Franklin Holman

• CMS Delays 2005 Oxygen Fee Schedule The Centers for Medicare and Medicaid Services (CMS) announced that it will continue to pay the 2004 Medicare fee schedule amounts for home oxygen and equipment until the new 2005 fee schedule amounts are computed. Due to the delay, CMS has decided to stop holding oxygen claims and will begin paying claims with 2005 dates of service based on the 2004 Medicare fee schedule amounts. These are the rates that would have otherwise been in effect. Once the report from the Office of Inspector General is received and the 2005 fee schedule amounts are calculated, all claims received with dates of service on or after January 1, 2005, will be paid using the 2005 fee schedule amounts. Claims with dates of service on or after January 1, 2005, that were paid using the 2004 fee schedule amounts will not be retroactively adjusted after the 2005 amounts are implemented. • Depression Influences Treatment Preferences in Patients With COPD A new study, which appears in the January issue of CHEST, finds that health-related quality of life does not affect end-of-life treatment preferences in patients with chronic obstructive pulmonary disease (COPD); yet, depression may influence treatment decisions in the same group of patients. Researchers conclude that clinicians should recognize the influence depression may have on patient treatment preferences and that improvement in depression symptoms may warrant reassessment of patient treatment preferences. • AFRICAN-AMERICANS MAY NEED MORE MEDICATION TO CONTROL ASTHMA Racial differences may play a significant role in determining a patient’s response to asthma medications. A new study in the February issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians (ACCP), shows that asthmatic and nonasthmatic African Americans required higher doses of glucocorticoids to suppress lymphocytes, which play an important role in airway inflammation. As a result, researchers speculate that African Americans may have a predisposition to a diminished medication response, which can contribute to more difficult asthma control among African Americans. “Asthma continues to be a significant health concern in the United States, particularly among minority populations,” said Paul A. Kvale, MD, FCCP, president of the ACCP. “By understanding how specific populations respond to asthma medication, health-care providers can provide the most effective treatments for these groups and, ultimately, improve overall asthma management.”

Secondhand Smoke Exposure May Lower Children’s IQ
Children exposed to environmental tobacco smoke (ETS)—commonly known as secondhand smoke—had mildly to moderately depressed scores on tests of math, reading, and visuospatial skills as compared to children who lacked such exposure, according to a study published in the January issue of the peer-reviewed journal Environmental Health Perspectives (EHP). “The range of decrement in scores is very roughly equivalent to the loss of two to five IQ points at varying levels of exposure,” Kimberly Yolton, the lead author on the study, told EHP for an accompanying article about the study.

Analysis of the study’s data revealed that even extremely low-level exposure to ETS may be neurotoxic. The findings in this study are further reason to keep children away from secondhand smoke, according to Jim Burkhart, PhD, science editor for EHP. “Children who are exposed to ETS are more likely to be held back in school, do worse on tests, have more ear infections, and die from sudden infant death syndrome. Today’s study is just the latest in a long list of reasons to keep children away from any sort of tobacco smoke,” Burkhart said.

Asthma Control Emphasized
The National Asthma Education and Prevention Program (NAEPP) recently issued the first new guidelines in more than a decade for managing asthma during pregnancy. The guidelines, featured in a quick reference guide in the January 2005 Journal of Allergy & Clinical Immunology, emphasize the use of a stepwise approach to control asthma during pregnancy. Under this approach, medication is stepped up in intensity if needed, and stepped down when possible, depending on asthma severity. “The NAEPP expert panel’s review of the evidence concludes that it is safer for pregnant women with asthma to be treated with asthma medications than to have asthma symptoms and exacerbations,” says Barbara Alving, MD, acting director of the National Heart, Lung, and Blood Institute.

Higher Asthma Rates Reported
US-born Mexican Americans have a higher prevalence of asthma than do Mexican Americans born in Mexico, according to a study in the January 15, 2005, issue of the American Thoracic Society’s peer-reviewed American Journal of Respiratory and Critical Care Medicine. “After adjustment for age, smoking status, body mass index, region of survey, language, and health care access, US-born Mexican Americans were at higher risk for asthma than were Mexican-born Mexican Americans from both surveys,” says Fernando Holguin, MD, of the Centers for Disease Control and Prevention and the Department of Pediatrics at Emory University in Atlanta. Slightly over 8% of the US-born Mexican Americans had asthma as contrasted with slightly over 2.5% of the Mexican-born participants.

Vitamin C Associated With Wheeze
Researchers studying diet during late pregnancy in 1,300 mothers showed that total maternal vitamin C intake was positively associated with wheeze in certain infants who did not have a cold during their second year of life. “Total maternal vitamin C intake during pregnancy was not statistically significantly associated with wheezing during the first year of life,” says Sheelagh Martindale, PhD, Department of Environmental and Occupational Medicine at the University of Aberdeen in Scotland. “However, in the second year of life, total vitamin C intake was positively associated with wheezing after adjusting for confounding variables, including total vitamin E intake.” The authors note that further studies are needed before making recommendations to pregnant women. The study appears in the January 15, 2005, issue of the American Thoracic Society’s peer-reviewed American Journal of Respiratory and Critical Care Medicine.

Behavior, Quality of Life Improve for Children Who Receive Sleep Apnea Treatment
Behavioral and emotional difficulties are found in children with obstructive sleep apnea (OSA), but they improve after treatment, according to a study in the January issue of Archives of Otolaryngology—Head & Neck Surgery, one of the JAMA/Archives journals. “Sleep-disordered breathing in children is most commonly caused by adenotonsillar hypertrophy [enlarged adenoids and tonsils], and tonsillectomy and adenoidectomy (T & A) is curative in 85% to 95% of cases,” according to background information in the article. Khoa D. Tran, MD, and colleagues from the State University of New York Downstate Medical Center, Brooklyn, assessed child behavior and quality of life by using standardized surveys completed by parents of children with OSA (n = 42) before and after T & A, compared with 41 children in the control group with no history of snoring undergoing unrelated elective surgery. The authors conclude, “This study provides further evidence that behavioral and emotional problems are present in children with OSA and improve after treatment. Large improvements in disease-specific, health-related QOL (quality of life) are also found.”

All Aerosol Therapy Devices Equally Effective
Recently published guidelines for the selection of aerosol medication devices indicate that all delivery systems are equally effective when used properly. The guidelines, which appear in the January issue of CHEST, the peer-reviewed journal of the ACCP, recommend that health care providers not base delivery system selection exclusively on efficacy; instead, they should base their choices on other patient-related factors. According to the guidelines, the aerosol device choice should be based on several criteria, including availability, cost, convenience, and the patient’s age, competence in using the delivery system, and preference.