Heidi Splete

WASHINGTON — Measures of exhaled nitric oxide levels may add another dimension to the evaluation of asthma beyond the information available from the Asthma Control Test and spirometry findings, based on data from a study presented at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

Fractional exhaled nitric oxide (FeNO) may be “a surrogate marker for airway inflammation,” Dr. Brian C. Schroer of the Cleveland Clinic said in an interview. Neither the Asthma Control Test (ACT) nor spirometry evaluate airway inflammation.

Dr. Schroer and his colleagues reviewed charts from the asthma-related medical visits of 139 adults, all of whom concurrently completed the ACT, FeNO, and spirometry tests. Approximately 66% of the patients were female, and 78% were white. The study excluded smokers and patients with concomitant conditions including chronic obstructive pulmonary disease and cystic fibrosis.

Overall, the average FeNO score was 30.8 parts per billion (ppb), the average ACT score was 19.2, the average forced expiratory volume in 1 second (FEV₁) score was 86.5%, and the average FEV₁/forced vital capacity (FVC) score was 87.4%. Scatter plots showed no correlation between FeNO and either ACT or spirometry measures.

Dr. Schroer said that he was initially surprised by the finding that inflammation was not increased in patients whose ACT scores were either decreased or normal. But the ACT doesn't take airway inflammation into account, and spirometry measures only airway hyperresponsiveness, he said. The lack of correlation held true when the patients were divided into four groups based on severity.

The FeNO measures in patients with intermittent asthma, mild persistent asthma, moderate persistent asthma, and severe persistent asthma were 20.4 ppb, 29.3 ppb, 25.9 ppb, and 39.7 ppb, respectively. The ACT scores in these groups were 22.2, 20.0, 19.7, and 17.1, respectively. The FEV₁ scores were 103%, 95.1%, 90.4%, and 70.4%, respectively, and the FEV₁/FVC scores were 93.3%, 90.7%, 91.2%, and 79.0%, respectively.

The study was supported by the William O. Wagner, M.D., Research and Education Fund. Dr. Schroer had no financial conflicts to disclose.

To view a related video, go to www.youtube.com/FamilyPracticeNews

WASHINGTON — Measures of exhaled nitric oxide levels may add another dimension to the evaluation of asthma beyond the information available from the Asthma Control Test and spirometry findings, based on data from a study presented at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

Fractional exhaled nitric oxide (FeNO) may be “a surrogate marker for airway inflammation,” Dr. Brian C. Schroer of the Cleveland Clinic said in an interview. Neither the Asthma Control Test (ACT) nor spirometry evaluate airway inflammation.

Dr. Schroer and his colleagues reviewed charts from the asthma-related medical visits of 139 adults, all of whom concurrently completed the ACT, FeNO, and spirometry tests. Approximately 66% of the patients were female, and 78% were white. The study excluded smokers and patients with concomitant conditions including chronic obstructive pulmonary disease and cystic fibrosis.

Overall, the average FeNO score was 30.8 parts per billion (ppb), the average ACT score was 19.2, the average forced expiratory volume in 1 second (FEV₁) score was 86.5%, and the average FEV₁/forced vital capacity (FVC) score was 87.4%. Scatter plots showed no correlation between FeNO and either ACT or spirometry measures.

Dr. Schroer said that he was initially surprised by the finding that inflammation was not increased in patients whose ACT scores were either decreased or normal. But the ACT doesn't take airway inflammation into account, and spirometry measures only airway hyperresponsiveness, he said. The lack of correlation held true when the patients were divided into four groups based on severity.

The FeNO measures in patients with intermittent asthma, mild persistent asthma, moderate persistent asthma, and severe persistent asthma were 20.4 ppb, 29.3 ppb, 25.9 ppb, and 39.7 ppb, respectively. The ACT scores in these groups were 22.2, 20.0, 19.7, and 17.1, respectively. The FEV₁ scores were 103%, 95.1%, 90.4%, and 70.4%, respectively, and the FEV₁/FVC scores were 93.3%, 90.7%, 91.2%, and 79.0%, respectively.

The study was supported by the William O. Wagner, M.D., Research and Education Fund. Dr. Schroer had no financial conflicts to disclose.

To view a related video, go to www.youtube.com/FamilyPracticeNews

WASHINGTON — Measures of exhaled nitric oxide levels may add another dimension to the evaluation of asthma beyond the information available from the Asthma Control Test and spirometry findings, based on data from a study presented at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

Fractional exhaled nitric oxide (FeNO) may be “a surrogate marker for airway inflammation,” Dr. Brian C. Schroer of the Cleveland Clinic said in an interview. Neither the Asthma Control Test (ACT) nor spirometry evaluate airway inflammation.

Dr. Schroer and his colleagues reviewed charts from the asthma-related medical visits of 139 adults, all of whom concurrently completed the ACT, FeNO, and spirometry tests. Approximately 66% of the patients were female, and 78% were white. The study excluded smokers and patients with concomitant conditions including chronic obstructive pulmonary disease and cystic fibrosis.

Overall, the average FeNO score was 30.8 parts per billion (ppb), the average ACT score was 19.2, the average forced expiratory volume in 1 second (FEV₁) score was 86.5%, and the average FEV₁/forced vital capacity (FVC) score was 87.4%. Scatter plots showed no correlation between FeNO and either ACT or spirometry measures.

Dr. Schroer said that he was initially surprised by the finding that inflammation was not increased in patients whose ACT scores were either decreased or normal. But the ACT doesn't take airway inflammation into account, and spirometry measures only airway hyperresponsiveness, he said. The lack of correlation held true when the patients were divided into four groups based on severity.

The FeNO measures in patients with intermittent asthma, mild persistent asthma, moderate persistent asthma, and severe persistent asthma were 20.4 ppb, 29.3 ppb, 25.9 ppb, and 39.7 ppb, respectively. The ACT scores in these groups were 22.2, 20.0, 19.7, and 17.1, respectively. The FEV₁ scores were 103%, 95.1%, 90.4%, and 70.4%, respectively, and the FEV₁/FVC scores were 93.3%, 90.7%, 91.2%, and 79.0%, respectively.

The study was supported by the William O. Wagner, M.D., Research and Education Fund. Dr. Schroer had no financial conflicts to disclose.

To view a related video, go to www.youtube.com/FamilyPracticeNews

WASHINGTON – The Obama administration has launched the first major U.S. initiative against HIV/AIDS in more than a decade.

The 5-year campaign, “Act Against Aids,” is a joint effort of the Centers for Disease Control and Prevention, the Department of Health and Human Services, and the White House to educate the public about HIV/AIDS, which remains a serious problem in the United States despite advances in treatment that allow more patients to survive.

Recent data from the Kaiser Family Foundation show that concern about HIV infection has declined in recent years, said Dr. Kevin Fenton, director of the CDC National Center for HIV/AIDS.

“People don't recognize that they are at risk, and they engage in high-risk behavior,” Dr. Fenton said.

The campaign, launched in early April, kicks off with a series of public service announcements, including radio ads, online ads, and public transportation ads, with the theme, “Every 91/2 minutes.” Data from the CDC show that about 56,000 Americans become infected with HIV each year, which translates to 1 person becoming infected every 91/2 minutes. Doctors need to know that the Act Against AIDS campaign will be working to raise awareness about HIV infection and encourage testing, Dr. Fenton said in an interview.

“This [effort] is likely to have an impact on health seeking behaviors,” he said.

Consumer information about the campaign can be found at NineAndaHalfMinutes.org

WASHINGTON – The Obama administration has launched the first major U.S. initiative against HIV/AIDS in more than a decade.

The 5-year campaign, “Act Against Aids,” is a joint effort of the Centers for Disease Control and Prevention, the Department of Health and Human Services, and the White House to educate the public about HIV/AIDS, which remains a serious problem in the United States despite advances in treatment that allow more patients to survive.

Recent data from the Kaiser Family Foundation show that concern about HIV infection has declined in recent years, said Dr. Kevin Fenton, director of the CDC National Center for HIV/AIDS.

“People don't recognize that they are at risk, and they engage in high-risk behavior,” Dr. Fenton said.

The campaign, launched in early April, kicks off with a series of public service announcements, including radio ads, online ads, and public transportation ads, with the theme, “Every 91/2 minutes.” Data from the CDC show that about 56,000 Americans become infected with HIV each year, which translates to 1 person becoming infected every 91/2 minutes. Doctors need to know that the Act Against AIDS campaign will be working to raise awareness about HIV infection and encourage testing, Dr. Fenton said in an interview.

“This [effort] is likely to have an impact on health seeking behaviors,” he said.

Consumer information about the campaign can be found at NineAndaHalfMinutes.org

WASHINGTON – The Obama administration has launched the first major U.S. initiative against HIV/AIDS in more than a decade.

The 5-year campaign, “Act Against Aids,” is a joint effort of the Centers for Disease Control and Prevention, the Department of Health and Human Services, and the White House to educate the public about HIV/AIDS, which remains a serious problem in the United States despite advances in treatment that allow more patients to survive.

Recent data from the Kaiser Family Foundation show that concern about HIV infection has declined in recent years, said Dr. Kevin Fenton, director of the CDC National Center for HIV/AIDS.

“People don't recognize that they are at risk, and they engage in high-risk behavior,” Dr. Fenton said.

The campaign, launched in early April, kicks off with a series of public service announcements, including radio ads, online ads, and public transportation ads, with the theme, “Every 91/2 minutes.” Data from the CDC show that about 56,000 Americans become infected with HIV each year, which translates to 1 person becoming infected every 91/2 minutes. Doctors need to know that the Act Against AIDS campaign will be working to raise awareness about HIV infection and encourage testing, Dr. Fenton said in an interview.

“This [effort] is likely to have an impact on health seeking behaviors,” he said.

Consumer information about the campaign can be found at NineAndaHalfMinutes.org

WASHINGTON — The Obama administration has launched the first major U.S. initiative against HIV/AIDS in more than a decade.

The 5-year campaign, “Act Against AIDS,” is a joint effort of the Centers for Disease Control and Prevention, the Department of Health and Human Services, and the White House to educate the public about HIV/AIDS, which remains a serious problem in the United States despite advances in treatment that allow more patients to survive longer.

Recent data from the Kaiser Family Foundation show that concern about HIV has declined in recent years, said Dr. Kevin Fenton, director of the CDC National Center for HIV/AIDS. “People don't recognize that they are at risk, and they engage in high-risk behavior,” he said.

The goal of the campaign is to educate the public about the risks of HIV.

The campaign kicks off with a series of public service announcements, including radio, online, and public transportation ads with the theme “Every 91/2 Minutes.” According to data from the CDC, approximately 56,000 Americans become infected with HIV each year, which translates to one person becoming infected every 91/2 minutes.

The campaign also will target specific communities that are at increased risk for HIV, starting with the African American community, said Melody Barnes, assistant to the president and director of the White House Domestic Policy Council. Targeted outreach is also planned for the gay, bisexual, and Latino communities, she said.

Consumer information regarding the educational campaign can be found at nineandahalfminutes.org

WASHINGTON — The Obama administration has launched the first major U.S. initiative against HIV/AIDS in more than a decade.

The 5-year campaign, “Act Against AIDS,” is a joint effort of the Centers for Disease Control and Prevention, the Department of Health and Human Services, and the White House to educate the public about HIV/AIDS, which remains a serious problem in the United States despite advances in treatment that allow more patients to survive longer.

Recent data from the Kaiser Family Foundation show that concern about HIV has declined in recent years, said Dr. Kevin Fenton, director of the CDC National Center for HIV/AIDS. “People don't recognize that they are at risk, and they engage in high-risk behavior,” he said.

The goal of the campaign is to educate the public about the risks of HIV.

The campaign kicks off with a series of public service announcements, including radio, online, and public transportation ads with the theme “Every 91/2 Minutes.” According to data from the CDC, approximately 56,000 Americans become infected with HIV each year, which translates to one person becoming infected every 91/2 minutes.

The campaign also will target specific communities that are at increased risk for HIV, starting with the African American community, said Melody Barnes, assistant to the president and director of the White House Domestic Policy Council. Targeted outreach is also planned for the gay, bisexual, and Latino communities, she said.

Consumer information regarding the educational campaign can be found at nineandahalfminutes.org

WASHINGTON — The Obama administration has launched the first major U.S. initiative against HIV/AIDS in more than a decade.

The 5-year campaign, “Act Against AIDS,” is a joint effort of the Centers for Disease Control and Prevention, the Department of Health and Human Services, and the White House to educate the public about HIV/AIDS, which remains a serious problem in the United States despite advances in treatment that allow more patients to survive longer.

Recent data from the Kaiser Family Foundation show that concern about HIV has declined in recent years, said Dr. Kevin Fenton, director of the CDC National Center for HIV/AIDS. “People don't recognize that they are at risk, and they engage in high-risk behavior,” he said.

The goal of the campaign is to educate the public about the risks of HIV.

The campaign kicks off with a series of public service announcements, including radio, online, and public transportation ads with the theme “Every 91/2 Minutes.” According to data from the CDC, approximately 56,000 Americans become infected with HIV each year, which translates to one person becoming infected every 91/2 minutes.

The campaign also will target specific communities that are at increased risk for HIV, starting with the African American community, said Melody Barnes, assistant to the president and director of the White House Domestic Policy Council. Targeted outreach is also planned for the gay, bisexual, and Latino communities, she said.

Consumer information regarding the educational campaign can be found at nineandahalfminutes.org

WASHINGTON — Heavier people may have worse asthma control than do their lighter counterparts, but they are not significantly less likely to respond to treatment, based on data from a pair of studies presented at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

In one study of 221 adults with severe asthma, body mass index (BMI) had no significant effect on impaired prednisone absorption or on any abnormalities in prednisone clearance.

Previous studies have shown a relationship between increased weight and asthma severity, said Dr. Joshua Davidson of National Jewish Health in Denver. Dr. Davidson and his colleagues measured the in vitro glucocorticoid responses to prednisone, dexamethasone, fluticasone propionate, and budesonide in asthma patients in three different weight categories.

BMI was positively associated with an increased number of steroid side effects, said Dr. Davidson, who had no conflicts of interest to disclose. But BMI was not associated with any reduction in prednisone absorption or clearance, or in steroid response.

But asthma control remains a problem for heavier patients. Dr. Hector Ortega of GlaxoSmithKline and his colleagues reviewed data from the Asthma Control Characteristics and Prevalence Survey Study (ACCESS), which included 2,238 patients aged 15 years and older from 35 asthma clinics across the United States.

The researchers found that 65% of the adults with a BMI greater than 30 had poorly controlled asthma vs. 52% of those with a BMI of 30 or less. This difference was statistically significant, Dr. Ortega said.

After controlling for multiple variables, a BMI greater than 30 was independently associated with a 54% increased risk of poorly controlled asthma, Dr. Ortega said.

WASHINGTON — Heavier people may have worse asthma control than do their lighter counterparts, but they are not significantly less likely to respond to treatment, based on data from a pair of studies presented at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

In one study of 221 adults with severe asthma, body mass index (BMI) had no significant effect on impaired prednisone absorption or on any abnormalities in prednisone clearance.

Previous studies have shown a relationship between increased weight and asthma severity, said Dr. Joshua Davidson of National Jewish Health in Denver. Dr. Davidson and his colleagues measured the in vitro glucocorticoid responses to prednisone, dexamethasone, fluticasone propionate, and budesonide in asthma patients in three different weight categories.

BMI was positively associated with an increased number of steroid side effects, said Dr. Davidson, who had no conflicts of interest to disclose. But BMI was not associated with any reduction in prednisone absorption or clearance, or in steroid response.

But asthma control remains a problem for heavier patients. Dr. Hector Ortega of GlaxoSmithKline and his colleagues reviewed data from the Asthma Control Characteristics and Prevalence Survey Study (ACCESS), which included 2,238 patients aged 15 years and older from 35 asthma clinics across the United States.

The researchers found that 65% of the adults with a BMI greater than 30 had poorly controlled asthma vs. 52% of those with a BMI of 30 or less. This difference was statistically significant, Dr. Ortega said.

After controlling for multiple variables, a BMI greater than 30 was independently associated with a 54% increased risk of poorly controlled asthma, Dr. Ortega said.

WASHINGTON — Heavier people may have worse asthma control than do their lighter counterparts, but they are not significantly less likely to respond to treatment, based on data from a pair of studies presented at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

In one study of 221 adults with severe asthma, body mass index (BMI) had no significant effect on impaired prednisone absorption or on any abnormalities in prednisone clearance.

Previous studies have shown a relationship between increased weight and asthma severity, said Dr. Joshua Davidson of National Jewish Health in Denver. Dr. Davidson and his colleagues measured the in vitro glucocorticoid responses to prednisone, dexamethasone, fluticasone propionate, and budesonide in asthma patients in three different weight categories.

BMI was positively associated with an increased number of steroid side effects, said Dr. Davidson, who had no conflicts of interest to disclose. But BMI was not associated with any reduction in prednisone absorption or clearance, or in steroid response.

But asthma control remains a problem for heavier patients. Dr. Hector Ortega of GlaxoSmithKline and his colleagues reviewed data from the Asthma Control Characteristics and Prevalence Survey Study (ACCESS), which included 2,238 patients aged 15 years and older from 35 asthma clinics across the United States.

The researchers found that 65% of the adults with a BMI greater than 30 had poorly controlled asthma vs. 52% of those with a BMI of 30 or less. This difference was statistically significant, Dr. Ortega said.

After controlling for multiple variables, a BMI greater than 30 was independently associated with a 54% increased risk of poorly controlled asthma, Dr. Ortega said.

WASHINGTON — Measures of exhaled nitric oxide levels may add another dimension to the evaluation of asthma, based on data from a study presented at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

Fractional exhaled nitric oxide (FeNO) may be “a surrogate marker for airway inflammation,” Dr. Brian C. Schroer of the Cleveland Clinic said in an interview. Neither the Asthma Control Test (ACT) nor spirometry evaluate airway inflammation.

Dr. Schroer and his colleagues reviewed charts from the asthma-related medical visits of 139 adults, all of whom concurrently completed the ACT, FeNO, and spirometry tests. Approximately 66% of the patients were female, and 78% were white. The study excluded smokers and patients with concomitant conditions including chronic obstructive pulmonary disease, cystic fibrosis, and hypereosinophilic syndrome.

Overall, the average FeNO score was 30.8 parts per billion (ppb), the average ACT score was 19.2, the average forced expiratory volume in 1 second (FEV₁) score was 86.5%, and the average FEV₁/forced vital capacity (FVC) score was 87.4%. Scatter plots showed no correlation between FeNO and either ACT or spirometry measures.

Dr. Schroer said that he was initially surprised by the finding that inflammation was not increased in patients whose ACT scores were either decreased or normal. But the ACT doesn't take airway inflammation into account, and spirometry measures only airway hyperresponsiveness, he said, “so it doesn't surprise me in the long run that the airway inflammation isn't correlated with these other measurements of asthma control.”

The lack of correlation held true when the patients were divided into four groups based on asthma severity.

The study was supported by the William O. Wagner, M.D., Research and Education Fund. Dr. Schroer had no financial conflicts to disclose.

A related video is at ww.youtube.com/InternalMedicineNews

WASHINGTON — Measures of exhaled nitric oxide levels may add another dimension to the evaluation of asthma, based on data from a study presented at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

Fractional exhaled nitric oxide (FeNO) may be “a surrogate marker for airway inflammation,” Dr. Brian C. Schroer of the Cleveland Clinic said in an interview. Neither the Asthma Control Test (ACT) nor spirometry evaluate airway inflammation.

Dr. Schroer and his colleagues reviewed charts from the asthma-related medical visits of 139 adults, all of whom concurrently completed the ACT, FeNO, and spirometry tests. Approximately 66% of the patients were female, and 78% were white. The study excluded smokers and patients with concomitant conditions including chronic obstructive pulmonary disease, cystic fibrosis, and hypereosinophilic syndrome.

Overall, the average FeNO score was 30.8 parts per billion (ppb), the average ACT score was 19.2, the average forced expiratory volume in 1 second (FEV₁) score was 86.5%, and the average FEV₁/forced vital capacity (FVC) score was 87.4%. Scatter plots showed no correlation between FeNO and either ACT or spirometry measures.

Dr. Schroer said that he was initially surprised by the finding that inflammation was not increased in patients whose ACT scores were either decreased or normal. But the ACT doesn't take airway inflammation into account, and spirometry measures only airway hyperresponsiveness, he said, “so it doesn't surprise me in the long run that the airway inflammation isn't correlated with these other measurements of asthma control.”

The lack of correlation held true when the patients were divided into four groups based on asthma severity.

The study was supported by the William O. Wagner, M.D., Research and Education Fund. Dr. Schroer had no financial conflicts to disclose.

A related video is at ww.youtube.com/InternalMedicineNews

WASHINGTON — Measures of exhaled nitric oxide levels may add another dimension to the evaluation of asthma, based on data from a study presented at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

Fractional exhaled nitric oxide (FeNO) may be “a surrogate marker for airway inflammation,” Dr. Brian C. Schroer of the Cleveland Clinic said in an interview. Neither the Asthma Control Test (ACT) nor spirometry evaluate airway inflammation.

Dr. Schroer and his colleagues reviewed charts from the asthma-related medical visits of 139 adults, all of whom concurrently completed the ACT, FeNO, and spirometry tests. Approximately 66% of the patients were female, and 78% were white. The study excluded smokers and patients with concomitant conditions including chronic obstructive pulmonary disease, cystic fibrosis, and hypereosinophilic syndrome.

Overall, the average FeNO score was 30.8 parts per billion (ppb), the average ACT score was 19.2, the average forced expiratory volume in 1 second (FEV₁) score was 86.5%, and the average FEV₁/forced vital capacity (FVC) score was 87.4%. Scatter plots showed no correlation between FeNO and either ACT or spirometry measures.

Dr. Schroer said that he was initially surprised by the finding that inflammation was not increased in patients whose ACT scores were either decreased or normal. But the ACT doesn't take airway inflammation into account, and spirometry measures only airway hyperresponsiveness, he said, “so it doesn't surprise me in the long run that the airway inflammation isn't correlated with these other measurements of asthma control.”

The lack of correlation held true when the patients were divided into four groups based on asthma severity.

The study was supported by the William O. Wagner, M.D., Research and Education Fund. Dr. Schroer had no financial conflicts to disclose.

A related video is at ww.youtube.com/InternalMedicineNews

ARLINGTON, VA. — Pressure ulcers on the heels present unique challenges, but proactive care can go a long way in preventing these wounds in immobile, elderly people, said Catherine Ratliff, Ph.D., at a meeting of the National Pressure Ulcer Advisory Panel.

The heels are especially sensitive to pressure because there's not much subcutaneous fat or tissue covering the bone in elderly people, explained Dr. Ratliff of the University of Virginia, Charlottesville.

“As we age, the shock absorbency of the foot decreases, which increases the risk of developing a heel pressure ulcer,” she said. Other factors that can increase risk with age include dry skin, leg spasms, and Parkinson's disease, which lead some people to dig their heels in the bed when they attempt to move, said Dr. Ratliff.

She recommended that caregivers assess four factors to determine an individual's risk for heel pressure ulcers: age older than 70 years, diagnosis of diabetes, decreased mental status, and lack of movement in the legs and feet. Also, consider whether individuals are ambulatory, walk with assistance, or are confined to bed, she said.

Caregivers should take some precautions to prevent heel pressure ulcers even in individuals who are at low risk, Dr. Ratliff said. Check the circulation in the affected area, check whether the skin is warm or cool to the touch, examine the feet for redness, and apply moisturizer to the heels. Encourage individuals to get out of bed at least three times a day if possible. If that doesn't happen, consider a pressure-redistributing mattress.

Individuals who are at higher risk, or those who already have a heel pressure ulcer, require stricter interventions, she said. Assess the patient and apply moisturizers more often, work hard to get the individual mobile, and perhaps use devices that take pressure off the heels.

Whether devices such as foam- or air-filled boots are used, the first step in caring for any pressure ulcer is to take the pressure off, said Dr. Ratliff. “It's important to go back and continually reassess the pressure situation.” For instance, blankets or pillows used as cushions can compress over time, she said.

In cases of stage I heel pressure ulcers, caregivers should assess whether shear is a factor and, if so, use moisturizers to reduce friction. It's important to regularly remove any dressing to monitor the ulcer, she added. Other tips include keeping the area warm and assessing whether the patient's bed and footwear might be increasing risk.

Blisters are a concern with stage II pressure ulcers on the heels, said Dr. Ratliff. If a blister pops, trim the surrounding skin, she advised.

For a stage III pressure ulcer on the heel, it's important to monitor the area for signs of infection and, if it develops, to treat with antimicrobials.

“The wound will not heal as long as there is any type of dead slough present,” Dr. Ratliff said. Unfortunately, circulation is an issue in many patients with pressure ulcers, especially older adults. If eschar is soft, it needs to come off, she said. Sometimes hard eschar will lift up by itself, and then it can be trimmed. But don't debride stable, hard heel eschar, she emphasized, because individuals with stable heel eschar have poor perfusion in their legs.

If using any device to relieve pressure on the heels, caregivers should check it periodically to make sure it isn't too tight. Dr. Ratliff added that although some beds have specialized designs meant to reduce pressure on the heels, “raising the bed changes the pressure relief for the heel.”

Dr. Ratliff disclosed no conflicts related to her talk.

ARLINGTON, VA. — Pressure ulcers on the heels present unique challenges, but proactive care can go a long way in preventing these wounds in immobile, elderly people, said Catherine Ratliff, Ph.D., at a meeting of the National Pressure Ulcer Advisory Panel.

The heels are especially sensitive to pressure because there's not much subcutaneous fat or tissue covering the bone in elderly people, explained Dr. Ratliff of the University of Virginia, Charlottesville.

“As we age, the shock absorbency of the foot decreases, which increases the risk of developing a heel pressure ulcer,” she said. Other factors that can increase risk with age include dry skin, leg spasms, and Parkinson's disease, which lead some people to dig their heels in the bed when they attempt to move, said Dr. Ratliff.

She recommended that caregivers assess four factors to determine an individual's risk for heel pressure ulcers: age older than 70 years, diagnosis of diabetes, decreased mental status, and lack of movement in the legs and feet. Also, consider whether individuals are ambulatory, walk with assistance, or are confined to bed, she said.

Caregivers should take some precautions to prevent heel pressure ulcers even in individuals who are at low risk, Dr. Ratliff said. Check the circulation in the affected area, check whether the skin is warm or cool to the touch, examine the feet for redness, and apply moisturizer to the heels. Encourage individuals to get out of bed at least three times a day if possible. If that doesn't happen, consider a pressure-redistributing mattress.

Individuals who are at higher risk, or those who already have a heel pressure ulcer, require stricter interventions, she said. Assess the patient and apply moisturizers more often, work hard to get the individual mobile, and perhaps use devices that take pressure off the heels.

Whether devices such as foam- or air-filled boots are used, the first step in caring for any pressure ulcer is to take the pressure off, said Dr. Ratliff. “It's important to go back and continually reassess the pressure situation.” For instance, blankets or pillows used as cushions can compress over time, she said.

In cases of stage I heel pressure ulcers, caregivers should assess whether shear is a factor and, if so, use moisturizers to reduce friction. It's important to regularly remove any dressing to monitor the ulcer, she added. Other tips include keeping the area warm and assessing whether the patient's bed and footwear might be increasing risk.

Blisters are a concern with stage II pressure ulcers on the heels, said Dr. Ratliff. If a blister pops, trim the surrounding skin, she advised.

For a stage III pressure ulcer on the heel, it's important to monitor the area for signs of infection and, if it develops, to treat with antimicrobials.

“The wound will not heal as long as there is any type of dead slough present,” Dr. Ratliff said. Unfortunately, circulation is an issue in many patients with pressure ulcers, especially older adults. If eschar is soft, it needs to come off, she said. Sometimes hard eschar will lift up by itself, and then it can be trimmed. But don't debride stable, hard heel eschar, she emphasized, because individuals with stable heel eschar have poor perfusion in their legs.

If using any device to relieve pressure on the heels, caregivers should check it periodically to make sure it isn't too tight. Dr. Ratliff added that although some beds have specialized designs meant to reduce pressure on the heels, “raising the bed changes the pressure relief for the heel.”

Dr. Ratliff disclosed no conflicts related to her talk.

ARLINGTON, VA. — Pressure ulcers on the heels present unique challenges, but proactive care can go a long way in preventing these wounds in immobile, elderly people, said Catherine Ratliff, Ph.D., at a meeting of the National Pressure Ulcer Advisory Panel.

The heels are especially sensitive to pressure because there's not much subcutaneous fat or tissue covering the bone in elderly people, explained Dr. Ratliff of the University of Virginia, Charlottesville.

“As we age, the shock absorbency of the foot decreases, which increases the risk of developing a heel pressure ulcer,” she said. Other factors that can increase risk with age include dry skin, leg spasms, and Parkinson's disease, which lead some people to dig their heels in the bed when they attempt to move, said Dr. Ratliff.

She recommended that caregivers assess four factors to determine an individual's risk for heel pressure ulcers: age older than 70 years, diagnosis of diabetes, decreased mental status, and lack of movement in the legs and feet. Also, consider whether individuals are ambulatory, walk with assistance, or are confined to bed, she said.

Caregivers should take some precautions to prevent heel pressure ulcers even in individuals who are at low risk, Dr. Ratliff said. Check the circulation in the affected area, check whether the skin is warm or cool to the touch, examine the feet for redness, and apply moisturizer to the heels. Encourage individuals to get out of bed at least three times a day if possible. If that doesn't happen, consider a pressure-redistributing mattress.

Individuals who are at higher risk, or those who already have a heel pressure ulcer, require stricter interventions, she said. Assess the patient and apply moisturizers more often, work hard to get the individual mobile, and perhaps use devices that take pressure off the heels.

Whether devices such as foam- or air-filled boots are used, the first step in caring for any pressure ulcer is to take the pressure off, said Dr. Ratliff. “It's important to go back and continually reassess the pressure situation.” For instance, blankets or pillows used as cushions can compress over time, she said.

In cases of stage I heel pressure ulcers, caregivers should assess whether shear is a factor and, if so, use moisturizers to reduce friction. It's important to regularly remove any dressing to monitor the ulcer, she added. Other tips include keeping the area warm and assessing whether the patient's bed and footwear might be increasing risk.

Blisters are a concern with stage II pressure ulcers on the heels, said Dr. Ratliff. If a blister pops, trim the surrounding skin, she advised.

For a stage III pressure ulcer on the heel, it's important to monitor the area for signs of infection and, if it develops, to treat with antimicrobials.

“The wound will not heal as long as there is any type of dead slough present,” Dr. Ratliff said. Unfortunately, circulation is an issue in many patients with pressure ulcers, especially older adults. If eschar is soft, it needs to come off, she said. Sometimes hard eschar will lift up by itself, and then it can be trimmed. But don't debride stable, hard heel eschar, she emphasized, because individuals with stable heel eschar have poor perfusion in their legs.

If using any device to relieve pressure on the heels, caregivers should check it periodically to make sure it isn't too tight. Dr. Ratliff added that although some beds have specialized designs meant to reduce pressure on the heels, “raising the bed changes the pressure relief for the heel.”

Dr. Ratliff disclosed no conflicts related to her talk.

ARLINGTON, VA. — It may not be the first tool that physicians think of, but nutrition can be a powerful one against pressure ulcers, dietitian Mary Ellen Posthauer told a meeting of the National Pressure Ulcer Advisory Panel.

“Please involve dietitians early on if you see people with pressure ulcers or those who are at high risk of developing pressure ulcers,” said Ms. Posthauer of the company Supreme Care West in Evansville, Ill.

People with pressure ulcers are in a hypermetabolic condition, she explained. A small person with a pressure ulcer is probably pulling protein from his or her lean body tissue.

More research is needed on the impact of nutrition on wound healing in obese patients, Ms. Posthauer said. Patients with stage III or IV pressure ulcers should not be on restricted diets. Patients with pressure ulcers need to eat 30-35 kilocalories per kilogram of body weight a day, she said. “If the person doesn't eat the food, you aren't going to get wound healing.”

Ms. Posthauer offered several tips for how to provide enough calories:

▸ Consider the individual's favorite foods and cultural preferences. The goal is to serve “foods that they are actually going to eat, not give to their tablemates.”

▸ Offer variety. A chocolate milkshake is less attractive than usual when a person gets three a day.

▸ Use fortified foods, such as high-density cereal and pudding, or follow recipes for high-calorie, high-protein foods.

▸ Offer high-calorie, high-protein supplements, using trial and error to determine which one the patient prefers. Research has shown that offering a nutritional supplement between meals improves the acceptance of the supplement and mealtime food.

“There needs to be a team effort in following up to see that the food is being consumed,” Ms. Posthauer emphasized. “Dietitians are great at developing menus and sending out food, but if nobody is eating it, we haven't achieved much.”

Studies have shown that increased protein intake is associated with better healing of pressure ulcers, with a recommended daily intake of 1.25 to 1.5 g/kg of body weight. But it's important to monitor both healing rates and renal function in a person getting supplements and to adjust intake as needed, Ms. Posthauer said. “Monitor the healing, and if you aren't seeing results, try increasing the amount of protein.”

Enteral nutrition is an option for some individuals, but only if it is monitored carefully, Ms. Posthauer said. When considering enteral nutrition, ask the individual and family members whether they understand the risks and benefits associated with this more invasive form of feeding. If individuals receive tube feeding, then the formula for the liquid being administered should be evaluated periodically to make sure that it is providing enough calories and protein to improve wound healing.

Research does not support the use of mega doses of vitamin C to enhance wound healing, but some evidence supports the use of zinc supplements if a deficiency exists in that mineral. Strive for a balanced diet and confirm a deficiency before adding any vitamin supplement, said Ms. Posthauer. Remember that many liquid calorie supplements meet the daily recommendations for most vitamins and minerals, so further additions may be unnecessary, she added.

Relatives may know which foods older kin prefer and may offer strategies to help elders get the calories they need for optimal wound healing.

Ms. Posthauer disclosed no financial conflicts relevant to her presentation.

ARLINGTON, VA. — It may not be the first tool that physicians think of, but nutrition can be a powerful one against pressure ulcers, dietitian Mary Ellen Posthauer told a meeting of the National Pressure Ulcer Advisory Panel.

“Please involve dietitians early on if you see people with pressure ulcers or those who are at high risk of developing pressure ulcers,” said Ms. Posthauer of the company Supreme Care West in Evansville, Ill.

People with pressure ulcers are in a hypermetabolic condition, she explained. A small person with a pressure ulcer is probably pulling protein from his or her lean body tissue.

More research is needed on the impact of nutrition on wound healing in obese patients, Ms. Posthauer said. Patients with stage III or IV pressure ulcers should not be on restricted diets. Patients with pressure ulcers need to eat 30-35 kilocalories per kilogram of body weight a day, she said. “If the person doesn't eat the food, you aren't going to get wound healing.”

Ms. Posthauer offered several tips for how to provide enough calories:

▸ Consider the individual's favorite foods and cultural preferences. The goal is to serve “foods that they are actually going to eat, not give to their tablemates.”

▸ Offer variety. A chocolate milkshake is less attractive than usual when a person gets three a day.

▸ Use fortified foods, such as high-density cereal and pudding, or follow recipes for high-calorie, high-protein foods.

▸ Offer high-calorie, high-protein supplements, using trial and error to determine which one the patient prefers. Research has shown that offering a nutritional supplement between meals improves the acceptance of the supplement and mealtime food.

“There needs to be a team effort in following up to see that the food is being consumed,” Ms. Posthauer emphasized. “Dietitians are great at developing menus and sending out food, but if nobody is eating it, we haven't achieved much.”

Studies have shown that increased protein intake is associated with better healing of pressure ulcers, with a recommended daily intake of 1.25 to 1.5 g/kg of body weight. But it's important to monitor both healing rates and renal function in a person getting supplements and to adjust intake as needed, Ms. Posthauer said. “Monitor the healing, and if you aren't seeing results, try increasing the amount of protein.”

Enteral nutrition is an option for some individuals, but only if it is monitored carefully, Ms. Posthauer said. When considering enteral nutrition, ask the individual and family members whether they understand the risks and benefits associated with this more invasive form of feeding. If individuals receive tube feeding, then the formula for the liquid being administered should be evaluated periodically to make sure that it is providing enough calories and protein to improve wound healing.

Research does not support the use of mega doses of vitamin C to enhance wound healing, but some evidence supports the use of zinc supplements if a deficiency exists in that mineral. Strive for a balanced diet and confirm a deficiency before adding any vitamin supplement, said Ms. Posthauer. Remember that many liquid calorie supplements meet the daily recommendations for most vitamins and minerals, so further additions may be unnecessary, she added.

Relatives may know which foods older kin prefer and may offer strategies to help elders get the calories they need for optimal wound healing.

Ms. Posthauer disclosed no financial conflicts relevant to her presentation.

ARLINGTON, VA. — It may not be the first tool that physicians think of, but nutrition can be a powerful one against pressure ulcers, dietitian Mary Ellen Posthauer told a meeting of the National Pressure Ulcer Advisory Panel.

“Please involve dietitians early on if you see people with pressure ulcers or those who are at high risk of developing pressure ulcers,” said Ms. Posthauer of the company Supreme Care West in Evansville, Ill.

People with pressure ulcers are in a hypermetabolic condition, she explained. A small person with a pressure ulcer is probably pulling protein from his or her lean body tissue.

More research is needed on the impact of nutrition on wound healing in obese patients, Ms. Posthauer said. Patients with stage III or IV pressure ulcers should not be on restricted diets. Patients with pressure ulcers need to eat 30-35 kilocalories per kilogram of body weight a day, she said. “If the person doesn't eat the food, you aren't going to get wound healing.”

Ms. Posthauer offered several tips for how to provide enough calories:

▸ Consider the individual's favorite foods and cultural preferences. The goal is to serve “foods that they are actually going to eat, not give to their tablemates.”

▸ Offer variety. A chocolate milkshake is less attractive than usual when a person gets three a day.

▸ Use fortified foods, such as high-density cereal and pudding, or follow recipes for high-calorie, high-protein foods.

▸ Offer high-calorie, high-protein supplements, using trial and error to determine which one the patient prefers. Research has shown that offering a nutritional supplement between meals improves the acceptance of the supplement and mealtime food.

“There needs to be a team effort in following up to see that the food is being consumed,” Ms. Posthauer emphasized. “Dietitians are great at developing menus and sending out food, but if nobody is eating it, we haven't achieved much.”

Studies have shown that increased protein intake is associated with better healing of pressure ulcers, with a recommended daily intake of 1.25 to 1.5 g/kg of body weight. But it's important to monitor both healing rates and renal function in a person getting supplements and to adjust intake as needed, Ms. Posthauer said. “Monitor the healing, and if you aren't seeing results, try increasing the amount of protein.”

Enteral nutrition is an option for some individuals, but only if it is monitored carefully, Ms. Posthauer said. When considering enteral nutrition, ask the individual and family members whether they understand the risks and benefits associated with this more invasive form of feeding. If individuals receive tube feeding, then the formula for the liquid being administered should be evaluated periodically to make sure that it is providing enough calories and protein to improve wound healing.

Research does not support the use of mega doses of vitamin C to enhance wound healing, but some evidence supports the use of zinc supplements if a deficiency exists in that mineral. Strive for a balanced diet and confirm a deficiency before adding any vitamin supplement, said Ms. Posthauer. Remember that many liquid calorie supplements meet the daily recommendations for most vitamins and minerals, so further additions may be unnecessary, she added.

Relatives may know which foods older kin prefer and may offer strategies to help elders get the calories they need for optimal wound healing.

Ms. Posthauer disclosed no financial conflicts relevant to her presentation.

WASHINGTON — Children with asthma who used 6 or more canisters of short-acting beta₂-agonists in a year had twice the risk of asthma exacerbation, compared with children who used fewer than 6 canisters, based on results of a database review of more than 33,000 children aged 6-17 years.

Studies have shown an association between increased use of short-acting beta₂-agonists (SABAs) and asthma exacerbation in children, but a threshold for high SABA use has not been established, said Christopher M. Blanchette, Ph.D., of Lovelace Respiratory Research Institute in Kannapolis, N.C.

Dr. Blanchette and his colleagues reviewed data from 33,951 children with asthma who were continuously enrolled for 2 years in the PharMetrics Patient-Centric Database (a pool of more than 70 commercial health insurance plans) between July 1, 2003, and June 30, 2007. The researchers excluded children with chronic obstructive pulmonary disease, bronchitis, cystic fibrosis, and other conditions that required oral cortico-steroids. Average age was 11 years.

Asthma exacerbation was determined by any or all of the following: oral corticosteroid prescriptions, urgent care or emergency department visits for asthma, and hospitalizations for asthma.

Overall, most (70%) children used 0-2 canisters per year. A total of 24% of the children used no canisters, 46% used 0.5-2 canisters, 23% used 2.5-6 canisters, 5% used 6.5-12 canisters, and 2% used more than 12 canisters, according to the results presented at annual meeting of the American Academy of Allergy, Asthma, and Immunology.

A total of 3,147 children (9%) used 6 or more SABA canisters, which was significantly associated with asthma exacerbation. In addition to a doubled risk of asthma exacerbation, children who used 6 or more canisters per year were more than three times as likely to be hospitalized or to have emergency department or urgent care visits, compared with children who used 0-5 canisters.

The study was limited by a lack of control for all potentially confounding factors, including the use of inhaled corticosteroids, the researchers wrote. The most common comorbidities were allergies or allergic rhinitis (35%), acute pharyngitis (25%), and acute upper respiratory infections (22%).

Although most of the children in the study did not meet the threshold associated with increased risk, the findings highlight the need for physicians to watch for the overuse of SABAs as a sign of uncontrolled asthma and adjust treatment accordingly to reduce the risk of exacerbation. The study was sponsored by AstraZeneca PLC.

To watch a related video, go to www.youtube.com/FamilyPracticeNews

WASHINGTON — Children with asthma who used 6 or more canisters of short-acting beta₂-agonists in a year had twice the risk of asthma exacerbation, compared with children who used fewer than 6 canisters, based on results of a database review of more than 33,000 children aged 6-17 years.

Studies have shown an association between increased use of short-acting beta₂-agonists (SABAs) and asthma exacerbation in children, but a threshold for high SABA use has not been established, said Christopher M. Blanchette, Ph.D., of Lovelace Respiratory Research Institute in Kannapolis, N.C.

Dr. Blanchette and his colleagues reviewed data from 33,951 children with asthma who were continuously enrolled for 2 years in the PharMetrics Patient-Centric Database (a pool of more than 70 commercial health insurance plans) between July 1, 2003, and June 30, 2007. The researchers excluded children with chronic obstructive pulmonary disease, bronchitis, cystic fibrosis, and other conditions that required oral cortico-steroids. Average age was 11 years.

Asthma exacerbation was determined by any or all of the following: oral corticosteroid prescriptions, urgent care or emergency department visits for asthma, and hospitalizations for asthma.

Overall, most (70%) children used 0-2 canisters per year. A total of 24% of the children used no canisters, 46% used 0.5-2 canisters, 23% used 2.5-6 canisters, 5% used 6.5-12 canisters, and 2% used more than 12 canisters, according to the results presented at annual meeting of the American Academy of Allergy, Asthma, and Immunology.

A total of 3,147 children (9%) used 6 or more SABA canisters, which was significantly associated with asthma exacerbation. In addition to a doubled risk of asthma exacerbation, children who used 6 or more canisters per year were more than three times as likely to be hospitalized or to have emergency department or urgent care visits, compared with children who used 0-5 canisters.

The study was limited by a lack of control for all potentially confounding factors, including the use of inhaled corticosteroids, the researchers wrote. The most common comorbidities were allergies or allergic rhinitis (35%), acute pharyngitis (25%), and acute upper respiratory infections (22%).

Although most of the children in the study did not meet the threshold associated with increased risk, the findings highlight the need for physicians to watch for the overuse of SABAs as a sign of uncontrolled asthma and adjust treatment accordingly to reduce the risk of exacerbation. The study was sponsored by AstraZeneca PLC.

To watch a related video, go to www.youtube.com/FamilyPracticeNews

WASHINGTON — Children with asthma who used 6 or more canisters of short-acting beta₂-agonists in a year had twice the risk of asthma exacerbation, compared with children who used fewer than 6 canisters, based on results of a database review of more than 33,000 children aged 6-17 years.

Studies have shown an association between increased use of short-acting beta₂-agonists (SABAs) and asthma exacerbation in children, but a threshold for high SABA use has not been established, said Christopher M. Blanchette, Ph.D., of Lovelace Respiratory Research Institute in Kannapolis, N.C.

Dr. Blanchette and his colleagues reviewed data from 33,951 children with asthma who were continuously enrolled for 2 years in the PharMetrics Patient-Centric Database (a pool of more than 70 commercial health insurance plans) between July 1, 2003, and June 30, 2007. The researchers excluded children with chronic obstructive pulmonary disease, bronchitis, cystic fibrosis, and other conditions that required oral cortico-steroids. Average age was 11 years.

Asthma exacerbation was determined by any or all of the following: oral corticosteroid prescriptions, urgent care or emergency department visits for asthma, and hospitalizations for asthma.

Overall, most (70%) children used 0-2 canisters per year. A total of 24% of the children used no canisters, 46% used 0.5-2 canisters, 23% used 2.5-6 canisters, 5% used 6.5-12 canisters, and 2% used more than 12 canisters, according to the results presented at annual meeting of the American Academy of Allergy, Asthma, and Immunology.

A total of 3,147 children (9%) used 6 or more SABA canisters, which was significantly associated with asthma exacerbation. In addition to a doubled risk of asthma exacerbation, children who used 6 or more canisters per year were more than three times as likely to be hospitalized or to have emergency department or urgent care visits, compared with children who used 0-5 canisters.

The study was limited by a lack of control for all potentially confounding factors, including the use of inhaled corticosteroids, the researchers wrote. The most common comorbidities were allergies or allergic rhinitis (35%), acute pharyngitis (25%), and acute upper respiratory infections (22%).

Although most of the children in the study did not meet the threshold associated with increased risk, the findings highlight the need for physicians to watch for the overuse of SABAs as a sign of uncontrolled asthma and adjust treatment accordingly to reduce the risk of exacerbation. The study was sponsored by AstraZeneca PLC.

To watch a related video, go to www.youtube.com/FamilyPracticeNews

ARLINGTON, VA. — The first international guidelines for the prevention and treatment of pressure ulcers are available for public comment, and a final version will be released in May, according to presenters at the National Pressure Ulcer Advisory Panel.

The international collaboration adds a new dimension to the guidelines, NPUAP President Laura Edsberg, Ph.D., said in an interview. “We have expanded the level of evidence that we are sharing,” she said. The draft guidelines result from the joint effort between the NPUAP and the European Pressure Ulcer Advisory Panel, based in England.

The treatment and prevention of pressure ulcers has become a hot topic in wound care, because pressure ulcers are among the conditions that Medicare considers preventable and soon will not reimburse hospitals for, if the wounds arise there.

The draft guidelines cover both prevention and treatment. The prevention section details what makes patients vulnerable to pressure ulcers, such as long-term contact with devices including nasal cannulae and tracheostomy plates. But the guidelines also emphasize preventive strategies, such as managing patient nourishment and hydration.

Additional guidelines compare different types of wound dressings, including foam, alginate, and hydrogel. Protocols for cleaning and supporting pressure ulcers, and alternative healing strategies including hydrotherapy, ultrasound, and maggot therapy are addressed.

More information on the draft guidelines and how to comment on them is at the NPUAP Web site, www.npuap.org

ARLINGTON, VA. — The first international guidelines for the prevention and treatment of pressure ulcers are available for public comment, and a final version will be released in May, according to presenters at the National Pressure Ulcer Advisory Panel.

The international collaboration adds a new dimension to the guidelines, NPUAP President Laura Edsberg, Ph.D., said in an interview. “We have expanded the level of evidence that we are sharing,” she said. The draft guidelines result from the joint effort between the NPUAP and the European Pressure Ulcer Advisory Panel, based in England.

The treatment and prevention of pressure ulcers has become a hot topic in wound care, because pressure ulcers are among the conditions that Medicare considers preventable and soon will not reimburse hospitals for, if the wounds arise there.

The draft guidelines cover both prevention and treatment. The prevention section details what makes patients vulnerable to pressure ulcers, such as long-term contact with devices including nasal cannulae and tracheostomy plates. But the guidelines also emphasize preventive strategies, such as managing patient nourishment and hydration.

Additional guidelines compare different types of wound dressings, including foam, alginate, and hydrogel. Protocols for cleaning and supporting pressure ulcers, and alternative healing strategies including hydrotherapy, ultrasound, and maggot therapy are addressed.

More information on the draft guidelines and how to comment on them is at the NPUAP Web site, www.npuap.org

ARLINGTON, VA. — The first international guidelines for the prevention and treatment of pressure ulcers are available for public comment, and a final version will be released in May, according to presenters at the National Pressure Ulcer Advisory Panel.

The international collaboration adds a new dimension to the guidelines, NPUAP President Laura Edsberg, Ph.D., said in an interview. “We have expanded the level of evidence that we are sharing,” she said. The draft guidelines result from the joint effort between the NPUAP and the European Pressure Ulcer Advisory Panel, based in England.

The treatment and prevention of pressure ulcers has become a hot topic in wound care, because pressure ulcers are among the conditions that Medicare considers preventable and soon will not reimburse hospitals for, if the wounds arise there.

The draft guidelines cover both prevention and treatment. The prevention section details what makes patients vulnerable to pressure ulcers, such as long-term contact with devices including nasal cannulae and tracheostomy plates. But the guidelines also emphasize preventive strategies, such as managing patient nourishment and hydration.

Additional guidelines compare different types of wound dressings, including foam, alginate, and hydrogel. Protocols for cleaning and supporting pressure ulcers, and alternative healing strategies including hydrotherapy, ultrasound, and maggot therapy are addressed.

More information on the draft guidelines and how to comment on them is at the NPUAP Web site, www.npuap.org

WASHINGTON — A 100-mcg dose of the inhaled corticosteroid mometasone furoate, given either once or twice daily, significantly reduced the need for rescue medications in 296 children aged 4–11 years with mild to moderate persistent asthma.

Overall, children in both the once- and twice-daily mometasone furoate (MF) groups averaged significantly fewer puffs of rescue medication after 12 weeks, compared with a placebo group. The average baseline rescue medication use was 1.3 puffs per day in all three groups. Children in the once-daily and twice-daily treatment groups reported average reductions in rescue medication use of 19.5% and 13.4%, respectively. By contrast, rescue medication use increased by an average of 22% in the placebo group during the study period.

“Rescue medication use was reduced quickly and showed a trend for progressive reduction over the entire 12-week treatment period,” Dr. William E. Berger, who is in private practice in Mission Viejo, Calif., and his colleagues, reported in a poster presentation at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

MF recently was approved to treat asthma in children aged 4–11 years. The current study was part of a larger trial that contributed to the drug's approval, Dr. Berger said in an interview.

The children were randomized to receive a 100-mcg dose of MF (via a dry powder inhaler) once daily (98 children) or twice daily (99 children), or a placebo (99 children). The researchers calculated changes in the number of rescue medication puffs per day and measured peak morning and evening expiratory flow.

The average age of the children was 9 years in the treatment groups and 8 years in the placebo group. The demographics and baseline uses of rescue medication and peak flow measurements were not significantly different among the three groups.

Significant improvements in peak expiratory flow were observed in both treatment groups compared with placebo during each week of the study.

Both doses of MF were well tolerated; the incidence of adverse events was similar in the once-daily, twice-daily, and placebo groups (55%, 60%, and 52%, respectively).

Adverse events included headache and upper respiratory tract infection.

The study population included children aged 4–11 years who had been diagnosed with asthma for at least 6 months. Children who used nebulizers or other long-acting beta2-agonists, had been hospitalized during the 3 months before the study, or who used systemic corticosteroids for at least 15 days during the 6 months before the study were excluded.

These findings parallel the results from the larger drug approval study, which showed that inhaled MF given either once or twice daily was significantly more effective than was placebo at improving pulmonary function in children with mild to moderate asthma, the researchers wrote.

The study was sponsored by Schering-Plough Corp.

WASHINGTON — A 100-mcg dose of the inhaled corticosteroid mometasone furoate, given either once or twice daily, significantly reduced the need for rescue medications in 296 children aged 4–11 years with mild to moderate persistent asthma.

Overall, children in both the once- and twice-daily mometasone furoate (MF) groups averaged significantly fewer puffs of rescue medication after 12 weeks, compared with a placebo group. The average baseline rescue medication use was 1.3 puffs per day in all three groups. Children in the once-daily and twice-daily treatment groups reported average reductions in rescue medication use of 19.5% and 13.4%, respectively. By contrast, rescue medication use increased by an average of 22% in the placebo group during the study period.

“Rescue medication use was reduced quickly and showed a trend for progressive reduction over the entire 12-week treatment period,” Dr. William E. Berger, who is in private practice in Mission Viejo, Calif., and his colleagues, reported in a poster presentation at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

MF recently was approved to treat asthma in children aged 4–11 years. The current study was part of a larger trial that contributed to the drug's approval, Dr. Berger said in an interview.

The children were randomized to receive a 100-mcg dose of MF (via a dry powder inhaler) once daily (98 children) or twice daily (99 children), or a placebo (99 children). The researchers calculated changes in the number of rescue medication puffs per day and measured peak morning and evening expiratory flow.

The average age of the children was 9 years in the treatment groups and 8 years in the placebo group. The demographics and baseline uses of rescue medication and peak flow measurements were not significantly different among the three groups.

Significant improvements in peak expiratory flow were observed in both treatment groups compared with placebo during each week of the study.

Both doses of MF were well tolerated; the incidence of adverse events was similar in the once-daily, twice-daily, and placebo groups (55%, 60%, and 52%, respectively).

Adverse events included headache and upper respiratory tract infection.

The study population included children aged 4–11 years who had been diagnosed with asthma for at least 6 months. Children who used nebulizers or other long-acting beta2-agonists, had been hospitalized during the 3 months before the study, or who used systemic corticosteroids for at least 15 days during the 6 months before the study were excluded.

These findings parallel the results from the larger drug approval study, which showed that inhaled MF given either once or twice daily was significantly more effective than was placebo at improving pulmonary function in children with mild to moderate asthma, the researchers wrote.

The study was sponsored by Schering-Plough Corp.

WASHINGTON — A 100-mcg dose of the inhaled corticosteroid mometasone furoate, given either once or twice daily, significantly reduced the need for rescue medications in 296 children aged 4–11 years with mild to moderate persistent asthma.

Overall, children in both the once- and twice-daily mometasone furoate (MF) groups averaged significantly fewer puffs of rescue medication after 12 weeks, compared with a placebo group. The average baseline rescue medication use was 1.3 puffs per day in all three groups. Children in the once-daily and twice-daily treatment groups reported average reductions in rescue medication use of 19.5% and 13.4%, respectively. By contrast, rescue medication use increased by an average of 22% in the placebo group during the study period.

“Rescue medication use was reduced quickly and showed a trend for progressive reduction over the entire 12-week treatment period,” Dr. William E. Berger, who is in private practice in Mission Viejo, Calif., and his colleagues, reported in a poster presentation at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

MF recently was approved to treat asthma in children aged 4–11 years. The current study was part of a larger trial that contributed to the drug's approval, Dr. Berger said in an interview.

The children were randomized to receive a 100-mcg dose of MF (via a dry powder inhaler) once daily (98 children) or twice daily (99 children), or a placebo (99 children). The researchers calculated changes in the number of rescue medication puffs per day and measured peak morning and evening expiratory flow.

The average age of the children was 9 years in the treatment groups and 8 years in the placebo group. The demographics and baseline uses of rescue medication and peak flow measurements were not significantly different among the three groups.

Significant improvements in peak expiratory flow were observed in both treatment groups compared with placebo during each week of the study.

Both doses of MF were well tolerated; the incidence of adverse events was similar in the once-daily, twice-daily, and placebo groups (55%, 60%, and 52%, respectively).

Adverse events included headache and upper respiratory tract infection.

The study population included children aged 4–11 years who had been diagnosed with asthma for at least 6 months. Children who used nebulizers or other long-acting beta2-agonists, had been hospitalized during the 3 months before the study, or who used systemic corticosteroids for at least 15 days during the 6 months before the study were excluded.

These findings parallel the results from the larger drug approval study, which showed that inhaled MF given either once or twice daily was significantly more effective than was placebo at improving pulmonary function in children with mild to moderate asthma, the researchers wrote.

The study was sponsored by Schering-Plough Corp.