients to a placebo cream. The patients, aged 18 years and older, had 5–20 clinically diagnosed actinic keratoses (AKs) on the face or balding scalp, said Dr. Neil Swanson of Oregon Health and Science University, Portland, and his colleagues in a poster at the Orlando Dermatology Aesthetic and Clinical Conference.

Both the 3.75% and 2.5% creams were significantly more effective than placebo at fully clearing AKs after 2 weeks of daily use. Overall, 36% of the 3.75% group and 31% of the 2.5% group achieved complete clearance, vs. 6% of the placebo group.

The 3.75% cream, however, was significantly better than the 2.5% cream for partial clearance and lesion reduction. Approximately 60% of the 3.75% group achieved partial clearance (defined as at least 75%), compared with 48% of the 2.5% group and 23% of the placebo group.

“Median percent lesion reduction of 81.8% was comparable to that observed for imiquimod 5% cream applied for 16 weeks,” the researchers noted. Median lesion reduction from baseline was 71.8% in the 2.5% group and 25% in the placebo group.

A companion study randomized 164 patients to a placebo cream, 164 patients to imiquimod 2.5% cream, and 162 patients to imiquimod 3.75% cream. No significant improvement was seen with either imiquimod cream, reported Dr. C. William Hanke, a dermatologic surgeon in Carmel, Ind., and his colleagues.

When both studies were evaluated together, though, “efficacy was better with imiquimod 3.75% than with 2.5%. Extending the cycle duration from 2 weeks to 3 weeks did not further increase efficacy,” Dr. Hanke and his colleagues wrote.

Major Finding: A 3.75% imiquimod cream used daily for 2 weeks yielded a median reduction in AK lesions of 82%.

Data Source: Two randomized trials including 969 patients.

Disclosures: Both studies were funded by Graceway Pharmaceuticals. Dr. Swanson, Dr. Hanke, and their coauthors have financial relationships with Graceway.

ORLANDO — Daily application of 3.75% imiquimod cream with a 2-week dosing cycle was well tolerated and effective for treating actinic keratoses in adults, based on data from two studies.

In the first study, 160 patients were randomized to 3.75% imiquimod cream (Aldara, Graceway Pharmaceuticals), 160 patients to 2.5% imiquimod cream, and 159 patients to a placebo cream. The patients, aged 18 years and older, had 5–20 clinically diagnosed actinic keratoses (AKs) on the face or balding scalp, said Dr. Neil Swanson of Oregon Health and Science University, Portland, and his colleagues in a poster at the Orlando Dermatology Aesthetic and Clinical Conference.

Both the 3.75% and 2.5% creams were significantly more effective than placebo at fully clearing AKs after 2 weeks of daily use. Overall, 36% of the 3.75% group and 31% of the 2.5% group achieved complete clearance, vs. 6% of the placebo group.

The 3.75% cream, however, was significantly better than the 2.5% cream for partial clearance and lesion reduction. Approximately 60% of the 3.75% group achieved partial clearance (defined as at least 75%), compared with 48% of the 2.5% group and 23% of the placebo group.

“Median percent lesion reduction of 81.8% was comparable to that observed for imiquimod 5% cream applied for 16 weeks,” the researchers noted. Median lesion reduction from baseline was 71.8% in the 2.5% group and 25% in the placebo group.

A companion study randomized 164 patients to a placebo cream, 164 patients to imiquimod 2.5% cream, and 162 patients to imiquimod 3.75% cream. No significant improvement was seen with either imiquimod cream, reported Dr. C. William Hanke, a dermatologic surgeon in Carmel, Ind., and his colleagues.

When both studies were evaluated together, though, “efficacy was better with imiquimod 3.75% than with 2.5%. Extending the cycle duration from 2 weeks to 3 weeks did not further increase efficacy,” Dr. Hanke and his colleagues wrote.

ORLANDO — Only 16% of adolescents are aware that there is a link between tobacco use and head and neck cancers, according to a survey of 51 respondents aged younger than 18 years.

“The two most common risk factors for head and neck cancers are tobacco use and alcohol consumption,” said Dr. Ajani Nugent of Emory University in Atlanta.

But few studies have examined awareness of head and neck cancer risk among children and adolescents, he said.

Dr. Nugent and his colleagues surveyed 139 medically underserved individuals during a community health screening that was offered at a transitional shelter. The participants who were surveyed included 51 adolescents aged younger than 18 years, 15 individuals aged 19–35 years, and 73 individuals aged 36 years and older. The results of the study were presented in a poster presentation at the Triological Society's Combined Sections Meeting.

Overall, 82% of the adolescent respondents reported that they were aware of the association between tobacco use and lung cancer. However, only 16% of the respondents were aware of a similar association between tobacco use and head and neck cancers, including cancers of the lips, mouth, salivary glands, and throat.

The survey findings are consistent with those from previous studies showing that a majority of the general public recognizes tobacco as a risk factor for lung cancer, but not for head and neck cancers, Dr. Nugent said at the meeting, which was jointly sponsored by the Triological Society and the American College of Surgeons.

In the current study, 53% of the adults aged 19–35 years and 31% of adults aged 36 years and older were aware that there is an association between tobacco use and head and neck cancers.

The study was limited by its small size and distinct population, but the results underscore the need to educate children and adolescents about the association between tobacco use and head and neck cancers, the researchers said.

“This is particularly important because of the well-known cumulative effects of tobacco on upper aerodigestive malignancies,” Dr. Nugent and his colleagues said.

Disclosures: Dr. Nugent and his associates reported having no relevant financial conflicts.

To view a video on the subject, go to www.youtube.com/ElsGlobalMedical

ORLANDO — Only 16% of adolescents are aware that there is a link between tobacco use and head and neck cancers, according to a survey of 51 respondents aged younger than 18 years.

“The two most common risk factors for head and neck cancers are tobacco use and alcohol consumption,” said Dr. Ajani Nugent of Emory University in Atlanta.

But few studies have examined awareness of head and neck cancer risk among children and adolescents, he said.

Dr. Nugent and his colleagues surveyed 139 medically underserved individuals during a community health screening that was offered at a transitional shelter. The participants who were surveyed included 51 adolescents aged younger than 18 years, 15 individuals aged 19–35 years, and 73 individuals aged 36 years and older. The results of the study were presented in a poster presentation at the Triological Society's Combined Sections Meeting.

Overall, 82% of the adolescent respondents reported that they were aware of the association between tobacco use and lung cancer. However, only 16% of the respondents were aware of a similar association between tobacco use and head and neck cancers, including cancers of the lips, mouth, salivary glands, and throat.

The survey findings are consistent with those from previous studies showing that a majority of the general public recognizes tobacco as a risk factor for lung cancer, but not for head and neck cancers, Dr. Nugent said at the meeting, which was jointly sponsored by the Triological Society and the American College of Surgeons.

In the current study, 53% of the adults aged 19–35 years and 31% of adults aged 36 years and older were aware that there is an association between tobacco use and head and neck cancers.

The study was limited by its small size and distinct population, but the results underscore the need to educate children and adolescents about the association between tobacco use and head and neck cancers, the researchers said.

“This is particularly important because of the well-known cumulative effects of tobacco on upper aerodigestive malignancies,” Dr. Nugent and his colleagues said.

Disclosures: Dr. Nugent and his associates reported having no relevant financial conflicts.

To view a video on the subject, go to www.youtube.com/ElsGlobalMedical

ORLANDO — Only 16% of adolescents are aware that there is a link between tobacco use and head and neck cancers, according to a survey of 51 respondents aged younger than 18 years.

“The two most common risk factors for head and neck cancers are tobacco use and alcohol consumption,” said Dr. Ajani Nugent of Emory University in Atlanta.

But few studies have examined awareness of head and neck cancer risk among children and adolescents, he said.

Dr. Nugent and his colleagues surveyed 139 medically underserved individuals during a community health screening that was offered at a transitional shelter. The participants who were surveyed included 51 adolescents aged younger than 18 years, 15 individuals aged 19–35 years, and 73 individuals aged 36 years and older. The results of the study were presented in a poster presentation at the Triological Society's Combined Sections Meeting.

Overall, 82% of the adolescent respondents reported that they were aware of the association between tobacco use and lung cancer. However, only 16% of the respondents were aware of a similar association between tobacco use and head and neck cancers, including cancers of the lips, mouth, salivary glands, and throat.

The survey findings are consistent with those from previous studies showing that a majority of the general public recognizes tobacco as a risk factor for lung cancer, but not for head and neck cancers, Dr. Nugent said at the meeting, which was jointly sponsored by the Triological Society and the American College of Surgeons.

In the current study, 53% of the adults aged 19–35 years and 31% of adults aged 36 years and older were aware that there is an association between tobacco use and head and neck cancers.

The study was limited by its small size and distinct population, but the results underscore the need to educate children and adolescents about the association between tobacco use and head and neck cancers, the researchers said.

“This is particularly important because of the well-known cumulative effects of tobacco on upper aerodigestive malignancies,” Dr. Nugent and his colleagues said.

Disclosures: Dr. Nugent and his associates reported having no relevant financial conflicts.

To view a video on the subject, go to www.youtube.com/ElsGlobalMedical

Major Finding: The prevalence of aortic valve ring stenosis was 38% in women aged 65 years and older who took nitrogen-containing bisphosphonates vs. 59% in women who didn't take bisphosphonates.

Data Source: A cross-sectional study of 3,710 women aged 45–84 years.

Disclosures: Dr. Elmariah has received grant support from the New York Academy of Medicine; the National Heart, Lung, and Blood Institute; and GlaxoSmithKline.

WASHINGTON — Nitrogen-containing bisphosphonates were associated with a significantly decreased prevalence of cardiovascular calcification in women older than 65 years, based on data from 3,710 women who are part of a large, ongoing study.

“Early on in the analysis, we came across a very unexpected finding,” said Dr. Sammy Elmariah of Mount Sinai School of Medicine in New York. “The association with bisphosphonate use was dependent on the patient's age.”

The data were taken from the Multi-Ethnic Study of Atherosclerosis (MESA), a longitudinal cohort study of 6,814 asymptomatic men and women aged 45–84 years. Overall, the bisphosphonate users were more likely to be older and white. In the current study, Dr. Elmariah and his colleagues examined the impact of bisphosphonates on cardiovascular calcification in women. The results were presented at the Eastern Regional Meeting of the American Federation for Medical Research.

Clinical studies have shown that bisphosphonates have an effect on serum lipids, Dr. Elmariah said. Some experimental data, including data from animal models and dialysis patients, suggest that nitrogen-containing bisphosphonates (NCBPs) may limit cardiovascular calcification. Also, the results of one recent study showed that patients on bisphosphonates for osteoporosis had a slower progression of aortic stenosis, he noted.

The prevalence of aortic valve ring stenosis was 38% in women aged 65 years and older who used NCBPs, which was significantly lower than in non-NCBP users of the same age (59%). Aortic valve ring stenosis prevalence also was 38% in women younger than 65 years who used NCBPs; it was significantly lower at 17% among similarly aged non-NCBP users.

Significant patterns also were seen for stenosis of the thoracic aorta and mitral annulus. The relationship between bisphosphonate use and the decrease in cardiovascular calcification in the 65-years-and-older group did not reach statistical significance for the prevalence of aortic valve stenosis and coronary artery stenosis, but the trends were similar.

This study is the first evaluation of the relationship between bisphosphonate use and the prevalence of cardiovascular calcification in a healthy patient population, Dr. Elmariah said.

Cardiovascular calcification was measured using cardiac CT. Bisphosphate use was defined as use of either oral or intravenous bisphosphonates at the time of the cardiac CT. The mean age of the NCBP users was 67 years, and the mean age of the nonusers was 62 years. About 60% of the women were white.

After adjustment for variables including age, body mass index, diabetes, hypertension, smoking, race, insurance status, education, and income level, the significance remained, Dr. Elmariah said.

“We get a fairly dramatic reduction in the prevalence of cardiovascular calcification in bisphosphonate users over the age of 65,” he added.

When the researchers divided the study population into 10-year age groups, they saw a gradual reduction in cardiovascular calcification with increasing age.

The study was limited by its cross-sectional design and by the lack of data on the duration of bisphosphonate use. “It's unclear whether this finding is due to true age-related differences in the pathogenesis of cardiovascular calcification or in the effect of bisphosphonates,” Dr. Elmariah said. But the results merit additional studies, he said.

Major Finding: The prevalence of aortic valve ring stenosis was 38% in women aged 65 years and older who took nitrogen-containing bisphosphonates vs. 59% in women who didn't take bisphosphonates.

Data Source: A cross-sectional study of 3,710 women aged 45–84 years.

Disclosures: Dr. Elmariah has received grant support from the New York Academy of Medicine; the National Heart, Lung, and Blood Institute; and GlaxoSmithKline.

WASHINGTON — Nitrogen-containing bisphosphonates were associated with a significantly decreased prevalence of cardiovascular calcification in women older than 65 years, based on data from 3,710 women who are part of a large, ongoing study.

“Early on in the analysis, we came across a very unexpected finding,” said Dr. Sammy Elmariah of Mount Sinai School of Medicine in New York. “The association with bisphosphonate use was dependent on the patient's age.”

The data were taken from the Multi-Ethnic Study of Atherosclerosis (MESA), a longitudinal cohort study of 6,814 asymptomatic men and women aged 45–84 years. Overall, the bisphosphonate users were more likely to be older and white. In the current study, Dr. Elmariah and his colleagues examined the impact of bisphosphonates on cardiovascular calcification in women. The results were presented at the Eastern Regional Meeting of the American Federation for Medical Research.

Clinical studies have shown that bisphosphonates have an effect on serum lipids, Dr. Elmariah said. Some experimental data, including data from animal models and dialysis patients, suggest that nitrogen-containing bisphosphonates (NCBPs) may limit cardiovascular calcification. Also, the results of one recent study showed that patients on bisphosphonates for osteoporosis had a slower progression of aortic stenosis, he noted.

The prevalence of aortic valve ring stenosis was 38% in women aged 65 years and older who used NCBPs, which was significantly lower than in non-NCBP users of the same age (59%). Aortic valve ring stenosis prevalence also was 38% in women younger than 65 years who used NCBPs; it was significantly lower at 17% among similarly aged non-NCBP users.

Significant patterns also were seen for stenosis of the thoracic aorta and mitral annulus. The relationship between bisphosphonate use and the decrease in cardiovascular calcification in the 65-years-and-older group did not reach statistical significance for the prevalence of aortic valve stenosis and coronary artery stenosis, but the trends were similar.

This study is the first evaluation of the relationship between bisphosphonate use and the prevalence of cardiovascular calcification in a healthy patient population, Dr. Elmariah said.

Cardiovascular calcification was measured using cardiac CT. Bisphosphate use was defined as use of either oral or intravenous bisphosphonates at the time of the cardiac CT. The mean age of the NCBP users was 67 years, and the mean age of the nonusers was 62 years. About 60% of the women were white.

After adjustment for variables including age, body mass index, diabetes, hypertension, smoking, race, insurance status, education, and income level, the significance remained, Dr. Elmariah said.

“We get a fairly dramatic reduction in the prevalence of cardiovascular calcification in bisphosphonate users over the age of 65,” he added.

When the researchers divided the study population into 10-year age groups, they saw a gradual reduction in cardiovascular calcification with increasing age.

The study was limited by its cross-sectional design and by the lack of data on the duration of bisphosphonate use. “It's unclear whether this finding is due to true age-related differences in the pathogenesis of cardiovascular calcification or in the effect of bisphosphonates,” Dr. Elmariah said. But the results merit additional studies, he said.

Major Finding: The prevalence of aortic valve ring stenosis was 38% in women aged 65 years and older who took nitrogen-containing bisphosphonates vs. 59% in women who didn't take bisphosphonates.

Data Source: A cross-sectional study of 3,710 women aged 45–84 years.

Disclosures: Dr. Elmariah has received grant support from the New York Academy of Medicine; the National Heart, Lung, and Blood Institute; and GlaxoSmithKline.

WASHINGTON — Nitrogen-containing bisphosphonates were associated with a significantly decreased prevalence of cardiovascular calcification in women older than 65 years, based on data from 3,710 women who are part of a large, ongoing study.

“Early on in the analysis, we came across a very unexpected finding,” said Dr. Sammy Elmariah of Mount Sinai School of Medicine in New York. “The association with bisphosphonate use was dependent on the patient's age.”

The data were taken from the Multi-Ethnic Study of Atherosclerosis (MESA), a longitudinal cohort study of 6,814 asymptomatic men and women aged 45–84 years. Overall, the bisphosphonate users were more likely to be older and white. In the current study, Dr. Elmariah and his colleagues examined the impact of bisphosphonates on cardiovascular calcification in women. The results were presented at the Eastern Regional Meeting of the American Federation for Medical Research.

Clinical studies have shown that bisphosphonates have an effect on serum lipids, Dr. Elmariah said. Some experimental data, including data from animal models and dialysis patients, suggest that nitrogen-containing bisphosphonates (NCBPs) may limit cardiovascular calcification. Also, the results of one recent study showed that patients on bisphosphonates for osteoporosis had a slower progression of aortic stenosis, he noted.

The prevalence of aortic valve ring stenosis was 38% in women aged 65 years and older who used NCBPs, which was significantly lower than in non-NCBP users of the same age (59%). Aortic valve ring stenosis prevalence also was 38% in women younger than 65 years who used NCBPs; it was significantly lower at 17% among similarly aged non-NCBP users.

Significant patterns also were seen for stenosis of the thoracic aorta and mitral annulus. The relationship between bisphosphonate use and the decrease in cardiovascular calcification in the 65-years-and-older group did not reach statistical significance for the prevalence of aortic valve stenosis and coronary artery stenosis, but the trends were similar.

This study is the first evaluation of the relationship between bisphosphonate use and the prevalence of cardiovascular calcification in a healthy patient population, Dr. Elmariah said.

Cardiovascular calcification was measured using cardiac CT. Bisphosphate use was defined as use of either oral or intravenous bisphosphonates at the time of the cardiac CT. The mean age of the NCBP users was 67 years, and the mean age of the nonusers was 62 years. About 60% of the women were white.

After adjustment for variables including age, body mass index, diabetes, hypertension, smoking, race, insurance status, education, and income level, the significance remained, Dr. Elmariah said.

“We get a fairly dramatic reduction in the prevalence of cardiovascular calcification in bisphosphonate users over the age of 65,” he added.

When the researchers divided the study population into 10-year age groups, they saw a gradual reduction in cardiovascular calcification with increasing age.

The study was limited by its cross-sectional design and by the lack of data on the duration of bisphosphonate use. “It's unclear whether this finding is due to true age-related differences in the pathogenesis of cardiovascular calcification or in the effect of bisphosphonates,” Dr. Elmariah said. But the results merit additional studies, he said.

Major Finding: Balance testing helped to identify brain stem tumors in three children who presented with vertigo.

Data Source: A prospective study of 71 children.

Disclosures: Dr. Dadgostar had no financial conflicts to disclose.

ORLANDO — Balance testing can help identify tumors in children presenting with vertigo, according to a review of 71 children younger than 18 years.

Currently, there isn't a consistent correlation between balance testing and the etiology of vertigo within a pediatric population, said Dr. Anali Dadgostar of the University of British Columbia, Vancouver.

Dr. Dadgostar and her colleagues reviewed all patients younger than age 17 years who were referred to a single hospital between 1999 and 2006 for assessment of vertigo.

Data from 110 patients were reviewed, and 71 underwent balance tests, such as posturography, which included uphill and downhill motion; and caloric testing, which stimulated the inner ear and nearby nerves using water of different temperatures.

In all, 15 patients had abnormal findings based on the balance assessment. These patients ranged in age from 7 to 16 years, with an average age of 12 years, according to the findings, which were presented at the Triological Society's Combined Sections Meeting.

“The most worrisome finding within the balance testing was the cerebellar sign,” Dr. Dadgostar said.

Four of the patients with abnormal findings had cerebellar signs, and three of these patients were ultimately diagnosed with brain stem tumors.

In addition, just over half (53%) of the patients with abnormal findings had caloric reductions that suggested Meniere's disease.

Children with vertigo often are referred to clinicians who don't have the professional training to get a correct evaluation, Dr. Dadgostar noted at the meeting, which was jointly sponsored by the Triological Society and the American College of Surgeons.

These results suggest that balance testing in children with vertigo can be a useful diagnostic adjunct that might spare some children the need for more invasive diagnostic procedures, Dr. Dadgostar said.

The study was limited by potential selection biases.

Additional research is needed to compare balance testing directly with other methods for assessing children with vertigo, she added.

Major Finding: Balance testing helped to identify brain stem tumors in three children who presented with vertigo.

Data Source: A prospective study of 71 children.

Disclosures: Dr. Dadgostar had no financial conflicts to disclose.

ORLANDO — Balance testing can help identify tumors in children presenting with vertigo, according to a review of 71 children younger than 18 years.

Currently, there isn't a consistent correlation between balance testing and the etiology of vertigo within a pediatric population, said Dr. Anali Dadgostar of the University of British Columbia, Vancouver.

Dr. Dadgostar and her colleagues reviewed all patients younger than age 17 years who were referred to a single hospital between 1999 and 2006 for assessment of vertigo.

Data from 110 patients were reviewed, and 71 underwent balance tests, such as posturography, which included uphill and downhill motion; and caloric testing, which stimulated the inner ear and nearby nerves using water of different temperatures.

In all, 15 patients had abnormal findings based on the balance assessment. These patients ranged in age from 7 to 16 years, with an average age of 12 years, according to the findings, which were presented at the Triological Society's Combined Sections Meeting.

“The most worrisome finding within the balance testing was the cerebellar sign,” Dr. Dadgostar said.

Four of the patients with abnormal findings had cerebellar signs, and three of these patients were ultimately diagnosed with brain stem tumors.

In addition, just over half (53%) of the patients with abnormal findings had caloric reductions that suggested Meniere's disease.

Children with vertigo often are referred to clinicians who don't have the professional training to get a correct evaluation, Dr. Dadgostar noted at the meeting, which was jointly sponsored by the Triological Society and the American College of Surgeons.

These results suggest that balance testing in children with vertigo can be a useful diagnostic adjunct that might spare some children the need for more invasive diagnostic procedures, Dr. Dadgostar said.

The study was limited by potential selection biases.

Additional research is needed to compare balance testing directly with other methods for assessing children with vertigo, she added.

Major Finding: Balance testing helped to identify brain stem tumors in three children who presented with vertigo.

Data Source: A prospective study of 71 children.

Disclosures: Dr. Dadgostar had no financial conflicts to disclose.

ORLANDO — Balance testing can help identify tumors in children presenting with vertigo, according to a review of 71 children younger than 18 years.

Currently, there isn't a consistent correlation between balance testing and the etiology of vertigo within a pediatric population, said Dr. Anali Dadgostar of the University of British Columbia, Vancouver.

Dr. Dadgostar and her colleagues reviewed all patients younger than age 17 years who were referred to a single hospital between 1999 and 2006 for assessment of vertigo.

Data from 110 patients were reviewed, and 71 underwent balance tests, such as posturography, which included uphill and downhill motion; and caloric testing, which stimulated the inner ear and nearby nerves using water of different temperatures.

In all, 15 patients had abnormal findings based on the balance assessment. These patients ranged in age from 7 to 16 years, with an average age of 12 years, according to the findings, which were presented at the Triological Society's Combined Sections Meeting.

“The most worrisome finding within the balance testing was the cerebellar sign,” Dr. Dadgostar said.

Four of the patients with abnormal findings had cerebellar signs, and three of these patients were ultimately diagnosed with brain stem tumors.

In addition, just over half (53%) of the patients with abnormal findings had caloric reductions that suggested Meniere's disease.

Children with vertigo often are referred to clinicians who don't have the professional training to get a correct evaluation, Dr. Dadgostar noted at the meeting, which was jointly sponsored by the Triological Society and the American College of Surgeons.

These results suggest that balance testing in children with vertigo can be a useful diagnostic adjunct that might spare some children the need for more invasive diagnostic procedures, Dr. Dadgostar said.

The study was limited by potential selection biases.

Additional research is needed to compare balance testing directly with other methods for assessing children with vertigo, she added.

Major Finding: Symptom scores related to sleep and sexual function improved significantly after adults with CRS underwent surgery.

Data Source: A prospective study of 113 adults with CRS who presented to a single tertiary care center.

Disclosures: Dr. Benninger is a consultant and has received research funding from ArthroCare Corp., and coauthor Dr. Timothy Smith is a consultant for Sinexus.

ORLANDO — Surgical treatment of chronic rhinosinusitis can improve sleep and sexual function in adult patients who failed medical therapy, based on a study of 113 patients.

“It has been shown that rhinosinusitis has a significant quality of life impact even in comparison to chronic debilitating diseases such as diabetes and congestive heart failure,” said Dr. Michael Benninger of the Cleveland Clinic, who presented the study findings at the annual meeting of the Triological Society.

Previous studies have examined how treatment of chronic rhinosinusitis (CRS) affects quality of life, but the impact of CRS treatment on patients' sleep and sexual function has not been well studied, Dr. Benninger said.

In this study, Dr. Benninger and his colleagues prospectively enrolled English-speaking adults aged 18 years and older who presented to a tertiary care center with chronic rhinosinusitis. Prior to endoscopic sinus surgery, each patient completed the Rhinosinusitis Disability Index to show how they perceived the impact of CRS on their quality of life. Responses were measured using a 5-point Likert scale, with 0 being “never” and 5 being “always.” The patients were followed for at least 9 months.

Before surgery, 41% of the patients said that their CRS “sometimes,” “almost always,” or “always” affected their sexual function, compared with a significantly lower 19% of patients following surgery.

The percentage of patients who reported that their CRS “never” or “almost never” affected their sleep improved significantly, from 15% before surgery to more than 50% after.

Many specific symptoms of CRS may have a negative impact both on sleep quality and sexual activity, Dr. Benninger said at the meeting. For example, CRS sufferers may not feel like kissing when they have a chronically runny nose and congestion.

The study results suggest that the surgery is effective in improving sleep and sexual function, although a longer follow-up period is needed to show whether the improvements persist. In addition, a more detailed analysis may be needed to better evaluate the relationships among particular CRS symptoms, such as nasal drainage or facial pain, on patients' overall perception of their sexual function, the researchers noted.

Major Finding: Symptom scores related to sleep and sexual function improved significantly after adults with CRS underwent surgery.

Data Source: A prospective study of 113 adults with CRS who presented to a single tertiary care center.

Disclosures: Dr. Benninger is a consultant and has received research funding from ArthroCare Corp., and coauthor Dr. Timothy Smith is a consultant for Sinexus.

ORLANDO — Surgical treatment of chronic rhinosinusitis can improve sleep and sexual function in adult patients who failed medical therapy, based on a study of 113 patients.

“It has been shown that rhinosinusitis has a significant quality of life impact even in comparison to chronic debilitating diseases such as diabetes and congestive heart failure,” said Dr. Michael Benninger of the Cleveland Clinic, who presented the study findings at the annual meeting of the Triological Society.

Previous studies have examined how treatment of chronic rhinosinusitis (CRS) affects quality of life, but the impact of CRS treatment on patients' sleep and sexual function has not been well studied, Dr. Benninger said.

In this study, Dr. Benninger and his colleagues prospectively enrolled English-speaking adults aged 18 years and older who presented to a tertiary care center with chronic rhinosinusitis. Prior to endoscopic sinus surgery, each patient completed the Rhinosinusitis Disability Index to show how they perceived the impact of CRS on their quality of life. Responses were measured using a 5-point Likert scale, with 0 being “never” and 5 being “always.” The patients were followed for at least 9 months.

Before surgery, 41% of the patients said that their CRS “sometimes,” “almost always,” or “always” affected their sexual function, compared with a significantly lower 19% of patients following surgery.

The percentage of patients who reported that their CRS “never” or “almost never” affected their sleep improved significantly, from 15% before surgery to more than 50% after.

Many specific symptoms of CRS may have a negative impact both on sleep quality and sexual activity, Dr. Benninger said at the meeting. For example, CRS sufferers may not feel like kissing when they have a chronically runny nose and congestion.

The study results suggest that the surgery is effective in improving sleep and sexual function, although a longer follow-up period is needed to show whether the improvements persist. In addition, a more detailed analysis may be needed to better evaluate the relationships among particular CRS symptoms, such as nasal drainage or facial pain, on patients' overall perception of their sexual function, the researchers noted.

Major Finding: Symptom scores related to sleep and sexual function improved significantly after adults with CRS underwent surgery.

Data Source: A prospective study of 113 adults with CRS who presented to a single tertiary care center.

Disclosures: Dr. Benninger is a consultant and has received research funding from ArthroCare Corp., and coauthor Dr. Timothy Smith is a consultant for Sinexus.

ORLANDO — Surgical treatment of chronic rhinosinusitis can improve sleep and sexual function in adult patients who failed medical therapy, based on a study of 113 patients.

“It has been shown that rhinosinusitis has a significant quality of life impact even in comparison to chronic debilitating diseases such as diabetes and congestive heart failure,” said Dr. Michael Benninger of the Cleveland Clinic, who presented the study findings at the annual meeting of the Triological Society.

Previous studies have examined how treatment of chronic rhinosinusitis (CRS) affects quality of life, but the impact of CRS treatment on patients' sleep and sexual function has not been well studied, Dr. Benninger said.

In this study, Dr. Benninger and his colleagues prospectively enrolled English-speaking adults aged 18 years and older who presented to a tertiary care center with chronic rhinosinusitis. Prior to endoscopic sinus surgery, each patient completed the Rhinosinusitis Disability Index to show how they perceived the impact of CRS on their quality of life. Responses were measured using a 5-point Likert scale, with 0 being “never” and 5 being “always.” The patients were followed for at least 9 months.

Before surgery, 41% of the patients said that their CRS “sometimes,” “almost always,” or “always” affected their sexual function, compared with a significantly lower 19% of patients following surgery.

The percentage of patients who reported that their CRS “never” or “almost never” affected their sleep improved significantly, from 15% before surgery to more than 50% after.

Many specific symptoms of CRS may have a negative impact both on sleep quality and sexual activity, Dr. Benninger said at the meeting. For example, CRS sufferers may not feel like kissing when they have a chronically runny nose and congestion.

The study results suggest that the surgery is effective in improving sleep and sexual function, although a longer follow-up period is needed to show whether the improvements persist. In addition, a more detailed analysis may be needed to better evaluate the relationships among particular CRS symptoms, such as nasal drainage or facial pain, on patients' overall perception of their sexual function, the researchers noted.