Congratulations to Dr. Rotenberg, Pediatric Neurologist, and Dr. Susarla, Pediatric Pulmonologist, named as Houston Top Docs for 2014

Congratulations to Houston Specialists nominated for recognition by their colleagues!

Dr. Rotenberg, Pediatric Neurologist, Sleep Specialist, Epileptologist &

Dr. Susarla, Pediatric Pulmonologist, Sleep Specialist

named as Houston Top Docs for 2014

Read the article here

When Should I See An Asthma Specialist To Treat My Asthma, And Do I Need A Pulmonologist?

When Should I See An Asthma Specialist To Treat My Asthma, 

And Do I Need A Pulmonologist? 

Stephen Wasserman, M.D., Professor of Medicine, UC San Diego School of Medicine

Question: When should I see an asthma specialist to treat my asthma, and do I need a pulmonologist?

Answer: Essentially all patients with asthma should at some point in their medical course see an asthma specialist. An asthma specialist may be someone specially trained in the subspecialty of pulmonary medicine or somebody specially trained in allergy and immunology. But also, many pediatricians and many general internist and many family physicians are well-versed in the management of asthma.

But at some point, particularly if the asthma is proving troublesome, an asthma specialist would be a beneficial person to evaluate the asthma, to look at the treatment plan that's been set forward and to decide if there are modifications.

In addition, when asthma is not responding as expected, it's important to see someone who can differentiate between asthma and things that mimic asthma. The old adage that physician use is, "Not everything that wheezes is asthma." And occasionally, asthma can be misdiagnosised and that is generally best approached by someone who is well-versed in the understanding of asthma.

http://abcnews.go.com/Health/AsthmaTreatment/story?id=4864251#.UIvfRGl26-M

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.

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.

Read full 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

Asthma Signs in Early Infancy

Recurrent wheezing in infants should not be ignored.  Here is more evidence that signs of asthma may be present in even very young children and infants.   SS

Lung Function Deficits in Babies May Lead to Future Asthma

Joanna Broder

March 30, 2012 — In the future, scientists may want to explore ways to prevent childhood asthma long before it fully evidences itself, by focusing on neonates and young babies.

New research suggests that lung function deficits related to future asthma may develop before birth, in infanthood, and in early childhood, suggesting that asthma research could target prevention at these times.

Hans Bisgaard, MD, head of the Danish Pediatric Asthma Centre in Copenhagen, Denmark, and colleagues presented the results of their study in an article published online March 29 in the American Journal of Respiratory and Critical Care Medicine. The authors found that children who develop asthma by age 7 years have respiratory problems as infants, including increased bronchial responsiveness and deficits in lung function.

"It seems that lung function changes associated with asthma occur very early in life and maybe even before birth," Dr. Bisgaard, who is also a professor of pediatrics at the University of Copenhagen, said in a news release. "This may explain the lack of effect from early intervention with inhaled corticosteroids and should direct research into the pathogenesis and prevention of asthma towards the earliest phases of life."

The authors of the study, which is the most comprehensive prospective study yet of the association between early childhood asthma and lung function from birth to school age, note that it is unclear which comes first: the development of asthma or the development of deficits in lung function.

"These questions are important for the direction of research into the origins and prevention of asthma," they write. "[S]hould we expect genetic or prenatal programming of the disease; or is there an early window of opportunity to prevent airway remodeling during early symptoms?"

In the study, the researchers analyzed the interaction between asthma and lung function growth from neonatal age to age 7 years in the Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), a prospective clinical study of a birth cohort of 411 children.

"Previous research on the relationship between neonatal lung function and the development of asthma has been conflicting," Dr. Bisgaard said in the news release. "Our study shows that children with asthma by age seven already had significant airflow deficits and increased bronchial responsiveness as neonates. Lung function deficits also progressed throughout childhood in our study, suggesting a potential opportunity for early intervention."

The newborns were enrolled in the first month of life and were assessed at 6-month intervals. Additional visits were arranged when there was an onset of respiratory symptoms.

The diagnosis of asthma was based on daily diary cards and health visits every 6 months during the first 7 years of life.

The researchers analyzed the interaction between asthma and lung function growth from neonatal age to age 7 years by measuring neonatal spirometry and bronchial responsiveness to methacholine through forced flow-volume measurements. They also measured lung function through spirometry when the child turned 7 years old, using a pneumotachograph, which records the rate of airflow to and from the lungs.

The results showed that children with asthma at age 7 years had experienced a significant airflow deficit as newborns (forced expiratory flow rate [FEF]₅₀ reduced by 0.34 Z score by 1 month; P < .03). This deficit worsened significantly through early childhood (FEF₅₀ reduced by 0.82 Z score by age 7 years; P < .0001).

"We found that approximately 40% of the airflow deficit that was associated with asthma in our study was present at birth, while 60% developed through early childhood along with the disease," Dr. Bisgaard said in the news release. "This indicates that both prenatal and early childhood mechanisms are potential intervention targets for the prevention of asthma."

Further results showed that bronchial responsiveness to methacholine, which leads to narrowing of the airways, was also significantly related to the development of asthma. Reactivity of the neonatal airway was a stronger predictor of asthma than neonatal lung function, the research showed.

"This airflow deficit progressed in the first 7 years of life suggesting that disease mechanisms are operating both before and after birth," the authors write.

One limitation is that the study used a homogenous study sample, which might limit the generalizability of results to other populations, according to written materials from the American Thoracic Society.

The Lundbeck Foundation, the Pharmacy Foundation of 1991, the Augustinus Foundation, the Danish Medical Research Council, and the Danish Pediatric Asthma Centre provided the core support for the study. The authors have disclosed no relevant financial relationships.

Am J Respir Crit Care Med. Published online March 29, 2012. Abstract

http://www.medscape.com/viewarticle/761273

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

Childhood Obesity Linked To Asthma

Obesity has been linked to a number of diseases associated with inflammation.  This large study provides strong evidence that obese children are more likely to have asthma.  SS 

Kaiser Permanente Study Finds Obesity-Asthma Link in Children Varies by Race/Ethnicity

Electronic Health Records Used to Study 681,000 Youth

By Kaiser Permanente

Published: Monday, Feb. 27, 2012 - 6:08 am

PASADENA, Calif., Feb. 27, 2012 -- PASADENA, Calif., Feb. 27, 2012 /PRNewswire/ -- Children and adolescents who are overweight or obese are more likely to have asthma than their healthy weight counterparts, according to a new Kaiser Permanente Southern California study published in the online edition of Obesity. The study, which included more than 681,000 children between ages 6 and 19, found that the association between asthma and body mass index varied by race and ethnicity.

The study found that the association between BMI and asthma was weaker for African Americans, a group that was previously known to have the highest prevalence of asthma, than for youth from other racial and ethnic groups. Researchers found the strongest association between BMI and asthma in Hispanic youth.

"This research contributes to the growing evidence that there is a relationship between childhood obesity and asthma, and suggests that factors related to race and ethnicity, particularly for Hispanic youth, may modify this relationship," said study lead author Mary Helen Black, PhD, of the Kaiser Permanente Southern California Department of Research & Evaluation. "The study's large and diverse population, which is broadly representative of the Southern California region,allowed us to examine a wide range of BMI categories in relation to asthma among youth from five racial/ethnic groups."

Researchers also found that, among youth with asthma, being overweight or obese was associated with more frequent visits to the doctor or emergency department for asthma. In addition, overweight or obese youth with asthma used more inhaled and oral corticosteroid asthma drugs, when compared to healthy weight youth. The need for these medical treatments could have broader health implications as other studies have suggested a link between these medications and type 2 diabetes. 

The cross-sectional, population-based study included youth from a racially and ethnically diverse population. Asthma was fairly common in this population, affecting about 18 percent of the youth in the study. Researchers used electronic health records to obtain height and weight measurements, asthma diagnoses, and dispensed prescriptions for asthma-specific medications for children and adolescents in the Kaiser Permanente Southern California integrated health planfrom 2007 to 2009. 

This study is part of the Kaiser Permanente Southern California Children's Health Study, and their ongoing work to better understand and prevent childhood obesity.

Last year, the KPSC Children's Health Study found that 7 percent of boys and 6 percent of girls ages 2 to 19 in the population were extremely obese. This study also has used electronic health records to determine that children who were obese or overweight have a significantly higher prevalence of psoriasis, a chronic inflammatory disease of the skin.

Other study authors included Ning Smith,PhD, Steven Jacobsen, MD, PhD, and Corinna Koebnick, PhD, from the Department of Research & Evaluation, Kaiser Permanente Southern California; and Amy H Porter, MD, from the Department of Pediatrics, Kaiser Permanente Los Angeles Medical Center.

Read more here: http://www.sacbee.com/2012/02/27/4294206/kaiser-permanente-study-finds.html#storylink=cpy

http://www.sacbee.com/2012/02/27/4294206/kaiser-permanente-study-finds.html

Indoor Allergens: Is it your house or your vacuum cleaner?

An old vacuum cleaner could be part of the problem for people suffering from asthma and allergies.

Are Vacuum Cleaners Bad for Your Health?

Australian Study Shows Most Vacuum Cleaners Release Dust, Bacteria Back Into the Air

Jan 6, 2012 -- You vacuum your house religiously to get rid of all the dust, dirt, and bacteria and make sure your indoor air is up to snuff.

But new research suggests that some vacuum cleaners may actually be making things worse, not better.

Certain vacuum cleaners spit fine dust and bacteria back into the air, where they can spread infections and trigger allergies.

Australian researchers tested 21 vacuum cleaners from 11 manufacturers, including two commercial models. The vacuums were six months to 22 years old, and ranged from less than $100 to almost $800. Brands included Dyson, Electrolux, Hoover, iRobot, and Sanyo. The researchers measured 62 different air emissions.

All released some bacteria, dust, and allergens back into the air. Newer and more expensive vacuum cleaners generally caused less indoor air pollution than older, cheaper models, the study showed.

Vacuums with high-efficiency particulate air (HEPA) filters released only slightly lower levels of dust and bacteria than vacuums that did not use these special filters. HEPA filters are supposed to remove 99.9% of the pollen, animal dander, and even bacteria from the air.

The new findings appear in Environmental Science & Technology.

“Both vacuum cleaning and the act of vacuuming can release and re-suspend dust and allergens, leading to increased exposure,” write study researchers from Queensland University of Technology in Brisbane, Australia.

Indoor Air Cleaning Tips From the Pros

But don’t go throwing your trusty vacuum cleaner out so quickly, says Viviana Temino, MD. She is an assistant professor of allergy and immunology at the University of Miami School of Medicine.

“For a vacuum to do more harm than good, it has to be a really old vacuum cleaner that has never been cleaned,” she says. “In general, most vacuums do take up more dust, dirt, and allergens than they release."

HEPA filters are still the way to go, she says: “They remove more particles than they release back.”

There are other things you can do to keep your indoor air clean. “If you or someone in your home does have indoor allergies, get rid of your carpet,” she says. “If you have throw rugs, wash them once a week in really hot water. This will kill off dust mites and other allergens.”

Feather dusters just relocate dust around the room. Instead, try a microfiber or electrostatic cloth. These don't stir up dust, she says.

Jeffrey May says HEPA filters are still the best. He is the principal scientist at May Indoor Air Investigations in Tyngsborough, Mass., and author of several books, including My House Is Killing Me! The Home Guide for Families With Allergies and Asthma. “A junky old vacuum cleaner will definitely release more allergens than a newer one,” he says.

His advice? Get a vacuum cleaner that has a HEPA filter, and change the filter and clean your house regularly. “Make sure to vacuum under furniture and behind furniture,” May says. “You can't believe the stuff that accumulates there, and this can be an enormous source of allergens.”

By Denise Mann
WebMD Health News

Reviewed by Michael W. Smith, MD

http://www.webmd.com/allergies/news/20120106/are-vacuum-cleaners-bad-for-health

Too Many Soft Drinks May Be Associated with Respiratory Diseases

Too Many Soft Drinks May Be Associated With Respiratory Diseases

Chronic respiratory conditions like asthma seems to occur more frequently in people drinking large quantities of sugary soft drinks, inflammation may be the key.

Soda Linked to Lung Disease

By Kristina Fiore, Staff Writer, MedPage Today

Published: February 07, 2012

More bad news for soda lovers: in addition to obesity and heart disease, the sugary drinks may be tied to asthma and chronic obstructive pulmonary disease (COPD), Australian researchers found.

People who consumed at least a half a liter of soft drinks a day were more than twice as likely to develop either lung condition compared with those who didn't partake at all (OR 2.33, 95% CI 1.51 to 3.60), Zumin Shi, MD, of the University of Adelaide in Australia, and colleagues reported in Respirology.

The cross-sectional study, however, couldn't prove causality, and researchers not involved in the study suspect an overall unhealthy diet effect might be at play.

"High soda intake is a good marker for poor overall diet, and poor overall attention to health," David Katz, MD, director of the Prevention Research Center at Yale University in New Haven, Conn., said in an email to MedPage Today. "It likely suggests greater exposure to everything from tobacco smoke to air pollution."

Sugar-sweetened beverages have long been linked to a host of poor health outcomes, includingstroke and heart disease, but no study has yet assessed potential ties to asthma or COPD, the researchers said.

There are many potential explanations for the increased burden of asthma in Western countries -- less exposure to indoor allergens, improved hygiene, and use of antibiotics (the "hygiene hypothesis"), as well as poor diet and increased obesity -- but fewer noted risk factors for COPD.

Smoking, of course, is a major one, but up to 50% of airway obstruction can't be explained away by cigarette use, they wrote, thus the need to identify novel risk factors.

The group looked at data from the South Australian Monitoring and Surveillance System on 16,907 adults, mean age 46.7, who responded to phone interviews from March 2008 to June 2010.

The prevalence of asthma and COPD, based on self-reported doctor diagnosis, was 12.5% and 4.4%, respectively.

Though the vast majority (72%) said they didn't drink any soda at all, 11.4% reported taking down more than a half a liter of soft drinks every day. In addition to carbonated brand-name soft drinks, lemonade, flavored mineral water, and sports drinks were consumed.

Shi and colleagues found that folks who drank this level of soda had a higher prevalence of asthma and COPD than those who didn't drink any (14.7% versus 11.9% and 6% versus 4.2%, respectively).

In multivariate analyses adjusting for sociodemographic factors, intake of fruit and vegetables, and other life style factors, drinking half a liter of soda a day was associated with an odds ratio of 1.26 for asthma (95% CI 1.01 to 1.58) and an OR of 1.79 for COPD (95% CI 1.32 to 2.43) compared with never drinking soda.

The researchers also saw combined effects for drinking soda and smoking. Consuming more than half a liter a day and being a current smoker carried a 6.6-fold greater risk of COPD and a 1.5-fold higher risk of asthma than not smoking and drinking soda, they reported.

"The combined effect of soft drink consumption and smoking on asthma/COPD emphasizes the importance of lifestyle factor clustering in the etiology of asthma/COPD," they wrote. "Promoting a healthy lifestyle should be encouraged as one means of preventing asthma/COPD."

The mechanisms behind the relationships, however, are unclear. Both asthma and COPD are associated with inflammation, and it could be that foods promoting oxidative stress and inflammation could affect the pathogenesis of these diseases, they wrote.

Drinking soda has also been tied to a higher risk of obesity, which in turn leads to a greater likelihood of developing both lung diseases, they said.

And studies have shown that chemicals such as phthalates from plastic bottles, as well as allergies to preservatives such as nitrites and sulphites, may be linked to asthma.

In addition to not being able to prove causality, the study was limited by its reliance on self-reported data.

Still, Shi and colleagues concluded that "regardless of whether there is a cause-and-effect relationship, the public health implications of consumption of large volumes of soft drink are substantial."

http://www.medpagetoday.com/AllergyImmunology/COPD/31060

Can Tylenol Explain the Rise in Asthma?

Some asthma researchers are worried that the rise in asthma and Tylenol use is too coincidental.  Does this mean you should restrict acetaminophen use in your child?

Does Tylenol Worsen Asthma For Kids?

Parents and doctors around the world have been alarmed by the dramatic increase in childhood asthma.

One factor in the upswing is better detection by doctors, but at least one doctor thinks a common over-the-counter drug also has something to do with it.

Dr. John McBride sees lots of kids with asthma. He's a pediatric pulmonologist at Akron Children's Hospital in Ohio. He knew of studies that raised concern about the safety of acetaminophen — brand name Tylenol — to treat colds and fever in kids with asthma. So he decided to look more closely at the research.

"I was stunned," he says. All the studies he looked at showed a link between asthma and acetaminophen.

"The more acetaminophen somebody takes, the more likely it is that they have asthma," he says. "Also, there's an incredible consistency. Everybody around the world who's looked for this association has been able to find it."

In asthma, the airways of the lungs get blocked by mucous and narrow. That leads to wheezing and shortness of breath. The rise in asthma has closely paralleled the increased use of acetaminophen.

There are no scientific studies proving the medication causes asthma, but McBride says it may make asthma worse in kids who already have it.

Nine-month-old Martez coughs and wheezes as McBride examines him and talks with his mom, Ceasha Moorer, about his asthma. "He coughs. He wheezes. There are multiple symptoms," she says. "He works very hard to breathe. When he's excited from crawling or even laughing, then he breathes really hard."

In the past when Martez got a cold, Moorer gave him Tylenol. But that seemed to make his symptoms worse. At McBride's suggestion, she stopped using it. Then one day, her aunt was looking after Martez when he had a cold.

"I told her don't give him Tylenol," Moorer says. "I didn't specify that it was acetaminophen. She actually gave him a cold medicine, but it seemed to make him kind of worse. I looked at the active ingredients and acetaminophen was in the active ingredients."

In fact, acetaminophen is an ingredient in many cough and cold products — includingNyQuil, Robitussin and Theraflu. It might exacerbate the asthma because it decreases levels of a molecule called glutathione, which protects the lungs.

"So removing the beneficial effect of glutathione exactly at a time children's lungs are being irritated might end up being just one factor that contributes to the onset of an asthma attack," McBride says.

McBride's recommendation? Don't give acetaminophen to a child who has asthma. Other doctors say it's too soon for that advice.

Many other factors could play a role in the rise of asthma, according to Dr. Stanley Szefler, head of pediatric pharmacology at National Jewish Health in Denver. "Vitamin D insufficiency, dietary changes, air pollution or better control of infections are perhaps all related to the increasing prevalence of asthma," he says.

Johnson & Johnson, maker of Tylenol, said in a statement that the medicine has been used safely and effectively for more than 50 years. "There are no prospective, randomized controlled studies that show a causal link between acetaminophen, the active ingredient in Tylenol, and asthma," the company said.

It's important to control a child's fever, Szefler says. McBride agrees but says ibuprofen is a safer bet — at least until ongoing studies provide answers about the safety of acetaminophen for kids with asthma.

http://www.npr.org/blogs/health/2012/02/20/147002356/does-tylenol-worsen-asthma-for-kids

See a similar article from the New York Times...

http://www.nytimes.com/2011/12/20/health/evidence-mounts-linking-acetaminophen-and-asthma.html?_r=2