American Thoracic Society Journal news tips for May 2005 (second issue)

05/13/05

HISPANICS SHOW WORSE LUNG CANCER SURVIVAL RATE

In a national population-based study of 16,036 lung cancer patients, Hispanics with curable stage I lung cancer had poorer lung cancer specific survival rates, as well as worse all-cause mortality, than a much larger group of white persons. Researchers said that the disparities between the two ethnic groups were largely explained by lower rates of surgical removal of cancerous tissue (surgical resection) among the Hispanics and a higher probably of being diagnosed at the more advanced IB stage for lung cancer.

According to the investigators, lung cancer is the leading cause of death among Hispanic men and the second leading cause of death among Hispanic women. They pointed out that meaningful long-term survival was only possible when non-small cell lung cancer cases are diagnosed at an early stage and treated with surgical resection of the affected lung tissue. Then patients have at least a 65 percent probability of surviving five years or longer. Without surgical resection, the median survival is less than two years.

In this study, the five-year lung cancer survival rate was 54 percent for Hispanics versus 62 percent for whites. Also, Hispanics were more frequently diagnosed with later stage lung cancer IB.

All cases in the investigation were selected from the Surveillance, Epidemiology, and End Results (SEER) program, a national database that collects information on all incident cancer cases in selected areas of the United States. Of the 16,036 eligible patients with stage I primary non-small cell lung cancer who were diagnosed between 1991 and 2000, 646 (4.3 percent) were Hispanics and 15,350 (95.7 percent) were white.

The study appears in the second issue for May 2005 of the American Thoracic Society's peer-reviewed American Journal of Respiratory and Critical Care Medicine.

NONINVASIVE MEASUREMENT OF AIRWAY INFLAMMATION IN ASTHMATIC CHILDREN

For the first time, researchers have reported results from a prospective study directed at determining the predictive value of using noninvasive measures to monitor airway inflammation in children with asthma who have undergone inhaled corticosteroid medication reduction.

British investigators showed that successful lowering of inhaled corticosteroid doses could be predicted based on two noninvasive markers that could demonstrate lower inflammation levels in the airways. The two markers used and their key indicator levels were: exhaled nitric oxide levels below 22 parts per billion (ppb) and an absence of eosinophils (a type of white blood cell) in induced sputum.

According to the authors, asthma is characterized by variable degrees of airway obstruction, hyperresponsiveness, and chronic inflammation. Inhaled corticosteroid treatment is a mainstay of asthma therapy because it targets underlying airway inflammation. However, possible side effects from high doses and long-term use include stunted growth in children, poor wound healing, elevated blood sugar levels, and stomach bleeding, to mention only a few specific problems.

In the study, every eight weeks, researchers checked 40 children with stable asthma who were eligible for inhaled steroid reduction. If clinically indicated, their steroid dose was halved. At each subsequent visit, in an effort to determine the degree of airway inflammation, the young persons had measurements of their exhaled nitric oxide, bronchial hyperresponsiveness as shown from sputum induction, and collection and analysis of exhaled breath condensate. These indicators were used in an effort to predict either success or failure of steroid reduction.

The researchers said that 30 of the 40 children, or 75 percent, tolerated at least a one dose reduction. Twelve of 40 children, or 30 percent, were successfully weaned off. In total, 15 of 40, or 38 percent, experienced loss of asthma control.

The investigators pointed out that treatment reduction was successful in all children who had no eosinophils in induced sputum before the attempted reduction.

They said that the percentage of sputum eosinophils and an exhaled nitric oxide level of 22 ppb or greater were the most significant predictors of failed inhaled corticosteroid reduction in children with apparently well-controlled asthma.

The study appears in the second issue for May 2005 of the American Thoracic Society's peer-reviewed American Journal of Respiratory and Critical Care Medicine.

Source: Eurekalert & others

Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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