News in brief - Jan. 19, 2004

Corticosteroids-fracture risk dispelled - Few fans of OTC allergy treatments - Air travel and DVT link studied - Carcinogens found in nonsmokers who hang around smokers - Doctors prefer prescribing newer blood pressure drugs

Corticosteroids-fracture risk dispelled

Canadian investigators concluded that the long-term use of inhaled or nasal corticosteroids at recommended doses is not associated with a higher risk of fractures.

Safety concerns have been expressed about long-term use of these drugs, especially in regard to the potential resulting increased risk of osteoporosis and fractures. Clinical studies have shown that accelerated resorption of bone occurs at all doses of the drug.

But the new study, published in the January American Journal of Respiratory and Critical Care Medicine, suggests that corticosteroids used at current recommended doses are safe.

Researchers at Royal Victoria Hospital and McGill University Health Center in Montreal examined data from 133,026 patients older than 65 who used certain respiratory medications at normal doses for four years or more. They compared the rate of fracture of prescription users to 191,622 age-matched controls and found no difference.

"Only the use of more than 2,000 micrograms of inhaled corticosteroids per day for an average of six years was associated with an elevated risk of fracture," said Samy Suissa, PhD, of Royal Victoria Hospital. "This means that 58 subjects would need to be treated with more than 2,000 micrograms of inhaled corticosteroids per day for six years to result in one extra fracture."

Few fans of OTC allergy treatments

The majority of allergy patients have not benefited from the availability of over-the-counter prescription-strength allergy medications, says a national Harris Interactive survey conducted by the Asthma and Allergy Foundation of America.

More than half of the 239 adult allergy patients contacted for the survey in November 2003 said they had spent more money out of pocket on allergy medications last year. The majority reported the reason as increased co-payments or lack of insurance coverage for a prescribed product.

The survey was conducted to assess the impact on patients of changes made in late 2002 that allowed the popular allergy medication, Claritin (loratadine), to be sold over-the-counter.

Of those who said health insurance changes had not benefited patients, 84% said insurance companies had gained the most.

More than 60% of those who had switched medications as a result of health insurance changes would prefer to go back to their former prescription allergy mediation, according to the survey.

Air travel and DVT link studied

Airplane flights of eight hours or more doubled the risk for calf muscle venous thrombosis and translated into an increased risk for deep venous thrombosis as well, said researchers in two studies published in the Dec. 8, 2003, issue of The Archives of Internal Medicine.

Another study in the Dec. 19, 2003, issue of The Lancet found that, contrary to earlier reports, wearing compression stockings apparently did not prevent DVT in several air travelers.

The Archives study led by Ida Martinelli, MD, PhD, of the University of Milano, Italy, found that factors such as the lack of certain proteins in the blood, use of oral contraceptives, recent surgery, cancer, pregnancy and prolonged immobilization increased the risk of blood clots in the veins.

Recommendations for avoiding clots made by the group Airhealth.org, include frequent flexing of the legs, even while seated, using anticoagulants and drinking electrolytic beverages.

Carcinogens found in nonsmokers who hang around smokers

Cancer-causing chemicals specific to tobacco have been measured in nonsmokers spending time with smokers, according to a study published in the journal, Cancer Epidemiology Biomarkers and Prevention, last month.

Researchers at the University of Minnesota, Minneapolis, took urine samples from nonsmokers before and after a four-hour visit to a casino where smoking was allowed. After the visit, the levels of NNK, which increases the risk of lung cancer, were twice as high.

Authors said that while this was an indicator that it might not be healthy for nonsmokers to hang out in smoky environments, it did not conclusively prove any ill-health effects.

"Environmental tobacco smoke in restaurants, bars and casinos presents a potential health hazard to employees and nonsmoking patrons," said Kristin Anderson, PhD, lead author and associate professor at the university's School of Public Health. "However, further studies are needed to examine the long-term health effects on employees and patrons."

Doctors prefer prescribing newer blood pressure drugs

Physicians are more likely to prescribe newer anti-hypertensives than their less expensive predecessors recommended by the Joint National Commission on High Blood Pressure Treatment, according to a study published in the December Journal of General Internal Medicine.

Researchers at the University of Michigan surveyed 1,700 primary care physicians, finding that most believed diuretics were less effective and that beta-blockers had more side effects than calcium channel blockers or ACE inhibitors. They also found that those who favored more expensive drugs were also more likely to give patients free drug samples.

"These new, more expensive medications are being more heavily promoted by the drug companies, and one way or another that information influences how people perceive the drug's effectiveness," said Peter A. Ubel, MD, lead author and associate professor of internal medicine at the University of Michigan Medical School in Ann Arbor. "I think a lot of physicians rely on sales representatives to tell them about the latest medications out there. The industry influence is pervasive."