Asthma and Other Diseases

Jul 23, 2010

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

Im the King of the World! That may be the most famous line yelled from the front of a ship. However the real story about the discovery of the Titanic was fascinating too. Dr. Robert Ballard had a long time interest in the Titanic and had developed some equipment and the underwater robot Argo that could look for it. The US Navy had no interest in the Titanic, but it wanted to find two of its submarines that had sank. So they struck a deal. Ballard would look for the two subs, and could use the money left over to find the Titanic. When Ballard found the subs, he found that each had a long trail of debris that led to the sub. The debris trail was relatively easy to find, and he could follow it to the sub. Ballard used this technique to follow the debris trail and find the Titanic on September 1, 1985. Are diseases like asthma a debris trail to other conditions?

Asthma is usually associated with young, otherwise healthy people. Unlike diabetes which seems to directly or indirectly cause heart disease, kidney disease, blindness, amputation and other conditions, asthma isnt usually associated with other conditions. During some of my asthma training we were told that there is an asthma, eczema, allergic rhinitis triad. That means people with asthma often also have the skin condition eczema and the runny nose that comes from allergic rhinitis. We arent exactly sure why. It may be genetics or environment, but whatever goes wrong with the immune system to cause asthma also seems to be involved with eczema and allergic rhinitis. So I was really interested when I heard there was a study in Ontario that was looking into what other diseases people with asthma get.

The study I read was published by Gershon et al. in the July issue of Thorax. It looked at 4 databases that covered all 12 million people in Ontario in 2005. They found that there were about 1.7 million people in Ontario with asthma or about 13% of the population. Of those people with asthma, they determined about 400,000 had active asthma, and the rest were determined to be less active asthma.

One of the main measures the researchers used to detetmeine how sick the patients were was how often their doctors made a claim to Ontario Health. Over one year for every 100 active asthma patients their doctors made an average of 1616 claims for clinic visits. For non-asthmatics, for every 100 patients their doctors billed Ontario Health an average of 942 times in one year. So the authors estimated that there were an extra 674 claims for the asthmatics.

Another way of looking at is for all the health claims in Ontario 6% of all clinic claims, 8% of all ER visits, and 6% of all hospitalizations were from asthmatics from diseases other than their asthma. That would be like an asthmatic visiting their doctor for depression.

As I said before, these extra co-existing conditions in the asthmatics is interesting because we usually think of asthmatics as being young and otherwise healthy. For example of all the identified active asthmatics in the 2005 Ontario study, the average age of an active asthmatic was 31 years old. However this group had more than twice as many claims for non-asthma respiratory diseases, almost twice as many psychiatric conditions like depression and anxiety and more musculoskeletal claims than the non-asthmatic control group.

Now for the chicken and egg part. Does having asthma make you more likely to get a psychiatric condition like depression? We dont know. Does treating asthma with inhaled steroids make you more likely to get a musculoskeletal condition like osteoporosis? We dont know. Do some of these other conditions make it more likely to get asthma? We dont know. We need more studies.

If you look in the sky, it can be very hard to see a tiny jet plane. But if you follow the contrails or smoke from the plane, you can more easily find it. Dr. Ballard used the debris trail to find the Titanic. Is asthma like a debris trail we can use to find more diseases in a person? We dont know yet, but it will be interesting to follow the trail.

As always if you have any questions or concerns about these or other products, ask your pharmacist.


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