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, September 23, 2012

Discovery May Lead to New Asthma Treatment

This promising research focuses on a unique step in the pathway that leads to asthma exacerbations. Dr. Susarla

Scientists Focus on Factors Behind Asthma Attacks

Findings could pave way to reducing 2 major airway symptoms, researchers say

THURSDAY, Sept. 20 (HealthDay News) -- Blocking two particular biological processes might help provide relief to people with asthma, according to a new study.
The University of California, San Francisco-led team found that a specific calcium-activated chloride channel called TMEM16A plays a role in the severity of asthma. The channel regulates airway secretions and smooth-muscle contraction: the major factors that lead to an asthma attack.
"Maybe if we could inhibit both of these processes by blocking this one channel, then we could affect the two symptoms of asthma," study senior author Jason Rock, an assistant professor at the UCSF anatomy department, said in a university news release.
People with asthma have a higher-than-normal number of mucus-producing cells in the lining of the airway tubes that lead to the lungs, and they also have an abnormal amount of smooth muscle surrounding the airway tubes. The slightest stimulus can cause the tubes to contract.
"The overabundance of mucus plugging the airways combined with hyper-contractility of the smooth muscle -- when the tubes get really small -- make it difficult to move air in or out," Rock explained. "A lot of people equate that with breathing through a straw."
In laboratory tests, the researchers identified three chemicals that inhibited the activity of TMEM16A and led to reduced mucus production and smooth muscle contraction.
The study was published Sept. 17 in the journal Proceedings of the National Academy of Sciences.
The next step is to test the safety and effectiveness of these chemical blockers in animals, the researchers say. If that goes well, human clinical trials could follow.

Using iPads before bed 'can lead to a poor night's sleep'

We all love them.  Unfortunately, these bright LED screens can interfere with our brain's cues that signal sleep onset.  Dr. Susarla

Using iPads before bed 'can lead to a poor night's sleep'

Using tablet computers like Apple’s iPad and Samsung’s Galaxy Note just before bed can lead to a poor night’s sleep, according to research.

More and more people are taking their tablets to bed with them to surf the web, check Facebook or email before switching off the light.
But researchers are warning that the blueish light their screens emit can stop users getting a good night’s sleep.
That is because this type of light mimics daylight, convincing the brain that it is still daytime.
Blue light suppresses production of a brain chemical called melatonin, which helps us fall sleep. This is because our brains have evolved to be wakeful during daylight hours.
By contrast, light which is more orange or red in tone does not suppress melatonin production, perhaps because our brains recognise it as a cue that the day is ending.
However, because mobiles and tablets are by nature portable - not to say addictive - more people are taking them into the bedroom.
Users also tend to hold them much closer to their eyes than a computer or television screen.
Researchers at the Lighting Research Centre, at the Rensselaer Polytechnic Institute in New York, are warning that looking at tablet displays for more than two hours “leads to a suppression of our natural melatonin levels as the devices emit optical radiation at short wavelengths” - in other words, they emit bluer light.
They say: “Although turning off devices at night is the ultimate solution, it is recommended that if these devices are used at night displays are dimmed as much as possible and that the time spent on them before bed should be limited.”
They drew their concludions after measuring melatonin levels in 13 volunteers, after they had spent time viewing iPads at full brightness at a distance of 10 inches, for two hours.
Melatonin levels were significantly lower after they had done this, than they were after the volunteers had viewed their iPads for the same time, but while wearing orange glass goggles, which cut out the blue light.
They wrote in the journal Applied Ergonomics that tablet makers could "tune the spectral power distribution of self-luminous devices" so that they disrupted the sleep patterns of users less.
It is not just a good night’s sleep that could be jeopardised by too much late night screen time.
Researchers know that persistent disruption to sleep patterns can lead to an increased risk of obesity, and even breast cancer.
However, these studies tend to be comparisons of those with chronic sleep disruption, such as long term shift workers, with those who have normal sleep patterns.

Monday, September 10, 2012

Infant Sleep Training is NOT Dangerous

The unspoken concern that we are "emotionally scarring" our children by training them to fall asleep alone appears to be unfounded. Dr. Susarla

Infant sleep training has no long term effects: study

(Reuters Health) - Using behavioral training to help babies fall asleep doesn't seem to harm them emotionally or developmentally years later, but it doesn't benefit them long-term either, according to a new study.
Australian researchers, who published their findings in the journal Pediatrics on Monday, found that of 225 six-year-olds, those who participated in sleep training when they were babies were no different in terms of emotional health from those who did not.
The study is a follow-up to some of the researchers' earlier work - originally published in 2007 - that found babies and their parents benefited when the infants were taught to settle themselves through various behavioral techniques.
Parents and doctors, however, have expressed concern that the techniques could harm the children's emotional development, and thus their later mental health and ability to handle stress. There were also concerns over whether the techniques would impact the children's relationships with their parents.
"We wanted to find out if the benefits were really long lasting and if there were any long term effects," said Anna Price, the study's lead author from The Royal Children's Hospital in Victoria,Australia.
Price and her colleagues turned to the same children and parents they followed for the 2007 study to answer those questions.
In the original study, 326 children who had trouble sleeping were randomly assigned to different groups for their parents to try various sleep-encouraging techniques with the help of nurses.
At the end of the study, researchers found the use of certain methods - such as "controlled comforting" and "camping out" - improved the children's sleep problems and helped mothers with depression.
Controlled comforting is when a parent periodically responds to their child's cries - instead of the frowned upon approach of letting the child "cry it out." Camping out, on the other hand, is when parents slowly ease out of a child's room, which eventually teaches the baby to sleep without a parent there.
For the new study, the researchers were able to follow-up with 225 of the children from the original study. Of those, 122 had gone through the sleep training while the other 103 had not.
Overall, nine percent of the six year olds who went through training were having sleep problems compared to seven percent of those who did not go through training - a difference so small that statistically, it could be due to chance.
The researchers also didn't find any differences when it came to the children's emotions, conduct or stress.
Among parents, the researchers didn't see a difference between those who had tried training their infants and those who did not when it came to rates of depression, anxiety and stress.
Moreover, there didn't seem to be any difference between the two groups in the degree of closeness between children and their parents.
Dr. Umakanth Khatwa, the sleep lab director at Boston Children's Hospital in Massachusetts, called the new study "excellent work."
"I think they looked at this from all sides, and we needed this kind of long term study," Khatwa, who was not involved in the new research, said in an interview.
Price told Reuters Health that the new results show the techniques are safe for children older than six months old. And, regarding possible harm, "the research that's out there answers the questions quite conclusively."

Friday, September 7, 2012

Scientists Determine Why Kids With Asthma Are Often Bullied

Poor asthma control can lead to a chain reaction that may affect how children interact with their peers at school.  Dr Susarla

Scientists Determine Why Kids With Asthma Are Often Bullied

A new study has identified several factors that may help us understand why kids with asthma are bullied more than healthy kids. The research, presented September 2, 2012 at the European Respiratory Society's Annual Congress in Vienna, emphasized how important it is for doctors to talk to their pediatric patients with asthma about bullying, while also explaining other potential effects the disease could have on other areas of their lives.

It has been known, unfortunately, that it is quite common for children to tease or harass their peers who have a chronic medical condition. However, scientists are not exactly sure what initiates this teasing.

In order to discover what factors are associated with this increased risk of bullying, a team from the Derbyshire Children's Hospital, in the UK, analyzed data from the large six-country "Room to Breathe" survey of childhood asthma.

The experts interviewed children (ages 7 and up) and their parents as part of the study. Data was gathered from 943 questionnaires regarding the lifestyle of parents and their kids, conditions at home, and their overall experience dealing with asthma.

A number of factors associated with an increased chance of bullying was found in the results. The factors that were significantly associated, include:
  • reduced participation in sports
  • feelings of sadness
Other factors contributing to this issue, that could be improved, include:
  • parental smoking
  • poor asthma control
  • parents continuously worrying about their child's heath
The authors hope that the findings will encourage pediatrician doctors to address the issue of bullying with their patients, as well as any other effects their condition has on their life.

Dr. Will Carroll, from the Derbyshire Children's Hospital, revealed:

"We know that bullying is associated with asthma and these findings can help us understand why this is case. A number of the factors identified are things that can be changed, such as participation in sport, asthma control and parental worry over their child's health. As doctors, we must work with families to ensure these risk factors are removed and work with schools and teachers to ensure children with asthma are able to participate in sports at a level that is safe for them."

David Supple, a parent of a child struggling with asthma, explained how hard it is to get kids with exercise-induced asthma to participate in games or sports with their peers.

He continued:

"You can be scared to push them - but the health and social benefits far outweigh the fear, and can help build a lifetime of confidence against bullying. We have made a real effort to include our son, Alex in as much sport as we can to ensure that he isn't excluded from different groups and to keep a wide balance of friends."
Read full article here.

Wednesday, September 5, 2012

Height Reduction in Children Using Inhaled Steroids

This is not as surprising as some might think.  For many children, the benefits of therapy which include preventing life threatening asthma attacks outweigh any risk.  However, confirming a diagnosis of asthma is key.  It's important to know that if your child is taking inhaled steroids that he/she in fact really needs them or is on the correct dose.  Dr. Susarla

Height Reduction in Children Using

Asthma Inhalers

Children using steroid inhalers tend to be slightly, 

about half inch, shorter than their peers when they 

reach adulthood, a new study says.

  • (Photo : Wikimedia Commons) EnlargeAccording to estimates, about 9 million children in the United States have asthma. Inhaled corticosteroids are the most effective drug to treat asthma symptoms. Previous research has shown that inhaled corticosteroids lower the chances of asthma attacks, wheezing and improve lung function in infants and preschoolers.

"This [study results] was surprising because in previous studies, we found that the slower growth would be temporary, not affecting adult height. But none of those studies followed patients from the time they entered the study until they had reached adult height," said Robert C. Strunk, MD, Professor of Pediatrics at Washington University School of Medicine in St. Louis.
The present study involved around 1,000 children suffering from asthma. The participants were aged between 5 and 12 years old and were randomly divided into three groups; group one received inhaled corticosteroid asthma medication (budesonide), the second group received inhaled medication without steroids (nedocromil) and the third group was given a placebo. All participants were given albuterol, a drug for relief of acute asthma symptoms, and oral corticosteroids as needed for asthma symptoms.
Participants' height and weight was measured at regular interval until they reached adulthood. More than 900 participants were followed until they reached 18 years old, for girls, and 20 years old, for boys.
Researchers found that participants who used budesonide were half inch shorter than those who used either nedocromil or a placebo. They also found that the slowest growth in height occurred when the children started using budesonide between the ages of five and 11.
 "We found it made no difference if they were boys or girls or how long they had had asthma, or any other of these factors. We also looked at the height of the parents, and that didn't have any impact, either," Strunk said.
Benefits of the corticosteroids versus half an inch of height
Strunk said that pediatric asthma specialists at St. Louis Children's Hospital monitored the participants' growth and maintained records of growth curve. He said that the "half-inch of lowered adult height must be balanced against the well-established benefit of inhaled corticosteroids in controlling persistent asthma. We will use the lowest effective dose to control symptoms to minimize concerns about effects on adult height."
"The loss of height compared to expected height was not dramatic in this study [and] without inhaled steroids, some of these persistent, asthmatic children may well have suffered considerable morbidity [illness], which was prevented by the inhaled steroids," Dr. Len Horovitz, a pulmonary specialist at Lenox Hill Hospital in New York City, HealthDay reports.
Read more here.

iSonea's AsthmaSense Smartphone App Now Free

Here's a chance to check out this free app if you or your child has asthma.  It's quite handy for those that follow a schedule, and hard to beat at this price.  Dr. Susarla
Most intelligent asthma app available to everyone through September as allergy and back-to-school season nears
With AsthmaSense, parents and children have the most intelligent asthma management app at their fingertips. Unlike most health apps which act as passive journals, AsthmaSense v.1.0.1 analyzes user symptoms, medication usage and lung function measurements against the National Institute of Health (NIH) asthma guidelines, alerting the user if it senses that their asthma is not well controlled.
With AsthmaSense, users can input their medication, symptoms and peak flow results, and set alerts for medication and lung function testing. In addition to using this information to determine the status of a user's asthma, the AsthmaSense app stores this data, giving the user and their doctor a better picture of their lung health.
"Autumn is a tough time for asthmatics, especially children. By offering AsthmaSense for free through September, we are increasing access to the most intelligent, easy-to-use asthma management app on the market during this troublesome season," said Michael Thomas, CEO of iSonea Ltd. "At iSonea, we are committed to helping asthmatics breathe easier and we are continuing to develop tools to help people control this disease."
AsthmaSense is the first of iSonea's family of asthma management apps. Future iSonea apps will incorporate the Company's proprietary Acoustic Respiratory Monitoring (ARM™) technology and diagnostic algorithms. The company is also developing the AsthmaSense Cloud™ for data sharing and enhanced capabilities for detecting asthma risk based on changes in environmental conditions such as air quality and weather.
AsthmaSense is available for free on the Apple App Store (for iPhone and iPad users), Google Play and Amazon App Stores (for Android users).
To see how one mother uses iSonea's technology to keep her son's asthma under control, please follow this link.

Read more here: http://www.heraldonline.com/2012/09/04/4234072/isoneas-asthmasense-smartphone.html#storylink=cpy

Monday, September 3, 2012

Therapy-Resistant Asthma May Be Neither

Don't accept your child's asthma treatment plan that assumes that daily symptoms or frequent flare-ups are normal.  Dr Susarla

Therapy-Resistant Asthma May Be Neither

STANFORD, CALIF. – Therapy-resistant asthma usually isn’t.
Often it’s asthma that’s not really resistant to therapy, but a result of poor adherence to therapy, poor inhalation technique, or poor asthma control due to exposure to smoke or allergens.
And sometimes, it’s not even asthma. So, for a child with apparently severe asthma, first confirm the diagnosis and ensure that basic management strategies are in place and being followed, Dr. John D. Mark said at a pediatric update sponsored by Stanford University.

If you can improve the patient’s adherence to treatment, drug delivery, and exposure to environmental triggers, "you could fix nearly all ‘treatment-resistant asthma,’ " said Dr. Mark, a pediatric pulmonologist at Lucile Packard Children’s Hospital at Stanford.
He said he sees many patients referred for therapy-resistant asthma, but noted that there are not a lot of data on how to manage them.
Only 55 of 292 children with moderate to severe asthma, despite being prescribed at least 400 mcg/day of budesonide plus a long-acting beta-2 agonist, could be randomized after eligibility assessment in one treatment trial. Among the 237 who didn’t qualify, children either were nonadherent to treatment (38%) or were found to have mild or no asthma (25%) (J. Allergy Clin. Immunol. 2008;122:1138-44).
In a separate study of 780 patients aged 12-20 years with "severe asthma," the focus on basic asthma management during the run-in period of the trial improved symptoms so much that no clinically significant gains were achieved during the main part of the study by the use of exhaled nitric oxides as an indicator of control, even though this measure increased corticosteroid use (Lancet 2008;372:1065-72).
Another study found that 86% of 100 adults with chronic obstructive pulmonary disease or asthma were misusing their metered-dose inhaler (MDI) and 71% were misusing their Diskus dry powder inhaler (J. Gen. Intern. Med. 2011;26:635-42). A separate study of 127 children and adults found incorrect use of inhaler devices in 64% of MDI users and 26% of patients using the Rotahaler dry powder inhaler. Spacer devices seldom were used (J. Assoc. Physicians India 2005;53:681-4).
Dr. Mark said "therapy-resistant asthma" may fall into one of four categories:
 The wrong diagnosis. This is common, so do a diagnostic re-evaluation, he said.
 Asthma plus. Mild asthma exacerbated by one or more comorbidities is another common scenario. Some studies suggest that up to 15% of patients with severe or persistent asthma have dysfunctional breathing, such as vocal cord dysfunction. Rhinosinusitis, obesity, and food allergy can affect asthma control. Treating gastroesophageal reflux disorder usually does not improve asthma control much, Dr. Mark said.
 Difficult-to-treat asthma. This is a very common category in which poor treatment adherence or poor inhalation technique is the root of the problem. It often overlaps with the previous category.
 True resistance. Probably not common, this is severe therapy-resistant asthma that remains refractory to treatment even after dealing with reversible factors.
Read more here.

Snoring Kids Should Be Screened for Sleep Apnea

It's nice to see media outlets covering this important health issue for children.  The AAP has rightfully updated an outdated guideline given the dangers of untreated sleep apnea. Dr. Susarla

AAP Issues New Guidelines for Kids’ Snoring

ABC News Medical Unit

A new set of practice guidelines released Monday by the American Academy of Pediatrics (AAP) may help parents and pediatricians uncover things that go snore in the night.
Pediatric sleep experts focused on children with a condition known as uncomplicated obstructive sleep apnea, which occurs when breathing is interrupted during sleep and is related to enlarged tonsils or obesity.  It is a condition the AAP says affects 1.2 to 5.7 percent of American children. They reviewed evidence from 350 study articles between 1999 and 2010 to create the following recommendations:
  • Screening: All children and adolescents should be screened for snoring at their routine health visits.
  • Sleep testing: Any children who have symptoms of obstructive sleep apnea, such as habitual snoring, disturbed sleep from intermittent pauses, snorts or gasps, or daytime behavioral problems, should be referred for a sleep study.
  • Adenotonsillectomy: Any child with obstructive sleep apnea and enlarged tonsils should be referred to a surgeon to consider tonsil removal surgery.
  • High risk: A child undergoing tonsil surgery is considered “high-risk” if he or she is under age 3, has severe sleep apnea on sleep testing, is obese or currently has an infection. These children should be closely monitored in the hospital after surgery for any complications.
  • Re-evaluation: After surgery, snoring children should be reassessed to see if their sleep apnea has improved or if they will need any further treatments.
  • CPAP: If symptoms do not improve after surgery or if a child is unable to get surgery for some reason, they should be considered for CPAP (continuous positive airway pressure), which is a breathing apparatus, often worn at night, that keeps airways open.
  • Weight loss: Weight loss is recommended for any overweight or obese patient in addition to any other treatments.
  • Intranasal steroids: Nasal sprays are recommended for patients with mild sleep apnea symptoms, whether in lieu of or after tonsil surgery.
The last set of guidelines for pediatric sleep apnea was released in 2002. The changes reflected in these new guidelines were made in light of research over the past 10 years that has suggested that delayed diagnosis of childhood sleep apnea “can result in severe complications if left untreated,” according to the American Academy of Pediatrics report. Examples include cognitive deficits, behavior problems, hypertension and heart problems, failure to thrive and inflammation throughout the body.
With these new guidelines, the AAP hopes that more cases of childhood sleep apnea will be diagnosed sooner and children will receive the proper treatments earlier to prevent these dangerous long-term effects.
“These new guidelines are extremely important,” says Dr. Vikas Jain, a sleep specialist at Integris Health in Oklahoma City.
“Pediatric sleep apnea is a rising problem among American children and leads to serious consequences,” he says. “The sooner we can diagnose a child with this condition, the sooner we can get these kids started on the right treatments to improve their quality of life and their overall health.”