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.

Tuesday, May 29, 2012

Severe Asthma in Children Linked to Fungus

Many children with poorly controlled asthma are sensitized to commonly occurring fungi.  SS

High Prevalence of Severe Asthma With Fungal Sensitization

ScienceDaily (May 22, 2012) — New research presented at the ATS 2012 International Conference in San Francisco suggests that a significant proportion of children with asthma failing Step 4 or greater therapy may have severe asthma with fungal sensitization (SAFS).

"Accordingly, we prospectively analyzed serum immunoglobulin E (IgE) levels and fungal sensitization patterns in 41 children failing combination asthma therapy. Of these 41 patients, 17 (41.5%) were diagnosed with SAFS.""SAFS is a newly described sub-phenotype of asthma, and its prevalence and clinical characteristics in children are unknown," said Alfin Vicencio, MD, chief of pediatric pulmonology and cystic fibrosis at the Cohen Children's Medical Center in Great Neck, NY, and David Goldman, associate professor of pediatric infectious diseases at the Children's Hospital at Montefiore, Bronx, NY.
Compared with those without SAFS, children with SAFS were older, had higher serum IgE levels, and performed worse on pulmonary function tests. These differences remained significant when children with SAFS were compared to a subset of children without SAFS who were sensitized to non-fungal environmental allergens.
The most commonly implicated organisms were Aspergillus spp (81.2%) and Alternaria spp (68.8%), but numerous other species were represented. More than 65% of children with SAFS exhibited sensitization to more than one fungal species. Airway remodeling and persistent eosinophilia may also be associated with SAFS, although the researchers note that additional studies are required to more clearly characterize these features of the disease.
"Our results suggest that SAFS may account for a significant proportion of severe asthma in our pediatric population," said Dr. Vicencio. "At this point, however, there are still many unanswered questions, including the role of anti-fungal therapy."
"We are actively pursuing new methods to identify fungal organisms in the lower airway, which would enable us to better define treatment protocols," Dr. Vicencio concluded. "In addition, we are hoping to identify genetic risk factors for disease, which could potentially lead to targeted preventive strategies early in life."

Thursday, May 24, 2012

Teenager Denied Asthma Inhaler Nearly Dies at School

This should never happen to your child.  Life threatening asthma attacks do occur and require prompt intervention.  Having a physician-authored asthma action plan can prevent this nightmarish scenario.  SS

Student having asthma attack denied inhaler by school nurse

A senior student at Delton High School near Orlando, Florida nearly died last week after a school nurse refused to give him a doctor-prescribed asthma inhaler, even after he passed out from lack of oxygen.
17-year-old Michael Rudi told Orlando news station Local 6 on Monday that as he lost consciousness in the nurse’s office, she closed the door on him, leaving Rudi wondering if he would even wake up.
The nurse, who was not named, was apparently following school policy, even despite Rudi’s name appearing on a prescription for the inhaler.  Students are not allowed to possess prescription drugs at Delton High School, so a release form signed by parents is required by school officials before medicine can be dispensed — something Rudi’s folks had not done.
Even though the nurse refused to step over the school’s policy and give Rudi his inhaler, she could have called 911. But she didn’t, and now Rudi’s mother wants to press charges for child endangerment.
“I mean its common sense if I saw an animal on the street in distress I would probably stop to help, why wouldn’t she help a child,” Sue Rudi told Local 6 reporter Shaun Chaiyabhat. “How dare you deny my son something that we all take for granted, breath. Why didn’t someone call 911?”
There are currently no over-the-counter medications available for Americans who suffer from asthma or reactive airways. Although U.S. pharmacies used to offer a non-prescription cardiac stimulant inhaler that helped relieve asthma symptoms, regulators pulled it from shelves in February. Other milder drugs that address asthma symptoms are much more costly and require a prescription.

Monday, May 21, 2012

Study Finds Increased Risk of Cancer and Cancer Death With Sleep Apnea

The Wisconsin Sleep Cohort and its Spanish counterpart provide striking data about the association of sleep apnea and drops in oxygen saturation with cancer and cancer mortality.  SS

Sleep Apnea Tied to Increased Cancer Risk

Two new studies have found that people with sleep apnea, a common disorder that causes snoring, fatigue and dangerous pauses in breathing at night, have a higher risk of cancer. The new research marks the first time that sleep apnea has been linked to cancer in humans.
About 28 million Americans have some form of sleep apnea, though many cases go undiagnosed. For sleep doctors, the condition is a top concern because it deprives the body of oxygen at night and often coincides with cardiovascular disease, obesity and diabetes.
“This is really big news,” said Dr. Joseph Golish, a professor of sleep medicine with the MetroHealth System in Cleveland who was not involved in the research. “It’s the first time this has been shown, and it looks like a very solid association,” he said.
Dr. Golish, the former chief of sleep medicine at the Cleveland Clinic, said that the cancer link may not prove to be as strong as the well-documented relationship between sleep apnea and cardiovascular disease, “but until disproven, it would be one more reason to get your apnea treated or to get it diagnosed if you think you might have it.”
In one of the new studies, researchers in Spain followed thousands of patients at sleep clinics and found that those with the most severe forms of sleep apnea had a 65 percent greater risk of developing cancer of any kind. The second study, of about 1,500 government workers in Wisconsin, showed that those with the most breathing abnormalities at night had five times the rate of dying from cancer as people without the sleep disorder. Both research teams only looked at cancer diagnoses and outcomes in general, without focusing on any specific type of cancer.
In both studies, being presented in San Francisco this week at an international conference organized by the American Thoracic Society, the researchers ruled out the possibility that the usual risk factors for cancer, like age, smoking, alcohol use, physical activity and weight, could have played a role. The association between cancer and disordered breathing at night remained even after they adjusted these and other variables.
Dr. Mitesh Borad, a cancer researcher and assistant professor of medicine at the Mayo Clinic who was not involved with the studies, called the findings “provocative” but said more research was needed to confirm the association. The studies were observational, and other, unknown factors may account for the correlation between sleep apnea and cancer.
Recent animal studies have suggested that sleep apnea might play a role in cancer. When mice with tumors were placed in low-oxygen environments that simulate the effects of sleep apnea, their cancers progressed more rapidly. Scientist speculate that depriving mice of oxygen may cause their bodies to develop more blood vessels to compensate, an effect that could act as a kind of fertilizer for cancer tissue and cause tumors to grow and spread more quickly.
The researchers wondered whether a similar relationship might exist in people with sleep apnea, in whom throat muscles collapse during sleep, choking off the airway and causing gasping and snoring as the body fights for air. Severe sleep apnea can produce hundreds of such episodes each night, depleting the body of oxygen.
In one study, a team at the University of Wisconsin School of Medicine and Public Health examined data on state workers taking part in the long-running Wisconsin Sleep Cohort, who since 1989 have undergone extensive overnight sleep studies and other measures of health about every four years. The landmark project was one of the first to reveal the widespread occurrence of sleep apnea in the general population.
The researchers found that the more severe a person’s breathing problems at night, the greater the likelihood of dying from cancer. People with moderate apnea were found to die of cancer at a rate double that of people without disordered breathing at night, while those in the severe category died at a rate 4.8 times that of those without the sleep disorder.
“That is really striking,” said Dr. F. Javier Nieto, one of the study’s authors and chairman of the department of population health sciences at the University of Wisconsin. “It could be something else, but it’s hard to imagine that something we didn’t control for is causing this.”
In the second study, researchers with the Spanish Sleep Network took a slightly different approach, looking not at cancer mortality among apnea patients, but at the incidence of cancer. They used a measure called the hypoxemia index, which looks at the amount of time the level of oxygen in a person’s blood drops below 90 percent at night.
About 5,200 people were followed for seven years, none of whom had a cancer diagnosis when the study began. The researchers found that the greater the extent of hypoxemia, or oxygen depletion, during sleep, the more likely a person would receive a cancer diagnosis during the study period.
People whose oxygen levels dropped below 90 percent for up to 12 percent of the total time they were asleep, for example, had a 68 percent greater likelihood of developing cancer than people whose oxygen levels did not plummet at night, said study author Dr. Miguel Angel Martinez-Garcia of La Fe University and Polytechnic Hospital in Spain. As time spent without oxygen increased, so, too, did cancer risk.
Although the study did not look for it, Dr. Martinez-Garcia speculated that treatments for sleep apnea like continuous positive airway pressure, or CPAP, which keeps the airways open at night, might reduce the association.
The Wisconsin study also did not specifically look at the impact of treatment for apnea on survival, either, but when people who were being treated with CPAP were removed from the analysis, the cancer association became stronger, “which is consistent with the hypoxemia theory,” Dr. Nieto said.
“I would say that this is one more instance that shows that sleep apnea can have profound impacts for people’s health,” he added. “Not breathing while you’re sleeping is a serious problem.”

Sunday, May 20, 2012

Exercise may reduce asthma symptoms or attacks

Not only is it safe for people with asthma to exercise, but doing so could reduce their risk of asthma symptoms or attacks, according to a new evidence review in TheCochrane Library.

Many people with asthma report avoiding exercise because they're afraid it could trigger symptoms including shortness of breath, wheezing or a full-blown asthma attack, said review author Kristin V. Carson. These fears might be encouraged from misreading their symptoms, their family's beliefs about exercise and asthma, or even from their physicians.

Over time, Carson explains, patients can become out of shape, losing muscle mass and cardiovascular fitness. That makes any future attempts at physical activity significantly harder, increasing the chances that patients will become fatigued and breathless and further discouraging physical activity.

"This results in a spiraling cycle," she says, in which patients are even more likely to avoid exercise.

To determine whether exercise was a danger to asthmatics, Carson and her colleagues reviewed previous studies that looked at the effects of physical training on people withasthma , comparing patients who received no or minimal physical activity to those who exercised for at least 20 minutes, twice a week, over the course of four weeks.

The researchers found that the patients who had exercised—using physical training as varied as running outdoors or on a treadmill, cycling, swimming or circuit training—were no more likely to have a serious asthma-related problem than those who weren't exercising or who did light exercising such as yoga. Additionally, Carson said, their findings showed that patients in exercise programs improved their cardiovascular fitness, which in turn could reduce asthma symptoms over time. Some limited evidence from the included studies also suggested that exercise improved patients' quality of life, she added, which could contribute to other health benefits and improved psychological well-being.

"We found no reason for people with stable asthma to refrain from regular exercise," Carson said. "Physicians should encourage their patents with stable asthma to engage in physical training programs."

Len Horowitz, M.D., a pulmonary specialist at Lenox Hill Hospital in New York City who wasn't involved in this review, agrees that asthma patients shouldn't shy away from exercise. However, even though research suggests that exercise is safe for asthmatics, he says that many people will still use their asthma as a reason to avoid physical activity. "Not everyone wants to exercise," he said. "When patients think exercise makes them symptomatic or makes them risk an attack, it's a good excuse not to do it."

Horowitz notes that may professional athletes have asthma, which hasn't negatively affected their careers. However, he explains, some patients do have exercise-inducedasthma, in which vigorous or prolonged exercise can trigger symptoms. He advises patients in his practice to take precautions if they're susceptible, including pre-treating themselves with an albuterol inhaler, avoiding exercise that exposes their lungs to cold, dry air (such as running outside in the winter) and building their activity levels gradually.

Read more here

Saturday, May 19, 2012

Asthma one of the Top Reasons Children Miss School

With cold and flu season right around the corner, keeping children healthy is on the top of every parent's mind.

According to 2010 figures from the National Center for Health Statistics, 43% of children ages 5-17 years missed three or more school days in the past year because of illness or injury; 6% missed 11 days or more. An estimated 22 million school days are lost annually because of colds alone.

"There is a correlation between academic success and being in school," says Martha Dewey Bergren, director of research for the National Association of School Nurses. "Seat time affects learning."

Here's a look at some of the ailments that most often keep students out of school, and advice for parents:


The chronic lung disease affects an estimated 7 million kids under 18 and accounts for more than 14 million absences annually. Parents should give the school office (plus teachers and coaches) a plan that specifies symptoms, medications and what to do if an asthma episode does not improve with prescribed medicine, says Norman Edelman, the American Lung Association's chief medical officer. Early in the school year, parents should "do an environmental check of the allergens and other irritants that can trigger an attack," he adds.

It's important that "families work together with their schools and health care provider to manage conditions," says Linda Caldart-Olson of the American School Health Association.

Respiratory infections

A group of viruses that cause various upper and lower respiratory infections are quite common in autumn, says Cynthia DiLaura Devore, chair of the American Academy of Pediatrics Council on School Health. These infections, which also can trigger asthma attacks, cause flu-like symptoms (coughs, fever, lack of appetite, vomiting, diarrhea) that can put a child out of commission for five to 10 days, and are contagious, says Devore. She says parents should keep children home until they're fever-free and off symptom-reducing medicines for 24 hours.


January to March is the height of flu season, but now is the time for everyone 6 months and older to get the flu vaccine, says pediatric infectious-disease specialist Mary Anne Jackson of the University of Missouri-Kansas City School of Medicine. This year's vaccine is formulated to protect against the same three strains as last year's.

Stomach viruses

A number of viruses can infect the gastrointestinal tract, resulting in gastroenteritis or "stomach flu." Marked by vomiting and diarrhea, it usually lasts only 24 to 72 hours, says Devore. Because the viruses are spread through close contact by sharing food or eating utensils, hand-washing and the use of hand sanitizers are critical.

Head lice

In school districts with "no nit" policies, kids with lice must stay home until any sign of eggs has passed. The American Academy of Pediatrics and the National Association of School Nurses oppose the policies because they have not been shown to effectively reduce the spread, no disease is linked to lice, and in-school transmission is rare, says Devore.

Preventable diseases

Outbreaks in the USA last year of potentially fatal, vaccine-preventable diseases, including pertussis (whooping cough) and measles, highlight the importance of "being vigilant about all immunizations," says Jackson. CDC offers immunization schedulers at cdc.gov/vaccines.

School refusal

Repeated episodes of what Devore calls "Sunday Night Stomach" or chronic absences without a medical excuse should be taken seriously, she says. When kids express anxieties, fears and resistance to school, they may simply need a little extra "reassurance, understanding and limit-setting" or there may be serious mental health concerns. Either way, it shouldn't be lightly dismissed, says Devore.

Read more here

Study Claims Asthma Could be Factor for Excessive Daytime Sleepiness

If your child is having trouble focusing while doing schoolwork, you might need to take a look at his or her sleep habits, a new study suggests.

New research published in the journalSLEEPshows that excessive daytime sleepiness (or EDS) is linked with an increased risk of trouble paying attention at school, being hyperactive, difficulty learning and conduct problems.

"When children are referred for neurobehavioral problems, they should be assessed for potential risk factors for EDS," study researcher Susan Calhoun, Ph.D., of Penn State University, said in a statement. "Recognizing and treating EDS can offer new strategies to address some of the most common neurobehavioral challenges in young school-age children."

The study included 508 children who were part of the Penn State Child Cohort. The researchers conducted sleep testing on them and had the parents report whether their children had any excessive daytime sleepiness. Then, they divided the children up into two groups: One that had the excessive daytime sleepiness, and one that didn't.

The researchers found that excessive daytime sleepiness was linked with "neurobehavioral (learning, attention/hyperactivity, conduct) problems and poorer performance in processing speed and working memory," researchers wrote in the study.

Rather, researchers found that factors like depression or anxiety, inattention, obesity, asthma and trouble falling asleep were linked with excessive daytime sleepiness in the kids (even those who "got enough sleep" during the sleep testing, and didn't have sleep apnea).

Excessive daytime sleepiness can be caused by a number of factors, including not getting enough sleep at night, sleep apnea, medications, and other mental conditions or sleep disorders, according to a 2009 article in the journal American Family Physician.

Recently, a New York Times article also examined the link between sleep and attention problems at school. That article looked specifically at how some cases of attention deficit hyperactivity disorder (ADHD) might actually be a sign of sleep apnea, which leads to sleep deprivation and, then, problems with focusing and attention.

The New York Times reported on a recent Pediatrics journal article, showing that kids with sleep problems -- such as sleep apnea or snoring -- have a 40 to 100 percentincreased risk of ADHD-like behavioral problems.

Read more here

Monday, May 7, 2012

Strategies to Control Asthma

This summary from the NHLBI provides invaluable information to parents of children with asthma.  SS

World Asthma Day and Asthma Awareness Month

Together we can help control asthma.
This World Asthma Day (May 1, 2012) and Asthma Awareness Month (May) the National Asthma Education and Prevention Program (NAEPP) encourages you to discover how.
One of the first steps—whether you have asthma or know someone who does—is to develop a written asthma action plan (AAP) in partnership with your healthcare provider. AAPs that meet the specific needs of a patient include details ranging from how to take medication to reduce airway inflammation, to ways to reduce environmental triggers of asthma such as dust mites or tobacco smoke.
But AAPs don’t stand alone. 
They are part of a comprehensive approach needed to improve asthma care and control. Like diabetes or high blood pressure, managing asthma symptoms requires daily attention and ongoing education.
An APP is just one of  the following six key actions, recommended by the NAEPP, that clinicians, patients, and all others who touch the life of someone with asthma can work together on to seize control of asthma so that asthma doesn't seize control of asthma patients.
When taken with these other actions, AAPs can help people with asthma live without limits. The NAEPP has identified personalized AAPs as “must-haves” for allasthma patients, particularly those with moderate and severe asthma, a history of asthma attacks, or poorly controlled asthma. 
It may take time to develop and guide a patient through an AAP on the front end, but providing patients with detailed instructions and educating them on how to manage their asthma themselves will ultimately save clinicians time and effort on the back end. And, if followed as one of the NAEPP's six recommended actions, it could ultimately save lives.
Currently, only about one in three patients with asthma has an AAP to guide them. So, for this World Asthma Day and throughout Asthma Awareness Month, the NAEPP and NACI encourage those without an AAP to get one.
Read more  below:

May is National Asthma Awareness Month

Asthma rates in the United States increased over the past decade to their highest level ever, according to a new government report.
The portion of people in the U.S. with asthma rose from 7.3 percent in 2001 to 8.4 percent in 2010, according to the report from the Centers for Disease Control and Prevention.
That means 25.7 million people had asthma in 2010, including 7 million who were younger than 18.
Over the same period, death rates from the condition dropped 33 percent. For every 10,000 people with asthma, there were 1.4 deaths in 2010, compared with 2.1 deaths in 2001.
The disorder has been linked with poverty, and the new findings showed that 11.2 percent of people living below the poverty level had asthma. However, asthma was also reported by 7.3 percent of those who earn at least twice the poverty level.
The findings also showed 9.2 percent of females had asthma in 2010, whereas the rate among males was 7 percent.
Asthma is a chronic airway disorder that can be triggered by exercise, infections, certain chemicals, airborne irritants such as tobacco smoke, or allergens such as pollen. During an asthma attack, the airway becomes obstructed because of inflammation and constriction of the surrounding muscles. It is not clear how to prevent asthma from developing, and there is no known cure, the CDC says.
The new findings are based on data gathered during the National Health Interview Survey, in which CDC researchers conducted household interviews with a nationally representative sample of participants.