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 or Pneumonia?

Perhaps an association between both, according to a recent study investigating the role of a bacteria commonly associated with "walking pneumonia" in children. Dr. Susarla

M. pneumoniae IgM higher in children with asthma

Mycoplasma pneumoniae may play a key role in pediatric asthma, according to study data published online.

 Tamar A. Smith-Norowitz, PhD, of the department of pediatrics and the Center for Allergy and Asthma Research at SUNY Downstate Medical Center, Brooklyn, N.Y., and colleagues published data on specific anti-M. pneumoniae immunoglobulin M, IgG and IgE antibody responses in 23 patients with asthma and 13 control patients.

All patients were aged younger than 20 years, had a physician’s diagnosis of asthma or current clinically defined persistent asthma symptoms, or both, along with allergic rhinoconjunctivitis with elevated serum IgE levels (>100 IU/mL). Patients were recruited from the Pediatric Asthma Clinic at Kings County Hospital Center, and outpatient pediatric offices in Brooklyn.

The researchers said, “Asthmatic subjects had higher levels of specific IgM [anti-M. pneumoniae antibodies] levels compared with non-asthmatics. In addition, IgM positivity was significantly higher in asthmatic compared with non-asthmatic subjects.”

M. pneumoniae may be more common or persistent in children with asthma than other populations, they said. However, further data are needed because the sample size of this study was small.

“Atypical respiratory infection such as M. pneumoniae continues to be a significant concern in children with asthma. More research is needed to identify high risk groups and develop intervention strategies directed at children with asthma,” Smith-Norowitz told Infectious Diseases in Children.

Although the researchers assessed respiratory tract infection incidence, they said it was only assessed by patient recall, which could have limited the results.

Read article here.

Junk food linked to asthma and eczema in children

Asthma is a complex chronic medical condition with many genetic and environmental contributors.  Although food exposure does not suggest cause, research like this is certainly relevant and deserves attention.  Dr. Susarla

The high saturated fat levels in food such as burgers lower children's immune systems, it is believed.

A research project involving more than 50 countries found that teenagers who ate junk food three times a week or more were 39 per cent more likely to get severe asthma. Younger children were 27 per cent more at risk.

Both were also more prone to the eye condition rhinoconjunctivitis, according to The Sun newspaper

But just three weekly portions of fruit and vegetables could cut that risk by 14 per cent in the younger group and 11 per cent among the teens, it is believed.

Researchers from New Zealand's Auckland University looked at the diets of 181,000 youngsters aged six to seven and 319,000 aged 13-14.

The scientists then asked if the children had allergy symptoms.

They wrote in the journal Thorax, where the study is published: "Fast food may be contributing to increasing asthma, rhinoconjunctivitis and eczema.

"Regular consumption of fruit and vegetables is likely to protect against these diseases."

In the UK alone 1.1 million children already suffer with asthma and one in five get eczema.

The team of researchers warn that their results do not prove cause and effect.

Read article here.

Smokers' Kids Don't Get a Break in Cars

The conventional wisdom is probably not enough.  A home smoke-free policy is important, but it is not enough if cigarette smoke exposure occurs in other places, like the car.  Children with asthma and recurrent respiratory infections are especially susceptible.  Dr. Susarla

Smokers' Kids Don't Get a Break in Cars

Most parents who smoke don't make strong efforts to protect their kids from it in the car, a trial-based survey showed.

Less than a third reported having a policy of keeping the car smoke-free, said Jonathan Winickoff, MD, MPH, of Massachusetts General Hospital for Children in Boston, and colleagues.

Nearly half of those who had no such policy said they smoked with their child in the car, the group reported in the December issue ofPediatrics.

While there is "no safe level of exposure" to tobacco smoke, secondhand smoke inside a vehicle is especially problematic.

"Studies have shown that smoking one cigarette in a confined space such as inside a car creates unsafe levels of respiratory suspended particles," Winickoff's group pointed out.

Rolling the window down doesn't help much. One experiment showed that air quality was still as bad as in a smoky bar, and that residual toxins remain on surfaces in the car even when a cigarette isn't actively lit.

Aside from raising their risk of cancer, exposure contributes to children's risk of lower respiratory infections, sudden infant death syndrome, and ear infections as well as worsening asthma.

The researchers examined exit interviews with smokers who served as controls as part of the larger Clinical Effort Against Secondhand Smoke Exposure, a pediatric office-based intervention trial.

Among the 795 parents with a car who were interviewed, 73% said they or someone else had smoked in the car in the prior 3 months. The researchers reported that of the 562 parents who did not have a smoke-free car policy, 48% smoked in the car when their children were present.

Fewer than one in three parents (29%) reported having a smoke-free car policy. Only 24% reported having a strictly enforced (no tobacco in the prior 3 months) smoke-free car policy.

By comparison, 57% of the parents reported having a strictly enforced policy of no smoking in the home.

Smoke-free cars tended to go along with smoke-free homes, as 82% of smokers with a strictly-enforced car policy stuck to such a strategy at home too.

However, the association didn't go the other direction. Most parents (66%) who kept their kids from being exposed in the home didn't do so for the car, "suggesting that parents may not recognize tobacco smoke exposure in cars as an important exposure source for their children."

Conversations with pediatricians on the topic appeared to be uncommon.

Although about one in five parents reported having been asked about their smoking status, just 14% had been asked about whether smoking was allowed in their vehicle, and 12% were advised to have a policy of no smoking in the car.

After adjustment for other factors, smokers with an infant under 1 year of age were 64% more likely to have a strict no smoking in the car policy.

Lighter smokers (≤10 cigarettes per day) were substantially more likely to forgo smoking in the car, with an adjusted odds ratio of 3.59. However, having more than one smoker in the home lowered the chances of a strictly enforced smoke-free car policy by 44%, with an aOR of 0.56.

"Childhood tobacco smoke exposure in confined spaces should be considered an intervention priority in the pediatric setting because children's exposure to tobacco smoke is involuntary, and no one other than the child's healthcare provider may have the opportunity to advocate for smoke-free cars," the researchers concluded.

They cautioned that the study results were based on self-reporting that may have been subject to recall and response bias and without implying causality.

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.

Can Vitamin D Help Asthma?

This research study is one to follow, since it still is not clear if supplementing with vitamin D can help children with poorly controlled asthma if levels are low.  Dr Susarla

New Study Aims To Determine Relation Between Vitamins & Asthma

Previous studies show that lung function is worse in asthmatic children with a vitamin D deficiency, even when treated with inhaled steroids.

But the way these studies have been designed, only a link can be established — not cause and effect.

That’s why doctors at Allegheny General Hospital are taking part in a multi-center, randomized, placebo-controlled clinical trial in adults.

“This is actually your true best test to find a cause and effect relationship,” Dr, Deborah Gentile, an allergist at AGH, said.

Obesity, living in the city, and being African-American are common risk factors for both vitamin D deficiency and asthma.

So is it the vitamin D or some other factor that makes asthma harder to control? That’s what this clinical trial is designed to figure out.

Right now, they’re still screening for 12 participants to be randomly assigned to take 5,000 units of vitamin D daily or placebo.

To participate you must be 18 or older and have asthma and take controller medications, such as an inhaled steroid and still have symptoms several times a week.

You will not be eligible if you’ve smoked within the last year or if you already take high-dose vitamin D.

Aimee Fogarty is being screened today.

“My main things in the fall are ragweed, and dust mites are a killer for me. In the spring, it’s more grass,” she said.

Her inhaled steroids aren’t cutting it.

“They normally do, but right now, I’m having a little bit of a difficult time, and had to double the dose,” Fogarty said. “The taking of the steroids, I just don’t like it. It’s bothering me that I have to take a steroid to breathe better.”

People eligible for the study get a blood test for a vitamin D level, and breathing tests. Then, they are randomly assigned to a treatment group.

“Some will get placebo. Some will get vitamin D,” Dr. Gentile said.

For six months, lung function and symptoms will be closely watched.

“On the one hand, we may find it works, and it very inexpensively improves the outcomes in our patients. On the other hand, if it’s negative and we find out it doesn’t help, we know that it doesn’t help,” Dr. Gentile said.

“My whole family has it,” Fogarty said. “And if this can help people in any way, I’d like to be a part of it.”

Read article here.

The potential of household mold to cause respiratory disease has sometimes been sensationalized.  However, there is definitely an association with asthma.  This new research suggests that having household mold exposure in infancy may increase risk for asthma later in life.  Dr. Sarat Susarla

Infants Exposed to Specific Molds Have Higher Asthma Risk

ScienceDaily (Aug. 2, 2012) — In the United States, one in 10 children suffers from asthma but the potential environmental factors contributing to the disease are not well known. Cincinnati-based researchers now report new evidence that exposure to three types of mold during infancy may have a direct link to asthma development during childhood.

These forms of mold -- Aspergillus ochraceus, Aspergillus unguis andPenicillium variabile -- are typically found growing in water-damaged homes, putting a spotlight on the importance of mold remediation for public health.

Lead author Tiina Reponen, PhD, and colleagues report these findings in the August 2012 issue of theJournal of Allergy and Clinical Immunology, the official scientific publication of the American Academy of Allergy, Asthma and Immunology.

In a long-term population study of nearly 300 infants,, researchers from the University of Cincinnati (UC), U.S. Environmental Protection Agency (EPA) and Cincinnati Children's Hospital Medical Center assessed allergy development and the respiratory health of children annually for the first four years of life then again at age 7 -- an early age for objective diagnosis of asthma in children. The team also monitored home allergens and mold. All infants enrolled in the study were born to at least one parent with allergies.

They found that 25 percent of children whose parents had allergies were asthmatic by age 7. Among the multiple indoor contaminants assessed, only mold exposure during infancy emerged as a risk factor for asthma at age 7.

"Previous scientific studies have linked mold to worsening asthma symptoms, but the relevant mold species and their concentrations were unknown, making it difficult for public health officials to develop tools to effectively address the underlying source of the problem," explains Reponen, who is a professor in the UC College of Medicine's environmental health department.

The UC-based team used the environmental relative moldiness index (ERMI), a DNA-based mold level analysis tool, to determine that exposure to Aspergillus ochraceus, Aspergillus unguis and Penicillium variabile was linked to asthma development in the high-risk study population. The ERMI tool was developed by the EPA to combine analysis results of 36 different types of mold into one index that describes a home's cumulative mold burden.

"This is strong evidence that indoor mold contributed to asthma development and this stresses the urgent need for remediating water damage in homes, particularly in lower income, urban areas where this is a common issue," says Reponen. "Therapeutics for asthma may be more efficient if targeted toward specific mold species."

Children included in this study were part of the Cincinnati Childhood Allergy and Air Pollution Study (CCAAPS), a long-term population-based study of more than 700 children from the Greater Cincinnati area. CCAAPS looked at the effects of environmental particles on childhood respiratory health and allergy development. Participants were identified during infancy as at high risk to develop allergies based on family medical history

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

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

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