A New Way to Treat Severe Asthma?

Asthma is an extraordinarily complex, simple disease.  By that, I mean identifying its cause and proper treatment is often harder than diagnosing the disease itself.  Patients with the more severe spectrum of disease are even more challenging, and may require asthma specialists to re-examine our own dogma by using innovative ways to use common medications.  Using combination inhalers as rescue medication may be one way to do this as this study from Lancet suggests.  However, this therapy is not for everyone with asthma, and is not without risk.  Dr. Susarla

Single Combined Asthma Inhaler Better Than Recommended Treatment

Using two asthma medications combined in a single inhaler provides superior rescue and preventive treatment than guideline-based treatments among adults whose asthma symptoms are not well controlled, according to two large, randomized clinical trials that were published in The Lancet Respiratory Medicine.

This new therapy is known as SMART (Single Inhaler Maintenance and RelieverTherapy).

The findings in these two studies challenge national (USA) and international asthmaguidelines, especially in the United States, where this combined inhaler approach has not yet been approved.

The authors added that the two-medications-in-one inhaler is safe and well tolerated.

As background information, the researchers explained that most adults with asthma do not manage to achieve good control of symptoms, despite effective drug treatment options. A survey of 1,000 asthma patients found that controller drugs are not used by nearly half of all adults and children with persistent asthma.

Medical guidelines advise doctors to prescribe corticosteroids (ICS) plus rapid-onset long-acting β2 agonist (LABA) combination inhaler to achieve control, together with a second short-acting β2 agonist (SABA) inhaler for rescue usage, for the treatment of symptoms.

SMART, on the other hand, uses only a single ICS/LABA inhaler for both relief and preventive treatment.

First Study - Europe

The first study involved 1,714 adults patients with moderate, persistent asthma from 14 different European countries. The study found that the patients in the SMART beclometasone/formoterol combination had a considerably smaller risk of severe asthma attacks, being hospitalized, or requiring urgent care compared to those receiving current best practice.

The authors said:

"We believe that the additional cost of inhaled corticosteroid and rapid-onset, long-acting β2 agonist combination (29 Eurocents per patient per day) is justifiable because of the significant reduction in severe exacerbations, and specifically hospital admissions, known to have a huge effect on health-care costs in asthma."

Read article here.

Hand Hygiene Cannot Stop Asthma, Study Shows

Although viruses are one of the main triggers of asthma exacerbations, aggressive hand hygiene did not appear to be enough to stop 'attacks'.  Dr. Susarla

School 'hand hygiene' plan shows no asthma benefit

An arsenal of hand sanitizers, hygiene education and good old-fashioned soap failed to prevent asthma attacks among school children in one Alabama county.

For children with asthma, the common cold is the top trigger of symptom attacks. So in theory, cleaner hands at school could mean fewer colds being passed around - and fewer asthma attacks.

But in a new clinical trial, researchers found that kids at schools with a "hand hygiene" plan, including alcohol-based hand sanitizers, suffered asthma attacks just often as their peers at other schools.

The findings are not, however, the final word, according to Lynn B. Gerald, a professor of health promotion sciences at the University of Arizona in Tucson who led the study.

That's because the trial hit an obstacle when the H1N1 "swine" flu epidemic broke out right at the study's outset: All of the schools in the trial became a lot more vigilant about clean hands, Gerald said.

Schools that weren't part of the hand-hygiene program started putting hand sanitizer on the list of school supplies given to parents.

"Hand sanitizer became ubiquitous in schools," Gerald said.

So, she told Reuters Health, it's hard to draw conclusions about whether hand sanitizers, added to old-fashioned hand washing, might prevent some asthma attacks.

The sanitizers and soap used in the trial were provided to schools for free by Akron, Ohio-based GOJO, which makes the Purell brand hand sanitizers.

GOJO "believes there is great benefit in establishing the effectiveness of hand hygiene interventions under real-world conditions and supports scientific studies that take that approach," the company told Reuters Health.

"We agree with the conclusion that the results of this study were highly confounded by increased overall hand hygiene practices, even in the usual-care schools, as a result of the H1N1 pandemic," they said in an emailed statement.

The findings appear in the Journal of Allergy and Clinical Immunology.

Read full article here.

Asthma attack led to teen's death

The rule is asthma-related deaths are avoidable, which makes stories like this shocking.  Even mild asthma requires routine evaluation.  Dr. Susarla

Asthma attack led to teen's death

Family and friends remember JheVontae Davis

CHESAPEAKE, Va. (WAVY) - Family members of a Chesapeake teen who died after football practice say the teen complained of chest pain before he collapsed earlier this week.

According to family members, 14-year-old JheVontae Davis, who played JV football at Oscar Smith High School, complained of a cough and chest pain before he collapsed at practice. Davis was diagnosed with severe asthma when he was a baby. 

"Early on, it was more intense, and he had to frequent the hospital multiple times," said Jamal Vaughn, Davis' cousin. "But as he grew older, the asthma became more controllable, to the point where he was able to just have his inhaler."

Davis used a breathing machine to sleep at night, but the asthma never crippled his competitive nature or his love for sports, especially football.

At Friday's varsity football game, Oscar Smith's team took a knee and prayed over Davis' jersey. The announcer called for a moment of silence and, in the fence, students used cups to draw a heart around the number Davis wore when he played.

"The moment of silence and the player that wore his jersey, it was just like, man, it was a very touching moment for myself, because he touched so many hearts," said Vaughn, who was a father figure in Davis' life.

He remembers Davis' plans to go to college. He says the teen had so much living left to do.

"We had our whole life planned out and what we wanted to do," said Zyuanya Laguerre, Davis' younger cousin. "I never thought that was the last time I was going to say goodbye to my cousin." 

Read article 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

SEVERNA PARK, MD., SEPT. 4, 2012 — /PRNewswire/ -- Medical technology company iSonea Ltd. (ASX: ISN; OTCQX: ISOAD) today announced that its asthma management smartphone app,AsthmaSense™ v.1.0.1, is  available for free for iPhone, iPad and Android users through September 30.  According to the American Lung Association, more than seven million children suffer from asthma, making it one of the most chronic childhood disorders in the United States.  Asthma is a leading cause of school absenteeism, accounting for more than 14 million lost school days.

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 article here.

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

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.

Exercise-Induced Bronchospasm (Asthma) : What you need to know (Part 2)

Exercise Related Asthma - Don’t let untreated asthma impact your child or adolescent’s sports training this season.

Asthma affects 5 million children and adolescents in the United States.  It is estimated that about half of children with asthma will experience exercise-related symptoms.  Breathing difficulty with sports and exercise is one of the consequences of asthma that is poorly controlled, and it may be the first or only warning sign that there is a problem.  

The National Heart, Lung, and Blood Institute (NHLBI) has published guidelines for the management of exercise-induced asthma.  The same organization has also published guidelines for teachers and coaches which you can read here. But how do you know if your child has breathing difficulty in sports due to asthma?  Exercise problems can be attributed to other medical problems or simply deconditioning.  

The gold standard test is exercise challenge spirometry.   Usually, the child will be asked to perform a treadmill run with a lung function test known as spirometry before and after exercise. This is the only test that can replicate the conditions that can trigger an asthmatic reaction (bronchospasm) which can be measured in the office.  

We are proud to offer this service at our Memorial City location.  Ask your pediatrician today about testing if your child has problems with exercise.

Dr. Susarla