Asthma in Premies More Likely To Resolve

There is a well observed and documented phenomenon of increased asthma risk particularly in ex-premies delivered before 30 weeks gestational age.  Parents may be alarmed by the "asthma" label, but that this study suggests that normal child growth and development may help resolve this form of early onset asthma.  Dr. Susarla

Parents of premature babies worry about many things, including an increased risk of asthma. But a large Danish study has found that asthma, common in premature babies, disappears as the children grow older. By the time they are adults, their risk of asthma is no greater than that of babies born full term.

Researchers combed birth and health data on 1.8 million people born from 1980 to 2009, checking for gestational age and neonatal respiratory problems.

The study, published in PLOS One, found that 27 percent of infants born earlier than 27 weeks required asthma medication during childhood, compared with 18 percent of those born at 28-31 weeks, 13 percent at 32-36 weeks, and 9 percent at full term.

But after controlling for socioeconomic status, maternal asthma, multiple birth and other factors, they found that by adolescence, the association had weakened, and by adulthood 2.4 percent of the former preemies required medication compared with 2.1 percent of those born full term, a clinically insignificant difference.

“There are more and more preemies,” said the lead author, Dr. Anne Louise Damgaard, a researcher at the University of Copenhagen, “and we don’t really know what happens to them as they get older. But up to age 31, their lungs are pretty healthy. It’s possible that the differences may become more evident as they age.”

Read article here.

Roche drug cuts asthma attacks, improves lung function -study

"Biological therapies" are the new frontier in asthma treatment, especially for patients with more severe disease. These antibody based medications provide a more targeted  strategy in asthma treatment compared to conventional asthma medications.  Dr. Susarla

Roche drug cuts asthma attacks, improves lung function -study

(Reuters) - An experimental drug reduced asthma attacks in patients with severe uncontrolled asthma by 60 percent and helped improve lung function in certain patients, indicating that the drug could offer the first personalized approach to treatment, according to data from a clinical trial released on Tuesday.

The biotech drug lebrikizumab, which was developed by Roche Holding's Genentech unit, was tested at three doses in patients whose asthma was not sufficiently controlled even with high-dose, inhaled corticosteroids and a second asthma-controlling therapy.

In the 463-patient Phase IIb study, lebrikizumab reduced asthma attacks by a statistically significant 60 percent more than a placebo in patients found to have a high level of the protein periostin, according to pooled data from the three doses tested - 37.5 milligrams, 125 mg and 250 mg. That compared with a 5 percent reduction versus placebo over 28 to 52 weeks of treatment in those with low levels of periostin.

"If this drug gets approved we would have for the first time a personalized approach other than just blanket therapy for everyone with uncontrolled disease," Dr Nicola Hanania, one of the study's lead investigators, said in a telephone interview.

Lebrikizumab works by blocking interleukin-13, or IL-13, which contributes to airway inflammation and mucous production. Periostin is believed to be a biomarker for IL-13 activity and a likely predictor of how well the Roche drug will work.

Roche is also developing a blood test for periostin in order to identify the patients most likely to benefit from lebrikizumab, which is injected once every four weeks.

Hanania, who is director of the Asthma Clinical Research Center at Baylor College of Medicine in Houston, called the data from the study "very exciting."

In those with severe asthma receiving existing treatments, "we still see patients who still have symptoms, who still have exacerbations, hospital admissions, and this is the type of patient this study was targeting," he said.

Curiously, the greatest level of asthma attack reduction, at 81 percent, was seen with the lowest dose of lebrikizumab, something that Hanania called surprising. Hanania, who presented the data at the American Academy of Allergy, Asthma and Immunology (AAAAI) meeting in San Diego, noted, "Higher is not always the better."

Fifteen percent of the estimated 25 million Americans with asthma suffer from severe asthma, according to the National Institutes of Health. About half of severe asthmatics are believed to have high periostin levels.

Among patients with high level periostin, the drug improved lung function by 9.1 percent after 12 weeks, compared with an improvement of just 2.6 percent in the low periostin group.

Lung function was tested by change in FEV1, a measure of the maximum amount of air that can be forcibly exhaled in one second. The greatest improvement in FEV1, of 10.7 percent, was seen with the 125 mg dose of lebrikizumab.

"Statistically it's significant, and I believe it is clinically significant because it goes hand in hand with reduction in exacerbations," Hanania said of the lung function improvement seen in the high periostin group.

The incidence of serious adverse side effects was low and similar in the lebrikizumab and placebo arms of the study, researchers said.

"The safety profile was very reassuring. Nothing really stood out as major side effect or major serious adverse effect," Hanania said.

If the results are replicated in large, ongoing Phase III trials that will include more than 2,000 patients, Roche said it expects to seek approval for the drug in 2016.

"As a clinician, this is important because there is a great need for additional therapy for those with poorly controlled asthma," Hanania said. "It's a light at the end of the tunnel."

Read article here.

Obesity and Asthma: Study Finds a Link in the Genes

New evidence identifies a genetic link with allergic inflammation. Dr. Susarla.

Obesity and Asthma: Study Finds a Link in the Genes

July 18, 2013 — Genes linked to chronic inflammation in asthma may be more active in people who are obese, according to new research that uncovers several biological ties between obesity and asthma.

"Our findings point the way to the management of asthma in the obese through simple weight reduction," said first author Paresh Dandona, MD, PhD, SUNY Distinguished Professor and Chief of Endocrinology, Diabetes and Metabolism at the University at Buffalo.

The research appeared online June 26 in the journal Obesity and involved two related studies: A comparative study between obese people and people of normal weights; and an experiment that looked at how various biological indicators -- including the behavior of asthma-linked genes -- changed when morbidly obese patients received gastric bypass surgery.

In the comparative study, the scientists found that four genes associated with chronic inflammation in asthma were more active in obese and morbidly obese people, by more than 100 percent in some cases. The highest activity was found in the morbidly obese.

This increased gene expression matters because it can cause white blood cells called mononuclear cells to produce far greater amounts of inflammatory factors like interleukin 4, LIGHT and lymphotoxinβ receptor which contribute to allergic inflammation and other abnormalities in the bronchial passages in asthma.

The scientists also found higher concentrations of two asthma-related compounds in the plasma of obese and morbidly obese patients: MMP-9, which is associated with inflammation, and nitric oxide metabolites (NOM), which are an indicator of oxidative stress.

Following gastric bypass surgery in morbidly obese diabetic patients, MMP-9 and NOM levels dropped, along with the expression of six asthma-related genes including the key factors, interleukin 4, LIGHT, lymphotoxinβ and interleukin 33 in parallel with weight loss and improvements in the status of their diabetes.

"Ours is the first study to provide a mechanistic link between obesity and asthma through biological/immunological mechanisms," Dandona said. "There has been, until now, no biological, mechanistic explanation other than the fact that obesity may raise the diaphragm and thus reduce lung volumes."

Read article here.

New research reveals swimming beneficial for young people with asthma

Exercise, particularly swimming, can be a potent way to improve lung function.  This may be particularly beneficial for children and adolescents with asthma.  Dr. Susarla

New research by medical students working in the Breathe Well Centre of Research Excellence at the UTAS School of Medicine has revealed swimming has health benefits for young people with asthma, with no adverse effects on asthma control or exacerbations.

Asthma is a common condition among children and adolescents causing intermittent wheezing, coughing and chest tightness and is the main reason why Tasmanian children present at emergency departments or are hospitalised.

Director of Paediatric Education at the Royal Hobart Hospital Dr Sean Beggs, who assisted in the research, said concerns that physical exercise such as swimming could worsen asthma, had the potential to reduce participation, resulting in reduced physical fitness.

"The review aimed to determine the effectiveness and safety of swimming training in children and adolescents with asthma aged 18 years and under," Dr Beggs said.

"Our research found swimming training is well-tolerated in children and adolescents with stable asthma, and increases physical and cardio-pulmonary fitness as well as lung function."

In 2011, the Asthma Foundation of Tasmania (AFT) provided funding to jointly support students Yi Chao Foong, Hong C Le and Danial Noor, undertaking their first health professional degree, to conduct the asthma review. The review was co-supervised by UTAS' Dr Julia Walters who heads the health services theme within the Centre of Research Excellence.

AFT Chief Executive Officer Cathy Beswick said the outcome of the project would ensure swimmers with respiratory problems achieved the best outcomes when trying to improve their health.

"Anecdotally it is understood swimming is an outstanding form of exercise for children and adults with asthma, but there have been concerns that it might have an impact on asthma control or even induce exacerbations," Ms Beswick said.

"This research provides a strong scientific foundation for deciding who to recommend this form of exercise to and the type of exercise they should undertake."

Ms Beswick said the student scholarship was awarded following an agreement with the UTAS School of Medicine, continuing the Australian Satellite of the Cochrane Airways Group's scholarship scheme.

"The Australian Satellite of the Cochrane Airways Group's scholarship scheme facilitates the activities of the Cochrane Collaboration, which encourages individuals to work together to provide the best evidence for health care," Ms Beswick said.

"Our funding has ensured a future for the scholarship scheme in Tasmania, meaning greater knowledge and insight into asthma and other respiratory diseases in our population."

The Tasmanian asthma research reviewed evidence from eight studies involving 262 participants and combined the results to see if swimming was a safe and beneficial activity for young people.

The review, titled Swimming training for asthma in children and adolescents aged 18 years and under, has been published online together with a podcast of the findings in the Cochrane Library at:

The Cochrane Library is an online collection of accessible high-quality, independent evidence to inform healthcare decision-making around the world.

The NHMRC-funded "Breathe Well" Centre of Research Excellence (CRE) focuses on preserving respiratory health in the community from youth to old age, and optimising respiratory health through innovative approaches to detection and therapy. The CRE houses the official Australian Satellite of the Cochrane Airways Group based in London.

Read article here.

Pri-Med Southwest 2013

Dear All,

I will be speaking at Pri-Med Southwest 2013 Product Theater tomorrow about asthma therapy, sponsored by Teva Respiratory.  I look forward to sharing some cutting edge research on small airways disease and asthma as well as my personal clinical experiences.

See conference information here

Childhood Obesity Associated with Asthma

Asthma associated with childhood obesity may be unique in other ways since it is often harder to treat. Dr. Susarla

Research Supports Role of BMI in Incident Asthma in Children

(HealthDay News) – Overweight and obese children have a significantly increased risk of incident asthma, with evidence of a dose-response effect of elevated body mass index (BMI), according to a meta-analysis published online Nov. 12 in Obesity Reviews.

Y.C. Chen, from the National Taiwan University in Taipei, and colleagues reviewed the literature and conducted a meta-analysis using a prospective cohort of pediatric studies that analyzed age- and sex-specific BMI (as a measure of childhood overweight) and the primary outcome of incident asthma.

Based on data from six studies meeting the inclusion criteria, the researchers found that, compared with non-overweight children, overweight children had increased risks of incident asthma (relative risk [RR], 1.19). When comparing obese vs. non-obese children, the association was further elevated (RR, 2.02). There was a significant dose-responsiveness of elevated BMI on asthma incidence (P for trend, 0.004). In addition, there was a gender difference noted, with obese boys exhibiting a significantly larger effect than obese girls (RR, boys: 2.47; girls: 1.25), also with a significant dose-dependent effect.

"Our findings support the impact of childhood obesity on incident asthma, and provide information to compel obese children to lose weight," the authors write. "Policy makers for children's health and parents should pay more attention on preventing obesity-associated risk and environments."

Read article here.

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.

Discovery May Lead to New Asthma Treatment

This promising research focuses on a unique step in the pathway that leads to asthma exacerbations. Dr. Susarla

Scientists Focus on Factors Behind Asthma Attacks

Findings could pave way to reducing 2 major airway symptoms, researchers say

THURSDAY, Sept. 20 (HealthDay News) -- Blocking two particular biological processes might help provide relief to people with asthma, according to a new study.

The University of California, San Francisco-led team found that a specific calcium-activated chloride channel called TMEM16A plays a role in the severity of asthma. The channel regulates airway secretions and smooth-muscle contraction: the major factors that lead to an asthma attack.

"Maybe if we could inhibit both of these processes by blocking this one channel, then we could affect the two symptoms of asthma," study senior author Jason Rock, an assistant professor at the UCSF anatomy department, said in a university news release.

People with asthma have a higher-than-normal number of mucus-producing cells in the lining of the airway tubes that lead to the lungs, and they also have an abnormal amount of smooth muscle surrounding the airway tubes. The slightest stimulus can cause the tubes to contract.

"The overabundance of mucus plugging the airways combined with hyper-contractility of the smooth muscle -- when the tubes get really small -- make it difficult to move air in or out," Rock explained. "A lot of people equate that with breathing through a straw."

In laboratory tests, the researchers identified three chemicals that inhibited the activity of TMEM16A and led to reduced mucus production and smooth muscle contraction.

The study was published Sept. 17 in the journal Proceedings of the National Academy of Sciences.

The next step is to test the safety and effectiveness of these chemical blockers in animals, the researchers say. If that goes well, human clinical trials could follow.

Read article here.

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.

Read more here.

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.

Read more here.

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.”

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

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."

Read more here