Inhaled Corticosteroids Raise Risk of Hip Fracture
In a large study of older persons, investigators found that the recent use of inhaled corticosteroids was associated with a dose-related increase in hip fracture, according to research published in the second issue for December 2002 of the American Thoracic Society’s peer-reviewed journal.

Writing in the American Journal of Respiratory and Critical Care Medicine, Richard Hubbard, MD, of the Division of Respiratory Medicine, University of Nottingham, United Kingdom, along with four associates, studied 16,341 cases of hip fracture found in the United Kingdom General Practice Research Database. The risk of hip fracture associated with exposure to inhaled corticosteroids showed an odds ratio of 1.26.

“Because hip fracture is so common in the older population, a small increase in the risk of fracture associated with the use of inhaled cortico-steroids could have a considerable public health effect,” Hubbard says.

In previously published results from the Lung Health Study, use of 1,200 micrograms per day of inhaled corticosteroids caused a reduction of bone mineral density in the lower lumbar spine and femur. The authors believe that the small dose-related increase in fracture risk associated with the use of inhaled corticosteroids is likely due in part to the direct effect of the corticosteroids on bone metabolism.

“The clinical implication is that patients with asthma and COPD should not take higher doses of inhaled corticosteroids than they need to control their airflow obstruction,” Hubbard says.

Pennsylvania “Here and Now” Conference
The Pennsylvania Society for Respiratory Care’s sixth annual eastern regional conference and exhibition will be held on April 10, 2003, at the Holiday Inn, King of Prussia, Pa. Titled “Here & Now,” the conference will cover new advances in critical care, pediatrics, and mechanical ventilation, and the afternoon sessions will feature hands-on workshops. Scheduled speakers include Brian McDonough, MD, medical editor of Fox Television in Philadelphia; James B. Fink, MS, RRT; and Martin Kessler, MD. In addition, the event will feature new products and services in the exhibit hall and a society party in the evening. Continuing education units may be available.

Medicare Covers Full-face CPAP Masks
For the first time, Medicare included a separate code for full-face continuous positive airway pressure (CPAP) masks on its 2003 fee schedule. Under A7030, Medicare provides a ceiling reimbursement of $188.64 and a floor of $160.34. This addition will allow beneficiaries a more affordable way to obtain a full-face CPAP mask.

Ground Zero Worker Examinations Reveal Respiratory Problems
More than three quarters of the World Trade Center (WTC) cleanup and rescue workers have suffered from at least one pulmonary symptom, according to the initial results of a federal screening program. Released in January, the preliminary findings from the $12 million program, conducted by the National Institute for Occupational Safety and Health and Mount Sinai Hospital, New York, were based on a sample of 250 people from the more than 3,500 workers who had participated as of January in the free examination. Even 10 months to 1 year after completing their work at ground zero, 46% of the sample still experienced at least one pulmonary symptom.

“The findings point to the need for treatment resources and for short- and long-term follow-up. The earlier these WTC-related illnesses are detected and treated, the more likely that treatment will prevent long-term illness and disability,” says Stephen Levin, MD, codirector of the World Trade Center Worker & Volunteer Medical Screening Program and medical director of the Mount Sinai-Irving J. Selikoff Center for Occupational and Environmental Medicine.

In addition to respiratory problems, about half of the sample also experienced persistent ear, nose, throat, and mental symptoms. Only about one third of the sample participants had received any prior medical care for their symptoms and conditions before participating in the program, which continues until July 2003.

Guidelines Issued on Allergy Shots
New guidelines recommend allergen immuno-therapy to prevent allergic asthma in children with allergic rhinitis. Called “Allergen Immuno-therapy: A Practice Parameter,” the guidelines appeared in the February issue of Annals of Allergy, Asthma, & Immunology, the journal of the American College of Allergy, Asthma, and Immunology (ACAAI). They were developed by the Joint Task Force on Practice Parameters of the American Academy of Allergy, Asthma, and Immunology (AAAAI), ACAAI, and the Joint Council of Allergy, Asthma, and Immunology (JCAAI) to help medical professionals more consistently provide effective treatment for patients.