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.

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Height Reduction in Children Using Inhaled Steroids

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

Height Reduction in Children Using

Asthma Inhalers

Children using steroid inhalers tend to be slightly, 

about half inch, shorter than their peers when they 

reach adulthood, a new study says.

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

"This [study results] was surprising because in previous studies, we found that the slower growth would be temporary, not affecting adult height. But none of those studies followed patients from the time they entered the study until they had reached adult height," said Robert C. Strunk, MD, Professor of Pediatrics at Washington University School of Medicine in St. Louis.

The present study involved around 1,000 children suffering from asthma. The participants were aged between 5 and 12 years old and were randomly divided into three groups; group one received inhaled corticosteroid asthma medication (budesonide), the second group received inhaled medication without steroids (nedocromil) and the third group was given a placebo. All participants were given albuterol, a drug for relief of acute asthma symptoms, and oral corticosteroids as needed for asthma symptoms.

Participants' height and weight was measured at regular interval until they reached adulthood. More than 900 participants were followed until they reached 18 years old, for girls, and 20 years old, for boys.

Researchers found that participants who used budesonide were half inch shorter than those who used either nedocromil or a placebo. They also found that the slowest growth in height occurred when the children started using budesonide between the ages of five and 11.

 "We found it made no difference if they were boys or girls or how long they had had asthma, or any other of these factors. We also looked at the height of the parents, and that didn't have any impact, either," Strunk said.

Benefits of the corticosteroids versus half an inch of height

Strunk said that pediatric asthma specialists at St. Louis Children's Hospital monitored the participants' growth and maintained records of growth curve. He said that the "half-inch of lowered adult height must be balanced against the well-established benefit of inhaled corticosteroids in controlling persistent asthma. We will use the lowest effective dose to control symptoms to minimize concerns about effects on adult height."

"The loss of height compared to expected height was not dramatic in this study [and] without inhaled steroids, some of these persistent, asthmatic children may well have suffered considerable morbidity [illness], which was prevented by the inhaled steroids," Dr. Len Horovitz, a pulmonary specialist at Lenox Hill Hospital in New York City, HealthDay reports.

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Exercise-Induced Bronchospasm (Asthma): What you need to know (Part 1)

Below is a summary from the Exercise-Induced Bronchospasm Landmark Survey, a study that evaluated exercise-related respiratory symptoms in children ages 4-17.  Dr. Susarla

Key Insights

The survey findings yield a number of important insights about asthma and exercise-induced bronchospasm in the United States: 

• Patients with asthma have a significant physical burden of disease, which produces lower self-health ratings, activity limitations, and sick days, compared with persons without asthma.
• Asthmatic patients with symptoms of exercise-induced bronchospasm (EIB) also have a significant emotional or psychological burden of disease as demonstrated by feeling more fearful, isolated, depressed, frustrated, and embarrassed than persons without EIB symptoms.
• Nearly half of asthma patients report their health interferes with their ability to participate and perform well in sports, and more than a third feel they cannot keep up as well as other persons their own age in physical activities.
• When asked what usually triggers their asthma or makes it worse, nearly a third of asthma patients volunteer “exercise” --- more than any other asthma trigger.
• Four out of five asthma patients report experiencing symptoms after sports, exercise, play or other physical activity, but less than a quarter have been diagnosed with either exercise-induced asthma (EIA) or exercise-induced bronchospasm (EIB).
• Less than a quarter of asthma patients with exercise-related symptoms take quick-relief medicine, like albuterol, always or most of the time prior to exercising.
• Patients’ understanding of exercise-related symptoms and their management are different than healthcare providers, which may lead to miscommunications between physicians and patients regarding proper asthma management.
• Results of the survey suggest that exercise-related symptoms among asthma patients may reflect uncontrolled or improperly managed asthma.
• The problem of EIB is not limited to persons with asthma with more than a quarter of the adult cross-section reporting respiratory symptoms during or after sports, exercise, play or other physical activities, while less than one in five have been diagnosed with exercise-induced asthma or exercise-induced bronchospasm. 

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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.

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UK Child Dies From Fatal Asthma Attack

We don't think of asthma as a cause of death in the modern world.  Unfortunately, it still happens even though it is almost always preventable.  Dr. Susarla

MILLOM BOY, 9, DIED FROM BAD ASTHMA ATTACK

A NINE-YEAR-OLD boy died as a result of a serious asthma attack at his Millom home, an inquest heard.

Rylan Cosgrove, who was a Year Five pupil at Black Combe Junior School, died on February 21 this year.

The keen rugby player was taken by ambulance to Furness General Hospital but was already dead upon arrival.

The inquest into his death was told yesterday that he was only diagnosed with asthma in December.

Doctor Mohamed Anass Olabi told the hearing in Barrow Town Hall it was not unusual for children to be diagnosed with the condition a little later, but it was more common to have symptoms such as wheezing in their early years.

The pathologist’s post-mortem report confirmed acute asthma attack as the cause of death.

Dr Olabi said the report revealed no infection was found, but one of Rylan’s lungs was very full of mucus.

Dr Olabi said: “It’s prevented the lungs from functioning and this has caused him to have shortness of breath and not much oxygen going through the system and then he collapsed.

“I think the likelihood of what caused his sad death is lack of oxygen, which affected his heart and eventually he was not able to cope – this is the most likely.”

Dr Olabi had researched similar cases in children and studied a report, published in March this year, titled Risk Factors for Childhood Asthma Death.

The report looked at children who died of asthma in the UK between 2001 and 2006.

Half of the children who died were labelled as having mild to moderate asthma, and one was not even known to have asthma.

Most were aged 11 to 13.

Dr Olabi said: “There are some factors here that have similarities – had it late, not very unwell, admitted once to hospital, and then sadly have a very bad asthma attack.

“What I’m trying to say is, it is not unheard of.”

In 2009, 12 children aged 14 or under died in the UK from the disease.

Dr Olabi said he did not believe there was anything that could have been done differently to prevent Rylan’s death.

But he added: “It’s a sad case, but it does exist.

“And until we get full education for families and the health care people, we won’t be able to prevent this completely.

“There are 12 cases of asthma deaths in children every year and we still think, of these 12 cases, possibly half of them could be prevented, so lots of hard work needs to be done in that area.”

Mr Ian Smith, South and East Cumbria coroner, recorded a verdict of death by natural causes.

He confirmed a police investigation was carried out, but there was nothing officers were concerned about.

Read article here

Have Asthma? Don't Say No To Exercise

There is a lot of confusion about asthma and its relationship to exercise.  Most athletes I treat DO NOT require any restrictions when it comes to sports.  Dr S.

Asthma doesn't have to mean game over for athletes

Sixteen-year-old basketball standout Larry Austin Jr. is doing what a doctor thought unlikely, given his asthma.

“Actually, my doctor told me awhile ago that I’d never play a sport,” says Austin, who has college basketball scholarship offers and plans to compete for a spot on the USA Basketball under-17 team that will play in the World Championships this summer.

Austin, who will be a junior this fall at Lanphier High School, said his asthma symptoms include a lot of sneezing and a nose that is “stopped up.” He’s battled asthma since he was 3 months old.

Time with a nebulizer and sometimes an inhaler helps Austin before basketball games. He says he hasn’t had any problems with asthma this year.

“I started to grow out of it, slowly,” he says.

A chronic lung disease that makes air movement in and out of lungs difficult, asthma can be managed but not cured. In asthma, the lungs’ airways (bronchi) become inflamed and can spasm, causing shortness of breath and wheezing. The exact cause isn’t known, but certain “triggers” (a condition, thing or activity) can make asthma worse.

Some refer to asthma that worsens with exercise as “exercise-induced” asthma. But that term can be misleading, say local medical doctors.

“Usually, the term ‘exercise-induced’ asthma is used. Potentially, it’s just episodic bronchial constriction, which follows exercising patients who have asthma,” says Dr. Anwar Shafi, assistant professor of pediatrics, specializing in pediatric pulmonology, at the Southern Illinois University School of Medicine.

“I think ‘exercise-induced asthma’ is potentially misleading because exercise is not an independent risk for asthma. It’s just a trigger for bronchial constriction in patients who have underlying asthma.”

Initially, it was thought that Austin’s asthma was exercise-induced, but it was later learned that allergens are his triggers.

“It took a lot of trips going to the hospital, being admitted into the hospital before they identified what was really causing it,” said Larry’s mother, Christa Austin, who adds that her son receives allergy shots every 20 days for maintenance.

Other side of the coin

Shafi says exercise can be a trigger for some of his asthmatic patients.

“When we see patients, we take a careful history ... we try to determine if the child has asthma ... (with) typical symptoms of asthma: cough, wheezing, shortness of breath, chest tightness,” Shafi says.

“Then we try to ascertain what can be the triggers. It depends on the age. Usually in children, viral infections are the most common cause for triggering asthma symptoms. If they do have significant allergies, then allergens can be a trigger for their asthma as well.”

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New Smartphone App Helps Patients With Asthma

Patients and parents: try this. Isonea has devised an innovative way to assist patients with monitoring and treating their asthma... all from the convenience of your smart phone.  Dr S

iSonea Unveils AsthmaSense App for iOS and Android

Medical technology company, iSonea Ltd. recently unveiled a new asthma management smartphone app, called the AsthmaSense. The app reiterates the growing popularity of the mHealth segment and is available for iPhone, iPad and Android users. As the name suggests, AsthmaSense is been targeted to asthma patients and has been designed specifically to help improve the way people live with and manage asthma.

Providing all-encompassing functionality, the AsthmaSense app allows one to record and track their symptoms, lung function tests, asthma events and medications. All one has to do is program their asthma action plan and then the app starts sending reminders and active alerts. It also delivers interactive medication and testing reminders, information which is crucial to anyone who suffers from asthma.

“Managing asthma is crucial to controlling the disease and improving health; however regular, diligent monitoring of symptoms, triggers and medications can be challenging for patients, caregivers and parents alike," said Lynn M. Taussig, M.D., chairman of iSonea's Medical Advisory Board, special advisor to the Provost for the Life Sciences at the University of Denver and the retired president and CEO of National Jewish Medical and Research Center. "AsthmaSense smartphone app is an easy and convenient way to monitor and track asthma and keep your doctor informed of your condition and progress. This ultimately leads to better health, avoids emergency visits and provides peace of mind for patients and their families."

"iSonea is dedicated to developing innovative, easy-to-use devices and mobile apps that help improve asthma monitoring and management," said Michael Thomas, CEO of iSonea Ltd. "We built the AsthmaSense app with the user in mind. We understand how critical it is to track your asthma, and so we built an app with key features that help you better manage your asthma anywhere, anytime."

Some other features found on the AsthmaSense app include; journal functionality which records peak flow, wheeze, medication use, ability to set tone and time for medication and testing reminders, easy access to emergency contact information and the ability to review and share your AsthmaSense data up to two months of medication use.

AsthmaSense is available for purchase at the Apple App Store (for iPhone and iPad users), Google Play and Amazon App Stores (for Android users) and has a one-time cost of $3.99.

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Study Shows Asthma Medications Prevent Hospitalization When Used Properly

The ICU is one place you don't want to be if you have asthma.  Research shows that available medications for asthma are highly effective in reducing hospitalizations.  SS

Inhaled Steroids Lead to Big Drop in Asthma Deaths at Texas Hospital: Study

They reduce inflammation in the lungs, improving control of asthma symptoms

TUESDAY, May 15 (HealthDay News) -- Patient education and medication compliance contributed to a 74 percent drop in the number of patients with life-threatening asthma admitted to the intensive care unit at University Hospital in San Antonio, Texas, researchers report.

Their review of 30 years of hospital data focused on patients with severe asthma who didn't respond to standard inhalers.

They found that there were 227 patients admitted to the intensive care unit (ICU) with 280 episodes of life-threatening asthma between 1980 and 2010. One patient died, but the death was from a different cause after the patient's asthma improved, according to the team at the University of Texas Health Science Center at San Antonio.

"The main reason for the decline in cases is that more of our patients are taking their controller medications, such as inhaled corticosteroids, which reduce the amount of inflammation in the airways," lead author Dr. Jay Peters, chief of pulmonary diseases at the Health Science Center, said in a university news release.

The researchers also found that insertion of a breathing tube, called intubation, when patients arrived in the emergency department did not lead to longer hospital stays.

"I think our methods of treating patients in the emergency department have improved so much that previous studies of issues with intubation don't hold up anymore," Peters said.

The study appears in the journal Respiratory Medicine.

"On the front end, this study reinforces the importance of staying on controller medications," he said. "On the back end, it shows low mortality for patients in the medical ICU and that we don't need to be afraid to intubate patients and place them on mechanical ventilation if necessary."

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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.

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