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Can A-fib worsen if asthma is poorly controlled?

March 23, 2019
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Atrial fibrillation (AF) is an increasingly common diagnosis for patients >40 years of age.  Treatment options vary from medications to surgical options.  For most patients, it is simply too late for lifestyle changes such as weight loss and diet changes to be effective as the damage is already done.
A recent study out of Norway examined the relationship between asthma and AF.  The study looked at a group of 54,000 adults that did NOT have AF initially.  The authors then looked at a sub-group of patients that also had asthma.  Over the following 15 years, 3.8% of the group developed AF.  The authors found that patients with poorly controlled asthma were more likely to develop AF, compared to those without asthma.  They also found that well controlled asthma was NOT a risk factor for developing AF.
It has been proposed that poorly controlled asthma increases inflammation in the body which leads to an increased heart rate and an increased risk of arrhythmias.  The study did NOT show any link between asthma MEDICATIONS and the risk of AF.
TAKE HOME MESSAGE: Well controlled asthma which in turn means less inflammation in the body has potential benefits beyond improved asthma symptoms and quality of life.
 
Cepelis et al. Associations of asthma and asthma control with atrial fibrillation risk: results from the Nord-Trondelage Health study. JAMA Cardiol. 2018;3:721-728.

Early Life Medications May Increase Allergy Risk

March 16, 2019
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We all recognize that infants are especially fragile when it comes to health concerns.  A recent article published in JAMA Pediatrics last year, suggests that infants exposed to antibiotics and acid-suppression medications in the first 6 months of life were significantly more likely to develop allergic disease.  The article highlighted the risk for food allergies and asthma as the greatest risks, respectively.
This study included more than 790,000 children in the US born between 2001 and 2013.  The study then evaluated the number of infants that received antibiotics or any type of acid-suppressing medication before 6 months of life.  Infants who received antibiotics during the first 6 months of life were at increased risk of developing asthma, hay-fever, and food allergies (specifically cow’s milk and egg allergy).  Receiving any type of acid-suppression medication was associated with an increased risk of food allergies.
The explanation is possibly that these medications change the gut bacteria or the microbiome.  There have been many recent medical studies that strongly support the idea that the bacteria in our gut are crucial for our immune system education.  These same studies show that it matters which bacteria you have in your gut.  The “wrong” type of bacteria may result in a poor education of the immune system which can then lead to the development of allergic disease.  Whereas, having the “right” kind of bacteria can lessen the risk of allergies.  Unfortunately, there is still much debate about which bacteria are “right” and which ones are “wrong”.
THINGS TO KEEP IN MIND:  Firstly this study was a retrospective study – that means that the data was collected afterward – the decision to treat these infants was based on their individual situations and symptoms not on any study recommendations.  Secondly, the study is merely reporting an association.  This type of research can NOT determine the cause of the increased risk of allergic disease.   A prospective study will be the best next step to better understand the risk of these medications when used during infancy.
TAKE HOME MESSAGE:  Any medication used, especially in our youngest patients, may have unanticipated side effects.  The benefits and the potential risks of each medication must be considered.  There will be situations when antibiotics and acid-suppression medications must be used despite the possibility of increasing the risk of allergic disease, because the risk of not treating is far greater.
Mitre E et al. Association between use of acid-suppressive medications and antibiotics during infancy and allergic diseases in early childhood.  JAMA Pediatrics. 2018;172e180315

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