Emergency room use for asthma highly prevalent in children

Although poor asthma control is multifactorial, there is no doubt that timely access to outpatient specialty asthma care can prevent exacerbations that result in frequent emergency room visits.  Dr. Susarla

Children in California increasingly are flocking to emergency rooms for treatment of asthma, despite millions of dollars spent on programs to control the disease.

Statewide, the rates of ER visits for asthma symptoms rose by about 18 percent for California children ages 5 to 17 and by 6 percent for children under 5 between 2005 and 2012, according to a Kaiser Health News analysis of the latest available rates by county.

In Los Angeles County, ER visit rates rose by 17 percent for children 5 and older and by 8 percent for children under 5. 

In some parts of the state, especially the Central Valley, the increases were far higher. The rate of emergency room visits for children 5 and older more than doubled in rural Madera County and nearly doubled in Merced. 

All told, more than 72,000 California children under 18 visited the ER for asthma in 2012, nearly 21,000 of them from Los Angeles County.

“There’s clearly more work to be done if this many kids are going to the emergency department,” said Anne Kelsey Lamb, director of the Regional Asthma Management and Prevention program of the Oakland-based Public Health Institute. “We know a lot about what works. We absolutely should be able to reduce the rates we’re seeing.”

At the national level, asthma-related emergency room visit rates have declined in recent years, according to federal health data through 2010, the latest available.

Although ER visits declined in some counties, including Alameda, San Mateo and Marin, the overall rise in California has frustrated public health experts who have spent millions of dollars and countless hours to improve and expand asthma prevention programs around the state. The state and federal governments alone spend $1.54 million annually on such projects in California, including grants to schools to improve indoor air quality and training community health workers.

The reasons for the increase in ER visits are complex, experts say. They include parents not properly administering medications, poverty and inadequate insurance coverage, persistently high levels of indoor and outdoor pollution in some regions and the limited reach of programs that seek to manage symptoms or prevent them.

Read article here.

Preterm Birth May Raise Child's Asthma Risk, Study Suggests

Premie infants seem to have a higher risk for early childhood wheezing, which often follows a pattern consistent with asthma. Dr. Susarla

THURSDAY, March 13, 2014 (HealthDay News) -- A new study may add asthma to the list of downsides of being born too early.

Children who were born prematurely appear to be at higher risk for asthma and wheezing disorders, according to a new review.

Researchers led by Dr. Aziz Sheikh, of Brigham and Women's Hospital in Boston, looked at 30 studies focused on links between preterm birth -- defined as less than 37 weeks' gestation -- and asthma or wheezing disorders among more than 1.5 million children.

Their analysis found that preterm babies were 70 percent more likely than full-term infants to develop asthma or wheezing disorders later in childhood. Overall, close to 14 percent of "preemie" babies went on to develop asthma during childhood, compared to 8.3 percent of babies born at term.

The risk was even higher for very preterm babies, defined as children born at less than 32 weeks' gestation. These infants were about three times more likely than full-term babies to develop asthma or wheezing disorders later on.

"Worldwide, more than 11 percent of babies are born preterm," Sheikh said in a hospital news release.

"As asthma is a chronic condition, our findings underscore the need to improve our understanding of the mechanisms underlying the association between preterm birth and asthma or wheezing disorders in order to develop preventive and therapeutic interventions," he said.

Although the study found an association between premature birth and later asthma, it could not prove cause and effect. The findings were published in a recent issue of the journal PLoS Medicine.

Read article here.

Education is the Key to Better Asthma Management

It takes time to educate patients and parents about managing asthma.  The right asthma specialist can condense volumes of evidenced based literature and practice guidelines into  more easily understandable pearls that can be practical in our busy lives.  Dr. Susarla

What Are Some Strategies to Enhance Asthma Education in My Practice?

Primary-care offices are typically very busy places. As a result, the educational needs of parents and children with asthma often go unmet.¹Lack of time is a common reason reported for not providing asthma education in the primary-care setting.² However, providing asthma care consistent with the National Asthma Education and Prevention ProgramExpert Panel Report 3 (NAEPP EPR-3) Guidelines for the Diagnosis and Management of Asthma, which includes self-management education, does not have to be time consuming. One study evaluated the effects on patients 2 years after pediatricians were taught by their peers to enhance their skills in asthma therapies and counseling. This study found that pediatricians who participated in the training benefited in important ways. Trained physicians received higher patient-rated performance scores regarding communication behaviors important to promoting patient’s satisfaction and ability to manage asthma on their own, and in addition, their patients were also less likely to incur disruption of sleep caused by asthma symptoms. Another important finding of this study was that these positive results were achieved even though there was no difference in the time that peer-trained physicians spent with their asthma patients when first diagnosing a patient, seeing a new patient, or seeing a return patient. In fact, the peer-trained physicians spent less time with patients during urgent visits.³ Such a method for enhancing education in your practice requires changing physician behavior.

System-level changes have also been evaluated. In one such study, researchers evaluated the effectiveness of 2 asthma-care improvement strategies in the primary-care setting. One was less time consuming and less expensive and consisted of peer leader education. The other was more intensive and more expensive and consisted of allocating a nurse to conduct planned asthma-care visits. This group also received peer education. Findings revealed that, although both strategies decreased asthma symptom days, the peer leader group did not reach statistical significance.⁴ Therefore, when attempting to enhance educational practices in your office, it may be more effective to institute changes that target systems-oriented improvements, for example, developing a system that ensures all patients with asthma receive a written asthma action plan as per NAEPP EPR-3 Guidelines. One way to accomplish this is to automate the process by using an electronic medical record system. Such an approach makes it easy for the provider, legible for the patient and family, and a permanent part of the medical record. If instituting an electronic medical record is not feasible in your practice, having asthma action plans that are preprinted with medication names allowing you to check off or circle the treatment prescribed or having asthma action plans with a preprinted short-acting beta-agonist so that you only need to write the long-term control medications are 2 time-saving options. Creative shortcuts can also be useful. For example, color-coded labels for long-term control and quick-relief medications can be preprinted and then added to the action plan at the end of the visit. An example of such a plan can be found in Figure 39-1. All action plans described allow for individualization in an efficient manner.

Figure 39-1.Sample written asthma action plan with preprinted labels. 

Having written asthma action plans is only one step in the process for enhancing education in your office; using them is an even more important step. To encourage use of the action plans in your office, it is important to keep them readily available. Some suggestions include keeping the asthma action plans in each exam room so that they are easily accessible during each patient visit or having them clipped to the front of each asthma patient’s chart before the visit begins.

Another method for enhancing education in your practice is to make resources available to your patients and to view each opportunity as a teachable moment. For example, providing patients and families with internet opportunities (such as the Quest for the Code asthma game found at www.asthma.starlight.org) for self-education while they are sitting in the waiting room or providing them with a list of resources (Table 39-1) that they can access at their convenience allows them to learn at their own pace. However, it is extremely vital to recognize that merely providing patients and families educational materials without providing explanation is not true education. All educational materials and resources provided to patients must be reviewed and reinforced by all members of your health care team. One way to accomplish this is to develop asthma-specific visit forms that include a list of key educational messages. This list can be used to prompt providers to introduce or review a message or messages at each visit. Thus, providing consistent and repeated educational messages by all members of your health care team is another step to enhancing education in your practice.

 

An alternative or supplementary method for providing self-management education and addressing key educational messages is to offer asthma education classes and resources in your office. Asthma education classes allow you to personally review important self-management concepts in a group setting, thus promoting efficiency as well as education. Numerous examples and forms (print, audio-video, online) of asthma educational resources are available that can also be tailored to meet the needs of an individual practice.

Two final recommendations for enhancing education in your practice include hiring a nationally certified asthma educator to provide education during patient visits as well as via telephone in between visits, and developing a system for referring patients who need additional education to asthma specialists. Both of these strategies are supported by the NAEPP EPR-3 Guidelines. The Guidelines recommend using health professionals and others trained in asthma self-management education to implement and teach asthma self-management. They also recommend referring patients who need additional education to improve adherence to asthma specialists.⁵National certification for asthma educators has been available since 2002; thus, it is relatively new, and the effectiveness of education provided by certified asthma educators has not been reported. However, numerous randomized controlled studies have reported improved asthma outcomes when patients and families were educated by someone specially trained in asthma care and self-management.⁶

Summary

There are many options for enhancing education in your practice; some are more labor-intensive and costly than others. Developing a system that fits within the confines of your practice makes quality asthma education accessible to all of your patients with asthma and their families, and using all members of your health care team is the best approach to enhancing asthma education in your practice.

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Some Asthma Patients May Be Overmedicated, Doctors Say

How is your child's asthma managed?  National asthma guidelines stress the importance of  scheduled reassessment of asthma control, which under the proper direction can reduce excessive use of asthma medication.  Consult a pediatric pulmonologist for asthma check-ups for best guidance coupled with state of the art lung function testing to help achieve the right balance.  Dr. Susarla 

Some Asthma Patients May Be Overmedicated, Doctors Say

People with mild asthma are advised to lower their medication dose once their asthma has been brought under control, but the best way to reduce the dose is not fully known, doctors say.

As a result, patients may be staying on higher doses than what's necessary to keep their condition under control.

"We need to find a way to help patients control their asthma, without overmedicating them," said Dr. John Mastronarde, director of the Asthma Center at Ohio State University's Wexner Medical Center.

"Right now, the recommendation is to reduce a patient's therapy once the asthma is controlled for at least three months," Mastronarde said.
To control asthma, patients typically take drugs called inhaled corticosteroids, to reduce inflammation in the lungs, and long-acting beta agonists (LABAs), to open the airways. Doctors adjust the medication dose based on the patient's symptoms and lung function.
Once a patient's asthma is controlled, the drug dose should be lowered carefully, to the minimum dose necessary, according to the National Institutes of Health's guidelines for treating asthma.
"But that's where things just don't happen," Mastronarde said. "Once you get the symptoms under control, sometimes both the patient and the doctor just leave the patient on whatever they are on, because they don't want it to get worse again."
Although low doses of inhaled corticosteroids are safe, it is thought that taking high doses of the drugs for a long time may weaken the bones, especially in post-menopausal women, or possibly increase the risk of eye cataracts. Higher doses also cost more, Mastronarde noted.
Long-acting beta agonists may have some effects on a person'sheartbeat and blood pressure. The U.S. Food and Drug Administration recommends these drugs be used for the shortest time needed to control asthma symptoms, and that they be discontinued if possible.
Although lowering the doses of these medications is recommended, no one knows the best way to do that, Mastronarde said.
To help establish guidelines, Mastronarde and his colleagues are launching a yearlong study to examine 450 people with moderate asthma, who will receive inhaled corticosteroids and beta agonists for eight weeks. For the participants whose asthma is well controlled, the researchers will then see which method would work better: reducing the doses of their medication, or eliminating the beta agonists.
But in the meantime, patients whose asthma is controlled for three months can talk to their doctor about whether they can decrease their medication dose, Mastronarde said.

Read article here.

New Biomarkers for Asthma on the Horizon

A biomarker is any measurable substance used to measure the state or presence of a disease.  A typical source for such a test might be a patient's blood or urine.  For asthma, markers of disease are being measured in exhaled breath condensate, which is the air you breathe out into a specialized collection device.  One known biomarker in asthma is exhaled nitric oxide, which can easily be measured in the doctor's office.  Other markers are being researched for use in the future. Dr. Susarla

Asymmetric Dimethylarginine in Exhaled Breath Condensate and Serum of Children With Asthma

Background:  Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor and uncoupler of nitric oxide synthase. By promoting the formation of peroxynitrite, ADMA is believed to contribute to several aspects of asthma pathogenesis (ie, airway inflammation, oxidative stress, bronchial hyperresponsiveness, and collagen deposition). The aim of the present study was to compare this mediator in healthy children and children with asthma using the completely noninvasive exhaled breath condensate (EBC) technique.

Methods:  We recruited 77 children with asthma (5-16 years of age) and 65 healthy children (5-15 years of age) who underwent EBC collection and spirometry. Serum ADMA levels and fractional exhaled nitric oxide levels were measured on the same day in a subgroup of children with asthma. EBC was collected using the Turbo-Deccs (Medivac). ADMA levels were measured using the ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) technique.

Results:  ADMA could be detected in the EBC of 71 subjects with asthma and 64 healthy subjects. ADMA levels in the EBC of children with asthma were significantly higher than in the healthy control subjects (median, 0.12 [interquartile range, 0.05-0.3] vs 0.07 [0.05-0.12]; P = .017), whereas no difference emerged between the children with asthma who were or were not receiving inhaled steroid treatment. No correlation was found between serum and EBC ADMA levels (P > .5).

Conclusions:  We measured ADMA in EBC by UPLC-MS/MS, a reference analytical technique. Higher ADMA levels were found in children with asthma, supporting a role for this mediator in asthma pathogenesis. This oxidative stress-related mediator also seems to be scarcely affected by steroid therapy. We speculate that ADMA might be a target for new therapeutic strategies designed to control oxidative stress in asthma.

Read abstract here.

Dealing with a new asthma diagnosis

A move to the gulf coast followed by new respiratory symptoms is a common theme in my practice.  Getting proactive by consulting a pediatric pulmonologist can make coping with a new asthma diagnosis a lot easier.  Dr. Susarla

Asthma arrives with move to Florida

My son did not win a perfect attendance award at school last year.

Instead, he set a personal record for the most days spent at the pediatrician's office.

Since moving from Colorado to Florida six months ago, my 7-year-old son, Ryan, developed asthma. He did not have allergies or any respiratory problems before we moved, but once we got to Florida, everything changed.

I noticed that he was constantly sneezing and sniffling, and his eyes were red and itchy, especially after being outside. These symptoms were manageable with the help of an over-the-counter antihistamine, but it was the cough that was troublesome.

Every few weeks, Ryan would start coughing and it would get so bad that and we'd end up at the pediatrician's office. At first, the doctor prescribed an oral steroid to alleviate the symptoms. This worked, but eventually the cough came back. After several more trips to the pediatrician's office due to severe coughing and wheezing, she determined that Ryan had asthma, or a reactive airway.

Ryan's body was reacting to something it perceived as harmful, and the airways of his lungs became inflamed and constricted. Since Ryan grew up in Colorado, he had never been exposed to certain allergy triggers that are common in Florida.

Working with Ryan's doctor, we came up with an asthma plan. He now has two prescribed inhalers to help control his asthma. He uses one inhaler on a daily basis to prevent asthma symptoms, and another he uses before playing sports to help his breathing. The doctor also had Ryan allergy tested so we could discover what his allergic triggers were. It turns out that he is highly allergic to mold, oak, and certain grasses, all things which are not common in Colorado.

In doing research, I found one website that was particularly helpful and has a lot of great information, asthma.com. It has a "For Parents" tab that discusses triggers and how to minimize exposure, and even a guideline for when your child should stay home from school due to symptoms.

Since Ryan is 7, he's old enough to understand and learn about his condition, so I found two websites that have informative and interactive games for him to play. Ryan likes watching Arthur, and pbskids.org has the Buster Baxter, Lung Defender game. There is also lungtropolis.com, which has a game for kids and a separate, informative section for parents.

Finding out that your child has asthma can be scary, but working with your doctor and arming yourself with information can help ease that anxiety. My goal is that Ryan won't have to miss any school because of his asthma, and he can win a perfect attendance award this year.

Read article here.

No Blood Test Yet for Asthma

Asthma is a syndrome diagnosed on the basis of history, physician findings, and some amount of office based testing.  As of yet, there is no blood test that can accurately predict asthma. Fortunately, "non-invasive" testing is available to assist in making the diagnosis. Dr. Susarla

Severe childhood asthma blood test hopes dashed

Blood eosinophil counts do not reliably reflect airway eosinophil concentrations in children with severe, therapy-resistant asthma, and therefore cannot be used to make therapeutic decisions, researchers report.

The findings are a disappointing set back in the development of a blood test to substitute more invasive techniques to measure airway inflammation, which has previously shown promise for adults with severe asthma.

"Our data suggest that if blood eosinophilia is present, it is highly probable that airway eosinophilia ([bronchoalveolar lavage] and biopsy) is also present, but if the blood eosinophil count is normal, it is not possible to predict whether airway eosinophilia is present," say Sejal Saglani (Imperial College London, UK) and colleagues.

The study, reported in Allergy, included 88 children aged 6-17 years with severe, therapy-resistant asthma. Patients underwent blood tests, exhaled nitric oxide measurement, sputum induction, bronchoalveolar lavage, and endobronchial biopsy.

Of 86% of children with normal blood eosinophil counts, 84% had evidence of airway eosinophilia detected either by bronchoalveolar lavage or endobronchial biopsy.

Conversely, all 12 children with elevated blood eosinophil levels had eosinophilia on brochoalveolar lavage, and nine had biopsy eosinophilia.

The authors showed that blood eosinophil levels of more than 0.2 x 10⁹/L predicted eosinophilia on bronchoalveolar lavage or endobronchial biopsy with negative predictive values of only 65% and 33%, respectively.

Saglani and colleagues explain that the management of severe, therapy-resistant asthma is optimal when guided by inflammatory phenotype in adults. While there is currently no comparable evidence to support this premise in children, the authors say that treating children on the basis of airway inflammation could avoid unnecessary treatment with increasingly potent anti-inflammatory medications.

However, their current results suggest that invasive methods will continue to be needed to determine pediatric inflammatory phenotypes.

"As peripheral blood counts are not reliable in characterizing airway inflammation in severe asthmatic children exposed to high dose inhaled and maintenance oral steroid therapy, bronchoscopy with [bronchoalveolar lavage] should be considered," they conclude.

Read article here.

Asthma Patients Often Depressed

Adjustment to a chronic disease can be difficult.    This study suggests that patients with asthma should be closely monitored for depressive symptoms.  Every effort should be made to reduce the impact of asthma on daily life.

Asthma Patients Often Depressed

ANAHEIM, Calif. -- Depression and asthma appear to go hand in hand, even in patients whose asthma is relatively mild and who report generally good health, a researcher said here.

Analysis of some 13,000 participants in the Cooper Institute Longitudinal Study indicated that a diagnosis of asthma was a risk factor for reports of significant current depressive symptoms with an odds ratio of 1.41 (95% CI 1.16 to 1.65, P<0.001) after adjusting for asthma severity and self-assessment of overall health status.

Asthma and a previous history of depression also were significantly associated, with an odds ratio of 1.65 (95% CI 1.40 to 1.90,P<0.001), Tim Trojan, MD, of the University of Texas Southwestern Medical Center in Dallas, told attendees at the American College of Allergy, Asthma, and Immunology annual meeting.

Associations between asthma and depression have been reported before, Trojan explained, but those studies could not rule out the possibility that patients were simply sad about feeling sick with asthma.

Consequently, he and his colleagues utilized records from the Cooper Institute Longitudinal Study, begun in 1970 by the institute's founder, Kenneth Cooper, MD, the aerobics advocate. The database has unusually detailed information on patients including spirometry values, scores on the Center for Epidemiologic Studies Depression Scale (CES-D), medical history, body mass index, and lifestyle factors such as smoking and drinking status, as well as standard demographics.

Trojan and colleagues analyzed data on 12,944 study participants, including 1,169 with a diagnosis of asthma. Of these, only 187 were on controller medications, suggesting that the sample mostly included people with relatively mild asthma.

About 81% of the overall sample indicated that their health status was good or excellent, as opposed to fair or poor. Current depressive symptoms (CES-D scores of 10 or higher) were present in 11% and a past history of depression in 14%.

Bivariate analyses indicated that the risk of depressive symptoms was significantly increased, not only by a diagnosis of asthma, but also by female gender, hypertension, and current smoking. It was significantly decreased in nonwhites, those with more than a high school education, age older than 50, and current drinking.

Multivariate analysis produced the odds ratio 0f 1.40 for depressive symptoms with an asthma diagnosis. When expressed as an r² correlation coefficient, the value of 0.119 suggested that the relationship was only modest at best, Trojan said.

But a classification analysis based on the association correctly categorized 89.5% of study participants, he said.

The same held true for the association between asthma and depression history. The r² correlation coefficient was 0.110, but the classification analysis categorized 85.7% of participants correctly, Trojan said.

He noted that the study had a number of limitations including the fact that some of the data such as depression history and smoking and drinking status were self-reported, and the Cooper Institute database consists of people who are "mostly white and mostly healthy." Trojan added that they are probably relatively affluent as well, although income data are not collected.

Nevertheless, he said, the study findings "mean that your mild asthmatic ... who doesn't look or feel all that bad still has a significant risk, or could have a significant risk, of having depressive symptoms and should be evaluated for this."

Read article here.

Yes this does seem... fishy.  There could be other reasons to explain this association.  We will have to wait and see.  Dr Susarla.

Does Eating Fish During Infancy Cut Asthma Risk?

FRIDAY, Nov. 16 (HealthDay News) -- Adding fish to babies' diets during the first year of life might reduce their risk of asthma later on, a study by Dutch researchers suggests.

This window of protection appears to occur between 6 months and 12 months of age. Adding fish to the diet before that or not at all in the first year seems to carry an increased risk of wheezing and shortness of breath, the researchers said.

"This study provides insight into what the optimal timing of introduction can be for fish," said lead study author Jessica Kiefte-de Jong, from the pediatrics and epidemiology departments at Erasmus Medical Center in Rotterdam.

[See: Top Recommended Infant Formulas]

"The results may assist health care workers about the recommendations regarding the introduction of complementary feeding in infants," she added.

Pediatricians may not agree with the findings, however. One expert objects to feeding children fish at such a young age because of potential harms.

"I have never heard that fish is a preventive against asthma," said Dr. Antonio Rodriguez, director of pediatric pulmonology at Miami Children's Hospital.

"There is a danger of an allergic reaction feeding fish to children under 1 year of age," he said. "In addition, there is always concern about the toxicity of mercury in fish."

This is why fish is not fed to infants, he said.

Kiefte-de Jong agreed that before parents start introducing fish to their infants these findings need confirmation in a real clinical trial. She also said the researchers aren't quite sure why eating fish at this age might benefit children's lung health.

[See: Top Recommended Children's Multivitamins]

For the study, published online Nov. 12 in the journal Pediatrics, the research team collected data from a population-based study of more than 7,200 children born between April 2002 and January 2006 in Rotterdam.

Reviewing questionnaires on overall diet, the researchers looked at when parents introduced fish to their infants' diets. They also looked at symptoms of asthma that developed at ages 3 and 4 years.

Children who started eating fish at 6 to 12 months had a significantly lower risk of wheezing when they were 4 years old compared with children who began eating fish later, Kiefte-de Jong's group found.

For children who started eating fish earlier -- or not at all -- within the first year, the risk for wheezing increased at 4 years, they noted. The risk of shortness of breath increased slightly as well.

The researchers acknowledged that other factors besides when the children started eating fish might have influenced the children's breathing ability at preschool age. And the study did not prove that the introduction of fish during the first year of life prevented asthma later on.

Read article here.

Hot Sticky Summer Days Can Pose Risks for Children With Asthma

In Houston, we experience a high number of ozone days during the summer.  For some children and adolescents, prolonged outdoor exposure can trigger asthma attacks.  Watch for "ozone alert" days.  Dr. Susarla

Avoiding asthma dangers on hot, humid days

It’s been hot all week -- okay, make that all summer -- in Boston, with air quality alertsissued as the temperature and humidity level climb. Poor air quality can pose particular dangers for those who have asthma and other lung diseases.

Hot humid air traps ozone and particulate matter, which can irritate the lining of lung airways, triggering wheezing and breathing difficulties in asthma patients, according to Dr. Elliot Israel, director of the respiratory therapy department at Brigham and Women’s Hospital.

“For some patients, irritation builds over time and they experience problems after several poor air quality days, but for others it takes just one blast,” Israel said.

Asthma sufferers shouldn’t run around outdoors on humid days that hit 90 degrees or above, Israel recommended. “Don’t do a 40-minute run if that’s what you usually do. Stick with a 10-minute run in the morning and a 10-minute run in the evening.”

In fact, he offers that same advice for anyone during hot sticky weather. Humidity increases the possibility of heat-related illnesses because our body’s cooling mechanisms don’t work as well on humid days. Instead of our sweat evaporating, as it would in dry heat, it clings to our skin, trapping heat.

But it’s tough to tell a 9-year-old with asthma that he can’t play capture the flag or soccer at an outdoor summer camp for days on end.

On “yellow” air-quality days like today -- which means the air quality is acceptable for most but may pose some problems for those with lung conditions -- kids with asthma can probably continue their normal actitivities but should keep their inhaler on hand just in case they need to use it more. But if it’s a hazardous air quality day -- an orange or red on the air quality index -- they should head for sitting activities in the shade and stick to indoor exercise in an air conditioned facility, Israel recommended.

An estimated 4,500 Americans die every year from asthma attacks, including former Globe reporter Anthony Shadid.

“Commonsense is what’s needed on those bad air days,” he said, “and an ounce of prevention is worth a pound of cure.” Those who experience an aggravation of their lung condition due to the heat -- uncontrolled wheezing, shortness of breath, or an inability to speak in complete sentences -- should seek immediate medical attention.

Read more here

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."

Read more here

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.

Read more here

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.

• Use inhaled corticosteroids to control asthma if you have persistent asthma. Your doctor will help you choose the best treatment.
• Use a written asthma action plan to highlight two things: 1) what to do daily to control your asthma, and 2) how to handle symptoms or asthma attacks.
• Assess asthma severity at the initial visit to determine what treatment to start to get your asthma under control.
• Assess and monitor how well controlled your asthma isat follow up visits. Your doctor may need to increase, or decrease your medicine to keep asthma under control.
• Schedule follow-up visits at periodic intervals, and at least every six months.
• Control environmental exposures such as  allergens or irritants that worsen your asthma.

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:

http://www.nhlbi.nih.gov/health/prof/lung/asthma/naci/news/world-asthma-day.htm