Sherry Boschert

SAN FRANCISCO – A 9-mm wheal after skin prick testing provided a 95% positive predictive value for egg or peanut allergy in an analysis of data from 5,000 12-month-old infants recruited from the general population.

The current clinical practice of diagnosing peanut or egg allergy in infants who develop wheals larger than 8 mm from skin prick testing is appropriate in the general population, Lyle Gurrin, Ph.D., and his associates reported at the annual meeting of the American Academy of Allergy, Asthma, and Immunology. Infants with a wheal of any size after a skin prick test were invited for a diagnostic oral food challenge unless they had a convincing reaction in the previous month.

The analysis included 181 infants who underwent peanut challenges, 310 with egg challenges, and 71 with sesame challenges. None of the wheal sizes after sesame challenges reached a 95% positive predictive value for allergy, said Dr. Gurrin of the University of Melbourne.

Previous studies have suggested skin-prick-test wheal sizes provide a 95% likelihood of food allergy if the wheal is 8 mm or larger for egg allergy and 7 mm or larger for peanut allergy. Most of those were small studies of high-risk patients drawn from clinics, not the general population. The studies included a broad range of ages and relied on a history of ingestion reaction rather than performing a formal food challenge.

The current analysis used data from the larger HealthNuts study, a population-based study of Australian 1-year-old infants that was conducted to identify the prevalence of food allergy and modifiable risk factors. Investigators recruited parents and infants at childhood immunization sessions, and 2,848 (73%) agreed to participate. Skin prick tests showed sensitization (a wheal of 1 mm or larger) to peanut in 9%, to raw egg white in 16%, and to sesame in 3% (J. Allergy Clin. Immunol. 2011;127:668-676.e2).

Oral food challenges in these sensitized patients proved that 3% of the entire cohort was allergic to peanut, 9% was allergic to raw egg 1%, and had sesame allergy. Of the infants with raw egg allergy, 80% were able to tolerate baked egg. Some infants were allergic to more than one food. Overall, more than 10% of the cohort had challenge-proven IgE-mediated allergy to one of the common allergenic foods of childhood.

Further analysis of wheal-size thresholds for diagnosis will stratify the findings by the presence or absence of eczema, a family history of allergy, and the ingestion/reaction history, Dr. Gurrin said.

A positive oral food challenge was defined as three or more concurrent, noncontact urticaria lasting at least 5 minutes, vomiting, periorbital angioedema, or anaphylaxis occurring within 2 hours of ingesting the test food.

No patients were excluded from the HealthNuts study due to severe eczema, said one of Dr. Gurrin’s study associates, Dr. Katrina Allen, also of the university.

Less than 1% of infants in the study were dark skinned, but demographic factors did not differ significantly between infants who were excluded from the study and those who were enrolled, she said during the question-and-answer session after Dr. Gurrin’s presentation.

The demographic characteristics of infants in the HealthNuts study were similar to population data from the Perinatal Data Collection Unit, but the mothers of HealthNuts infants tended to be older than in the general population.

A brief questionnaire completed by parents who declined to participate in the HealthNuts study suggested that nonparticipating infants were less likely to have a family history of allergy and more likely to already be eating and tolerating peanuts.

The study was funded by the Australian National Health and Medical Research Council, the Ilhan Food Allergy Foundation, AnaphylaxiStop, the U.S. Department of Defense, and the Australian Egg Corp. Dr. Gurrin and Dr. Allen said they had no relevant financial disclosures.

SAN FRANCISCO – A 9-mm wheal after skin prick testing provided a 95% positive predictive value for egg or peanut allergy in an analysis of data from 5,000 12-month-old infants recruited from the general population.

The current clinical practice of diagnosing peanut or egg allergy in infants who develop wheals larger than 8 mm from skin prick testing is appropriate in the general population, Lyle Gurrin, Ph.D., and his associates reported at the annual meeting of the American Academy of Allergy, Asthma, and Immunology. Infants with a wheal of any size after a skin prick test were invited for a diagnostic oral food challenge unless they had a convincing reaction in the previous month.

The analysis included 181 infants who underwent peanut challenges, 310 with egg challenges, and 71 with sesame challenges. None of the wheal sizes after sesame challenges reached a 95% positive predictive value for allergy, said Dr. Gurrin of the University of Melbourne.

Previous studies have suggested skin-prick-test wheal sizes provide a 95% likelihood of food allergy if the wheal is 8 mm or larger for egg allergy and 7 mm or larger for peanut allergy. Most of those were small studies of high-risk patients drawn from clinics, not the general population. The studies included a broad range of ages and relied on a history of ingestion reaction rather than performing a formal food challenge.

The current analysis used data from the larger HealthNuts study, a population-based study of Australian 1-year-old infants that was conducted to identify the prevalence of food allergy and modifiable risk factors. Investigators recruited parents and infants at childhood immunization sessions, and 2,848 (73%) agreed to participate. Skin prick tests showed sensitization (a wheal of 1 mm or larger) to peanut in 9%, to raw egg white in 16%, and to sesame in 3% (J. Allergy Clin. Immunol. 2011;127:668-676.e2).

Oral food challenges in these sensitized patients proved that 3% of the entire cohort was allergic to peanut, 9% was allergic to raw egg 1%, and had sesame allergy. Of the infants with raw egg allergy, 80% were able to tolerate baked egg. Some infants were allergic to more than one food. Overall, more than 10% of the cohort had challenge-proven IgE-mediated allergy to one of the common allergenic foods of childhood.

Further analysis of wheal-size thresholds for diagnosis will stratify the findings by the presence or absence of eczema, a family history of allergy, and the ingestion/reaction history, Dr. Gurrin said.

A positive oral food challenge was defined as three or more concurrent, noncontact urticaria lasting at least 5 minutes, vomiting, periorbital angioedema, or anaphylaxis occurring within 2 hours of ingesting the test food.

No patients were excluded from the HealthNuts study due to severe eczema, said one of Dr. Gurrin’s study associates, Dr. Katrina Allen, also of the university.

Less than 1% of infants in the study were dark skinned, but demographic factors did not differ significantly between infants who were excluded from the study and those who were enrolled, she said during the question-and-answer session after Dr. Gurrin’s presentation.

The demographic characteristics of infants in the HealthNuts study were similar to population data from the Perinatal Data Collection Unit, but the mothers of HealthNuts infants tended to be older than in the general population.

A brief questionnaire completed by parents who declined to participate in the HealthNuts study suggested that nonparticipating infants were less likely to have a family history of allergy and more likely to already be eating and tolerating peanuts.

The study was funded by the Australian National Health and Medical Research Council, the Ilhan Food Allergy Foundation, AnaphylaxiStop, the U.S. Department of Defense, and the Australian Egg Corp. Dr. Gurrin and Dr. Allen said they had no relevant financial disclosures.

SAN FRANCISCO – A 9-mm wheal after skin prick testing provided a 95% positive predictive value for egg or peanut allergy in an analysis of data from 5,000 12-month-old infants recruited from the general population.

The current clinical practice of diagnosing peanut or egg allergy in infants who develop wheals larger than 8 mm from skin prick testing is appropriate in the general population, Lyle Gurrin, Ph.D., and his associates reported at the annual meeting of the American Academy of Allergy, Asthma, and Immunology. Infants with a wheal of any size after a skin prick test were invited for a diagnostic oral food challenge unless they had a convincing reaction in the previous month.

The analysis included 181 infants who underwent peanut challenges, 310 with egg challenges, and 71 with sesame challenges. None of the wheal sizes after sesame challenges reached a 95% positive predictive value for allergy, said Dr. Gurrin of the University of Melbourne.

Previous studies have suggested skin-prick-test wheal sizes provide a 95% likelihood of food allergy if the wheal is 8 mm or larger for egg allergy and 7 mm or larger for peanut allergy. Most of those were small studies of high-risk patients drawn from clinics, not the general population. The studies included a broad range of ages and relied on a history of ingestion reaction rather than performing a formal food challenge.

The current analysis used data from the larger HealthNuts study, a population-based study of Australian 1-year-old infants that was conducted to identify the prevalence of food allergy and modifiable risk factors. Investigators recruited parents and infants at childhood immunization sessions, and 2,848 (73%) agreed to participate. Skin prick tests showed sensitization (a wheal of 1 mm or larger) to peanut in 9%, to raw egg white in 16%, and to sesame in 3% (J. Allergy Clin. Immunol. 2011;127:668-676.e2).

Oral food challenges in these sensitized patients proved that 3% of the entire cohort was allergic to peanut, 9% was allergic to raw egg 1%, and had sesame allergy. Of the infants with raw egg allergy, 80% were able to tolerate baked egg. Some infants were allergic to more than one food. Overall, more than 10% of the cohort had challenge-proven IgE-mediated allergy to one of the common allergenic foods of childhood.

Further analysis of wheal-size thresholds for diagnosis will stratify the findings by the presence or absence of eczema, a family history of allergy, and the ingestion/reaction history, Dr. Gurrin said.

A positive oral food challenge was defined as three or more concurrent, noncontact urticaria lasting at least 5 minutes, vomiting, periorbital angioedema, or anaphylaxis occurring within 2 hours of ingesting the test food.

No patients were excluded from the HealthNuts study due to severe eczema, said one of Dr. Gurrin’s study associates, Dr. Katrina Allen, also of the university.

Less than 1% of infants in the study were dark skinned, but demographic factors did not differ significantly between infants who were excluded from the study and those who were enrolled, she said during the question-and-answer session after Dr. Gurrin’s presentation.

The demographic characteristics of infants in the HealthNuts study were similar to population data from the Perinatal Data Collection Unit, but the mothers of HealthNuts infants tended to be older than in the general population.

A brief questionnaire completed by parents who declined to participate in the HealthNuts study suggested that nonparticipating infants were less likely to have a family history of allergy and more likely to already be eating and tolerating peanuts.

The study was funded by the Australian National Health and Medical Research Council, the Ilhan Food Allergy Foundation, AnaphylaxiStop, the U.S. Department of Defense, and the Australian Egg Corp. Dr. Gurrin and Dr. Allen said they had no relevant financial disclosures.

SAN FRANCISCO – Using inhaled budesonide daily for chronic asthma for a mean of 16 years from childhood into adulthood didn’t cause more cataracts or significantly change intraocular pressure or vision in a prospective, longitudinal, placebo-controlled study.

Among 300 Danish patients taking inhaled budesonide for chronic asthma, 148 underwent eye examinations 15-20 years after the start of the study, as did 53 of 163 healthy siblings in the control group. The exams detected two posterior subcapsular cataracts that were outside the central 3-mm zone, but both were in the control group and none in the budesonide group, Dr. Søren Pedersen and his associates reported at the annual meeting of the American Academy of Allergy, Asthma and Immunology.

Nineteen cataracts in the budesonide group would have been needed to demonstrate a statistically significant 5% increased risk for cataracts, a poststudy power analysis found.

Average vision measurements were identical between groups (1.04 in each eye), said Dr. Pedersen of the University of Southern Denmark, Kolding. Intraocular pressures did not differ significantly between groups, with average measurements of 13.8 mm Hg in each eye of the asthma patients, and averages of 14.5 mm Hg in the right eyes and 14.2 mm Hg in the left eyes of the control group.

“This is a very strong finding” of safety with long-term inhaled budesonide, he said in an interview.

Patients took a mean daily dose of 385 mcg of budesonide and accumulated a mean dose of 2.3 g. Increased intraocular pressures (higher than 21 mm Hg) were seen in five patients (3.4%) and in one sibling in the control group (1.9%), a nonsignificant difference between groups. The accumulated dose of budesonide was not significantly associated with intraocular pressure, Dr. Pedersen said.

The study is part of a larger study that began with 270 children, including 62 with asthma who did not use inhaled corticosteroids, all of whom were evaluated for cataracts, bruises, growth, bone mineral density, and clinical effects of inhaled budesonide 4-6 years after treatment started, with no adverse effects found. At that point, 32 children in the control group dropped out, the other 30 shifted to the budesonide group, and 163 healthy siblings became the new control group. Patients were followed with various evaluations every 1-2 years.

The mean age of those who had eye exams 15-20 years into the study was 26 years for patients and 28 years for siblings. A total of 68% of patients and 47% of controls were male. Treatment duration ranged from 3 to 22 years. Daily budesonide dose ranged from 50 to 1,220 mcg. The accumulated budesonide dose ranged from less than 1 g to 8.8 g.

The ophthalmologist who performed all of the eye exams did not know which subjects were patients and which were controls.

Previous studies of the risk of posterior subcapsular cataracts from oral or inhaled steroids were cross-sectional studies with little or no information on the dose of inhaled corticosteroid used, he said.

AstraZeneca, which markets budesonide, funded the study. Dr. Pedersen said there were no other conflicts of interest.

SAN FRANCISCO – Using inhaled budesonide daily for chronic asthma for a mean of 16 years from childhood into adulthood didn’t cause more cataracts or significantly change intraocular pressure or vision in a prospective, longitudinal, placebo-controlled study.

Among 300 Danish patients taking inhaled budesonide for chronic asthma, 148 underwent eye examinations 15-20 years after the start of the study, as did 53 of 163 healthy siblings in the control group. The exams detected two posterior subcapsular cataracts that were outside the central 3-mm zone, but both were in the control group and none in the budesonide group, Dr. Søren Pedersen and his associates reported at the annual meeting of the American Academy of Allergy, Asthma and Immunology.

Nineteen cataracts in the budesonide group would have been needed to demonstrate a statistically significant 5% increased risk for cataracts, a poststudy power analysis found.

Average vision measurements were identical between groups (1.04 in each eye), said Dr. Pedersen of the University of Southern Denmark, Kolding. Intraocular pressures did not differ significantly between groups, with average measurements of 13.8 mm Hg in each eye of the asthma patients, and averages of 14.5 mm Hg in the right eyes and 14.2 mm Hg in the left eyes of the control group.

“This is a very strong finding” of safety with long-term inhaled budesonide, he said in an interview.

Patients took a mean daily dose of 385 mcg of budesonide and accumulated a mean dose of 2.3 g. Increased intraocular pressures (higher than 21 mm Hg) were seen in five patients (3.4%) and in one sibling in the control group (1.9%), a nonsignificant difference between groups. The accumulated dose of budesonide was not significantly associated with intraocular pressure, Dr. Pedersen said.

The study is part of a larger study that began with 270 children, including 62 with asthma who did not use inhaled corticosteroids, all of whom were evaluated for cataracts, bruises, growth, bone mineral density, and clinical effects of inhaled budesonide 4-6 years after treatment started, with no adverse effects found. At that point, 32 children in the control group dropped out, the other 30 shifted to the budesonide group, and 163 healthy siblings became the new control group. Patients were followed with various evaluations every 1-2 years.

The mean age of those who had eye exams 15-20 years into the study was 26 years for patients and 28 years for siblings. A total of 68% of patients and 47% of controls were male. Treatment duration ranged from 3 to 22 years. Daily budesonide dose ranged from 50 to 1,220 mcg. The accumulated budesonide dose ranged from less than 1 g to 8.8 g.

The ophthalmologist who performed all of the eye exams did not know which subjects were patients and which were controls.

Previous studies of the risk of posterior subcapsular cataracts from oral or inhaled steroids were cross-sectional studies with little or no information on the dose of inhaled corticosteroid used, he said.

AstraZeneca, which markets budesonide, funded the study. Dr. Pedersen said there were no other conflicts of interest.

SAN FRANCISCO – Using inhaled budesonide daily for chronic asthma for a mean of 16 years from childhood into adulthood didn’t cause more cataracts or significantly change intraocular pressure or vision in a prospective, longitudinal, placebo-controlled study.

Among 300 Danish patients taking inhaled budesonide for chronic asthma, 148 underwent eye examinations 15-20 years after the start of the study, as did 53 of 163 healthy siblings in the control group. The exams detected two posterior subcapsular cataracts that were outside the central 3-mm zone, but both were in the control group and none in the budesonide group, Dr. Søren Pedersen and his associates reported at the annual meeting of the American Academy of Allergy, Asthma and Immunology.

Nineteen cataracts in the budesonide group would have been needed to demonstrate a statistically significant 5% increased risk for cataracts, a poststudy power analysis found.

Average vision measurements were identical between groups (1.04 in each eye), said Dr. Pedersen of the University of Southern Denmark, Kolding. Intraocular pressures did not differ significantly between groups, with average measurements of 13.8 mm Hg in each eye of the asthma patients, and averages of 14.5 mm Hg in the right eyes and 14.2 mm Hg in the left eyes of the control group.

“This is a very strong finding” of safety with long-term inhaled budesonide, he said in an interview.

Patients took a mean daily dose of 385 mcg of budesonide and accumulated a mean dose of 2.3 g. Increased intraocular pressures (higher than 21 mm Hg) were seen in five patients (3.4%) and in one sibling in the control group (1.9%), a nonsignificant difference between groups. The accumulated dose of budesonide was not significantly associated with intraocular pressure, Dr. Pedersen said.

The study is part of a larger study that began with 270 children, including 62 with asthma who did not use inhaled corticosteroids, all of whom were evaluated for cataracts, bruises, growth, bone mineral density, and clinical effects of inhaled budesonide 4-6 years after treatment started, with no adverse effects found. At that point, 32 children in the control group dropped out, the other 30 shifted to the budesonide group, and 163 healthy siblings became the new control group. Patients were followed with various evaluations every 1-2 years.

The mean age of those who had eye exams 15-20 years into the study was 26 years for patients and 28 years for siblings. A total of 68% of patients and 47% of controls were male. Treatment duration ranged from 3 to 22 years. Daily budesonide dose ranged from 50 to 1,220 mcg. The accumulated budesonide dose ranged from less than 1 g to 8.8 g.

The ophthalmologist who performed all of the eye exams did not know which subjects were patients and which were controls.

Previous studies of the risk of posterior subcapsular cataracts from oral or inhaled steroids were cross-sectional studies with little or no information on the dose of inhaled corticosteroid used, he said.

AstraZeneca, which markets budesonide, funded the study. Dr. Pedersen said there were no other conflicts of interest.

SAN FRANCISCO – Using inhaled budesonide daily for chronic asthma for a mean of 16 years from childhood into adulthood didn’t cause more cataracts or significantly change intraocular pressure or vision in a prospective, longitudinal, placebo-controlled study.

Among 300 Danish patients taking inhaled budesonide for chronic asthma, 148 underwent eye examinations 15-20 years after the start of the study, as did 53 of 163 healthy siblings in the control group. The exams detected two posterior subcapsular cataracts that were outside the central 3-mm zone, but both were in the control group and none in the budesonide group, Dr. Søren Pedersen and his associates reported at the annual meeting of the American Academy of Allergy, Asthma and Immunology.

Nineteen cataracts in the budesonide group would have been needed to demonstrate a statistically significant 5% increased risk for cataracts, a poststudy power analysis found.

Average vision measurements were identical between groups (1.04 in each eye), said Dr. Pedersen of the University of Southern Denmark, Kolding. Intraocular pressures did not differ significantly between groups, with average measurements of 13.8 mm Hg in each eye of the asthma patients, and averages of 14.5 mm Hg in the right eyes and 14.2 mm Hg in the left eyes of the control group.

“This is a very strong finding” of safety with long-term inhaled budesonide, he said in an interview.

Patients took a mean daily dose of 385 mcg of budesonide and accumulated a mean dose of 2.3 g. Increased intraocular pressures (higher than 21 mm Hg) were seen in five patients (3.4%) and in one sibling in the control group (1.9%), a nonsignificant difference between groups. The accumulated dose of budesonide was not significantly associated with intraocular pressure, Dr. Pedersen said.

The study is part of a larger study that began with 270 children, including 62 with asthma who did not use inhaled corticosteroids, all of whom were evaluated for cataracts, bruises, growth, bone mineral density, and clinical effects of inhaled budesonide 4-6 years after treatment started, with no adverse effects found. At that point, 32 children in the control group dropped out, the other 30 shifted to the budesonide group, and 163 healthy siblings became the new control group. Patients were followed with various evaluations every 1-2 years.

The mean age of those who had eye exams 15-20 years into the study was 26 years for patients and 28 years for siblings. A total of 68% of patients and 47% of controls were male. Treatment duration ranged from 3 to 22 years. Daily budesonide dose ranged from 50 to 1,220 mcg. The accumulated budesonide dose ranged from less than 1 g to 8.8 g.

The ophthalmologist who performed all of the eye exams did not know which subjects were patients and which were controls.

Previous studies of the risk of posterior subcapsular cataracts from oral or inhaled steroids were cross-sectional studies with little or no information on the dose of inhaled corticosteroid used, he said.

AstraZeneca, which markets budesonide, funded the study. Dr. Pedersen said there were no other conflicts of interest.

SAN FRANCISCO – Using inhaled budesonide daily for chronic asthma for a mean of 16 years from childhood into adulthood didn’t cause more cataracts or significantly change intraocular pressure or vision in a prospective, longitudinal, placebo-controlled study.

Among 300 Danish patients taking inhaled budesonide for chronic asthma, 148 underwent eye examinations 15-20 years after the start of the study, as did 53 of 163 healthy siblings in the control group. The exams detected two posterior subcapsular cataracts that were outside the central 3-mm zone, but both were in the control group and none in the budesonide group, Dr. Søren Pedersen and his associates reported at the annual meeting of the American Academy of Allergy, Asthma and Immunology.

Nineteen cataracts in the budesonide group would have been needed to demonstrate a statistically significant 5% increased risk for cataracts, a poststudy power analysis found.

Average vision measurements were identical between groups (1.04 in each eye), said Dr. Pedersen of the University of Southern Denmark, Kolding. Intraocular pressures did not differ significantly between groups, with average measurements of 13.8 mm Hg in each eye of the asthma patients, and averages of 14.5 mm Hg in the right eyes and 14.2 mm Hg in the left eyes of the control group.

“This is a very strong finding” of safety with long-term inhaled budesonide, he said in an interview.

Patients took a mean daily dose of 385 mcg of budesonide and accumulated a mean dose of 2.3 g. Increased intraocular pressures (higher than 21 mm Hg) were seen in five patients (3.4%) and in one sibling in the control group (1.9%), a nonsignificant difference between groups. The accumulated dose of budesonide was not significantly associated with intraocular pressure, Dr. Pedersen said.

The study is part of a larger study that began with 270 children, including 62 with asthma who did not use inhaled corticosteroids, all of whom were evaluated for cataracts, bruises, growth, bone mineral density, and clinical effects of inhaled budesonide 4-6 years after treatment started, with no adverse effects found. At that point, 32 children in the control group dropped out, the other 30 shifted to the budesonide group, and 163 healthy siblings became the new control group. Patients were followed with various evaluations every 1-2 years.

The mean age of those who had eye exams 15-20 years into the study was 26 years for patients and 28 years for siblings. A total of 68% of patients and 47% of controls were male. Treatment duration ranged from 3 to 22 years. Daily budesonide dose ranged from 50 to 1,220 mcg. The accumulated budesonide dose ranged from less than 1 g to 8.8 g.

The ophthalmologist who performed all of the eye exams did not know which subjects were patients and which were controls.

Previous studies of the risk of posterior subcapsular cataracts from oral or inhaled steroids were cross-sectional studies with little or no information on the dose of inhaled corticosteroid used, he said.

AstraZeneca, which markets budesonide, funded the study. Dr. Pedersen said there were no other conflicts of interest.

SAN FRANCISCO – Using inhaled budesonide daily for chronic asthma for a mean of 16 years from childhood into adulthood didn’t cause more cataracts or significantly change intraocular pressure or vision in a prospective, longitudinal, placebo-controlled study.

Among 300 Danish patients taking inhaled budesonide for chronic asthma, 148 underwent eye examinations 15-20 years after the start of the study, as did 53 of 163 healthy siblings in the control group. The exams detected two posterior subcapsular cataracts that were outside the central 3-mm zone, but both were in the control group and none in the budesonide group, Dr. Søren Pedersen and his associates reported at the annual meeting of the American Academy of Allergy, Asthma and Immunology.

Nineteen cataracts in the budesonide group would have been needed to demonstrate a statistically significant 5% increased risk for cataracts, a poststudy power analysis found.

Average vision measurements were identical between groups (1.04 in each eye), said Dr. Pedersen of the University of Southern Denmark, Kolding. Intraocular pressures did not differ significantly between groups, with average measurements of 13.8 mm Hg in each eye of the asthma patients, and averages of 14.5 mm Hg in the right eyes and 14.2 mm Hg in the left eyes of the control group.

“This is a very strong finding” of safety with long-term inhaled budesonide, he said in an interview.

Patients took a mean daily dose of 385 mcg of budesonide and accumulated a mean dose of 2.3 g. Increased intraocular pressures (higher than 21 mm Hg) were seen in five patients (3.4%) and in one sibling in the control group (1.9%), a nonsignificant difference between groups. The accumulated dose of budesonide was not significantly associated with intraocular pressure, Dr. Pedersen said.

The study is part of a larger study that began with 270 children, including 62 with asthma who did not use inhaled corticosteroids, all of whom were evaluated for cataracts, bruises, growth, bone mineral density, and clinical effects of inhaled budesonide 4-6 years after treatment started, with no adverse effects found. At that point, 32 children in the control group dropped out, the other 30 shifted to the budesonide group, and 163 healthy siblings became the new control group. Patients were followed with various evaluations every 1-2 years.

The mean age of those who had eye exams 15-20 years into the study was 26 years for patients and 28 years for siblings. A total of 68% of patients and 47% of controls were male. Treatment duration ranged from 3 to 22 years. Daily budesonide dose ranged from 50 to 1,220 mcg. The accumulated budesonide dose ranged from less than 1 g to 8.8 g.

The ophthalmologist who performed all of the eye exams did not know which subjects were patients and which were controls.

Previous studies of the risk of posterior subcapsular cataracts from oral or inhaled steroids were cross-sectional studies with little or no information on the dose of inhaled corticosteroid used, he said.

AstraZeneca, which markets budesonide, funded the study. Dr. Pedersen said there were no other conflicts of interest.

SAN FRANCISCO – Using inhaled budesonide daily for chronic asthma for a mean of 16 years from childhood into adulthood didn’t cause more cataracts or significantly change intraocular pressure or vision in a prospective, longitudinal, placebo-controlled study.

Among 300 Danish patients taking inhaled budesonide for chronic asthma, 148 underwent eye examinations 15-20 years after the start of the study, as did 53 of 163 healthy siblings in the control group. The exams detected two posterior subcapsular cataracts that were outside the central 3-mm zone, but both were in the control group and none in the budesonide group, Dr. Søren Pedersen and his associates reported at the annual meeting of the American Academy of Allergy, Asthma and Immunology.

Nineteen cataracts in the budesonide group would have been needed to demonstrate a statistically significant 5% increased risk for cataracts, a poststudy power analysis found.

Average vision measurements were identical between groups (1.04 in each eye), said Dr. Pedersen of the University of Southern Denmark, Kolding. Intraocular pressures did not differ significantly between groups, with average measurements of 13.8 mm Hg in each eye of the asthma patients, and averages of 14.5 mm Hg in the right eyes and 14.2 mm Hg in the left eyes of the control group.

“This is a very strong finding” of safety with long-term inhaled budesonide, he said in an interview.

Patients took a mean daily dose of 385 mcg of budesonide and accumulated a mean dose of 2.3 g. Increased intraocular pressures (higher than 21 mm Hg) were seen in five patients (3.4%) and in one sibling in the control group (1.9%), a nonsignificant difference between groups. The accumulated dose of budesonide was not significantly associated with intraocular pressure, Dr. Pedersen said.

The study is part of a larger study that began with 270 children, including 62 with asthma who did not use inhaled corticosteroids, all of whom were evaluated for cataracts, bruises, growth, bone mineral density, and clinical effects of inhaled budesonide 4-6 years after treatment started, with no adverse effects found. At that point, 32 children in the control group dropped out, the other 30 shifted to the budesonide group, and 163 healthy siblings became the new control group. Patients were followed with various evaluations every 1-2 years.

The mean age of those who had eye exams 15-20 years into the study was 26 years for patients and 28 years for siblings. A total of 68% of patients and 47% of controls were male. Treatment duration ranged from 3 to 22 years. Daily budesonide dose ranged from 50 to 1,220 mcg. The accumulated budesonide dose ranged from less than 1 g to 8.8 g.

The ophthalmologist who performed all of the eye exams did not know which subjects were patients and which were controls.

Previous studies of the risk of posterior subcapsular cataracts from oral or inhaled steroids were cross-sectional studies with little or no information on the dose of inhaled corticosteroid used, he said.

AstraZeneca, which markets budesonide, funded the study. Dr. Pedersen said there were no other conflicts of interest.

SAN FRANCISCO – Using inhaled budesonide daily for chronic asthma for a mean of 16 years from childhood into adulthood didn’t cause more cataracts or significantly change intraocular pressure or vision in a prospective, longitudinal, placebo-controlled study.

Among 300 Danish patients taking inhaled budesonide for chronic asthma, 148 underwent eye examinations 15-20 years after the start of the study, as did 53 of 163 healthy siblings in the control group. The exams detected two posterior subcapsular cataracts that were outside the central 3-mm zone, but both were in the control group and none in the budesonide group, Dr. Søren Pedersen and his associates reported at the annual meeting of the American Academy of Allergy, Asthma and Immunology.

Nineteen cataracts in the budesonide group would have been needed to demonstrate a statistically significant 5% increased risk for cataracts, a poststudy power analysis found.

Average vision measurements were identical between groups (1.04 in each eye), said Dr. Pedersen of the University of Southern Denmark, Kolding. Intraocular pressures did not differ significantly between groups, with average measurements of 13.8 mm Hg in each eye of the asthma patients, and averages of 14.5 mm Hg in the right eyes and 14.2 mm Hg in the left eyes of the control group.

“This is a very strong finding” of safety with long-term inhaled budesonide, he said in an interview.

Patients took a mean daily dose of 385 mcg of budesonide and accumulated a mean dose of 2.3 g. Increased intraocular pressures (higher than 21 mm Hg) were seen in five patients (3.4%) and in one sibling in the control group (1.9%), a nonsignificant difference between groups. The accumulated dose of budesonide was not significantly associated with intraocular pressure, Dr. Pedersen said.

The study is part of a larger study that began with 270 children, including 62 with asthma who did not use inhaled corticosteroids, all of whom were evaluated for cataracts, bruises, growth, bone mineral density, and clinical effects of inhaled budesonide 4-6 years after treatment started, with no adverse effects found. At that point, 32 children in the control group dropped out, the other 30 shifted to the budesonide group, and 163 healthy siblings became the new control group. Patients were followed with various evaluations every 1-2 years.

The mean age of those who had eye exams 15-20 years into the study was 26 years for patients and 28 years for siblings. A total of 68% of patients and 47% of controls were male. Treatment duration ranged from 3 to 22 years. Daily budesonide dose ranged from 50 to 1,220 mcg. The accumulated budesonide dose ranged from less than 1 g to 8.8 g.

The ophthalmologist who performed all of the eye exams did not know which subjects were patients and which were controls.

Previous studies of the risk of posterior subcapsular cataracts from oral or inhaled steroids were cross-sectional studies with little or no information on the dose of inhaled corticosteroid used, he said.

AstraZeneca, which markets budesonide, funded the study. Dr. Pedersen said there were no other conflicts of interest.

SAN FRANCISCO – Using inhaled budesonide daily for chronic asthma for a mean of 16 years from childhood into adulthood didn’t cause more cataracts or significantly change intraocular pressure or vision in a prospective, longitudinal, placebo-controlled study.

Among 300 Danish patients taking inhaled budesonide for chronic asthma, 148 underwent eye examinations 15-20 years after the start of the study, as did 53 of 163 healthy siblings in the control group. The exams detected two posterior subcapsular cataracts that were outside the central 3-mm zone, but both were in the control group and none in the budesonide group, Dr. Søren Pedersen and his associates reported at the annual meeting of the American Academy of Allergy, Asthma and Immunology.

Nineteen cataracts in the budesonide group would have been needed to demonstrate a statistically significant 5% increased risk for cataracts, a poststudy power analysis found.

Average vision measurements were identical between groups (1.04 in each eye), said Dr. Pedersen of the University of Southern Denmark, Kolding. Intraocular pressures did not differ significantly between groups, with average measurements of 13.8 mm Hg in each eye of the asthma patients, and averages of 14.5 mm Hg in the right eyes and 14.2 mm Hg in the left eyes of the control group.

“This is a very strong finding” of safety with long-term inhaled budesonide, he said in an interview.

Patients took a mean daily dose of 385 mcg of budesonide and accumulated a mean dose of 2.3 g. Increased intraocular pressures (higher than 21 mm Hg) were seen in five patients (3.4%) and in one sibling in the control group (1.9%), a nonsignificant difference between groups. The accumulated dose of budesonide was not significantly associated with intraocular pressure, Dr. Pedersen said.

The study is part of a larger study that began with 270 children, including 62 with asthma who did not use inhaled corticosteroids, all of whom were evaluated for cataracts, bruises, growth, bone mineral density, and clinical effects of inhaled budesonide 4-6 years after treatment started, with no adverse effects found. At that point, 32 children in the control group dropped out, the other 30 shifted to the budesonide group, and 163 healthy siblings became the new control group. Patients were followed with various evaluations every 1-2 years.

The mean age of those who had eye exams 15-20 years into the study was 26 years for patients and 28 years for siblings. A total of 68% of patients and 47% of controls were male. Treatment duration ranged from 3 to 22 years. Daily budesonide dose ranged from 50 to 1,220 mcg. The accumulated budesonide dose ranged from less than 1 g to 8.8 g.

The ophthalmologist who performed all of the eye exams did not know which subjects were patients and which were controls.

Previous studies of the risk of posterior subcapsular cataracts from oral or inhaled steroids were cross-sectional studies with little or no information on the dose of inhaled corticosteroid used, he said.

AstraZeneca, which markets budesonide, funded the study. Dr. Pedersen said there were no other conflicts of interest.

SAN FRANCISCO – Overweight inner-city teenagers with nonobstructive asthma were more likely than their normal-weight peers to report that their asthma was out of control even when spirometry results suggested they were having a relatively good day, a study of 114 teens found.

The study included 102 normal-weight adolescents and 112 overweight adolescents (defined as a body mass index greater than the 85th percentile) who completed the Asthma Control Test and spirometry measures. Observed lung function was similar between the two groups, Iwalola Awoyinka and her associates reported at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

Overall, the overweight teenagers were more likely than the normal-weight teenagers to report uncontrolled asthma on the Asthma Control Test. When compared by asthma pattern, however, only teens with nonobstructive asthma were significantly more likely to report uncontrolled asthma (in more than 60%), compared with normal-weight teens with nonobstructive asthma, approximately 50% of whom reported uncontrolled asthma.

Among teens with an obstructive asthma pattern, reports of uncontrolled asthma were statistically similar between the overweight and normal-weight groups, hovering around 60%, said Ms. Awoyinka, a pulmonary function specialist and research coordinator at the University of Wisconsin, Madison.

What some overweight teens perceive as uncontrolled asthma may be a symptom of deconditioning, Ms. Awoyinka suggested. Misperceptions of uncontrolled asthma may lead to overuse of asthma medication. Perhaps prescriptions for overweight teens with asthma should include prescriptions to exercise, she added in an interview.

Uncontrolled asthma, defined as a score of 19 or less on the Asthma Control Test, was reported by 131 adolescents. Spirometry identified 99 teens as having nonobstructive asthma and 115 as having an obstructive asthma pattern, defined as less than 80% of predicted forced expiratory volume in 1 second (FEV₁) or a ratio of FEV₁ to forced vital capacity (FVC) of less than 0.85.

The analysis was part of a larger study of the use of electronic technology to improve asthma control in 218 inner-city teens on Medicaid, 4 of whom were excluded from the analysis because of a lack of acceptable spirometry results. Previous studies have shown that teens with low socioeconomic status are more likely to be overweight and to have asthma than are more affluent teens.

The National Institutes of Health funded the study. The investigators reported having no relevant conflicts of interest.

SAN FRANCISCO – Overweight inner-city teenagers with nonobstructive asthma were more likely than their normal-weight peers to report that their asthma was out of control even when spirometry results suggested they were having a relatively good day, a study of 114 teens found.

The study included 102 normal-weight adolescents and 112 overweight adolescents (defined as a body mass index greater than the 85th percentile) who completed the Asthma Control Test and spirometry measures. Observed lung function was similar between the two groups, Iwalola Awoyinka and her associates reported at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

Overall, the overweight teenagers were more likely than the normal-weight teenagers to report uncontrolled asthma on the Asthma Control Test. When compared by asthma pattern, however, only teens with nonobstructive asthma were significantly more likely to report uncontrolled asthma (in more than 60%), compared with normal-weight teens with nonobstructive asthma, approximately 50% of whom reported uncontrolled asthma.

Among teens with an obstructive asthma pattern, reports of uncontrolled asthma were statistically similar between the overweight and normal-weight groups, hovering around 60%, said Ms. Awoyinka, a pulmonary function specialist and research coordinator at the University of Wisconsin, Madison.

What some overweight teens perceive as uncontrolled asthma may be a symptom of deconditioning, Ms. Awoyinka suggested. Misperceptions of uncontrolled asthma may lead to overuse of asthma medication. Perhaps prescriptions for overweight teens with asthma should include prescriptions to exercise, she added in an interview.

Uncontrolled asthma, defined as a score of 19 or less on the Asthma Control Test, was reported by 131 adolescents. Spirometry identified 99 teens as having nonobstructive asthma and 115 as having an obstructive asthma pattern, defined as less than 80% of predicted forced expiratory volume in 1 second (FEV₁) or a ratio of FEV₁ to forced vital capacity (FVC) of less than 0.85.

The analysis was part of a larger study of the use of electronic technology to improve asthma control in 218 inner-city teens on Medicaid, 4 of whom were excluded from the analysis because of a lack of acceptable spirometry results. Previous studies have shown that teens with low socioeconomic status are more likely to be overweight and to have asthma than are more affluent teens.

The National Institutes of Health funded the study. The investigators reported having no relevant conflicts of interest.

SAN FRANCISCO – Overweight inner-city teenagers with nonobstructive asthma were more likely than their normal-weight peers to report that their asthma was out of control even when spirometry results suggested they were having a relatively good day, a study of 114 teens found.

The study included 102 normal-weight adolescents and 112 overweight adolescents (defined as a body mass index greater than the 85th percentile) who completed the Asthma Control Test and spirometry measures. Observed lung function was similar between the two groups, Iwalola Awoyinka and her associates reported at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

Overall, the overweight teenagers were more likely than the normal-weight teenagers to report uncontrolled asthma on the Asthma Control Test. When compared by asthma pattern, however, only teens with nonobstructive asthma were significantly more likely to report uncontrolled asthma (in more than 60%), compared with normal-weight teens with nonobstructive asthma, approximately 50% of whom reported uncontrolled asthma.

Among teens with an obstructive asthma pattern, reports of uncontrolled asthma were statistically similar between the overweight and normal-weight groups, hovering around 60%, said Ms. Awoyinka, a pulmonary function specialist and research coordinator at the University of Wisconsin, Madison.

What some overweight teens perceive as uncontrolled asthma may be a symptom of deconditioning, Ms. Awoyinka suggested. Misperceptions of uncontrolled asthma may lead to overuse of asthma medication. Perhaps prescriptions for overweight teens with asthma should include prescriptions to exercise, she added in an interview.

Uncontrolled asthma, defined as a score of 19 or less on the Asthma Control Test, was reported by 131 adolescents. Spirometry identified 99 teens as having nonobstructive asthma and 115 as having an obstructive asthma pattern, defined as less than 80% of predicted forced expiratory volume in 1 second (FEV₁) or a ratio of FEV₁ to forced vital capacity (FVC) of less than 0.85.

The analysis was part of a larger study of the use of electronic technology to improve asthma control in 218 inner-city teens on Medicaid, 4 of whom were excluded from the analysis because of a lack of acceptable spirometry results. Previous studies have shown that teens with low socioeconomic status are more likely to be overweight and to have asthma than are more affluent teens.

The National Institutes of Health funded the study. The investigators reported having no relevant conflicts of interest.

SAN FRANCISCO – Overweight inner-city teenagers with nonobstructive asthma were more likely than their normal-weight peers to report that their asthma was out of control even when spirometry results suggested they were having a relatively good day, a study of 114 teens found.

The study included 102 normal-weight adolescents and 112 overweight adolescents (defined as a body mass index greater than the 85th percentile) who completed the Asthma Control Test and spirometry measures. Observed lung function was similar between the two groups, Iwalola Awoyinka and her associates reported at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

Overall, the overweight teenagers were more likely than the normal-weight teenagers to report uncontrolled asthma on the Asthma Control Test. When compared by asthma pattern, however, only teens with nonobstructive asthma were significantly more likely to report uncontrolled asthma (in more than 60%), compared with normal-weight teens with nonobstructive asthma, approximately 50% of whom reported uncontrolled asthma.

Among teens with an obstructive asthma pattern, reports of uncontrolled asthma were statistically similar between the overweight and normal-weight groups, hovering around 60%, said Ms. Awoyinka, a pulmonary function specialist and research coordinator at the University of Wisconsin, Madison.

What some overweight teens perceive as uncontrolled asthma may be a symptom of deconditioning, Ms. Awoyinka suggested. Misperceptions of uncontrolled asthma may lead to overuse of asthma medication. Perhaps prescriptions for overweight teens with asthma should include prescriptions to exercise, she added in an interview.

Uncontrolled asthma, defined as a score of 19 or less on the Asthma Control Test, was reported by 131 adolescents. Spirometry identified 99 teens as having nonobstructive asthma and 115 as having an obstructive asthma pattern, defined as less than 80% of predicted forced expiratory volume in 1 second (FEV₁) or a ratio of FEV₁ to forced vital capacity (FVC) of less than 0.85.

The analysis was part of a larger study of the use of electronic technology to improve asthma control in 218 inner-city teens on Medicaid, 4 of whom were excluded from the analysis because of a lack of acceptable spirometry results. Previous studies have shown that teens with low socioeconomic status are more likely to be overweight and to have asthma than are more affluent teens.

The National Institutes of Health funded the study. The investigators reported having no relevant conflicts of interest.

SAN FRANCISCO – Overweight inner-city teenagers with nonobstructive asthma were more likely than their normal-weight peers to report that their asthma was out of control even when spirometry results suggested they were having a relatively good day, a study of 114 teens found.

The study included 102 normal-weight adolescents and 112 overweight adolescents (defined as a body mass index greater than the 85th percentile) who completed the Asthma Control Test and spirometry measures. Observed lung function was similar between the two groups, Iwalola Awoyinka and her associates reported at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

Overall, the overweight teenagers were more likely than the normal-weight teenagers to report uncontrolled asthma on the Asthma Control Test. When compared by asthma pattern, however, only teens with nonobstructive asthma were significantly more likely to report uncontrolled asthma (in more than 60%), compared with normal-weight teens with nonobstructive asthma, approximately 50% of whom reported uncontrolled asthma.

Among teens with an obstructive asthma pattern, reports of uncontrolled asthma were statistically similar between the overweight and normal-weight groups, hovering around 60%, said Ms. Awoyinka, a pulmonary function specialist and research coordinator at the University of Wisconsin, Madison.

What some overweight teens perceive as uncontrolled asthma may be a symptom of deconditioning, Ms. Awoyinka suggested. Misperceptions of uncontrolled asthma may lead to overuse of asthma medication. Perhaps prescriptions for overweight teens with asthma should include prescriptions to exercise, she added in an interview.

Uncontrolled asthma, defined as a score of 19 or less on the Asthma Control Test, was reported by 131 adolescents. Spirometry identified 99 teens as having nonobstructive asthma and 115 as having an obstructive asthma pattern, defined as less than 80% of predicted forced expiratory volume in 1 second (FEV₁) or a ratio of FEV₁ to forced vital capacity (FVC) of less than 0.85.

The analysis was part of a larger study of the use of electronic technology to improve asthma control in 218 inner-city teens on Medicaid, 4 of whom were excluded from the analysis because of a lack of acceptable spirometry results. Previous studies have shown that teens with low socioeconomic status are more likely to be overweight and to have asthma than are more affluent teens.

The National Institutes of Health funded the study. The investigators reported having no relevant conflicts of interest.

SAN FRANCISCO – Overweight inner-city teenagers with nonobstructive asthma were more likely than their normal-weight peers to report that their asthma was out of control even when spirometry results suggested they were having a relatively good day, a study of 114 teens found.

The study included 102 normal-weight adolescents and 112 overweight adolescents (defined as a body mass index greater than the 85th percentile) who completed the Asthma Control Test and spirometry measures. Observed lung function was similar between the two groups, Iwalola Awoyinka and her associates reported at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

Overall, the overweight teenagers were more likely than the normal-weight teenagers to report uncontrolled asthma on the Asthma Control Test. When compared by asthma pattern, however, only teens with nonobstructive asthma were significantly more likely to report uncontrolled asthma (in more than 60%), compared with normal-weight teens with nonobstructive asthma, approximately 50% of whom reported uncontrolled asthma.

Among teens with an obstructive asthma pattern, reports of uncontrolled asthma were statistically similar between the overweight and normal-weight groups, hovering around 60%, said Ms. Awoyinka, a pulmonary function specialist and research coordinator at the University of Wisconsin, Madison.

What some overweight teens perceive as uncontrolled asthma may be a symptom of deconditioning, Ms. Awoyinka suggested. Misperceptions of uncontrolled asthma may lead to overuse of asthma medication. Perhaps prescriptions for overweight teens with asthma should include prescriptions to exercise, she added in an interview.

Uncontrolled asthma, defined as a score of 19 or less on the Asthma Control Test, was reported by 131 adolescents. Spirometry identified 99 teens as having nonobstructive asthma and 115 as having an obstructive asthma pattern, defined as less than 80% of predicted forced expiratory volume in 1 second (FEV₁) or a ratio of FEV₁ to forced vital capacity (FVC) of less than 0.85.

The analysis was part of a larger study of the use of electronic technology to improve asthma control in 218 inner-city teens on Medicaid, 4 of whom were excluded from the analysis because of a lack of acceptable spirometry results. Previous studies have shown that teens with low socioeconomic status are more likely to be overweight and to have asthma than are more affluent teens.

The National Institutes of Health funded the study. The investigators reported having no relevant conflicts of interest.

SAN FRANCISCO – Overweight inner-city teenagers with nonobstructive asthma were more likely than their normal-weight peers to report that their asthma was out of control even when spirometry results suggested they were having a relatively good day, a study of 114 teens found.

The study included 102 normal-weight adolescents and 112 overweight adolescents (defined as a body mass index greater than the 85th percentile) who completed the Asthma Control Test and spirometry measures. Observed lung function was similar between the two groups, Iwalola Awoyinka and her associates reported at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

Overall, the overweight teenagers were more likely than the normal-weight teenagers to report uncontrolled asthma on the Asthma Control Test. When compared by asthma pattern, however, only teens with nonobstructive asthma were significantly more likely to report uncontrolled asthma (in more than 60%), compared with normal-weight teens with nonobstructive asthma, approximately 50% of whom reported uncontrolled asthma.

Among teens with an obstructive asthma pattern, reports of uncontrolled asthma were statistically similar between the overweight and normal-weight groups, hovering around 60%, said Ms. Awoyinka, a pulmonary function specialist and research coordinator at the University of Wisconsin, Madison.

What some overweight teens perceive as uncontrolled asthma may be a symptom of deconditioning, Ms. Awoyinka suggested. Misperceptions of uncontrolled asthma may lead to overuse of asthma medication. Perhaps prescriptions for overweight teens with asthma should include prescriptions to exercise, she added in an interview.

Uncontrolled asthma, defined as a score of 19 or less on the Asthma Control Test, was reported by 131 adolescents. Spirometry identified 99 teens as having nonobstructive asthma and 115 as having an obstructive asthma pattern, defined as less than 80% of predicted forced expiratory volume in 1 second (FEV₁) or a ratio of FEV₁ to forced vital capacity (FVC) of less than 0.85.

The analysis was part of a larger study of the use of electronic technology to improve asthma control in 218 inner-city teens on Medicaid, 4 of whom were excluded from the analysis because of a lack of acceptable spirometry results. Previous studies have shown that teens with low socioeconomic status are more likely to be overweight and to have asthma than are more affluent teens.

The National Institutes of Health funded the study. The investigators reported having no relevant conflicts of interest.

SAN FRANCISCO – Overweight inner-city teenagers with nonobstructive asthma were more likely than their normal-weight peers to report that their asthma was out of control even when spirometry results suggested they were having a relatively good day, a study of 114 teens found.

The study included 102 normal-weight adolescents and 112 overweight adolescents (defined as a body mass index greater than the 85th percentile) who completed the Asthma Control Test and spirometry measures. Observed lung function was similar between the two groups, Iwalola Awoyinka and her associates reported at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

Overall, the overweight teenagers were more likely than the normal-weight teenagers to report uncontrolled asthma on the Asthma Control Test. When compared by asthma pattern, however, only teens with nonobstructive asthma were significantly more likely to report uncontrolled asthma (in more than 60%), compared with normal-weight teens with nonobstructive asthma, approximately 50% of whom reported uncontrolled asthma.

Among teens with an obstructive asthma pattern, reports of uncontrolled asthma were statistically similar between the overweight and normal-weight groups, hovering around 60%, said Ms. Awoyinka, a pulmonary function specialist and research coordinator at the University of Wisconsin, Madison.

What some overweight teens perceive as uncontrolled asthma may be a symptom of deconditioning, Ms. Awoyinka suggested. Misperceptions of uncontrolled asthma may lead to overuse of asthma medication. Perhaps prescriptions for overweight teens with asthma should include prescriptions to exercise, she added in an interview.

Uncontrolled asthma, defined as a score of 19 or less on the Asthma Control Test, was reported by 131 adolescents. Spirometry identified 99 teens as having nonobstructive asthma and 115 as having an obstructive asthma pattern, defined as less than 80% of predicted forced expiratory volume in 1 second (FEV₁) or a ratio of FEV₁ to forced vital capacity (FVC) of less than 0.85.

The analysis was part of a larger study of the use of electronic technology to improve asthma control in 218 inner-city teens on Medicaid, 4 of whom were excluded from the analysis because of a lack of acceptable spirometry results. Previous studies have shown that teens with low socioeconomic status are more likely to be overweight and to have asthma than are more affluent teens.

The National Institutes of Health funded the study. The investigators reported having no relevant conflicts of interest.

SAN FRANCISCO – Overweight inner-city teenagers with nonobstructive asthma were more likely than their normal-weight peers to report that their asthma was out of control even when spirometry results suggested they were having a relatively good day, a study of 114 teens found.

The study included 102 normal-weight adolescents and 112 overweight adolescents (defined as a body mass index greater than the 85th percentile) who completed the Asthma Control Test and spirometry measures. Observed lung function was similar between the two groups, Iwalola Awoyinka and her associates reported at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

Overall, the overweight teenagers were more likely than the normal-weight teenagers to report uncontrolled asthma on the Asthma Control Test. When compared by asthma pattern, however, only teens with nonobstructive asthma were significantly more likely to report uncontrolled asthma (in more than 60%), compared with normal-weight teens with nonobstructive asthma, approximately 50% of whom reported uncontrolled asthma.

Among teens with an obstructive asthma pattern, reports of uncontrolled asthma were statistically similar between the overweight and normal-weight groups, hovering around 60%, said Ms. Awoyinka, a pulmonary function specialist and research coordinator at the University of Wisconsin, Madison.

What some overweight teens perceive as uncontrolled asthma may be a symptom of deconditioning, Ms. Awoyinka suggested. Misperceptions of uncontrolled asthma may lead to overuse of asthma medication. Perhaps prescriptions for overweight teens with asthma should include prescriptions to exercise, she added in an interview.

Uncontrolled asthma, defined as a score of 19 or less on the Asthma Control Test, was reported by 131 adolescents. Spirometry identified 99 teens as having nonobstructive asthma and 115 as having an obstructive asthma pattern, defined as less than 80% of predicted forced expiratory volume in 1 second (FEV₁) or a ratio of FEV₁ to forced vital capacity (FVC) of less than 0.85.

The analysis was part of a larger study of the use of electronic technology to improve asthma control in 218 inner-city teens on Medicaid, 4 of whom were excluded from the analysis because of a lack of acceptable spirometry results. Previous studies have shown that teens with low socioeconomic status are more likely to be overweight and to have asthma than are more affluent teens.

The National Institutes of Health funded the study. The investigators reported having no relevant conflicts of interest.

SAN FRANCISCO – Seven forms of psychotherapy have been proven in randomized clinical trials to be effective in treating borderline personality disorder.

No one knows why so many approaches work, but there are some common elements among them, Dr. Glen O. Gabbard said at the annual meeting of the American College of Psychiatrists. Researchers and clinicians are trying to figure out which psychotherapy might be best for any subset of patients with borderline personality disorder.

Within each individual patient, too, there are aspects of the disorder that might respond to one form of therapy, while another aspect of the disorder requires a different therapeutic approach, said Dr. Gabbard, professor of psychiatry and chair of psychoanalysis at Baylor College of Medicine, Houston.

Psychotherapies that are effective in treating borderline personality disorder include dialectical behavior therapy, mentalization-based therapy, transference-focused psychotherapy, schema-focused therapy, supportive psychotherapy, systems training for emotional predictability and problem solving, and general psychiatric management with dynamically oriented therapy.

All provide a systematic conceptual framework of pathogenesis and treatment that helps patients organize their internal chaos and make sense of it. Research shows that the therapeutic alliance is the key factor, while the technique gets credited with only 12%-15% of therapeutic change across different kinds of therapy.

In each of the psychotherapies, change happens through similar underlying neurophysiologic processes: increased activity of the prefrontal cortex modifies amygdala hyperactivity, and the therapeutic relationship is used to sharpen patients’ ability to reappraise their assumptions, perceptions, and "knee-jerk" beliefs, he said. "All seven models have somebody sitting with patients and helping them sharpen self-observation."

Within individual patients, some aspects of the disorder respond to insight, while others require internalization of the therapeutic relationship over time.

The therapeutic relationship by itself is not enough, however. "We might overvalue that," Dr. Gabbard said. The therapeutic frame is an envelope within which the therapist helps the patient impose a way of thinking to manage unbearable affect states, "those that can’t be borne by one person alone. You need somebody else to help you through that," he said. The aim is to help patients develop their own capacity for thinking and feeling their experience.

Building "procedural memories" requires multiple repetitions to develop new neural networks of self and other, which don’t replace old maladaptive neural networks but gradually supersede them over time. "It’s interesting that all of those seven therapies are long-term therapies. There’s no quick fix with borderline" personality disorder, he said.

Efforts aimed at tailoring the therapeutic approach to patients’ individual characteristics all have the common goal of activating the prefrontal cortex and the anterior cingulate cortex to modulate limbic-based negative feelings and promote thinking in the service of regulating intolerable affect states.

A recent study suggesting that there are two subtypes of post-traumatic stress disorder (PTSD) – including a dissociative subtype – might hold lessons for treating borderline personality disorder, he said (Am. J. Psychiatry 2010;167:640-7).

In a study by other investigators that will be published in the Journal of Personality Disorders, a high level of dissociation was an important predictor of negative outcomes in 57 females treated with dialectical behavior therapy for borderline personality disorder, he said. A phase-oriented approach that focuses on building better functioning in multiple domains might be a better than exposure-based treatment for patients with a dissociative subtype of borderline personality disorder.

People with borderline personality disorder seem to be hard-wired for opioid deficits, which might be one reason for high rates of self-cutting in this disorder – cutting might be a form of self-medicating to release endogenous opioids. Opioids are involved in both emotional regulation and social behavior.

"I don’t think this gets enough attention," Dr. Gabbard said.

Separate studies in the last 3 years report high rates of opiate abuse in patients with borderline personality disorder, and high rates of the disorder in patients seeking buprenorphine treatment (44%). Insufficient endogenous opioids might be a reason that patients with borderline personality disorder have difficulty feeling the satisfaction that usually accompanies intimacy, posing a barrier to the therapeutic alliance.

"I don’t think we’ve fully appreciated how that may be relevant to psychotherapy" for this disorder, he said.

On the other hand, knowing that the opiate deficit might contribute to a feeling that the patient’s pain is not bearable can help prevent the therapist from "blaming" the patient, he said.

Dr. Gabbard said he has no relevant conflicts of interest.

SAN FRANCISCO – Seven forms of psychotherapy have been proven in randomized clinical trials to be effective in treating borderline personality disorder.

No one knows why so many approaches work, but there are some common elements among them, Dr. Glen O. Gabbard said at the annual meeting of the American College of Psychiatrists. Researchers and clinicians are trying to figure out which psychotherapy might be best for any subset of patients with borderline personality disorder.

Within each individual patient, too, there are aspects of the disorder that might respond to one form of therapy, while another aspect of the disorder requires a different therapeutic approach, said Dr. Gabbard, professor of psychiatry and chair of psychoanalysis at Baylor College of Medicine, Houston.

Psychotherapies that are effective in treating borderline personality disorder include dialectical behavior therapy, mentalization-based therapy, transference-focused psychotherapy, schema-focused therapy, supportive psychotherapy, systems training for emotional predictability and problem solving, and general psychiatric management with dynamically oriented therapy.

All provide a systematic conceptual framework of pathogenesis and treatment that helps patients organize their internal chaos and make sense of it. Research shows that the therapeutic alliance is the key factor, while the technique gets credited with only 12%-15% of therapeutic change across different kinds of therapy.

In each of the psychotherapies, change happens through similar underlying neurophysiologic processes: increased activity of the prefrontal cortex modifies amygdala hyperactivity, and the therapeutic relationship is used to sharpen patients’ ability to reappraise their assumptions, perceptions, and "knee-jerk" beliefs, he said. "All seven models have somebody sitting with patients and helping them sharpen self-observation."

Within individual patients, some aspects of the disorder respond to insight, while others require internalization of the therapeutic relationship over time.

The therapeutic relationship by itself is not enough, however. "We might overvalue that," Dr. Gabbard said. The therapeutic frame is an envelope within which the therapist helps the patient impose a way of thinking to manage unbearable affect states, "those that can’t be borne by one person alone. You need somebody else to help you through that," he said. The aim is to help patients develop their own capacity for thinking and feeling their experience.

Building "procedural memories" requires multiple repetitions to develop new neural networks of self and other, which don’t replace old maladaptive neural networks but gradually supersede them over time. "It’s interesting that all of those seven therapies are long-term therapies. There’s no quick fix with borderline" personality disorder, he said.

Efforts aimed at tailoring the therapeutic approach to patients’ individual characteristics all have the common goal of activating the prefrontal cortex and the anterior cingulate cortex to modulate limbic-based negative feelings and promote thinking in the service of regulating intolerable affect states.

A recent study suggesting that there are two subtypes of post-traumatic stress disorder (PTSD) – including a dissociative subtype – might hold lessons for treating borderline personality disorder, he said (Am. J. Psychiatry 2010;167:640-7).

In a study by other investigators that will be published in the Journal of Personality Disorders, a high level of dissociation was an important predictor of negative outcomes in 57 females treated with dialectical behavior therapy for borderline personality disorder, he said. A phase-oriented approach that focuses on building better functioning in multiple domains might be a better than exposure-based treatment for patients with a dissociative subtype of borderline personality disorder.

People with borderline personality disorder seem to be hard-wired for opioid deficits, which might be one reason for high rates of self-cutting in this disorder – cutting might be a form of self-medicating to release endogenous opioids. Opioids are involved in both emotional regulation and social behavior.

"I don’t think this gets enough attention," Dr. Gabbard said.

Separate studies in the last 3 years report high rates of opiate abuse in patients with borderline personality disorder, and high rates of the disorder in patients seeking buprenorphine treatment (44%). Insufficient endogenous opioids might be a reason that patients with borderline personality disorder have difficulty feeling the satisfaction that usually accompanies intimacy, posing a barrier to the therapeutic alliance.

"I don’t think we’ve fully appreciated how that may be relevant to psychotherapy" for this disorder, he said.

On the other hand, knowing that the opiate deficit might contribute to a feeling that the patient’s pain is not bearable can help prevent the therapist from "blaming" the patient, he said.

Dr. Gabbard said he has no relevant conflicts of interest.

SAN FRANCISCO – Seven forms of psychotherapy have been proven in randomized clinical trials to be effective in treating borderline personality disorder.

No one knows why so many approaches work, but there are some common elements among them, Dr. Glen O. Gabbard said at the annual meeting of the American College of Psychiatrists. Researchers and clinicians are trying to figure out which psychotherapy might be best for any subset of patients with borderline personality disorder.

Within each individual patient, too, there are aspects of the disorder that might respond to one form of therapy, while another aspect of the disorder requires a different therapeutic approach, said Dr. Gabbard, professor of psychiatry and chair of psychoanalysis at Baylor College of Medicine, Houston.

Psychotherapies that are effective in treating borderline personality disorder include dialectical behavior therapy, mentalization-based therapy, transference-focused psychotherapy, schema-focused therapy, supportive psychotherapy, systems training for emotional predictability and problem solving, and general psychiatric management with dynamically oriented therapy.

All provide a systematic conceptual framework of pathogenesis and treatment that helps patients organize their internal chaos and make sense of it. Research shows that the therapeutic alliance is the key factor, while the technique gets credited with only 12%-15% of therapeutic change across different kinds of therapy.

In each of the psychotherapies, change happens through similar underlying neurophysiologic processes: increased activity of the prefrontal cortex modifies amygdala hyperactivity, and the therapeutic relationship is used to sharpen patients’ ability to reappraise their assumptions, perceptions, and "knee-jerk" beliefs, he said. "All seven models have somebody sitting with patients and helping them sharpen self-observation."

Within individual patients, some aspects of the disorder respond to insight, while others require internalization of the therapeutic relationship over time.

The therapeutic relationship by itself is not enough, however. "We might overvalue that," Dr. Gabbard said. The therapeutic frame is an envelope within which the therapist helps the patient impose a way of thinking to manage unbearable affect states, "those that can’t be borne by one person alone. You need somebody else to help you through that," he said. The aim is to help patients develop their own capacity for thinking and feeling their experience.

Building "procedural memories" requires multiple repetitions to develop new neural networks of self and other, which don’t replace old maladaptive neural networks but gradually supersede them over time. "It’s interesting that all of those seven therapies are long-term therapies. There’s no quick fix with borderline" personality disorder, he said.

Efforts aimed at tailoring the therapeutic approach to patients’ individual characteristics all have the common goal of activating the prefrontal cortex and the anterior cingulate cortex to modulate limbic-based negative feelings and promote thinking in the service of regulating intolerable affect states.

A recent study suggesting that there are two subtypes of post-traumatic stress disorder (PTSD) – including a dissociative subtype – might hold lessons for treating borderline personality disorder, he said (Am. J. Psychiatry 2010;167:640-7).

In a study by other investigators that will be published in the Journal of Personality Disorders, a high level of dissociation was an important predictor of negative outcomes in 57 females treated with dialectical behavior therapy for borderline personality disorder, he said. A phase-oriented approach that focuses on building better functioning in multiple domains might be a better than exposure-based treatment for patients with a dissociative subtype of borderline personality disorder.

People with borderline personality disorder seem to be hard-wired for opioid deficits, which might be one reason for high rates of self-cutting in this disorder – cutting might be a form of self-medicating to release endogenous opioids. Opioids are involved in both emotional regulation and social behavior.

"I don’t think this gets enough attention," Dr. Gabbard said.

Separate studies in the last 3 years report high rates of opiate abuse in patients with borderline personality disorder, and high rates of the disorder in patients seeking buprenorphine treatment (44%). Insufficient endogenous opioids might be a reason that patients with borderline personality disorder have difficulty feeling the satisfaction that usually accompanies intimacy, posing a barrier to the therapeutic alliance.

"I don’t think we’ve fully appreciated how that may be relevant to psychotherapy" for this disorder, he said.

On the other hand, knowing that the opiate deficit might contribute to a feeling that the patient’s pain is not bearable can help prevent the therapist from "blaming" the patient, he said.

Dr. Gabbard said he has no relevant conflicts of interest.

SAN FRANCISCO – Seven forms of psychotherapy have been proven in randomized clinical trials to be effective in treating borderline personality disorder.

No one knows why so many approaches work, but there are some common elements among them, Dr. Glen O. Gabbard said at the annual meeting of the American College of Psychiatrists. Researchers and clinicians are trying to figure out which psychotherapy might be best for any subset of patients with borderline personality disorder.

Within each individual patient, too, there are aspects of the disorder that might respond to one form of therapy, while another aspect of the disorder requires a different therapeutic approach, said Dr. Gabbard, professor of psychiatry and chair of psychoanalysis at Baylor College of Medicine, Houston.

Psychotherapies that are effective in treating borderline personality disorder include dialectical behavior therapy, mentalization-based therapy, transference-focused psychotherapy, schema-focused therapy, supportive psychotherapy, systems training for emotional predictability and problem solving, and general psychiatric management with dynamically oriented therapy.

All provide a systematic conceptual framework of pathogenesis and treatment that helps patients organize their internal chaos and make sense of it. Research shows that the therapeutic alliance is the key factor, while the technique gets credited with only 12%-15% of therapeutic change across different kinds of therapy.

In each of the psychotherapies, change happens through similar underlying neurophysiologic processes: increased activity of the prefrontal cortex modifies amygdala hyperactivity, and the therapeutic relationship is used to sharpen patients’ ability to reappraise their assumptions, perceptions, and "knee-jerk" beliefs, he said. "All seven models have somebody sitting with patients and helping them sharpen self-observation."

Within individual patients, some aspects of the disorder respond to insight, while others require internalization of the therapeutic relationship over time.

The therapeutic relationship by itself is not enough, however. "We might overvalue that," Dr. Gabbard said. The therapeutic frame is an envelope within which the therapist helps the patient impose a way of thinking to manage unbearable affect states, "those that can’t be borne by one person alone. You need somebody else to help you through that," he said. The aim is to help patients develop their own capacity for thinking and feeling their experience.

Building "procedural memories" requires multiple repetitions to develop new neural networks of self and other, which don’t replace old maladaptive neural networks but gradually supersede them over time. "It’s interesting that all of those seven therapies are long-term therapies. There’s no quick fix with borderline" personality disorder, he said.

Efforts aimed at tailoring the therapeutic approach to patients’ individual characteristics all have the common goal of activating the prefrontal cortex and the anterior cingulate cortex to modulate limbic-based negative feelings and promote thinking in the service of regulating intolerable affect states.

A recent study suggesting that there are two subtypes of post-traumatic stress disorder (PTSD) – including a dissociative subtype – might hold lessons for treating borderline personality disorder, he said (Am. J. Psychiatry 2010;167:640-7).

In a study by other investigators that will be published in the Journal of Personality Disorders, a high level of dissociation was an important predictor of negative outcomes in 57 females treated with dialectical behavior therapy for borderline personality disorder, he said. A phase-oriented approach that focuses on building better functioning in multiple domains might be a better than exposure-based treatment for patients with a dissociative subtype of borderline personality disorder.

People with borderline personality disorder seem to be hard-wired for opioid deficits, which might be one reason for high rates of self-cutting in this disorder – cutting might be a form of self-medicating to release endogenous opioids. Opioids are involved in both emotional regulation and social behavior.

"I don’t think this gets enough attention," Dr. Gabbard said.

Separate studies in the last 3 years report high rates of opiate abuse in patients with borderline personality disorder, and high rates of the disorder in patients seeking buprenorphine treatment (44%). Insufficient endogenous opioids might be a reason that patients with borderline personality disorder have difficulty feeling the satisfaction that usually accompanies intimacy, posing a barrier to the therapeutic alliance.

"I don’t think we’ve fully appreciated how that may be relevant to psychotherapy" for this disorder, he said.

On the other hand, knowing that the opiate deficit might contribute to a feeling that the patient’s pain is not bearable can help prevent the therapist from "blaming" the patient, he said.

Dr. Gabbard said he has no relevant conflicts of interest.

SAN FRANCISCO – Seven forms of psychotherapy have been proven in randomized clinical trials to be effective in treating borderline personality disorder.

No one knows why so many approaches work, but there are some common elements among them, Dr. Glen O. Gabbard said at the annual meeting of the American College of Psychiatrists. Researchers and clinicians are trying to figure out which psychotherapy might be best for any subset of patients with borderline personality disorder.

Within each individual patient, too, there are aspects of the disorder that might respond to one form of therapy, while another aspect of the disorder requires a different therapeutic approach, said Dr. Gabbard, professor of psychiatry and chair of psychoanalysis at Baylor College of Medicine, Houston.

Psychotherapies that are effective in treating borderline personality disorder include dialectical behavior therapy, mentalization-based therapy, transference-focused psychotherapy, schema-focused therapy, supportive psychotherapy, systems training for emotional predictability and problem solving, and general psychiatric management with dynamically oriented therapy.

All provide a systematic conceptual framework of pathogenesis and treatment that helps patients organize their internal chaos and make sense of it. Research shows that the therapeutic alliance is the key factor, while the technique gets credited with only 12%-15% of therapeutic change across different kinds of therapy.

In each of the psychotherapies, change happens through similar underlying neurophysiologic processes: increased activity of the prefrontal cortex modifies amygdala hyperactivity, and the therapeutic relationship is used to sharpen patients’ ability to reappraise their assumptions, perceptions, and "knee-jerk" beliefs, he said. "All seven models have somebody sitting with patients and helping them sharpen self-observation."

Within individual patients, some aspects of the disorder respond to insight, while others require internalization of the therapeutic relationship over time.

The therapeutic relationship by itself is not enough, however. "We might overvalue that," Dr. Gabbard said. The therapeutic frame is an envelope within which the therapist helps the patient impose a way of thinking to manage unbearable affect states, "those that can’t be borne by one person alone. You need somebody else to help you through that," he said. The aim is to help patients develop their own capacity for thinking and feeling their experience.

Building "procedural memories" requires multiple repetitions to develop new neural networks of self and other, which don’t replace old maladaptive neural networks but gradually supersede them over time. "It’s interesting that all of those seven therapies are long-term therapies. There’s no quick fix with borderline" personality disorder, he said.

Efforts aimed at tailoring the therapeutic approach to patients’ individual characteristics all have the common goal of activating the prefrontal cortex and the anterior cingulate cortex to modulate limbic-based negative feelings and promote thinking in the service of regulating intolerable affect states.

A recent study suggesting that there are two subtypes of post-traumatic stress disorder (PTSD) – including a dissociative subtype – might hold lessons for treating borderline personality disorder, he said (Am. J. Psychiatry 2010;167:640-7).

In a study by other investigators that will be published in the Journal of Personality Disorders, a high level of dissociation was an important predictor of negative outcomes in 57 females treated with dialectical behavior therapy for borderline personality disorder, he said. A phase-oriented approach that focuses on building better functioning in multiple domains might be a better than exposure-based treatment for patients with a dissociative subtype of borderline personality disorder.

People with borderline personality disorder seem to be hard-wired for opioid deficits, which might be one reason for high rates of self-cutting in this disorder – cutting might be a form of self-medicating to release endogenous opioids. Opioids are involved in both emotional regulation and social behavior.

"I don’t think this gets enough attention," Dr. Gabbard said.

Separate studies in the last 3 years report high rates of opiate abuse in patients with borderline personality disorder, and high rates of the disorder in patients seeking buprenorphine treatment (44%). Insufficient endogenous opioids might be a reason that patients with borderline personality disorder have difficulty feeling the satisfaction that usually accompanies intimacy, posing a barrier to the therapeutic alliance.

"I don’t think we’ve fully appreciated how that may be relevant to psychotherapy" for this disorder, he said.

On the other hand, knowing that the opiate deficit might contribute to a feeling that the patient’s pain is not bearable can help prevent the therapist from "blaming" the patient, he said.

Dr. Gabbard said he has no relevant conflicts of interest.

SAN FRANCISCO – Seven forms of psychotherapy have been proven in randomized clinical trials to be effective in treating borderline personality disorder.

No one knows why so many approaches work, but there are some common elements among them, Dr. Glen O. Gabbard said at the annual meeting of the American College of Psychiatrists. Researchers and clinicians are trying to figure out which psychotherapy might be best for any subset of patients with borderline personality disorder.

Within each individual patient, too, there are aspects of the disorder that might respond to one form of therapy, while another aspect of the disorder requires a different therapeutic approach, said Dr. Gabbard, professor of psychiatry and chair of psychoanalysis at Baylor College of Medicine, Houston.

Psychotherapies that are effective in treating borderline personality disorder include dialectical behavior therapy, mentalization-based therapy, transference-focused psychotherapy, schema-focused therapy, supportive psychotherapy, systems training for emotional predictability and problem solving, and general psychiatric management with dynamically oriented therapy.

All provide a systematic conceptual framework of pathogenesis and treatment that helps patients organize their internal chaos and make sense of it. Research shows that the therapeutic alliance is the key factor, while the technique gets credited with only 12%-15% of therapeutic change across different kinds of therapy.

In each of the psychotherapies, change happens through similar underlying neurophysiologic processes: increased activity of the prefrontal cortex modifies amygdala hyperactivity, and the therapeutic relationship is used to sharpen patients’ ability to reappraise their assumptions, perceptions, and "knee-jerk" beliefs, he said. "All seven models have somebody sitting with patients and helping them sharpen self-observation."

Within individual patients, some aspects of the disorder respond to insight, while others require internalization of the therapeutic relationship over time.

The therapeutic relationship by itself is not enough, however. "We might overvalue that," Dr. Gabbard said. The therapeutic frame is an envelope within which the therapist helps the patient impose a way of thinking to manage unbearable affect states, "those that can’t be borne by one person alone. You need somebody else to help you through that," he said. The aim is to help patients develop their own capacity for thinking and feeling their experience.

Building "procedural memories" requires multiple repetitions to develop new neural networks of self and other, which don’t replace old maladaptive neural networks but gradually supersede them over time. "It’s interesting that all of those seven therapies are long-term therapies. There’s no quick fix with borderline" personality disorder, he said.

Efforts aimed at tailoring the therapeutic approach to patients’ individual characteristics all have the common goal of activating the prefrontal cortex and the anterior cingulate cortex to modulate limbic-based negative feelings and promote thinking in the service of regulating intolerable affect states.

A recent study suggesting that there are two subtypes of post-traumatic stress disorder (PTSD) – including a dissociative subtype – might hold lessons for treating borderline personality disorder, he said (Am. J. Psychiatry 2010;167:640-7).

In a study by other investigators that will be published in the Journal of Personality Disorders, a high level of dissociation was an important predictor of negative outcomes in 57 females treated with dialectical behavior therapy for borderline personality disorder, he said. A phase-oriented approach that focuses on building better functioning in multiple domains might be a better than exposure-based treatment for patients with a dissociative subtype of borderline personality disorder.

People with borderline personality disorder seem to be hard-wired for opioid deficits, which might be one reason for high rates of self-cutting in this disorder – cutting might be a form of self-medicating to release endogenous opioids. Opioids are involved in both emotional regulation and social behavior.

"I don’t think this gets enough attention," Dr. Gabbard said.

Separate studies in the last 3 years report high rates of opiate abuse in patients with borderline personality disorder, and high rates of the disorder in patients seeking buprenorphine treatment (44%). Insufficient endogenous opioids might be a reason that patients with borderline personality disorder have difficulty feeling the satisfaction that usually accompanies intimacy, posing a barrier to the therapeutic alliance.

"I don’t think we’ve fully appreciated how that may be relevant to psychotherapy" for this disorder, he said.

On the other hand, knowing that the opiate deficit might contribute to a feeling that the patient’s pain is not bearable can help prevent the therapist from "blaming" the patient, he said.

Dr. Gabbard said he has no relevant conflicts of interest.

SAN FRANCISCO – A collaborative, community-based program to improve care for publicly insured children has reduced emergency department visits, hospitalizations, and costs, thanks in large part to a strong focus on asthma care.

Dr. Tom Peterson and his associates emulated a similar program at Denver Children’s Hospital to start the Children’s Healthcare Access Program (CHAP) for pediatric Medicaid recipients in Grand Rapids, Mich. Their 3-year-old program has been so successful that other Michigan counties are now copying it.

"It’s not just an asthma program, but asthma is the biggest and most collaborative project we’ve pulled together" in CHAP, he said at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

In its first 3 years, CHAP connected almost 2,000 new Medicaid patients with clinicians and helped those clinicians access approximately $500,000 in provider incentives such as pay-for-performance incentives, he said. Of the approximately 15,300 children covered by CHAP, almost 6,000 were referred for CHAP services, including transportation for patients who might otherwise be no-shows for appointments.

In the CHAP population overall, emergency department visits decreased by 12% and hospitalizations decreased by 14%, reported Dr. Peterson, a pediatrician and executive director of safety, quality, and community health at Helen DeVos Children’s Hospital, Grand Rapids. Much greater decreases were seen in teaching clinics involved in CHAP.

Previous research by Dr. Peterson showed that children with public insurance or no insurance in Michigan were twice as likely to have asthma as were privately insured children (J. Pediatrics 2011;158:313-8.e2).

His hospital partnered with the Asthma Network of West Michigan and a managed care organization to pull together a group consisting of 40 pediatricians; 10-12 family physicians; and midlevel providers from four private practices, nine community- and school-based clinics, a pediatric resident teaching clinic, and a nurse practitioner clinic in CHAP.

The program features a team of six or seven people who help improve the children’s "medical homes" in primary care practices and help clinicians by coordinating the care. "Education is a significant piece of this, not just for the families but also for providers, sites, and patients," Dr. Peterson said.

CHAP can help practices improve efficiencies and scheduling. It helps coordinate care with mental health services, transportation, and other services. Education covers not just asthma but also flu shots, diet and nutrition, and inappropriate use of emergency departments. CHAP also acts as a neutral convener of meetings with community stakeholders (some of whom had never met together) to address systemic issues.

The asthma program within CHAP provides ongoing education and training of health care providers, families, and patients. High-risk children get monthly home-based visits for disease management for the first 6 months, then two visits in the next 6 months. CHAP pays attention to transitions of care between inpatient stays and medical homes, and now includes schools in postdischarge care. Services currently are provided by four certified, culturally skilled, multilingual asthma educators and two social workers, who may visit families to assist with psychosocial barriers to asthma care. CHAP also provides funding for home-based asthma case management through the Asthma Network of West Michigan.

Among seven high-risk children with asthma in CHAP’s case-management program, emergency department visits have decreased by 30% and hospitalizations have decreased by 63%, he said.

CHAP’s asthma team includes five pediatricians, asthma educators, an asthma and allergy specialist, school leaders or nurses, Medicaid health plan representatives and case managers, the Children’s Hospital quality improvement specialist, CHAP’s medical director and manager, and data analysts. "It’s a pretty diverse group of people to get together," Dr. Peterson said.

The CHAP team assesses participating medical practices for 12 characteristics "that we think constitute a really good asthma site," he said. These include asthma in-service training for staff and education for patients, having an in-office asthma educator, referring appropriate patients to CHAP or the Asthma Network of West Michigan, teaching peak flow monitoring, assessing exposure to environmental tobacco, in-office spirometry, use of management plans, the Asthma Control Test and an asthma registry, and routine 6-month asthma visits.

With 1 point allotted for each of the 12 factors, the average score of CHAP practices increased from 6 to 10 in the first 3 years of the program.

Priority Health, a managed care organization, provided kits for the program. CHAP is funded by the hospital and by a variety of private and corporate foundations, including the Douglas and Maria DeVos Foundation, W.K. Kellogg Foundation, Steelcase Foundation, Sebastian Foundation, Early Childhood Investment Corporation, Frey Foundation, Grand Rapids Community Foundation, Heart of West Michigan United Way, O’Donovan Family Foundation, and PNC Grow Up Great. Dr. Peterson said he has no conflicts of interest.

SAN FRANCISCO – A collaborative, community-based program to improve care for publicly insured children has reduced emergency department visits, hospitalizations, and costs, thanks in large part to a strong focus on asthma care.

Dr. Tom Peterson and his associates emulated a similar program at Denver Children’s Hospital to start the Children’s Healthcare Access Program (CHAP) for pediatric Medicaid recipients in Grand Rapids, Mich. Their 3-year-old program has been so successful that other Michigan counties are now copying it.

"It’s not just an asthma program, but asthma is the biggest and most collaborative project we’ve pulled together" in CHAP, he said at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

In its first 3 years, CHAP connected almost 2,000 new Medicaid patients with clinicians and helped those clinicians access approximately $500,000 in provider incentives such as pay-for-performance incentives, he said. Of the approximately 15,300 children covered by CHAP, almost 6,000 were referred for CHAP services, including transportation for patients who might otherwise be no-shows for appointments.

In the CHAP population overall, emergency department visits decreased by 12% and hospitalizations decreased by 14%, reported Dr. Peterson, a pediatrician and executive director of safety, quality, and community health at Helen DeVos Children’s Hospital, Grand Rapids. Much greater decreases were seen in teaching clinics involved in CHAP.

Previous research by Dr. Peterson showed that children with public insurance or no insurance in Michigan were twice as likely to have asthma as were privately insured children (J. Pediatrics 2011;158:313-8.e2).

His hospital partnered with the Asthma Network of West Michigan and a managed care organization to pull together a group consisting of 40 pediatricians; 10-12 family physicians; and midlevel providers from four private practices, nine community- and school-based clinics, a pediatric resident teaching clinic, and a nurse practitioner clinic in CHAP.

The program features a team of six or seven people who help improve the children’s "medical homes" in primary care practices and help clinicians by coordinating the care. "Education is a significant piece of this, not just for the families but also for providers, sites, and patients," Dr. Peterson said.

CHAP can help practices improve efficiencies and scheduling. It helps coordinate care with mental health services, transportation, and other services. Education covers not just asthma but also flu shots, diet and nutrition, and inappropriate use of emergency departments. CHAP also acts as a neutral convener of meetings with community stakeholders (some of whom had never met together) to address systemic issues.

The asthma program within CHAP provides ongoing education and training of health care providers, families, and patients. High-risk children get monthly home-based visits for disease management for the first 6 months, then two visits in the next 6 months. CHAP pays attention to transitions of care between inpatient stays and medical homes, and now includes schools in postdischarge care. Services currently are provided by four certified, culturally skilled, multilingual asthma educators and two social workers, who may visit families to assist with psychosocial barriers to asthma care. CHAP also provides funding for home-based asthma case management through the Asthma Network of West Michigan.

Among seven high-risk children with asthma in CHAP’s case-management program, emergency department visits have decreased by 30% and hospitalizations have decreased by 63%, he said.

CHAP’s asthma team includes five pediatricians, asthma educators, an asthma and allergy specialist, school leaders or nurses, Medicaid health plan representatives and case managers, the Children’s Hospital quality improvement specialist, CHAP’s medical director and manager, and data analysts. "It’s a pretty diverse group of people to get together," Dr. Peterson said.

The CHAP team assesses participating medical practices for 12 characteristics "that we think constitute a really good asthma site," he said. These include asthma in-service training for staff and education for patients, having an in-office asthma educator, referring appropriate patients to CHAP or the Asthma Network of West Michigan, teaching peak flow monitoring, assessing exposure to environmental tobacco, in-office spirometry, use of management plans, the Asthma Control Test and an asthma registry, and routine 6-month asthma visits.

With 1 point allotted for each of the 12 factors, the average score of CHAP practices increased from 6 to 10 in the first 3 years of the program.

Priority Health, a managed care organization, provided kits for the program. CHAP is funded by the hospital and by a variety of private and corporate foundations, including the Douglas and Maria DeVos Foundation, W.K. Kellogg Foundation, Steelcase Foundation, Sebastian Foundation, Early Childhood Investment Corporation, Frey Foundation, Grand Rapids Community Foundation, Heart of West Michigan United Way, O’Donovan Family Foundation, and PNC Grow Up Great. Dr. Peterson said he has no conflicts of interest.

SAN FRANCISCO – A collaborative, community-based program to improve care for publicly insured children has reduced emergency department visits, hospitalizations, and costs, thanks in large part to a strong focus on asthma care.

Dr. Tom Peterson and his associates emulated a similar program at Denver Children’s Hospital to start the Children’s Healthcare Access Program (CHAP) for pediatric Medicaid recipients in Grand Rapids, Mich. Their 3-year-old program has been so successful that other Michigan counties are now copying it.

"It’s not just an asthma program, but asthma is the biggest and most collaborative project we’ve pulled together" in CHAP, he said at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

In its first 3 years, CHAP connected almost 2,000 new Medicaid patients with clinicians and helped those clinicians access approximately $500,000 in provider incentives such as pay-for-performance incentives, he said. Of the approximately 15,300 children covered by CHAP, almost 6,000 were referred for CHAP services, including transportation for patients who might otherwise be no-shows for appointments.

In the CHAP population overall, emergency department visits decreased by 12% and hospitalizations decreased by 14%, reported Dr. Peterson, a pediatrician and executive director of safety, quality, and community health at Helen DeVos Children’s Hospital, Grand Rapids. Much greater decreases were seen in teaching clinics involved in CHAP.

Previous research by Dr. Peterson showed that children with public insurance or no insurance in Michigan were twice as likely to have asthma as were privately insured children (J. Pediatrics 2011;158:313-8.e2).

His hospital partnered with the Asthma Network of West Michigan and a managed care organization to pull together a group consisting of 40 pediatricians; 10-12 family physicians; and midlevel providers from four private practices, nine community- and school-based clinics, a pediatric resident teaching clinic, and a nurse practitioner clinic in CHAP.

The program features a team of six or seven people who help improve the children’s "medical homes" in primary care practices and help clinicians by coordinating the care. "Education is a significant piece of this, not just for the families but also for providers, sites, and patients," Dr. Peterson said.

CHAP can help practices improve efficiencies and scheduling. It helps coordinate care with mental health services, transportation, and other services. Education covers not just asthma but also flu shots, diet and nutrition, and inappropriate use of emergency departments. CHAP also acts as a neutral convener of meetings with community stakeholders (some of whom had never met together) to address systemic issues.

The asthma program within CHAP provides ongoing education and training of health care providers, families, and patients. High-risk children get monthly home-based visits for disease management for the first 6 months, then two visits in the next 6 months. CHAP pays attention to transitions of care between inpatient stays and medical homes, and now includes schools in postdischarge care. Services currently are provided by four certified, culturally skilled, multilingual asthma educators and two social workers, who may visit families to assist with psychosocial barriers to asthma care. CHAP also provides funding for home-based asthma case management through the Asthma Network of West Michigan.

Among seven high-risk children with asthma in CHAP’s case-management program, emergency department visits have decreased by 30% and hospitalizations have decreased by 63%, he said.

CHAP’s asthma team includes five pediatricians, asthma educators, an asthma and allergy specialist, school leaders or nurses, Medicaid health plan representatives and case managers, the Children’s Hospital quality improvement specialist, CHAP’s medical director and manager, and data analysts. "It’s a pretty diverse group of people to get together," Dr. Peterson said.

The CHAP team assesses participating medical practices for 12 characteristics "that we think constitute a really good asthma site," he said. These include asthma in-service training for staff and education for patients, having an in-office asthma educator, referring appropriate patients to CHAP or the Asthma Network of West Michigan, teaching peak flow monitoring, assessing exposure to environmental tobacco, in-office spirometry, use of management plans, the Asthma Control Test and an asthma registry, and routine 6-month asthma visits.

With 1 point allotted for each of the 12 factors, the average score of CHAP practices increased from 6 to 10 in the first 3 years of the program.

Priority Health, a managed care organization, provided kits for the program. CHAP is funded by the hospital and by a variety of private and corporate foundations, including the Douglas and Maria DeVos Foundation, W.K. Kellogg Foundation, Steelcase Foundation, Sebastian Foundation, Early Childhood Investment Corporation, Frey Foundation, Grand Rapids Community Foundation, Heart of West Michigan United Way, O’Donovan Family Foundation, and PNC Grow Up Great. Dr. Peterson said he has no conflicts of interest.