Houston Area Pediatric Specialists

Independent pediatric specialists aim to serve our community. We want to share news and analysis regarding our specialties and our practices.

Sunday, March 25, 2012

Can Children Outgrow Asthma?

Perhaps the most common question a parent asks me about asthma is whether the disease is life long.  This question is hard to answer and it is risky to assume that children may "outgrow" their condition.  SS

Patients can’t outgrow breathing illness

It’s not the news parents want to hear, especially those who have watched their children gasp for every breath.

   But the reality is that you can’t outgrow asthma.

   Sure, the symptoms might ease, especially during teenage years. And, yes, getting a handle on any triggers that might worsen the problem — mold, pollen, dust mites, smoke, pollution and strong odors chief among them — can help.

   Still, “Asthma is a chronic disease, not a temporary condition,” said Dr. Jonathan Parsons, a pulmonologist and associate director of the Asthma Center at Ohio State University’s Wexner Medical Center.

   “It’s like high blood pressure or diabetes. There’s waxing and waning of the symptoms, but you have to be aware that you have it, and you have to know how to manage it.”

   Doctors say that asthma is most often diagnosed in children, and of those, about 90 percent experience a recurrence of symptoms, Parsons said.

   Managing the condition becomes a way of life. Asthma occurs when airways are narrow and swollen, impeding the flow and speed of air intake.

   “That’s a wheeze,” Parsons said.

   But sufferers don’t have to huff and puff all the time to have the problem. Asthma can manifest itself as a cough or an uncomfortable feeling or tightness in the chest or can masquerade as a runny nose attributed to a sinus problem or allergies.

   The only way to really diagnosis it is to undergo pulmonary-function tests, which measure airflow.

   Parents often don’t want to accept the diagnosis, said Dr. Karen S. McCoy, chief of the Division of Pediatric Pulmonology at Nationwide Children’s Hospital.

   “An asthma diagnosis is perfect for making a parent as worried and apprehensive as they can be,” McCoy said. “They don’t want to think that their child would have something ongoing or chronic, and the potential for ongoing and long-term medications is a concern for them.”

   She said childhood asthmatics often get a respite during their teenage years mostly because teens aren’t as prone to viral infections, which trigger symptoms, and because a change in the size of the airways means that a little bit of swelling doesn’t affect breathing as much.

   But as those kids grow older, they must remember to watch for the signs again.

   Xandula Gaitor said she wishes her two sons were so lucky.

   Her boys, now ages 20 and 10, have long struggled with severe asthma. Her older son, Alwyn Burns, caught a break in his teen years, but that was largely because his condition was so severe that the family relocated to Phoenix for its drier climate, she said.

   To help her younger son, Isaiah Burns, manage his asthma, they relocated to Alabama for a time.

   Now they are back in Westerville to be closer to family, and Isaiah’s symptoms remain severe.

   Gaitor said that when Alwyn was 5 months old and doctors diagnosed his asthma, she was scared yet relieved to know why he suffered terrifying breathing episodes.

   “I just said, ‘OK. Tell me what we need to do and how we can get him better.’”

   Alwyn’s asthma is so severe that the smell of cleaning supplies can trigger an attack. So can a whiff of smoke. And his linens must be washed often in extra-hot water to kill dust mites.

   “It has altered our lifestyle in so many ways,” Gaitor said.

   Treating childhood or adult asthma is largely the same — a maintenance dose of inhaled steroids to reduce inflammation in the airways and a rescue inhaler or breathing machine (called a nebulizer) for serious episodes.

   While childhood patients typically don’t outgrow asthma, some adults end up developing the breathing disorder. It’s called adult-onset asthma, but Parsons said it’s virtually impossible to tell whether the inflammation is new or had always been there.

   Genetics and family history play a role, and exposure to mold or chemicals can make a difference. hzachariah@dispatch.com  


Wednesday, March 14, 2012

Snoring Linked to Childhood Behavioral Problems

When I ask children and their parents about snoring, it often elicits laughter or some sense of embarrassment.  However, their is extensive evidence that snoring may not be harmless.  SS

Child behaviour link' to snoring

Sleep apnoea and snoring made conditions such as hyperactivity more likely later on, researchers said.
The study, published in the US journal Pediatrics, looked at data on 11,000 children living in the UK.
Lead researcher Dr Karen Bonuck said the sleep problems could be harming the developing brain.
One estimate suggests one in 10 children regularly snores and 2% to 4% suffer from sleep apnoea, which means the breathing is obstructed and interrupted during sleep.
Often enlarged tonsils or adenoids are to blame for the conditions.
In adults, the result can be severe day-time tiredness, and some studies have hinted that behavioural problems such as attention-deficit hyperactivity disorder might be linked to the condition in children.
The latest study is sufficiently large to offer a clearer view of this.
Oxygen supply
Parents were asked to fill in a questionnaire in which both the level of snoring and apnoea were recorded in the first six or seven years of life, and contrasted with their own assessment of the child's behaviour.
SocietyDr Bonuck, from the Albert Einstein College of Medicine at Yeshiva University in New York, said that children with breathing issues during sleep were between 40% and 100% more likely to develop "neurobehavioural problems" by the age of seven.She believes that the sleep breathing issues could cause behavioural problems in a number of ways - by reducing the supply of oxygen to the brain, interrupting the "restorative processes" of sleep or disrupting the balance of brain chemicals.
She said: "Until now, we really didn't have strong evidence that sleep-disordered breathing actually preceded problematic behaviour such as hyperactivity.
"But this study shows clearly that symptoms do precede behavioural problems and strongly suggests that they are causing these problems."
Marianne Davey, from the British Snoring and Sleep Apnoea Society, said that sleep problems in the young were an under-recognised reason for poor behaviour.
She said: "Often parents won't make the connection and mention them to the GP, so this label of ADHD is given to the child, and sometimes they are even given drugs.
"This is wrong, as if the sleep problem is addressed, the behaviour will improve almost immediately."

Wednesday, March 7, 2012

Welcome to the blog - Dr. Ori Hampel, Adult & Pediatric Urology

Welcome to Ori Hampel MD 
Adult & Pediatric Urology of Houston, LLP
3230 Strawberry Road, Pasadena, TX 77504
(713) 477-8600 
Dr. Hampel will contribute articles related to pediatric urology.
Dr. Hampel welcomes consultation for:

Thursday, March 1, 2012

Childhood Obesity Linked To Asthma

Obesity has been linked to a number of diseases associated with inflammation.  This large study provides strong evidence that obese children are more likely to have asthma.  SS 

Kaiser Permanente Study Finds Obesity-Asthma Link in Children Varies by Race/Ethnicity

Electronic Health Records Used to Study 681,000 Youth

Published: Monday, Feb. 27, 2012 - 6:08 am
PASADENA, Calif., Feb. 27, 2012 /PRNewswire/ -- Children and adolescents who are overweight or obese are more likely to have asthma than their healthy weight counterparts, according to a new Kaiser Permanente Southern California study published in the online edition of Obesity. The study, which included more than 681,000 children between ages 6 and 19, found that the association between asthma and body mass index varied by race and ethnicity.
The study found that the association between BMI and asthma was weaker for African Americans, a group that was previously known to have the highest prevalence of asthma, than for youth from other racial and ethnic groups. Researchers found the strongest association between BMI and asthma in Hispanic youth.
"This research contributes to the growing evidence that there is a relationship between childhood obesity and asthma, and suggests that factors related to race and ethnicity, particularly for Hispanic youth, may modify this relationship," said study lead author Mary Helen Black, PhD, of the Kaiser Permanente Southern California Department of Research & Evaluation. "The study's large and diverse population, which is broadly representative of the Southern California region,allowed us to examine a wide range of BMI categories in relation to asthma among youth from five racial/ethnic groups."
Researchers also found that, among youth with asthma, being overweight or obese was associated with more frequent visits to the doctor or emergency department for asthma. In addition, overweight or obese youth with asthma used more inhaled and oral corticosteroid asthma drugs, when compared to healthy weight youth. The need for these medical treatments could have broader health implications as other studies have suggested a link between these medications and type 2 diabetes. 
The cross-sectional, population-based study included youth from a racially and ethnically diverse population. Asthma was fairly common in this population, affecting about 18 percent of the youth in the study. Researchers used electronic health records to obtain height and weight measurements, asthma diagnoses, and dispensed prescriptions for asthma-specific medications for children and adolescents in the Kaiser Permanente Southern California integrated health planfrom 2007 to 2009. 
This study is part of the Kaiser Permanente Southern California Children's Health Study, and their ongoing work to better understand and prevent childhood obesity.
Last year, the KPSC Children's Health Study found that 7 percent of boys and 6 percent of girls ages 2 to 19 in the population were extremely obese. This study also has used electronic health records to determine that children who were obese or overweight have a significantly higher prevalence of psoriasis, a chronic inflammatory disease of the skin.
Other study authors included Ning Smith,PhD, Steven Jacobsen, MD, PhD, and Corinna Koebnick, PhD, from the Department of Research & Evaluation, Kaiser Permanente Southern California; and Amy H Porter, MD, from the Department of Pediatrics, Kaiser Permanente Los Angeles Medical Center.

Read more here: http://www.sacbee.com/2012/02/27/4294206/kaiser-permanente-study-finds.html#storylink=cpy


Indoor Allergens: Is it your house or your vacuum cleaner?

An old vacuum cleaner could be part of the problem for people suffering from asthma and allergies.

Are Vacuum Cleaners Bad for Your Health?

Australian Study Shows Most Vacuum Cleaners Release Dust, Bacteria Back Into the Air

Jan 6, 2012 -- You vacuum your house religiously to get rid of all the dust, dirt, and bacteria and make sure your indoor air is up to snuff.
But new research suggests that some vacuum cleaners may actually be making things worse, not better.
Certain vacuum cleaners spit fine dust and bacteria back into the air, where they can spread infections and trigger allergies.
Australian researchers tested 21 vacuum cleaners from 11 manufacturers, including two commercial models. The vacuums were six months to 22 years old, and ranged from less than $100 to almost $800. Brands included Dyson, Electrolux, Hoover, iRobot, and Sanyo. The researchers measured 62 different air emissions.
All released some bacteria, dust, and allergens back into the air. Newer and more expensive vacuum cleaners generally caused less indoor air pollution than older, cheaper models, the study showed.
Vacuums with high-efficiency particulate air (HEPA) filters released only slightly lower levels of dust and bacteria than vacuums that did not use these special filters. HEPA filters are supposed to remove 99.9% of the pollen, animal dander, and even bacteria from the air.
The new findings appear in Environmental Science & Technology.
“Both vacuum cleaning and the act of vacuuming can release and re-suspend dust and allergens, leading to increased exposure,” write study researchers from Queensland University of Technology in Brisbane, Australia.

Indoor Air Cleaning Tips From the Pros

But don’t go throwing your trusty vacuum cleaner out so quickly, says Viviana Temino, MD. She is an assistant professor of allergy and immunology at the University of Miami School of Medicine.
“For a vacuum to do more harm than good, it has to be a really old vacuum cleaner that has never been cleaned,” she says. “In general, most vacuums do take up more dust, dirt, and allergens than they release."
HEPA filters are still the way to go, she says: “They remove more particles than they release back.”
There are other things you can do to keep your indoor air clean. “If you or someone in your home does have indoor allergies, get rid of your carpet,” she says. “If you have throw rugs, wash them once a week in really hot water. This will kill off dust mites and other allergens.”
Feather dusters just relocate dust around the room. Instead, try a microfiber or electrostatic cloth. These don't stir up dust, she says.
Jeffrey May says HEPA filters are still the best. He is the principal scientist at May Indoor Air Investigations in Tyngsborough, Mass., and author of several books, including My House Is Killing Me! The Home Guide for Families With Allergies and Asthma. “A junky old vacuum cleaner will definitely release more allergens than a newer one,” he says.
His advice? Get a vacuum cleaner that has a HEPA filter, and change the filter and clean your house regularly. “Make sure to vacuum under furniture and behind furniture,” May says. “You can't believe the stuff that accumulates there, and this can be an enormous source of allergens.”
WebMD Health News
Reviewed by Michael W. Smith, MD