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.”

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Therapy-Resistant Asthma May Be Neither

Don't accept your child's asthma treatment plan that assumes that daily symptoms or frequent flare-ups are normal.  Dr Susarla

Therapy-Resistant Asthma May Be Neither

STANFORD, CALIF. – Therapy-resistant asthma usually isn’t.

Often it’s asthma that’s not really resistant to therapy, but a result of poor adherence to therapy, poor inhalation technique, or poor asthma control due to exposure to smoke or allergens.

And sometimes, it’s not even asthma. So, for a child with apparently severe asthma, first confirm the diagnosis and ensure that basic management strategies are in place and being followed, Dr. John D. Mark said at a pediatric update sponsored by Stanford University.

If you can improve the patient’s adherence to treatment, drug delivery, and exposure to environmental triggers, "you could fix nearly all ‘treatment-resistant asthma,’ " said Dr. Mark, a pediatric pulmonologist at Lucile Packard Children’s Hospital at Stanford.

He said he sees many patients referred for therapy-resistant asthma, but noted that there are not a lot of data on how to manage them.

Only 55 of 292 children with moderate to severe asthma, despite being prescribed at least 400 mcg/day of budesonide plus a long-acting beta-2 agonist, could be randomized after eligibility assessment in one treatment trial. Among the 237 who didn’t qualify, children either were nonadherent to treatment (38%) or were found to have mild or no asthma (25%) (J. Allergy Clin. Immunol. 2008;122:1138-44).

In a separate study of 780 patients aged 12-20 years with "severe asthma," the focus on basic asthma management during the run-in period of the trial improved symptoms so much that no clinically significant gains were achieved during the main part of the study by the use of exhaled nitric oxides as an indicator of control, even though this measure increased corticosteroid use (Lancet 2008;372:1065-72).

Another study found that 86% of 100 adults with chronic obstructive pulmonary disease or asthma were misusing their metered-dose inhaler (MDI) and 71% were misusing their Diskus dry powder inhaler (J. Gen. Intern. Med. 2011;26:635-42). A separate study of 127 children and adults found incorrect use of inhaler devices in 64% of MDI users and 26% of patients using the Rotahaler dry powder inhaler. Spacer devices seldom were used (J. Assoc. Physicians India 2005;53:681-4).

Dr. Mark said "therapy-resistant asthma" may fall into one of four categories:

• The wrong diagnosis. This is common, so do a diagnostic re-evaluation, he said.

• Asthma plus. Mild asthma exacerbated by one or more comorbidities is another common scenario. Some studies suggest that up to 15% of patients with severe or persistent asthma have dysfunctional breathing, such as vocal cord dysfunction. Rhinosinusitis, obesity, and food allergy can affect asthma control. Treating gastroesophageal reflux disorder usually does not improve asthma control much, Dr. Mark said.

• Difficult-to-treat asthma. This is a very common category in which poor treatment adherence or poor inhalation technique is the root of the problem. It often overlaps with the previous category.

• True resistance. Probably not common, this is severe therapy-resistant asthma that remains refractory to treatment even after dealing with reversible factors.

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Asthma Common Among Olympic Athletes

Evidence that asthma does not prohibit competitive sports.  Dr. Susarla

Asthma Common Among Olympic Athletes

THURSDAY, Aug. 2 (HealthDay News) -- Asthma and airway hyper-responsiveness are the most common chronic conditions among Olympic athletes, affecting about 8 percent of the competitors, according to a new study.

The Australian researcher suggested the conditions may be linked to the athletes' intense training, particularly those who participate in endurance sports or winter sports. The inhalation of cold air contributes to airway damage.

Airway hyper-responsiveness involves marked narrowing of the airways in response to some kind of outside trigger.

"Inhaling polluted or cold air is considered an important factor which might explain the cause in some sports, but not in all," explained study author Kenneth Fitch, of the University of Western Australia, in a university news release. "The quality of inhaled air could be harmful to the airways, but does not cause the same effect in all sports."

Fitch counted the number of athletes with asthma and airway hyper-responsiveness from the five Olympic games between 2002 and 2010. He identified the athletes by tracking the use of inhaled beta-2 agonists, an anti-asthma drug commonly used by top athletes.

In 2001, the International Olympic Committee recognized the increased use of the drug between 1996 and 2000, and issued a new rule requiring athletes to provide proof of their condition to safeguard the health of Olympic athletes, not as an anti-doping measure, according to the news release.

Fitch noted that athletes with asthma have routinely beaten their opponents. He added, however, there is no proof that treatments for the condition improved their performance. He suggested that training harder than other athletes could help explain why many athletes develop asthma or airway hyper-responsiveness as adults.

The study was published online in the British Journal of Sports Medicine.

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Animal Lovers Do Not Despair If You Have Asthma or Allergies

It's overly simplistic if not wrong to say that animals cause or are responsible for poor asthma control in children.  While pet dander may truly exacerbate symptoms in some children, having pets alone does not necessarily increase asthma risk or risk of poor control.  In fact, pets may be helpful.  Dr S

Why Having a Dog Helps Keep Kids Asthma-Free
If you’re a dog person, your kids might be in luck. Research suggests that children who grow up in homes with pets are less likely to develop allergies, and now a recent study by researchers from the University of California, San Francisco, sheds some light on why.

Working with mice, the scientists found that exposure to house dust from homes with a pet appeared to protect the mice against a common virus called respiratory syncytial virus (RSV), which infects the lungs and breathing passages and is a major cause of respiratory illness in young children. (In adults, it usually causes run-of-the-mill cold symptoms.) Severe infections in infancy are linked with an increased risk of developing respiratory problems like asthma later on.

Lead researcher Kei Fujimura and her team looked at three groups of mice. One group was fed house dust from homes with dogs, and then exposed to RSV; a second group was infected with RSV without exposure to dust; and a control group of mice was not exposed to RSV or dust.

The study found that the mice that ingested house dust and were exposed to RSV didn’t develop the telltale symptoms of infection, such as lung inflammation and mucus production — these animals looked just like the controls. The researchers then examined the microbes living in the protected animals’ guts, and found that the types of bacteria they harbored were different and more diverse than the bugs in the RSV-infected animals guts.

What do gut bugs have to do with asthma? Potentially a lot. Researchers are discovering that the microbiome, as it’s known — the vast community of good bacteria and viruses that live in and on the human body, including in the intestines — not only play a vital role in basic bodily functions like digesting food, producing vitamins and fending off infection, but may also contribute to the development of chronic conditions and diseases like obesity, cancer and asthma.

Our bodies begin to acquire these crucial microbes at birth, during our journey through the birth canal. From that point, exposure to everything — from grandparents to pets — influences the makeup of the microbiome. It’s theorized that microbial exposure in infancy, when the immune system is maturing, may help protect children against later allergies and asthma.

In earlier work, Fujimura found that house dust from homes with cats and dogs had significantly different types of bacteria than dust from homes without pets. And previous studies have suggested that early life pet exposure and ownership is associated with reduced risk of asthma. “This led us to speculate that microbes within dog-associated house dust may colonize the GI tract, modulate immune responses and protect the host against an asthmagenic pathogen, RSV,” she said in statement about the study, which was presented at the annual meeting of the American Society for Microbiology in San Francisco.

The findings support the hygiene hypothesis of allergy and asthma development, which posits that exposure to germs in childhood helps strengthen the immune system, reducing the risk of childhood respiratory and allergic diseases. Studies have shown, for instance, that kids who grow up on farms and around livestock are less likely to develop asthma and allergies than those who live in more sterile urban environments.

“Everybody appreciates the fact that we’re all missing something big in asthma,” Dr. Robert Mellins, a pediatric pulmonologist at Columbia University, told ABC News. “People have appreciated that viral infections clearly have an association, and this kind of experiment is interesting because it suggests a mechanism of how that could come about.”

Fujimura concludes that identifying the specific species of microbes and the precise mechanisms that underlie the protective effect of dog-associated house dust could help researchers better understand and treat allergies and asthma.

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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."

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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/