458 Canadian Family Physician • Le Médecin de famille canadien VOL 48: MARCH • MARS 2002
letters
correspondance
VOL 48: MARCH • MARS 2002 Canadian Family Physician • Le Médecin de famille canadien 459
letters
correspondance
A study by Nystad and colleagues3 compared bronchial responsiveness using a methacholine challenge test in children with asthma who exercised and did not exercise.
The authors also compared these results with children who did not have asthma. Their results showed that inac- tive children with asthma had increased levels of bronchial responsiveness.
Although this study cannot make causal conclusions because it was a cross-sectional study, it raises an inter- esting discussion regarding our current thinking about asthma and exercise in children. In the future, will fam- ily practitioners be able to tell their pediatric asthmatic patients to exercise to improve their asthma?
—Maureen F. Kennedy, MD, CCFP, MSC, DIPSPORTMED
Sport and Exercise Physician Director, Fitness MD Calgary, Alta by e-mail References
1. Childhood asthma costly [Briefing]. Can Fam Physician 2001;47:2421.
2. Belamarich PF, Luder E, Kattan M, Mitchell H, Islam S, Lynn H, et al. Do obese inner-city children with asthma have more symptoms than nonobese children with asthma? Pediatrics 2000;106(6):1436-41.
3. Nystad W, Stigum H, Carlsen KH. Increased level of bronchial responsiveness in inactive children with asthma. Respir Med 2001;95(10):806-10.
Nicotine patches and pregnancy
I
read with interest your Motherisk Update ar ticle,“Nicotine replacement therapy in pregnancy,”1 which appeared in the October 2001 issue. Dr Koren’s discus- sion revolved around the study by Wisborg et al.2 The nicotine patches that were used in this study contained only a very low dose of nicotine (only 15 + 10 mg), and were used for only very short courses (3 weeks each), and for only 16 hours daily! I am unhappy that this article was cited as evidence against the efficacy of nicotine replacement therapy for these reasons: the generalizability of this study is highly questionable, and this point should have been expressed more clearly in your article.
Despite my negative comment, I urge you to continue your excellent work, which has helped me so much in the past.
—Stephen DiTommaso, MD, CCFP, FCFP
Montreal, Que CLSC des Faubourgs University of Montreal Centre de recherche et aide aux narcomanes (CRAN, methadone clinic) by e-mail References
1. Koren G. Nicotine replacement therapy during pregnancy [Motherisk Update]. Can Fam Physician 2001;47:1971-2.
2. Wisborg K, Henriksen TB, Jespersen LB, Secher NJ. Nicotine patches for pregnant smokers: a randomized controlled study. Obstet Gynecol 2000;96:
967-71.
Response
I
wish to thank Dr DiTommaso for his interest and kind words. I concur that the dose of nicotine in the patch used in the Danish study was too low. In my Update, I explicitly say “Perhaps these women need more intense therapy than the therapy used in the Danish study.… It is possible that, because they are rapid metabolizers of nicotine, pregnant women need higher doses of nicotine in the patch than those given to non-pregnant women.”The main outstanding issue is, of course, the safety of the patch during pregnancy. Until better data on fetal safety of the low dose are available, it will be difficult to justify increased doses of nicotine.
—Gideon Koren, MD, FRCPC
Director, The Motherisk Program
