Winter Viruses, Not Asthma, Culprit Behind Sleep-Disordered Breathing in Children

Pediatric sleep medicine includes the practice of evaluating and treating children with sleep related breathing disorders like obstructive sleep apnea.  This disorder, according to new research, may have a seasonal variation that worsens significantly during the virus season.  Dr. Susarla

Winter Viruses, Not Asthma, Culprit Behind Sleep-Disordered Breathing in Children

A new study reveals that during the winter and spring months, viruses alone — not allergies or asthma — can lead to an increased risk for sleepbreathing disorders in children that can impair their mental and physical development.

Over time, sleep-disordered breathing in children can cause stunted growth, heart disease, and neurocognitive problems associated with poor academic performance, impaired language development, and behavioral problems.

Until now, researchers believed that asthma, allergies, and viral respiratory infections, such as the flu, contributed to disorders that affect children’s breathing during sleep.  Now, however, they have found that viruses alone contribute to these breathing problems.

Lead researcher Dr. Riva Tauman and her colleagues at Tel Aviv University say the study has broad implications for the treatment of sleep-breathing disorders in children.

“We knew from research and clinical practice that sleep-disordered breathing in children gets worse during the colder months,” Tauman said. “What we didn’t expect is that the trend has nothing to do with asthma or allergies.”

During the study, researchers statistically analyzed data of more than 2,000 children and adolescents who were referred to the sleep center to be tested for suspected sleep-disordered breathing between 2008 and 2010.

The researchers found that pediatric sleep-disordered breathing is worse in the winter months than in the summer. The seasonal variability is most apparent in children less than five years old, they found.

The researchers also found that wheezing and asthma do not contribute to these problems.  Based on their findings, the researchers speculate that viral respiratory infections — which are more common in younger children during colder months — are the main reason behind the seasonal variability found in pediatric sleep-disordered breathing.

The researchers estimate that seven percent fewer children would have been diagnosed with sleep-disordered breathing if all the tests had been done in the summer.

“Our study suggests that if a child comes into the sleep laboratory in the winter with a mild case, I may consider not treating him. I can assume he will be better in the summer,” said Tauman.

“But if he has only mild symptoms in the summer, I can assume they are more severe in the winter.”

Read article here.

Asthma Tied to Sleep Apnea

Both asthma and obstructive sleep apnea are diseases of inflammation, though affecting different aspects of breathing.  These data presented at the American Thoracic Society suggest not only reinforce this association, but also identify CHILDHOOD ASTHMA as a major predictor of obstructive sleep apnea. Dr Susarla

Asthma Tied to Sleep Apnea

PHILADELPHIA -- Patients with asthma were also more likely to develop obstructive sleep apnea, researchers reported here.

Participants in the Wisconsin Sleep Cohort who self-identified as having asthma at the start of the research in 1988 had a 41% incident obstructive sleep apnea rate, compared with an obstructive sleep apnea incident rate of 29% among participants who did not report asthma at the beginning of the study (P<0.001), said Mihaela Teodorescu, MD, of the University of Wisconsin in Madison.

Of the 205 individuals who reported a history of asthma, 84 developed obstructive sleep apnea during the 8-year interval sleep studies, she reported at the annual meeting of the American Thoracic Society.

Of the 1,278 individuals who entered the study without a self-report of asthma, 369 had developed incident obstructive sleep apnea after 8 years.

"There has been a body of evidence published suggesting that there is a relationship between obstructive sleep apnea and asthma," Teodorescu told MedPage Today. "Each disorder makes the other worse, so understanding what starts this vicious cycle is very important. We asked the question of whether asthma promotes the development of obstructive sleep apnea."

"In this cohort we found that having asthma at baseline predicted an increased incidence of obstructive sleep apnea 8 years later," she said. "Overall, having any asthma at baseline predicted about a 72% higher likelihood of developing obstructive sleep apnea 8 years later."

"Interestingly, when stratifying by the age of diagnosis, childhood onset of asthma was a higher predictor for development of obstructive sleep apnea, with an odds ratio of about 2.1," she said in a press briefing following her poster presentation.

"For each 5 years increment in duration of asthma, the likelihood of developing obstructive sleep apnea increased by 12%," she said.

Susheel Patil, MD, of Johns Hopkins University, who moderated the press briefing, said, "Over the years obstructive sleep apnea has been found not to just be associated with excessive daytime sleepiness but has been associated with other diseases such as cardiovascular outcomes, diabetes and metabolic syndromes."

"I think that the relationship between asthma and obstructive sleep apnea may, indeed, be bidirectional as exhibited in this new study," he told MedPage Today.

Teodorescu explained that in the prospective Wisconsin Sleep Cohort participants are studied every 4 years with laboratory polysomnography, validated questionnaires, and structured interviews.

"We selected people in the cohort who were free of obstructive sleep apnea at baseline," she said. "We stratified them based on their asthma diagnosis which was self-reported and they also self-reported the duration of asthma. We didn't see any differences in obstructive sleep apnea severity when we looked at stratification of asthmatics versus no asthma, but the sample sizes became quite small when we tried to separate these groups."

"Overall we conclude that these prospective data suggest that asthma, particularly of childhood onset may contribute to the development of obstructive sleep apnea later on in life. Childhood asthma onset seems to be more of a risk factor for this disease," she said.

The research into teasing out how the diseases impact each other will require further study, she said. "How intrinsic disease characteristics or associated features starting early in life affect upper airway patency during sleep remains unknown," she said.

Read article here.

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.

Read more 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

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.

Read more here

Strategies to Control Asthma

This summary from the NHLBI provides invaluable information to parents of children with asthma.  SS

World Asthma Day and Asthma Awareness Month

Together we can help control asthma.

This World Asthma Day (May 1, 2012) and Asthma Awareness Month (May) the National Asthma Education and Prevention Program (NAEPP) encourages you to discover how.

One of the first steps—whether you have asthma or know someone who does—is to develop a written asthma action plan (AAP) in partnership with your healthcare provider. AAPs that meet the specific needs of a patient include details ranging from how to take medication to reduce airway inflammation, to ways to reduce environmental triggers of asthma such as dust mites or tobacco smoke.

But AAPs don’t stand alone. 

They are part of a comprehensive approach needed to improve asthma care and control. Like diabetes or high blood pressure, managing asthma symptoms requires daily attention and ongoing education.

An APP is just one of  the following six key actions, recommended by the NAEPP, that clinicians, patients, and all others who touch the life of someone with asthma can work together on to seize control of asthma so that asthma doesn't seize control of asthma patients.

• Use inhaled corticosteroids to control asthma if you have persistent asthma. Your doctor will help you choose the best treatment.
• Use a written asthma action plan to highlight two things: 1) what to do daily to control your asthma, and 2) how to handle symptoms or asthma attacks.
• Assess asthma severity at the initial visit to determine what treatment to start to get your asthma under control.
• Assess and monitor how well controlled your asthma isat follow up visits. Your doctor may need to increase, or decrease your medicine to keep asthma under control.
• Schedule follow-up visits at periodic intervals, and at least every six months.
• Control environmental exposures such as  allergens or irritants that worsen your asthma.

When taken with these other actions, AAPs can help people with asthma live without limits. The NAEPP has identified personalized AAPs as “must-haves” for allasthma patients, particularly those with moderate and severe asthma, a history of asthma attacks, or poorly controlled asthma. 

It may take time to develop and guide a patient through an AAP on the front end, but providing patients with detailed instructions and educating them on how to manage their asthma themselves will ultimately save clinicians time and effort on the back end. And, if followed as one of the NAEPP's six recommended actions, it could ultimately save lives.

Currently, only about one in three patients with asthma has an AAP to guide them. So, for this World Asthma Day and throughout Asthma Awareness Month, the NAEPP and NACI encourage those without an AAP to get one.

Read more  below:

http://www.nhlbi.nih.gov/health/prof/lung/asthma/naci/news/world-asthma-day.htm

May is National Asthma Awareness Month

Asthma rates in the United States increased over the past decade to their highest level ever, according to a new government report.

The portion of people in the U.S. with asthma rose from 7.3 percent in 2001 to 8.4 percent in 2010, according to the report from the Centers for Disease Control and Prevention.

That means 25.7 million people had asthma in 2010, including 7 million who were younger than 18.

Over the same period, death rates from the condition dropped 33 percent. For every 10,000 people with asthma, there were 1.4 deaths in 2010, compared with 2.1 deaths in 2001.

The disorder has been linked with poverty, and the new findings showed that 11.2 percent of people living below the poverty level had asthma. However, asthma was also reported by 7.3 percent of those who earn at least twice the poverty level.

The findings also showed 9.2 percent of females had asthma in 2010, whereas the rate among males was 7 percent.

Asthma is a chronic airway disorder that can be triggered by exercise, infections, certain chemicals, airborne irritants such as tobacco smoke, or allergens such as pollen. During an asthma attack, the airway becomes obstructed because of inflammation and constriction of the surrounding muscles. It is not clear how to prevent asthma from developing, and there is no known cure, the CDC says.

The new findings are based on data gathered during the National Health Interview Survey, in which CDC researchers conducted household interviews with a nationally representative sample of participants.

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

Whooping Cough - An Under Recognized Cause of Prolonged Cough

Whooping Cough Scare In Middle School

Most kids vaccinated, but many adults are not

By Bridget LeRoy | April 5, 2012 - 12:30pm

    Pertussis, the highly infectious bacterial disease also known as whooping cough, has made an appearance at the East Hampton Middle School, where one case was reported last week. A letter from the Suffolk County Department of Health was almost immediately put up on the East Hampton Union Free School District’s Web site, and was given to staff and parents at all the schools in the East Hampton system.
    Dr. Gail Schonfeld of East End Pediatrics said on Tuesday that she has diagnosed four cases in the last three weeks, including a 3-month-old infant who was admitted to the hospital but eventually recovered.
    Most children have been vaccinated against the illness, and the vaccine is reported to be 95 percent effective. However, when a child, particularly a baby, gets infected with pertussis, the results can be very serious and sometimes fatal.
    Pertussis is spread through the air by the cough of an infected individual. A course of antibiotics is usually helpful, while cough syrups and elixirs are not.
    According to the Suffolk County Department of Health, in a letter that is posted on the East Hampton School District’s Web site, “A person with pertussis is infectious for 21 days from the start of the cough or until he/she has been on five full days of appropriate antibiotic therapy. Children and adults may be susceptible and still develop pertussis even if they are up to date with their vaccinations, as immunity to pertussis wanes over the years.”
    Whooping cough earned its name by the distinctive whooping sound made by someone with the illness as they attempt to draw in breath. “In between coughing fits, a patient could feel pretty good,” Dr. Schonfeld said. “But when they start coughing, they can’t stop. There is really thick mucus that blocks the airways, so there is a feeling of not being able to breathe.”
    Patients with pertussis often have other cold-like symptoms: fever, nausea, a runny nose. But it is the whooping and gasping for air that are the surest signs. In other countries, it is sometimes known as the “100-day cough.”
    According to the Web site for the World Health Organization, in 2008, 16 million people were affected worldwide and 195,000 children died from the illness.
    “Pertussis has been with us a long, long time,” Dr. Schonfeld said on Tuesday. “Only 10 percent of the cases were diagnosed until recently, but now we have a test that’s fairly accurate.” The test involves a “skinny little Q-tip” being inserted way back in the throat. “It’s not a really pleasant sensation,” she said.
    Up until 2005, she continued, there was no vaccine approved for children over 7 years old. Therefore, many adults could have the disease without knowing it. “If a cough lasts for more than a month in an adult, one-third of the time it’s pertussis,” Dr. Schonfeld said. Only a small percentage of adults in the U.S. have been vaccinated, but there is currently a campaign in progress to encourage adults — particularly those who spend time around a newborn — to get immunized.
    Another unpleasant fact: Getting pertussis once does not bring immunity to the illness. “You can get it more than once,” Dr. Schonfeld said.

Read more here:
http://easthamptonstar.com/?q=News/2012405/Whooping-Cough-Scare-Middle-School