Virus Patterns Where Kids Live May Affect Asthma Risk

Not all asthma triggers are allergic.  A major one is respiratory viruses which begin to surge in fall and persist until spring.  Dr. Susarla

Virus Patterns Where Kids Live May Affect Asthma Risk

Certain respiratory infections more common in urban than suburban infants, study finds

WEDNESDAY, Sept. 26 (HealthDay News) -- Infants in urban areas have different patterns of viral respiratory illness than those in the suburbs, which may explain why inner-city children are more likely to develop asthma, a new study suggests.

The findings may lead to new ways to treat childhood asthma, according to Dr. James Gern of the University of Wisconsin, Madison, and colleagues.

Previous studies have linked viral respiratory illnesses to the development of asthma in children and have shown that children with human rhinovirus infections are more likely to develop asthma by age 6 than those with respiratory syncytial virus infections.

In this study, researchers analyzed nasal secretions from 500 infants living in inner-city areas of Boston, Baltimore, New York City and St. Louis, and 285 infants from suburban Madison, Wis. The samples were taken while the children were healthy, and also when they had respiratory illnesses.

Inner-city infants had lower rates of human rhinovirus and respiratory syncytial virus than suburban infants, but were more likely to test positive for adenovirus infections -- 4.8 percent of urban babies tested positive for adenovirus only versus 0.7 percent of suburban babies.

Adenovirus can cause persistent infections and the researchers suggested that adenovirus infections early in life could alter the development of the lungs or airways. The investigators plan to follow the inner-city kids for at least 10 years to determine whether adenovirus infections are associated with increased rates of asthma and lower levels of lung function.

Read article here.

The Facts About Asthma (in kids)

Parents, please check out my article in this month's issue of Houston Family Magazine in the "Talk to the Doc" section.  It features some fundamentals of childhood asthma I feel every parent should know. Dr S

The Facts About Asthma

by Sarat Susarla, MD

Board Certified in Pediatric Pulmonology, Sleep Medicine, and Pediatrics

Why worry if your child has a cough? Many self-limiting infections can trigger a cough, which will usually resolve within 7-10 days.

But when respiratory symptoms like cough are chronic or become associated with other problems like wheezing and shortness of breath, it’s time to consider asthma.

Asthma is a chronic lung condition associated with inflammation of the airways, making it hard to breathe. It often starts in childhood, although it affects people of all ages.

According to the American Academy of Pediatrics, between 80 and 90 percent of children develop symptoms by age 4 or 5.

And according to a 2010 National Health Interview Survey by the Centers for Disease Control, 7 million U.S. children (10%) aged 17 years and under have asthma.

Asthma seems to be on the rise, although the medical community isn’t sure if this is simply because we’re better at diagnosing the disease or whether it’s due to changes in our environment. Asthma is often confused with infections like bronchitis, which often present in a similar way.

Remarkably, rates of hospitalization and emergency room visits in children have not decreased in the past 10 years, despite the availability of highly effective preventative medication.

Asthma can be difficult to diagnose, especially in children. A combination of symptoms; family history (due to genetic factors); and lung function testing are helpful in reaching a diagnosis.

There is no cure for asthma, but it can be managed with medication.

Read more here

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.

http://www.foxnews.com/health/2012/05/02/asthma-rates-at-highest-level-ever-cdc-says/

What's in a Wheeze?

The search continues for the perfect home asthma test... the pediatric lung specialist is still the gold standard.  SS

iSonea begins recruiting for pediatric asthma trial

By: Brian Dolan | Mar 28, 2012   

iSonea, makers of the WheezoMeter, has begun recruiting for a post-market study of its asthma monitoring device for children under the age of 12 years old. The company aims to determine the device’s ability to accurately assess wheeze rate in a group of pediatric patients. The study is expected to include about 95 participants and will be based in Folsom, California,according to the clinical trial’s listing on clinicaltrials.gov.

iSonea’s core offering today is a medical device called the WheezoMeter, a point of care, handheld device that “analyzes 30 seconds of breath sounds using advanced signal processing algorithms to detect, quantify and objectively document the presence of wheeze and its extent,” according to iSonea’s website. The company is currently seeking an over-the-counter (OTC) status for the WheezoMeter from the FDA. Last month iSonea announced plans to leverage Qualcomm’s 2net platform for home health devices.

“Asthma impacts more than 7 million children in the United States, and the number of children expected to be diagnosed with this chronic condition continues to climb at alarming rates,” Dr. Jonathan Freudman, medical director for iSonea, stated in a company release. “This study is an important milestone for iSonea. In the pediatric asthma population, it is challenging to accurately monitor and manage asthma symptoms in patients using conventional techniques. The WheezoMeter has the potential to meet a critical unmet need for better, easy to use monitoring tools for young asthma patients.”

At the HIMSS event in February, iSonea demonstrated its device as part of the Qualcomm Life booth. While the company’s setup included an image of an iPhone app called Asthma Sense (pictured), the app is not yet available for download from Apple’s AppStore.

In the future, iSonea hopes to become hardware agnostic and create smartphone peripherals that work like its WheezoMeter today. Assuming the FDA grants the Wheezometer OTC status based on the bench validation study the company currently has underway, iSonea CEO Michael Thomas said the company plans to create smartphone-based versions of the medical device for iPhone, Android, and BlackBerry devices. Thomas told a journalist in Australia last year that since there were about half a billion smartphones sold the world over in the past year, and there are expected to be about 1 billion smartphones sold in 2015, the smartphone has become the most efficient way for iSonea to get its technology to the 300 million people worldwide who have asthma.

Read more below:

http://mobihealthnews.com/16797/isonea-begins-recruiting-for-pediatric-asthma-trial/

Early Detection of Asthma Flare-Ups Reduces Hospitalizations

Early detection leads to prompt treatment of symptoms... which reduces emergency room visits and hospitalizations.  A good line of communication with a pediatric asthma specialist is the key.  S Susarla

Reducing Hospital Admissions for Asthmatics

ScienceDaily (Apr. 4, 2012) — Children with moderate or severe asthma attacks who are treated with systemic corticosteroids during the first 75 minutes of triage in the Emergency Department (ED) were 16% less likely to be admitted to hospital. This highlights the importance of adopting a strategy to rapidly identify and begin treating children with moderate or severe asthma attacks directly after triage, according to a team of investigators working at the Sainte-Justine University Hospital Center (UHC), the University of Montreal, McGill University and the Research Institute of the McGill University Health Centre (RI MUHC).

"We knew that corticosteroids could help avoid hospital admissions and relapses. However, just how delays between ED admission and administration of the treatment impacted outcomes remained unclear," says Dr. Sanjit K. Bhogal, the lead author of a new study published in Annals of Emergency Medicine and graduate of the Department of Epidemiology, Biostatistics and Occupational Health at McGill.

"Our study demonstrates that, to be effective in preventing hospital admission, treatment with corticosteroids should be administered within 75 minutes of triage, regardless of patient age," says the senior author Dr. Francine Ducharme, who supervised the study while she was a McGill and RI MUHC researcher based at the Montreal Children's Hospital.

According to Dr. Ducharme, now pediatrician and researcher at Sainte-Justine UHC, "in fact, the earlier the treatment is given within this time frame, the more effective it is, hence the advantage of starting treatment right after triage. Furthermore, beginning early treatment reduces ED stay by almost 45 minutes for patients who will be discharged from the ED."

The challenge now is to ensure that the severity of the asthma attack is flagged at the triage stage in order to initiate treatment immediately. In fact, it seems that patients who are treated "too late" were due, for the most part, to not been given high triage priorities or to physicians not being able to assess them early enough. ED congestion did not significantly impact on the time frame for administering corticosteroids.

"Given the findings of the study, the need to implement a nursing strategy that involves identifying the severity of the child's condition and beginning treatment as soon as a patient arrives in the ED, seemed obvious," said Dr. Ducharme, who is also clinical epidemiologist at the Sainte-Justine UHC, where the study data were compiled and analyzed. Dr. Ducharme also holds the Academic Chair in Clinical Research and Knowledge Transfer in Childhood Asthma at the Sainte-Justine UHC Research Center and is a full professor in the Faculty of Medicine of the University of Montreal.

The pediatric respiratory assessment measure (PRAM) scale, developed by Dr. Ducharme's team, was used to identify the degree of severity of the asthma attack and to rapidly initiate the severity-specific treatment recommended by asthma guidelines. At the Sainte-Justine UHC, Dr. Ducharme' s team has now develop a teaching module that will allow training of the triage nurses, ED physicians, and respiratory therapists to implement severity-specific guidelines and, whenever possible, to avoid patients being admitted to hospital.

The educational module will be available online by the end of 2012 on the University of Montreal's website. It is eagerly awaited by health institutions in Ontario and Alberta, as well as in several institutions in the US, which have decided to adopt the proposed treatment protocol based on the PRAM scale and who wish to receive training. The tool is an offspring of the integration of research, education and health care. As such, it will make it possible to transfer the knowledge acquired through the study to the EDs around the world, for the direct benefit of patients and their families.

http://www.sciencedaily.com/releases/2012/04/120404101953.htm

Can Children Outgrow Asthma?

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

Patients can’t outgrow breathing illness

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

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

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

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

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

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

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

   “That’s a wheeze,” Parsons said.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


http://www.dispatch.com/content/stories/local/2012/03/25/health/Patients-cant-outgrow-breathing-illness.html

Snoring Linked to Childhood Behavioral Problems

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

Child behaviour link' to snoring

Continue reading the main story

Sleep apnoea and snoring made conditions such as hyperactivity more likely later on, researchers said.

The study, published in the US journal Pediatrics, looked at data on 11,000 children living in the UK.

Lead researcher Dr Karen Bonuck said the sleep problems could be harming the developing brain.

One estimate suggests one in 10 children regularly snores and 2% to 4% suffer from sleep apnoea, which means the breathing is obstructed and interrupted during sleep.

Often enlarged tonsils or adenoids are to blame for the conditions.

In adults, the result can be severe day-time tiredness, and some studies have hinted that behavioural problems such as attention-deficit hyperactivity disorder might be linked to the condition in children.

The latest study is sufficiently large to offer a clearer view of this.

Oxygen supply

Parents were asked to fill in a questionnaire in which both the level of snoring and apnoea were recorded in the first six or seven years of life, and contrasted with their own assessment of the child's behaviour.

Continue reading the main story

SocietyDr Bonuck, from the Albert Einstein College of Medicine at Yeshiva University in New York, said that children with breathing issues during sleep were between 40% and 100% more likely to develop "neurobehavioural problems" by the age of seven.She believes that the sleep breathing issues could cause behavioural problems in a number of ways - by reducing the supply of oxygen to the brain, interrupting the "restorative processes" of sleep or disrupting the balance of brain chemicals.

She said: "Until now, we really didn't have strong evidence that sleep-disordered breathing actually preceded problematic behaviour such as hyperactivity.

"But this study shows clearly that symptoms do precede behavioural problems and strongly suggests that they are causing these problems."

Marianne Davey, from the British Snoring and Sleep Apnoea Society, said that sleep problems in the young were an under-recognised reason for poor behaviour.

She said: "Often parents won't make the connection and mention them to the GP, so this label of ADHD is given to the child, and sometimes they are even given drugs.

"This is wrong, as if the sleep problem is addressed, the behaviour will improve almost immediately."

http://www.bbc.co.uk/news/health-17237576

High Air Pollution Days Can Increase the Risk of Asthma-related Hospitalization

In a recent study published in the Journal of Allergy and Clinical Immunology, researchers in Canada studied the effect on aeroallergens and the likelihood of hospitalization due to asthma.  As expected, aeroallergen exposure increased the risk of hospitalization.  However, that risk was amplified significantly on high air pollution days.

Does air pollution increase the effect of aeroallergens on hospitalization for asthma?

Background

Clinical experiments demonstrate that the asthmatic response to an aeroallergen can be enhanced by prior exposure to an air pollutant.

Objective

We sought to compare the effects of ambient aeroallergens on hospitalization for asthma between high and low air pollution days in 11 large Canadian cities.

Methods

Daily time-series analysis was used, and results were adjusted for day of the week, temperature, barometric pressure, and relative humidity.

Results

The relative risk of admission for an interquartile increase in tree pollen levels was 1.124 (95% CI, 1.101-1.147) on days of lower values of fine particulate matter with a median aerodynamic diameter less than or equal to 2.5 μm (PM_2.5) compared with 1.179 (95% CI, 1.149-1.21) on days of higher PM_2.5 values. Significant (P ≤ .05) differences in the relative risks of admission between lower versus higher values of particulate matter with a median aerodynamic diameter less than or equal to 10 μm in diameter were 1.149 (95% CI, 1.118-1.181) versus 1.210 (95% CI, 1.161-1.261) for ascomycetes, 1.112 (95% CI, 1.085-1.14) versus 1.302 (95% CI, 1.242-1.364) for basidiomycetes, 1.159 (95% CI, 1.125-1.195) versus 1.149 (95% CI, 1.129-1.169) for deuteromycetes, and 1.061 (95% CI, 1.016-1.107) versus 1.117 (95% CI, 1.092-1.143) for weeds.

Conclusion

We identified an association between aeroallergens and hospitalizations for asthma, which was enhanced on days of higher air pollution. Minimizing exposure to air pollution might reduce allergic exacerbations of asthma.

• http://dx.doi.org.ezproxyhost.library.tmc.edu/10.1016/j.jaci.2011.09.025, How to Cite or Link Using DOI