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Content 7


The Doctor and the Pharmacist

Radio Show Articles:
July 18, 2015

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Male Breast Cancer: It's All About the Estrogen
Should Systemic Hormone Therapy Be Continued After Age 65?
Polycystic Ovary Syndrome in Childhood: Diagnostic and Therapeutic Challenges
Vulvar Lichen Sclerosus in Prepubertal Girls
Choosing Wisely: 5 Recommendations for Ordering Genetic Tests
Lucrative Weight-Loss Clinics on the Rise Under New Health Law
Combining Antidepressants and NSAIDs Tied to Elevated Risk for Abnormal Bleeding
Are Glucocorticoids a Risk Factor for Bleeding Peptic Ulcers?
Pathogens in Adult Community-Acquired Pneumonia Often Not Identified
Mediterranean Diet Might Improve Cognitive Function
Citrus Fruit Consumption Associated with Increased Melanoma Risk
Health Insurers Requesting Rate Hikes for 2016
Prognosis at 15 Years After Coronary Artery Calcium Evaluation
Lithium in the Long Run: Renal and Thyroid Toxicity
Pumping Iron, Physical Function, and Breast Cancer Survivors
Weight Loss Is Associated with Improved Airway Hyperresponsiveness and Asthma Control

J Clin Oncol 2015 Jun 20; 33:2041.
Male Breast Cancer: It's All About the Estrogen
Men with the highest versus lowest quartile levels of circulating estrogen had an odds ratio of 2.47 for developing the disease.
Male breast cancer is difficult to study because of its relative rarity compared with breast cancer in women; it is 100-fold more frequent in women. Similar risk factors have been noted for men and women who develop breast cancer, including the effect of hormones manifested by obesity, physical inactivity, diabetes, and exogenous hormone use. In men with Klinefelter syndrome — a condition characterized by the 46-XXY karyotype and an increase risk for breast cancer — gynecomastia and an altered ratio of estrogen to androgens (high) have been reported, highlighting the role of estrogen as a risk factor. There have also been reports suggesting low levels of androgens and excess ratio of estrogen to androgens as risk factors for male breast cancer.
Now, academic investigators for the Male Breast Cancer Pooling Project collected prediagnostic serum or plasma samples for 101 men with breast cancer and 217 matched controls (males without breast cancer).Androgens or the ratio of estrogen to androgens was not found to enhance risk for developing the disease. However, men with the highest quartile of estrogen compared to the lowest had an odds ratio of 2.47.
Comment: These findings are consistent with an elevated risk of breast cancer in women with the highest level of circulating estrogen, whereas androgen levels were less-important predictors. In men, in contrast to women, body-mass index did not appear to influence estrogen levels. Whether there was an interaction with free testosterone levels and risk for breast cancer could not be determined in this analysis because sex-hormone–binding globulin was not evaluated.
Citation(s):Brinton LA et al. Prediagnostic sex steroid hormones in relation to male breast cancer risk. J Clin Oncol 2015 Jun 20; 33:2041.
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Menopause 2015 Jul; 22:693
Should Systemic Hormone Therapy Be Continued After Age 65?
A new statement from NAMS says yes.
Patterns of HT use changed markedly following the Women's Health Initiative (WHI) report that the risks of menopausal hormone therapy (HT) exceeded its benefits (JAMA 2002; 288:321) — but since then, several studies have suggested that the story is far more complicated and that HT is warranted in certain instances. In 2012, the North American Menopause Society (NAMS), noting that HT carries fewer risks in younger postmenopausal women, recommended the lowest possible dose for the shortest time necessary (generally <5 years; Menopause 2012; 19:257). Because many women experience vasomotor symptoms even after age 65, NAMS has recently issued a position statement that continuing HT past age 65 is acceptable provided the woman has been advised of increased risks after age 60, she continues to have bothersome symptoms or is unable to use any other appropriate medication, and her clinician has determined that benefits outweigh risks. Estrogen remains the most effective agent for relief of menopausal symptoms (and is effective in preventing fractures in high-risk women who cannot use other therapies).
Comment: Editorialists urge that HT be removed from the Beers list of potentially inappropriate medications for adults aged >65 (J Am Geriatr Soc 2012; 60:616) and instead be considered a medication to be used with caution (or that exceptions in commonly used quality-of-care metrics be made). Such changes might well have important implications for insurance coverage as well as evaluation of care provided by individual clinicians.
Should healthy symptomatic women be denied HT merely because of their chronologic age? The use of an indicated medication is rarely straightforward. The initial WHI report led to emotional responses and inappropriate discontinuation of HT in many women who would have otherwise benefited; accordingly, use plummeted in the months following publication of that report. Now, many clinicians continue to disregard recent findings indicating that the risks are generally not as great as initially reported — and continue to refuse to prescribe therapy, even for women who could benefit greatly. I have continued to prescribe HT to selected women for many years, even after age 65, with appropriate counseling and surveillance. This NAMS statement is both appropriate and timely.
Citation(s):North American Menopause Society.The North American Menopause Society statement on continuing use of systemic hormone therapy after age 65.
Menopause 2015 Jul; 22:693.

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Pediatr Dermatol 2015 Mar 19
Polycystic Ovary Syndrome in Childhood: Diagnostic and Therapeutic Challenges
The prevalence of PCOS is 5% to 10% in adults; the prevalence in children is unknown
Polycystic ovary syndrome (PCOS) is an endocrine disorder characterized by oligomenorrhea, hyperandrogenism, and polycystic ovaries. Dermatologic manifestations include acne, hirsutism, androgenic alopecia, acanthosis nigricans, and seborrheic dermatitis. PCOS is associated with impaired glucose tolerance, obesity, decreased fertility, complications in pregnancy, increased risk for endometrial cancer, and possibly, cardiovascular complications. It is phenotypically heterogeneous and manifests in the prenatal period, childhood, or adulthood. Early identification and intervention are important, but diagnosis and management in children and adolescents can be challenging. For example, irregular periods are normal for the first 18 months after menarche and normative standards of androgen levels in adolescents are lacking — hyperandrogenism is common in puberty, and androgen levels are cyclical.
Two of the three Rotterdam diagnostic criteria are required for diagnosis:

Patients with type 1 classic PCOS have all three criteria. Other types require two of the three criteria while the third is absent. When a suspected diagnosis cannot be confirmed, a diagnosis of provisional PCOS should be made to ensure ongoing monitoring and interventions to reduce obesity.
Comment: PCOS occurs at all ages, and the classic triad is not necessarily present. A high index of suspicion should be retained for girls with treatment-resistant acne (especially inflammatory jawline/chin acne) or hirsutism. Patients should be questioned about menstrual irregularities, family history of PCOS, and when pubertal development started. Patients with PCOS may be thin (lean PCOS). Referral to pediatric endocrinology or adolescent gynecology is important for diagnosis and management.
Citation(s):Kamangar F et al. Polycystic ovary syndrome: Special diagnostic and therapeutic considerations for children. Pediatr Dermatol 2015 Mar 19; [e-pub].
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Pediatr Dermatol 2015 May 7
Vulvar Lichen Sclerosus in Prepubertal Girls
Early diagnosis and prompt treatment induced remission and preserved normal anatomy.
Vulvar lichen sclerosus (VLS) is an inflammatory and scarring dermatosis occurring predominantly in prepubertal and postmenopausal females. Girls typically present with itching, dysuria, and constipation. Diagnosis is often delayed, and physical signs can be misdiagnosed as child abuse. Potent topical corticosteroid therapy is accepted management for VLS at all ages. However, continued treatment of patients in whom remission is not achieved is less standardized. There is little data on long-term management in prepubertal girls.
Investigators in Australia performed a retrospective study of outcomes of long-term treatment. The target outcome was an asymptomatic, normal examination. They studied 46 girls with prepubertal-onset VSL; photographs were available for all. This cohort was characterized as adherent (using treatment all or most of the time) and nonadherent (using treatment some or less of the time). Of 26 patients (56%) who had received prior treatment, only 3 had controlled disease on daily potent topical corticosteroids (TCS); 12 presented with scarring. All had disease suppression with induction treatment of potent TCS. Of 33 adherent patients, 31 (94%) had sustained complete remission without progression or scarring. Only 1 of the 13 nonadherent patients (8%) achieved complete remission.
The authors note that ongoing maintenance treatment with individualized regimens is often necessary to achieve symptom control and preserve normality of vulvar structures.
Comment: Early recognition of VLS in prepubertal girls, coupled with appropriate use of potent (or ultrapotent) topical steroids is important to induce remission and preserve normal anatomy and prevent permanent scarring. In addition, maintenance therapy is often necessary, as VLS can be chronic. These findings demonstrate that compliance at home is crucial to achieving successful outcomes, but serial examination and guidance from an experienced provider is also key.
Citation(s):Ellis E and Fischer G.Prepubertal-onset vulvar lichen sclerosus: The importance of maintenance therapy in long-term outcomes. Pediatr Dermatol 2015 May 7; [e-pub].
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Choosing Wisely: 5 Recommendations for Ordering Genetic Tests
By Kelly Young, Edited by Susan Sadoughi, MD, and Richard Saitz, MD, MPH, FACP, FASAM
As part of the Choosing Wisely campaign, the American College of Medical Genetics and Genomics has released a set of five evidence-based recommendations for genetic test ordering.
The group recommends against ordering the following:

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Lucrative Weight-Loss Clinics on the Rise Under New Health Law
By Amy Orciari Herman, Edited by Susan Sadoughi, MD, and André Sofair, MD, MPH
A front-page story in Sunday's New York Times casts a harsh light on the growing diet-clinic industry in the U.S.
The Affordable Care Act requires insurers to pay for obesity screening and, for some patients, counseling. This provision, according to the Times, has "created a financial opportunity for a corner of the diet industry that has often operated on the fringe of the medical establishment: for-profit diet clinics overseen by doctors."
Physician oversight at many of these clinics, the Times contends, simply means reviewing patient charts remotely, while assistants without much training do most of the counseling. In addition, unproven — and even disproven — weight-loss methods are often used. For example, a Long Island weight-loss clinic advertises vitamin injections to increase metabolism. The physician at the clinic's helm "acknowledged that the treatments are not scientifically proven, but he said they do not hurt, and patients have come to expect them as an option," the Times reports.
A second story in Sunday's Times highlights the remarkable staying power of the weight-loss drug phentermine, an appetite suppressant similar to amphetamine. One reason: phentermine is prescribed widely at diet clinics nationwide.
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Combining Antidepressants and NSAIDs Tied to Elevated Risk for Abnormal Bleeding
By Jenni Whalen, Edited by David G. Fairchild, MD, MPH, and Lorenzo Di Francesco, MD, FACP, FHM
Combining antidepressants and nonsteroidal anti-inflammatory drugs (NSAIDs) might put patients at a greater risk for intracranial hemorrhage, suggests a retrospective BMJ study.
Building on the established knowledge that NSAIDs and antidepressants independently increase the risk for abnormal bleeding, researchers examined data on hospital admissions and prescriptions from more than 4 million Korean patients who were prescribed antidepressants for the first time between 2010 and 2013.
Individuals who took both antidepressants and NSAIDs at the same time were at a heightened risk for experiencing intracranial hemorrhage within 30 days of beginning the drugs, compared with those who used antidepressants alone (5.7 vs. 1.6 events per 1000 person-years).
This is most worrying because, according to editorialists, "conditions requiring NSAIDs and antidepressants commonly coexist." As such, extra vigilance may be necessary when prescribing both types of drugs concomitantly.
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Aliment Pharmacol Ther 2015 Jun 22
Are Glucocorticoids a Risk Factor for Bleeding Peptic Ulcers?
In a large retrospective study, short-term exposure increased bleeding risk.
Data on the relation between glucocorticoids and peptic ulcer bleeding (PUB) are mixed, with some studies suggesting an increased risk for PUB and others showing no additional risk. To explore this issue, investigators in Taiwan searched a national database for adults hospitalized with newly diagnosed PUB between 2000 and 2012. They identified patients with short-term (≤28 days) antecedent use of glucocorticoids, using a case-crossover design to manage unidentified confounding factors and determine the self-matched odds ratios for PUB in patients with 7-day, 14-day, or 28-day exposure to glucocorticoids immediately preceding PUB diagnosis.
For the 8894 patients with PUB, the self-matched odds ratios for glucocorticoid exposure were 1.37 (95% confidence interval, 1.12–1.68) for 7 days, 1.66 (95% CI, 1.38–2.00) for 14 days, and 1.84 (95% CI, 1.57–2.16) for 28 days. The effect was dose-dependent: Individuals receiving low-dose glucocorticoids (<4 mg/day of methylprednisolone or equivalent) had no increased risk for PUB. Risk was higher in patients who used glucocorticoids plus nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) or aspirin than in those who used glucocorticoids alone.
Comment: This large, retrospective study was designed to control for unknown confounding factors. The findings suggest that short-term glucocorticoid use increases the risk for PUB, particularly in patients who are also taking nonselective NSAIDs or aspirin. The effect increases with dose and with duration of therapy. A remaining confounder, which could affect these results, is the fact that all patients taking glucocorticoids had an underlying inflammatory condition that warranted steroid treatment and might be an independent risk factor for PUB, potentially making glucocorticoid therapy a surrogate marker for inflammatory disease. Although the mechanism underlying the association remains speculative, glucocorticoid use should be considered when assessing patients' risk for PUB.
Citation(s):Tseng C-L et al. Short-term use of glucocorticoids and risk of peptic ulcer bleeding: A nationwide population-based case-crossover study. Aliment Pharmacol Ther 2015 Jun 22; [e-pub].
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Pathogens in Adult Community-Acquired Pneumonia Often Not Identified
By Joe Elia, Edited by David G. Fairchild, MD, MPH, and Lorenzo Di Francesco, MD, FACP, FHM
In adults, community-acquired pneumonia most often doesn't arise from a detectable pathogen, according to a New England Journal of Medicine study.
Among some 2300 adults hospitalized in Chicago and Nashville with radiographic evidence of pneumonia, pathogens were identifiable in just over a third of the cases. Viral causes (rhinoviruses and influenza) predominated, with Streptococcus pneumoniae as the most common bacterial cause.
The rates of pneumonia-related hospitalization in the 30-month study were up to 25-fold higher among the elderly than younger adults.
The rate of pathogen discovery was much higher in a related study done among children . That study found viral pathogens in over 80% of cases. And unaccountably, 90% of the kids received antibiotic therapy.
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JAMA Intern Med 2015 Jul 1; 175:1094
Mediterranean Diet Might Improve Cognitive Function
Or, at least, it might slow deterioration.
Oxidative stress and endothelial dysfunction might play a role in development of dementia, and an antioxidant-rich diet could provide protection. To evaluate this association, researchers conducted a post hoc analysis of 334 participants (mean age, 67; without known cardiovascular disease but with high cardiovascular risk based on traditional risk factors) in a large Spanish diet study (NEJM JW Gen Med Apr 1 2013 and N Engl J Med 2013; 368:1279). Participants had been randomized to eat a Mediterranean diet supplemented with either olive oil (≥4 tablespoons daily) or nuts (30 g daily) or to a control group who were advised to reduce intake of dietary fat.
Batteries of neurocognitive tests were performed at baseline and after a median 4.1 years of follow-up. In adjusted analyses, barely significant differences favored either version of the Mediterranean diet over the low-fat control diet for composite measures of memory and overall cognition. Participants who followed a Mediterranean diet exhibited small mean improvements in several measures, and control-diet participants exhibited slight deteriorations.
Comment: These post hoc results from a subgroup of a larger study are modest at best but intriguing. More rigorous studies are warranted.
Citation(s):Valls-Pedret C et al. Mediterranean diet and age-related cognitive decline: A randomized clinical trial. JAMA Intern Med 2015 Jul 1; 175:1094. (http://dx.doi.org/10.1001/jamainternmed.2015.1668)

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Citrus Fruit Consumption Associated with Increased Melanoma Risk
By Kelly Young, Edited by David G. Fairchild, MD, MPH, and
Lorenzo Di Francesco, MD, FACP, FHM
High consumption of citrus fruit is associated with increased melanoma risk, suggests a study in the Journal of Clinical Oncology.
Nearly 100,000 white participants in the Nurses' Health Study and the Health Professionals Follow-up Study completed questionnaires about their consumption of citrus fruits and juices and were followed for roughly 25 years.
Over 1800 incident melanomas occurred. After multivariable adjustment, participants who reported consuming at least 1.6 servings of citrus daily had a 36% increased risk for melanoma, compared with those who ate less than two servings a week. In analyses by citrus type, the findings were significant only for orange juice (increased risk seen with 5-6 servings/week vs. <1/week) and grapefruit (increased risk with <1/week vs. never).The authors speculate that the association could be due to the psoralen found in citrus fruits. Animal studies have found that psoralen has photocarcinogenic properties.
An editorialist concludes: "A public overreaction leading to avoidance of citrus products is to be avoided. For people who would be considered at high risk, the best course might be to advise individuals to use multiple sources of fruit and juice in the diet and to use sun protection, particularly if one is sun sensitive. There is clearly a need for replication of the study findings in a different population before modifying current dietary advice to the public
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Health Insurers Requesting Rate Hikes for 2016
By Amy Orciari Herman, Edited by Susan Sadoughi, MD, and André Sofair, MD, MPH
Many U.S. health insurance companies are seeking large rate increases for 2016 because the customers they've gained under the Affordable Care Act are "sicker than expected," the New York Times reports.
Blue Cross and Blue Shield plans, for example, have requested rate increases averaging over 20% in Illinois and North Carolina, over 30% in Oklahoma and Tennessee, and over 50% in Minnesota.
Companies planning to increase their premiums by 10% or more must submit their requests to state or federal regulators, and it's unknown how many of the proposed increases will actually be accepted. Earlier this week, President Obama said that if regulators closely review the proposed rates, he expects that "they'll come in significantly lower than what's being requested," according to the Times.
HHS Secretary Sylvia Burwell told the paper that federal subsidies can help offset the cost of any increases; she also urged consumers to shop for less pricey plans during open enrollment in November.
To search for rate change requests from particular insurers, follow the link below.
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Ann Intern Med 2015 Jul 7; 163:14
Prognosis at 15 Years After Coronary Artery Calcium Evaluation
People with scores of ≥1000 were 9 times more likely than people with scores of 0 to die within 15 years.
Previous studies have established that a strong relation exists between increasing coronary artery calcium (CAC) scores and additional adverse clinical outcomes. However, most of the literature has been focused on shorter-term prognoses (5-year outcomes). In this single-center observational study, ≥9000 patients without known coronary artery disease (CAD) at baseline underwent CAC evaluations from 1996 through 1999.
Mean follow-up duration was 15 years. Unadjusted all-cause mortality increased steadily with progressively higher CAC scores, ranging from 3% (in participants with scores of 0) to 28% (in participants with scores of ≥1000). After adjustment for CAD risk factors, CAC score remained highly predictive of time to all-cause mortality. Adding CAC scores to standard CAD risk factors improved classification into low-, intermediate-, and high-risk groups overall, but this model, compared with a standard risk-factor model, incorrectly reclassified 7% of survivors into a higher-risk category.
Comment :— General Medicine Jamaluddin Moloo, MD, MPH
This study demonstrates that CAC scores predict all-cause mortality for as long as 15 years, adding to the information generated by standard cardiovascular risk factors. However, the study does not tell us whether use of prediction models that include CAC, compared with use of standard risk-factor models, would lead to clinical interventions that lower 15-year mortality.
Comment — CardiologyHarlan M. Krumholz, MD, SMThis study supports the notion that CAC has utility in risk stratification and may be most useful for people on the fence about whether it is worth taking a statin.
Citation(s):Shaw LJ et al. Long-term prognosis after coronary artery calcification testing in asymptomatic patients: A cohort study. Ann Intern Med 2015 Jul 7; 163:14. (http://dx.doi.org/10.7326/M14-0612

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Lancet 2015 May 20
Lithium in the Long Run: Renal and Thyroid Toxicity
Lithium is a first-line mood stabilizer but requires delicate dose adjustments and vigorous monitoring for renal, thyroid, and parathyroid effects.
Lithium has renal, thyroid, and parathyroid effects, which are well documented but mostly in short-term studies. Using data from a laboratory information system in the U.K. between 1985 and 2014, researchers compared creatinine, thyroid-stimulating hormone (TSH), and calcium values in 2795 patients with at least two lithium levels and in 689,228 patients not taking lithium (median follow-up, 3 years).After the presence of diabetes was controlled for, lithium was associated with elevated risks of stage 3 kidney disease (glomerular filtration rate, <60 mL/min), hypothyroidism (TSH, >5.5 mU/L), and elevated total (but not ionized) calcium. Young women were the group at greatest risk for renal and thyroid effects. Overall, adverse effects were greater with higher-than-median lithium levels and shorter length of treatment.
Comment: These findings highlight the importance of (1) optimizing lithium dose to the minimum required for efficacy and (2) monitoring patients early in the course of treatment when those who are vulnerable, especially young women, might begin to show effects.
Stage 3 kidney disease is not necessarily serious; few lithium-treated patients (1%–2%) go on to develop end-stage renal disease. In addition, concomitant use of the diuretic amiloride can often help minimize renal effects.
This study did not monitor parathyroid hormone levels. Calcium levels are only a proxy for hyperparathyroidism, which although rare, does occur. Thus, monitoring both calcium and parathyroid levels is also important.
The study results remind us that, despite lithium's first-line status as a mood stabilizer (NEJM JW Psychiatry Feb 2010 and Lancet 2010; 375:385) and its antisuicidal effects (NEJM JW Psychiatry Aug 2013 and BMJ 2013; 346:f3646), the medication can be toxic and requires delicate dose adjustments and vigorous monitoring.
Citation(s):Shine B et al. Long-term effects of lithium on renal, thyroid, and parathyroid function: A retrospective analysis of laboratory data. Lancet 2015 May 20; [e-pub]. (http://dx.doi.org/10.1016/S0140-6736(14)61842-0)
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J Clin Oncol 2015 May 11
Pumping Iron, Physical Function, and Breast Cancer Survivors
Women who completed a 12-month weight-lifting program had less physical deterioration than those who received standard care.
To determine whether modest exercise could preserve or improve physical function for nonmetastatic breast cancer survivors, investigators conducted a 12-month, single-blind, randomized, controlled trial in which 295 women were assigned to a twice-per-week weight-lifting program or standard baseline activity (controls).
During the first 13 weeks, the weight-lifting group participated in supervised sessions that included stretching, aerobic warm-up, and lifting exercises for the upper and lower body; for the remaining 39 weeks, the group followed the same program without supervision. Characteristics of the weight-lifting and control groups were similar (mean age, about 56 years; more than 60% were white; nearly half had stage I/II disease; half had some degree of lymphedema; and about 5 years had passed since diagnosis). Adjuvant therapy received and baseline physical function were similar in both groups. The incident deterioration of physical function was defined as a ≥10-point decrease in the physical function subscale of the Medical Outcomes Short-Form 36-item questionnaire.
Significantly fewer women in the exercise group than in the control group experienced incident deterioration (8.1% vs. 16.3%; relative risk, 0.49; P=0.04).). Participants who did not complete the full program were more likely to be younger, have greater upper and lower body strength, and have a higher body-mass index.
Comment: This study affirms that physical activity in the form of weight lifting lowers the risk for physical deterioration. Whether this exercise is equivalent or superior to other physical interventions cannot be determined from this study. Given that the program did not begin until about 5 years after the diagnosis, it is conceivable that earlier interventions might have had a greater impact on physical function, endurance, and coping.
Citation(s):Brown JC and Schmitz KH.Weight lifting and physical function among survivors of breast cancer: A post hoc analysis of a randomized controlled trial.
J Clin Oncol 2015 May 11; [e-pub].
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Chest 2015 Jun 1; 147:1582
Weight Loss Is Associated with Improved Airway Hyperresponsiveness and Asthma Control
The exact relations among obesity, asthma, and increased airway hyperresponsiveness are unclear.
In a Canadian study, 22 adult obese asthma patients were followed for 3 months to examine the effect of weight loss on airway hyperresponsiveness. The intervention group was 16 patients who were enrolled in a 12-month behavioral weight-loss program, whereas 6 patients awaiting bariatric surgery served as controls. All patients had asthma (diagnosed by methacholine challenge) and body-mass index >32.5 kg/m2. The intervention group received liquid meal replacements and behavioral and exercise counseling.
During the study, the intervention group lost a mean 16.5 kg, whereas the control group gained 0.6 kg. The intervention group's PC20 (provocative concentration of methacholine causing a 20% fall in forced expiratory volume in 1 second [FEV1]) improved significantly from 5.0 to 10.2 mg/mL (P=0.05; a higher number indicates less airway hyperresponsiveness); the control group showed no improvement. FEV1 and forced vital capacity (FVC) increased by 5% (FEV1/FVC ratio was unchanged), and asthma symptoms and asthma–specific quality of life improved in the intervention group only.
Comment: In this small study, weight loss was associated with somewhat improved airway hyperresponsiveness, lung function, and asthma symptoms. Although improvements could be attributed to the participants' increased exercise and participation in social-support groups, obese asthma patients should be counseled on healthy lifestyle measures and the potential benefit of improved asthma control.
Citation(s):Pakhale S et al. Effects of weight loss on airway responsiveness in obese adults with asthma: Does weight loss lead to reversibility of asthma? Chest 2015 Jun 1; 147:1582. (http://dx.doi.org/10.1378/chest.14-3105)

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