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    <recommendedItem id="20100101_19_366"
                     title="Placental Infection Could Spur Asthma (CME/CE)"
                     score="0.011"
                     href="http://www.medpagetoday.com/Pediatrics/Asthma/tb/18252?impressionId=1265794251619"
                     
      Preterm birth complicated by chorioamnionitis may modestly increase a child&apos;s risk of later asthma, researchers found.&lt;br&gt;
&lt;br&gt;Children born preterm after a pregnancy complicated by the bacterial infection of placenta and amniotic fluid (chorioamnionitis) were significantly more likely to develop asthma by age eight than preemies without such exposure, according to Darios Getahun, MD, MPH, of Kaiser Permanente Department of Research and Evaluation in Pasadena.&lt;br&gt;
&lt;br&gt;Asthma diagnosis was nearly threefold more common among chorioamnionitis-exposed children who had been born preterm than those carried to term, they wrote in the February &lt;em&gt;Archives of Pediatrics &amp;amp; Adolescent Medicine&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;Premature birth may not give an infant&apos;s lungs a chance to fully develop, leading to early infection and inflammation that elevate risk of chronic lung disease, such as asthma.&lt;p&gt;&lt;/p&gt;
&lt;p&gt;However, in utero exposures could be an important contributor as well, Getahun explained in an interview.&lt;/p&gt;
&lt;p&gt;Chorioamnionitis is thought to be associated with more than half of all preterm births.&lt;/p&gt;
&lt;p&gt;Fetal lungs stay in contact with the amniotic fluid which, when infected, may expose the developing lung to microorganisms, toxic substances, and inflammatory mediators, the researchers wrote.&lt;/p&gt;
&lt;p&gt;Animal model evidence suggests the condition may lead to scarring and fibrosis in the lung and damage to other fetal organs &quot;during a very critical time at preterm gestation,&quot; Getahun told &lt;em&gt;MedPage Today&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;So, his group retrospectively studied Kaiser&apos;s matched perinatal records on 510,216 singleton children born at the managed care group&apos;s hospitals in Southern California between 1991 and 2007.&lt;/p&gt;
&lt;p&gt;Physician-diagnosed asthma incidence by age 8 years, as expected, was significantly higher overall for preemies born at 23 to 36 weeks&apos; gestation than for those carried full-term (60.2 versus 40.0 per 1,000 person-years).&lt;/p&gt;
&lt;p&gt;But chorioamnionitis diagnosed during pregnancy substantially boosted this risk.&lt;/p&gt;
&lt;p&gt;Incidence of asthma rose to 100.7 per 1,000 person-years in exposed children born preterm, versus 39.6 per 1,000 among exposed, full-term children (IR 2.9, 95% CI 2.6 to 3.3).&lt;/p&gt;
&lt;p&gt;This association between chorioamnionitis and asthma in preemies persisted (HR 1.68, 95% CI 1.52 to 1.87) after adjustment for important confounding variables, including maternal age, race or ethnicity, smoking during pregnancy, prenatal care, and maternal asthma.&lt;/p&gt;
&lt;p&gt;Although the asthma risk appeared to rise with greater prematurity in exposed children, the elevated risk associated with chorioamnionitis exposure in utero was seen in every category of prematurity: &lt;ul&gt; &lt;li&gt; 1.23 times higher risk in children born at 23 to 28 weeks (95% CI 1.02 to 1.49)&lt;/li&gt; &lt;li&gt; 1.51 times higher risk in children born at 28 to 33 weeks (95% CI 1.26 to 1.80)&lt;/li&gt; &lt;li&gt; 1.20 times higher risk in children born at 34 to 36 weeks (95% CI 1.03 to 1.47)&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;Additional adjustment for bronchopulmonary dysplasia  --  &quot;one of the mechanisms through which preterm birth is presumably associated with respiratory problems in early childhood&quot;  --  had little impact on the findings.&lt;/p&gt;
&lt;p&gt;Thus, the bacterial infection appeared to be an independent risk factor for asthma in prematurely born children, the researchers concluded.&lt;/p&gt;
&lt;p&gt;The risks were particularly high for children born to African-American women who developed chorioamnionitis, suggesting this may be an at-risk group to single out for attention clinically, they suggested.&lt;/p&gt;
&lt;p&gt;Getahun cautioned, though, that his group&apos;s study could not prove causality. The researchers also noted that the study was limited by lack of data on parental atopy and smoking.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by Kaiser Permanente Direct Community Benefit funds. The researchers reported no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_343"
                     title="U.S. Marshals Seize Unapproved Ozone Generators"
                     score="0.009"
                     href="http://www.medpagetoday.com/PublicHealthPolicy/EnvironmentalHealth/tb/18228?impressionId=1265794251619"
                     
      &lt;p&gt;WASHINGTON  --  U.S. Marshals have seized 77 unapproved ozone generators, valued at almost $76,000 from a California device manufacturer, the FDA announced.&lt;/p&gt;
&lt;p&gt;The devices were advertised as treatments for various conditions, including cancer, AIDS, hepatitis, herpes, and other diseases, but lacked approval or efficacy data to support the claims made on their behalf, an FDA release said.&lt;/p&gt;
&lt;p&gt;The raid came after the company, Applied Ozone Systems (AOS) of Auburn, Calif., failed to respond to a voluntary recall request last December, the agency said.&lt;/p&gt;
&lt;p&gt;The FDA raised concerns that patients using AOS-IM and AOS-IMD devices will consider it an appropriate treatment for an affliction and delay or stop FDA-approved and proven medical treatments. Patients using the devices may risk infection from contamination of the applicator or catheter, the release said.&lt;/p&gt;
&lt;p&gt;The FDA recommended that healthcare professionals and consumers cease use of the devices.&lt;/p&gt;
&lt;p&gt;The agency said it obtained an inspection warrant for the company&apos;s manufacturing facilities after the owner refused to admit FDA inspectors. It said the inspection revealed several breaches of the FDA&apos;s good manufacturing practice requirements for medical devices, which had never been approved in the first place.&lt;/p&gt;
&lt;p&gt;Ozone is an unstable allotrope of oxygen with three atoms, instead of the normal two. Ozone generators produce ozone from oxygen and have consumer and industrial applications, but ozone itself is harmful to the respiratory system, even at relatively low concentrations.&lt;/p&gt;
&lt;p&gt;Instructions with the Applied Ozone Systems devices suggest blowing ozoned air into the rectal and vaginal areas.&lt;/p&gt;
&lt;p&gt;Friday&apos;s seizure was part of a joint effort of the FDA and the California Department of Public Health to remove or prevent unapproved or unsafe medical devices from entering the market.&lt;/p&gt;
&lt;p&gt;A statement on the company&apos;s Web site said the two ozone generator models, which sold for $750 and $1,200 respectively, were no longer available by order of the FDA and California authorities.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_320"
                     title="Low Vitamin D Worsens Asthma (CME/CE)"
                     score="0.006"
                     href="http://www.medpagetoday.com/Pulmonology/Asthma/tb/18187?impressionId=1265794251619"
                     
      &lt;p&gt;Low levels of vitamin D correlated with poorer lung function, increased airway reactivity, and reduced response to steroid treatment in adult asthmatics, researchers said.&lt;/p&gt;
&lt;p&gt;For every 1-ng/mL increase in serum levels of 25-hydroxyvitamin D (25-OH-D), forced one-second expiratory volume (FEV&lt;sub&gt;1&lt;/sub&gt;) increased by 21 mL (&lt;em&gt;P&lt;/em&gt;=0.03, &lt;em&gt;r&lt;/em&gt;=0.8), reported E. Rand Sutherland, MD, MPH, of National Jewish Health in Denver, and colleagues online in the &lt;em&gt;American Journal of Respiratory and Critical Care Medicine&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;The study of 54 adult patients with asthma also showed that airway hyperreactivity in those with serum 25-OH-D levels below 30 ng/mL  --  defined as vitamin D insufficiency  --  measured at almost twice the average levels seen in those with normal levels of 25-OH-D.&lt;/p&gt;
&lt;p&gt;The dose of methacholine required to induce a 20% drop in FEV&lt;sub&gt;1&lt;/sub&gt; was 1.03 mg/mL (SE 0.2) in those with low 25-OH-D levels, compared with 1.92 mg/mL (SD 0.2) in patients with higher serum vitamin D levels (&lt;em&gt;P&lt;/em&gt;=0.01), Sutherland and colleagues reported.&lt;/p&gt;
&lt;p&gt;Cellular responses in vitro to dexamethasone were also significantly correlated with 25-OH-D levels (&lt;em&gt;r&lt;/em&gt;=0.05, &lt;em&gt;P&lt;/em&gt;=0.02). Peripheral blood mononuclear cells from those with higher 25-OH-D levels demonstrated greater MAP kinase phosphatase expression after dexamethasone stimulation than cells from individuals with lower vitamin D levels.&lt;/p&gt;
&lt;p&gt;The effects observed were greater in those who had not received steroid treatment.&lt;/p&gt;
&lt;p&gt;&quot;In adults with persistent asthma, there is a significant and deleterious association between reduced serum vitamin D levels and lung function, airway hyperresponsiveness, and glucocorticoid sensitivity, which together constitute three important biomarkers of asthma severity, impairment, and prognosis,&quot; the researchers concluded.&lt;/p&gt;
&lt;p&gt;Sutherland and colleagues added that the findings suggest that vitamin D supplements might improve symptoms in some asthma patients, although they did not test the hypothesis.&lt;/p&gt;
&lt;p&gt;Their cross-sectional study included 54 patients with persistent asthma, mean age 38 and with FEV&lt;sub&gt;1&lt;/sub&gt; levels that were a mean 83% of predictions. Participants underwent a round of standard tests for lung function and asthma symptoms as well as laboratory measurements of 25-OH-D.&lt;/p&gt;
&lt;p&gt;Serum 25-OH-D levels averaged 28.1 ng/mL (SE 10.2), with 32 participants having levels below the insufficiency threshold of 30 ng/mL.&lt;/p&gt;
&lt;p&gt;The researchers found that vitamin D levels did not correlate only with asthma symptoms. Body mass index was also significantly and inversely associated with 25-OH-D.&lt;/p&gt;
&lt;p&gt;Each unit increase of BMI was associated with a decrease of 0.56 ng/mL (SE 0.18) in serum 25-OH-D (&lt;em&gt;r&lt;/em&gt;=0.4, &lt;em&gt;P&lt;/em&gt;=0.002) after adjusting for age, sex, and physical impairment.&lt;/p&gt;
&lt;p&gt;Sutherland and colleagues noted that earlier research had linked obesity with asthma risk, and also with reduced responses to corticosteroid treatment in asthmatic patients.&lt;/p&gt;
&lt;p&gt;They suggested that vitamin D &quot;may be one pathway by which obesity and reduced steroid response are related.&quot;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;Funding for the study came from the National Institutes of Health.&lt;/p&gt;&lt;p&gt;No potential conflicts of interest were reported.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_218"
                     title="Even Mild COPD Affects the Heart (CME/CE)"
                     score="-0.003"
                     href="http://www.medpagetoday.com/Pulmonology/SmokingCOPD/tb/18070?impressionId=1265794251619"
                     
      Chronic lung disease begins to affect cardiac function at even mild levels of emphysema, data from a large prospective cohort study showed.&lt;br&gt;
&lt;br&gt;A 10-point increase in percent emphysema by lung CT had a linear inverse relationship with left ventricular end-diastolic volume (LVEDV), stroke volume, and cardiac output (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001 for all parameters), researchers reported in the Jan. 21 issue of the &lt;em&gt;New England Journal of Medicine&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;Current smoking status increased the magnitude of the association compared with former smokers and nonsmokers, the researchers found.&lt;br&gt;
&lt;br&gt;Left ventricular ejection fraction did not change with increasing percent of emphysema and airflow obstruction.&lt;br&gt;
&lt;br&gt;&quot;Previously, it has been well known that in very severe lung disease, the damage to the lungs affects heart function,&quot; lead author R. Graham Barr, MD, of Columbia University in New York, said in an interview.&lt;p&gt;&lt;/p&gt;
&lt;p&gt;&quot;What we have shown is that a similar physiology, a similar relationship, would appear to extend up and down the spectrum of lung disease from mild, subclinical COPD and emphysema, all the way to moderately severe lung disease.&quot;&lt;/p&gt;
&lt;p&gt;Severe COPD can lead to cor pulmonale, characterized by increased vascular resistance and right heart failure, accompanied by reduced left ventricular filling, left ventricular stroke volume, and cardiac output.&lt;/p&gt;
&lt;p&gt;However, left ventricular ejection fraction (LVEF) usually is preserved. Whether similar changes occurred with less severe COPD had not been determined, and examining that question was the principal objective of the study by Barr and colleagues.&lt;/p&gt;
&lt;p&gt;The study population comprised a subgroup of patients enrolled in the Multi-Ethnic Study of Atherosclerosis (MESA), which is exploring the prevalence, correlates, and progression of subclinical cardiovascular disease. The MESA Lung Study comprised 2,816 MESA participants who underwent cardiac MRI assessment of left ventricular structure and function.&lt;/p&gt;
&lt;p&gt;Investigators in the lung study excluded patients who had a restrictive pattern on spirometry, defined as a forced vital capacity (FVC) below the lower limit of normal and an FEV&lt;sub&gt;1&lt;/sub&gt;:FVC ratio &amp;gt;0.7.&lt;/p&gt;
&lt;p&gt;Information collected for the lung study included patient demographics, smoking history, medical history, level of physical activity, height, weight, resting blood pressure, serum glucose, C-reactive protein, and fibrinogen levels.&lt;/p&gt;
&lt;p&gt;Extent of emphysema was calculated from lung fields of cardiac CT scans, which included 70% of the lung volume from the carina to the base. Investigators defined extent of emphysema as the percentage of voxels below -910 Hounsfield units in the lung windows of cardiac CT scans.&lt;/p&gt;
&lt;p&gt;Participants who smoked at least one cigarette in the 30 days before CT or who had urinary cotinine levels &amp;gt;100 ng/mL were classified as current smokers.&lt;/p&gt;
&lt;p&gt;The mean age of the lung population was 61, and 51% were women. Current smokers accounted for 13% of the participants, former smokers for 38%, and nonsmokers for 49%. LVEF averaged about 70%.&lt;/p&gt;
&lt;p&gt;Mean spirometric measures were normal, as were measures of left ventricular structure and function. Median percent emphysema was 15%. Comparison of percent emphysema with left ventricular measures showed that a 10-point increase in percent emphysema was associated with a: &lt;ul&gt; &lt;li&gt;4.1 mL decrement in LVEDV&lt;/li&gt; &lt;li&gt;2.7 mL decrement in stroke volume&lt;/li&gt; &lt;li&gt;0.19 L/min decrement in cardiac output&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;The investigators observed no evidence of an association between percent emphysema and LVEF, reflected in a 0.02-point mean increase with each 10-point increase in extent of emphysema.&lt;/p&gt;
&lt;p&gt;Smoking status significantly influenced associations of percent emphysema with LVEDV (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001 for interaction) and stroke volume (&lt;em&gt;P&lt;/em&gt;=0.008 for interaction).&lt;/p&gt;
&lt;p&gt;The magnitude of the association was greater among smokers than former smokers, and greater among former smokers than nonsmokers. However, the associations were evident in smokers and nonsmokers alike.&lt;/p&gt;
&lt;p&gt;&quot;The apparent effect of emphysema on left ventricular end-diastolic volume and cardiac output was similar to that of traditional cardiac risk factors previously reported in MESA and, among smokers, was greater than that of traditional cardiac risk factors,&quot; the authors wrote.&lt;/p&gt;
&lt;p&gt;The linearity of associations across the study population &quot;suggests that even early-stage COPD influences stroke volume and left ventricular size,&quot; Anton Vonk-Noordegraaf, MD, of Vrije University Medical Center in Amsterdam, wrote in an accompanying editorial.&lt;/p&gt;
&lt;p&gt;&quot;Since oxygen delivery is directly related to cardiac output, a lower cardiac output in patients with COPD leads to impaired oxygen delivery,&quot; Vonk-Noordegraaf continued.&lt;/p&gt;
&lt;p&gt;&quot;Although the effects on cardiac output were small in this study population, they may be more pronounced in severe cases of emphysema and during exercise, as has been shown previously. The question is whether the striking clinical resemblance between COPD and chronic heart failure can be explained in part by a factor both diseases have in common: decreased cardiac output.&quot;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;Co-author Paul L. Enright disclosed relationships with Pfizer and Gilead.&lt;/p&gt;&lt;p&gt;Coauthor Eric A. Hoffman disclosed relationships with VIDA Diagnostics, sanofi-aventis, AstraZeneca, and Chiesi Pharmaceuticals.&lt;/p&gt;&lt;p&gt;Coauthor Kawut disclosed a relationship with Pfizer.&lt;/p&gt;&lt;p&gt;Co-author Jo&amp;#227;o A. C. Lima disclosed relationships with Toshiba Medical Systems and General Electric.&lt;/p&gt;&lt;p&gt;Co-author Lewis J. Smith disclosed relationships with Merck and KarmelSonix.&lt;/p&gt;&lt;p&gt;Vonk-Noordegraaf had no disclosures.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_1_122"
                     title="FDA Panel Calls for Banning OTC Asthma Inhalers"
                     score="-0.005"
                     href="