title: Asthma drug use and the development of Churg-Strauss syndrome (CSS).
abstract: OBJECTIVE
  Case reports suggest that leukotriene modifier use may be associated with the onset of Churg-Strauss syndrome (CSS). Using pooled data from two nested case-control studies, we examined the association between asthma drug use and the development of CSS.
  
  
  METHODS
  The study was performed in three US managed care organizations and a US national health plan with chart access and complete electronic pharmacy data, with a covered population of 13.9 million. There were 47 cases of possible or definite CSS and 4700 asthma drug user controls identified between January 1, 1995 and December 31, 2002. We examined exposure to asthma drugs in cases and controls, including leukotriene modifiers (6 cases and 202 controls), in the two to 6 months prior to the onset of adjudicated CSS.
  
  
  RESULTS
  While the crude association between use of leukotriene modifiers and CSS was strong (odds ratio (OR) 4.00, 95% confidence interval (CI): 1.49-10.60), in a multivariable analysis controlling for use of oral corticosteroids, inhaled corticosteroids, and number of categories of asthma drugs dispensed, there was no significant association (OR 1.32, 95% CI: 0.44-3.96). Use of inhaled and oral corticosteroids, evaluated as markers of asthma severity, were associated with CSS (OR 3.07, 95% CI: 1.34-7.03 and OR 5.36, 95% CI: 2.51-11.45, respectively).
  
  
  CONCLUSIONS
  No association was found between CSS and leukotriene modifiers after controlling for asthma drug use However, it is not possible to rule out modest associations with asthma treatments given CSS is so rare and so highly correlated with asthma severity, suggesting further investigation is warranted.
authors.affiliation: Meyers Primary Care Institute, University of Massachusetts Medical School, Fallon Clinic and Fallon Community Health Plan, Worcester, MA 01655, USA. HarroldL@ummhc.org
authors.forename: Leslie R
authors.initials: LR
authors.lastname: Harrold
authors.forename: M Kay
authors.initials: MK
authors.lastname: Patterson
authors.forename: Susan E
authors.initials: SE
authors.lastname: Andrade
authors.forename: Timothy
authors.initials: T
authors.lastname: Dube
authors.forename: Alan S
authors.initials: AS
authors.lastname: Go
authors.forename: A Sonia
authors.initials: AS
authors.lastname: Buist
authors.forename: K Arnold
authors.initials: KA
authors.lastname: Chan
authors.forename: Peter F
authors.initials: PF
authors.lastname: Weller
authors.forename: Michael E
authors.initials: ME
authors.lastname: Wechsler
authors.forename: Robert A
authors.initials: RA
authors.lastname: Yood
authors.forename: Kourtney J
authors.initials: KJ
authors.lastname: Davis
authors.forename: Richard
authors.initials: R
authors.lastname: Platt
authors.forename: Alexander M
authors.initials: AM
authors.lastname: Walker
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000009:adverse effects; D000328:Adult; D000368:Aged; D018927:Anti-Asthmatic Agents / Q000009:adverse effects*; D001249:Asthma / Q000188:drug therapy*; D016022:Case-Control Studies; D015267:Churg-Strauss Syndrome / Q000139:chemically induced*; D005260:Female; D006801:Humans; D020024:Leukotriene Antagonists / Q000009:adverse effects; D008297:Male; D008875:Middle Aged
chemical_list: D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents; D020024:Leukotriene Antagonists