Emergency room use for asthma highly prevalent in children

Although poor asthma control is multifactorial, there is no doubt that timely access to outpatient specialty asthma care can prevent exacerbations that result in frequent emergency room visits.  Dr. Susarla

Children in California increasingly are flocking to emergency rooms for treatment of asthma, despite millions of dollars spent on programs to control the disease.

Statewide, the rates of ER visits for asthma symptoms rose by about 18 percent for California children ages 5 to 17 and by 6 percent for children under 5 between 2005 and 2012, according to a Kaiser Health News analysis of the latest available rates by county.

In Los Angeles County, ER visit rates rose by 17 percent for children 5 and older and by 8 percent for children under 5. 

In some parts of the state, especially the Central Valley, the increases were far higher. The rate of emergency room visits for children 5 and older more than doubled in rural Madera County and nearly doubled in Merced. 

All told, more than 72,000 California children under 18 visited the ER for asthma in 2012, nearly 21,000 of them from Los Angeles County.

“There’s clearly more work to be done if this many kids are going to the emergency department,” said Anne Kelsey Lamb, director of the Regional Asthma Management and Prevention program of the Oakland-based Public Health Institute. “We know a lot about what works. We absolutely should be able to reduce the rates we’re seeing.”

At the national level, asthma-related emergency room visit rates have declined in recent years, according to federal health data through 2010, the latest available.

Although ER visits declined in some counties, including Alameda, San Mateo and Marin, the overall rise in California has frustrated public health experts who have spent millions of dollars and countless hours to improve and expand asthma prevention programs around the state. The state and federal governments alone spend $1.54 million annually on such projects in California, including grants to schools to improve indoor air quality and training community health workers.

The reasons for the increase in ER visits are complex, experts say. They include parents not properly administering medications, poverty and inadequate insurance coverage, persistently high levels of indoor and outdoor pollution in some regions and the limited reach of programs that seek to manage symptoms or prevent them.

Read article here.

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.”

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Some Asthma Patients May Be Overmedicated, Doctors Say

How is your child's asthma managed?  National asthma guidelines stress the importance of  scheduled reassessment of asthma control, which under the proper direction can reduce excessive use of asthma medication.  Consult a pediatric pulmonologist for asthma check-ups for best guidance coupled with state of the art lung function testing to help achieve the right balance.  Dr. Susarla 

Some Asthma Patients May Be Overmedicated, Doctors Say

People with mild asthma are advised to lower their medication dose once their asthma has been brought under control, but the best way to reduce the dose is not fully known, doctors say.

As a result, patients may be staying on higher doses than what's necessary to keep their condition under control.

"We need to find a way to help patients control their asthma, without overmedicating them," said Dr. John Mastronarde, director of the Asthma Center at Ohio State University's Wexner Medical Center.

"Right now, the recommendation is to reduce a patient's therapy once the asthma is controlled for at least three months," Mastronarde said.
To control asthma, patients typically take drugs called inhaled corticosteroids, to reduce inflammation in the lungs, and long-acting beta agonists (LABAs), to open the airways. Doctors adjust the medication dose based on the patient's symptoms and lung function.
Once a patient's asthma is controlled, the drug dose should be lowered carefully, to the minimum dose necessary, according to the National Institutes of Health's guidelines for treating asthma.
"But that's where things just don't happen," Mastronarde said. "Once you get the symptoms under control, sometimes both the patient and the doctor just leave the patient on whatever they are on, because they don't want it to get worse again."
Although low doses of inhaled corticosteroids are safe, it is thought that taking high doses of the drugs for a long time may weaken the bones, especially in post-menopausal women, or possibly increase the risk of eye cataracts. Higher doses also cost more, Mastronarde noted.
Long-acting beta agonists may have some effects on a person'sheartbeat and blood pressure. The U.S. Food and Drug Administration recommends these drugs be used for the shortest time needed to control asthma symptoms, and that they be discontinued if possible.
Although lowering the doses of these medications is recommended, no one knows the best way to do that, Mastronarde said.
To help establish guidelines, Mastronarde and his colleagues are launching a yearlong study to examine 450 people with moderate asthma, who will receive inhaled corticosteroids and beta agonists for eight weeks. For the participants whose asthma is well controlled, the researchers will then see which method would work better: reducing the doses of their medication, or eliminating the beta agonists.
But in the meantime, patients whose asthma is controlled for three months can talk to their doctor about whether they can decrease their medication dose, Mastronarde said.

Read article here.

Having bronchiolitis in infancy, a wheezy illness associated with viral infections, seems to leave its footprint in the lungs for years to come including adulthood.  Dr Susarla

Infant Wheezing Episodes Impact Lungs Later

BARCELONA -- Children who suffer through a bout of bronchiolitis can end up with lungs early in adulthood that look like those of patients with chronic obstructive pulmonary disease (COPD), researchers reported here.

Thirty years after being hospitalized for bronchiolitis when they were younger than 2 years of age, 11% of the patients exhibited lung function that fell below the 0.7 FEV (forced expiratory volume in one second)/FCV (forced vital capacity) ratio that is threshold for the definition of COPD, said Katri Backman, MD, a researcher in pediatrics at Kuopio University Hospital in Finland.

"We found that [about] 30 years after first being hospitalized for bronchiolitis, many of these patients exhibited irreversible airway obstruction -- even though [they] were 28 to 31 years of age," Backman told MedPage Today. She reported her results in a late-breaking poster abstract session at the annual meeting of the European Respiratory Society.

"Irreversible airway obstruction is present 30 years after infantile bronchiolitis for more than 20% of former bronchiolitis patients, suggesting permanent structural changes in airways," Backman said.

Backman and colleagues determined that these patients' airways had been permanently damaged by performing lung function tests before and after administration of bronchodilating medications. But there were no differences in lung function among the bronchiolitis patients, compared with controls or with patients who had been hospitalized with pneumonia in childhood.

"The lack of effect among the bronchiolitis patients of these medicines leads us to believe that the disease has irreversibly damaged their lungs," she said.

In the study, Backman and colleagues identified 83 children hospitalized for bronchiolitis and 44 who were hospitalized for pneumonia at Kuopio University Hospital in 1981-82. All the children in the study were under 2 years of age. "All these children had viral infections in their lungs," she said. "What differentiates bronchiolitis and pneumonia is that the bronchiolitis children have their illness accompanied by this wheezing."

In 2010, the researchers tracked down 47 of the bronchiolitis patients and 22 of the pneumonia patients and compared them with controls who had avoided hospitals as youths. The researchers also recruited 138 healthy, matched controls. All the subjects then underwent multiple lung function tests, such as forced vital capacity, FEV1, the FVC-FEV-1ratio and the FVC/FEV1-ratio % of predicted (FEV%).

They found irreversible airway obstruction that could be considered COPD in five of the bronchiolitis patients (P=0.012); in one of the pneumonia patients (P=0.360), and in two of the controls. "I think that if we had more pneumonia patients, then that number would be statistically significant too. These are both serious diseases in infancy."

Irreversible airway obstruction -- defined as an FEV % of less than 88% -- was observed in 21% of bronchiolitis patients (P=0.001); in 9% of pneumonia patients (P=0.247), and in 4% of controls.

Backman said making comparisons between the bronchiolitis patients and pneumonia patients was difficult because there were few pneumonia patients.

"These findings are similar to what we are finding in our children," Guilia Cangiano, MD, resident in pediatrics at Sapienza University in Rome, told MedPage Today. "Our children have reached the age of 6 and we are seeing these kinds of long-term problems." She did not participate in Backman's study.

Read article here.

Genetic Test Could Predict Lasting Asthma Symptoms

Asthma for many, is certainly a combination of genetic risk and environmental exposure.  Tests may be available in the future to help identify risk.  Dr. Susarla

Genetic Test Could Predict Which Kids Will Have Lasting Asthma Symptoms

Half of children with asthma will continue to suffer from the respiratory disorder as adults, and a new genetic test could reveal who remains at risk past childhood.

About one in 11 children suffers from asthma, according to the Centers for Disease Control (CDC), and although half will eventually grow out of the condition, a recent CDC survey found that medical costs of asthma and its complications add up to about $56 billion each year. Improved treatment of those most likely to live with their condition longer term, say experts, could help to lower some of these costs, which include treating complications and mismanaged symptoms.

Researchers report in the journal Lancet Respiratory Medicine that a new genetic test may be able to predict a child’s risk of having asthma into adulthood, and therefore help doctors figure out which children might need more intensive care in childhood to potentially lower their risk of longer term symptoms.

The new study piggy backs on so-called genome-wide association (GWAS) studies, which compare those affected by asthma to those who are not to isolate specific genetic markers that could be associated with the disease. In the 40-year long study, Duke University researchers developed a genetic risk score that was based on 15 variants gleaned from previous GWAS, and looked at how these scores matched up to physical symptoms of asthma over time among 880 participants. The genetic score reflected only individual participant’s asthma risk, independent of family history.

The kids with higher scores, which meant they were more likely to possess more of the genetic markers linked to asthma, were also more likely to have asthma symptoms as adults, based on a 38 year follow-up. Those with the higher genetic risk also tended to miss school or work or be hospitalized for their symptoms more often than those with lower genetic scores.

Family history of asthma, the researchers say, did not appear to correlate with a higher genetic risk of the disease; many of the participants with high genetic risk had no family history of asthma, and conversely, people with a strong family history of the disease showed low genetic risk. That suggests that many of the cases were caused by environmental factors such as exposure to pollution or other irritants that have been linked to respiratory problems.

That means that doctors may need to expand the criteria they use to assess asthma risk to include measures such as genetic factors, which may be more predictive of future disease than family history. “What we are discovering in GWAS and doing molecular studies of asthma, is giving us new information over and above the old fashioned way we used to evaluate the genetic risk for asthma and still are in the clinic, which is to take family histories,” says study author Dan Belsky, a postdoctoral Fellow at Duke University. “I think that we are seeing more and more genomic medicine as time goes on. It is really coming into play in cancer medicine. It is not yet there in the treatment of asthma, but I think it will be coming. This study shows some of what may be possible.”

Belsky says scientists are far from knowing which genetic factors are directly responsible for causing asthma, but GWAS are a first step toward narrowing down the field of likely candidates. Most experts believe that for conditions such as asthma, multiple genes may contribute to the disease’s symptoms, so panels such as the one discovered in the current study could help to triage patients and ultimately guide them toward the most effective treatments — both in childhood and in adulthood.

Read article here.

Impulse Oscillometry Offers Hope of Early Diagnosis of Asthma

Impulse oscillometry is an advanced lung function testing method that allows early asthma diagnosis and better prediction in loss of asthma control.  Dr Susarla

Impulse Oscillometry Offers Hope of Early Diagnosis of Asthma

A study led by researchers at NIAID suggests that impulse oscillometry (IOS), a non-invasive method for measuring lung function, is more effective in detecting asthma in children than spirometry, the commonly used method. The results appear in the August 2011 issue of Pediatric Pulmonology.

Background

A child uses an IOS machine to measure lung function. Credit: NIAID

Jason¹ was only 3 years old when he first arrived at the Pediatric Allergy Clinic at the National Institutes of Health (NIH), in Bethesda, Maryland. He had a history of severe allergic reactions to food and suffered from chronic atopic dermatitis, also called eczema. Recently, he had developed recurrent coughing and wheezing. His doctor suspected asthma and prescribed daily use of inhaled corticosteroids.

Before adding another drug to Jason’s daily regimen, his parents wanted conclusive proof that he had asthma. The standard test used to diagnose asthma, called spirometry, requires that a person exhale vigorously into a machine for 10 to 15 seconds. As a result, younger children and some adults with physical impairment may not be able to use the test. Because of Jason’s age, he would have to wait two to three years before he could take a lung function test to confirm his doctor’s diagnosis.

“A challenge for clinicians is how to make an accurate diagnosis in cases when the patient is not capable of performing the test required for that diagnosis,” said Hirsh D. Komarow, M.D., of the NIAID Laboratory of Allergic Diseases.

New Technology

IOS is a newer method of measuring lung function that has gradually been gaining acceptance by clinicians. The IOS machine works by producing small-pressure oscillations (vibrations) that are applied at the mouth and transmitted into the lungs. Measuring how the respiratory system responds to these impulses during natural breathing provides an indirect analysis of lung function. Unlike spirometry, IOS is non-invasive and easy-to-perform and requires minimal assistance from the patient.

“IOS offers several advantages over spirometry in the evaluation of young children in clinical practice,” said Dr. Komarow, “We sought to answer the question: Are the test results obtained from IOS as accurate as those produced by spirometry.”

Study Results and Significance

Dr. Komarow’s study compared results from lung function tests measured by IOS and by spirometry in 117 children who already were receiving medical care at the NIH Pediatric Allergy Clinic.

“The data were conclusive,” said Dean Metcalfe, M.D., chief of the Laboratory of Allergic Diseases, “In these children, IOS was not only more sensitive than spirometry, it was more specific in identifying children with asthma.”

This is a promising advance in asthma care. Asthma is a chronic lung disease that affects more than 22 million people in the United States, including nearly 7 million children under age 6. Early diagnosis of asthma promises several benefits: parents are able to more closely monitor their child for respiratory symptoms that may worsen asthma; doctors can track the course of the disease over a longer time period to better predict its outcome; and there are studies that indicate that beginning asthma treatment at a younger age improves long-term control of the illness.

Dr. Komarow examined Jason using IOS and in moments confirmed that Jason had asthma.

“I was pleased that Jason could be evaluated with IOS at the clinic,” said Dr. Komarow, “We made an objective diagnosis and he is receiving appropriate treatment to manage his asthma. This would not have been possible without IOS.”

Read article here.

Adding to the state of asthma research in children, there appear to be specific genes that confer risk of wheezing in children possibly portending risk of asthma as well.  Dr. Susarla

Genetic Variants and Wheezing Put Kids At Risk For Asthma

Almost every toddler will sniffle through a cold by the time they are three, but if they wheeze while they’re sick, they may be at higher risk of developing asthma.

Previous research found that wheezing-related illnesses can increase a child’s risk for developing asthma, and other studies connected certain genetic factors to this heightened tendency to wheeze. In a new study published in the New England Journal of Medicine, researchers connected the two and found that 90% of three-year-olds with a combination of specific genes and a particular wheezing illness were diagnosed with asthma by the age of 6.

The scientists focused on a region of chromosome 17, known as 17q21 that has been associated with an elevated risk of asthma early in life. Two genes in the region likely increase this risk — ORMDL3 and GSDMB. Variants of these genes, which are relatively common, seemed to confer higher risk of wheezing when children were infected with the rhinovirus, which is responsible for the common cold. About half of the infants in the study had one copy of the variant, while a quarter had both copies, which significantly increased their likelihood of wheezing and developing asthma.

The researchers included children from two separate study groups, all of whom came from families with a history of allergies or asthma. The first group included 200 children toddlers with at least one, and possibly two parents who had allergies or asthma while the second group consisted of Danish toddlers whose mothers were diagnosed with asthma. Among children without the high-risk genetic variants for asthma, 40% who wheezed when they caught a cold before age three developed asthma by age six, compared to 60% who had one copy of the variant and wheezed, and 90% of those who had two copies and also wheezed.

“We found that the interaction between this specific wheezing illness and a gene or genes on a region of chromosome 17 determines childhood asthma risk. The combination of genetic predisposition and the child’s response to this infection has a huge effect,” said study author Carole Ober, a Blum-Riese Professor of Human Genetics at the University of Chicago in a statement.

Overall, the children with the genetic and wheezing illness combination were almost four times as likely to develop asthma compared to kids who did not have the genetic variation or did not wheeze, suggesting that wheezing might be a relatively easy marker for identifying toddlers who might be at highest risk of developing asthma later.

The biological mechanisms underlying the connection are not well understood, but to get a better idea of what’s going on, the researchers collected blood from 100 healthy adults and exposed their immune cells to human rhinovirus. Infection with the cold virus seemed to make the asthma-related genes on chromosome 17 more active, possibly leading to more wheezing.

If the results are confirmed, then doctors and parents could be more alert to early signs of wheezing, and consider testing for the presence of the genetic variants that could increase the risk of asthma. Such early intervention could help to limit exposure to asthma triggers, such as cigarette smoke, bisphenol A and other potential irritants, and hopefully reduce the severest symptoms as well.

Read article here.

Spring Can Be Especially Challenging For Asthma Patients

Spring is both a beautiful and ominous time, depending upon whether you are sensitized for allergies.  For children with asthma, it can especially be problematic since children with asthma are often likely to have coexisting allergies.  Below is a summary of allergies and asthma and an often misunderstood problem known as small airways disease. Dr. Susarla

Spring Can Be Especially Challenging For Asthma Patients Spring Allergies May Trigger Increased Inflammation in the Airways

(NAPSI)—While many people are excited about the warmer weather and blooming flowers that springtime brings, nearly 40 million Americans are also preparing for the onslaught of seasonal allergy symptoms. For some, springtime allergies can feel like a cold that just won’t go away, but for others, spring allergies can be a trigger for more serious respiratory conditions like asthma. People with asthma can experience chronic inflammation in both their large and small airways, which in turn can make the airways of the lungs very sensitive. Similar to tree limbs, the airways of the lungs are divided into “branches,” or bronchial tubes that begin with the large, main bronchi and then break off into many small airways in the lungs. Increasing evidence suggests that these small airways, when inflamed, may play a significant role in contributing to asthma symptoms and attacks. If inflammation is not treated properly, each time the airways are exposed to triggers, like pollen or other spring allergens, the inflammation increases and asthma symptoms are more likely to occur. There have been many advances in drug delivery over the past several years, which have led to the availability of treatments that target the small airways in particular—and when used daily, as prescribed, have the ability to improve asthma control. “About half of all asthmatics also have allergies,” said Dr. LeRoy Graham, pediatric pulmonologist at Georgia PediatricPulmonology Associates. “Spring allergies may seem like a small inconvenience to some people, but for a person with persistent asthma, allergy season can be very problematic, particularly among people who may not have been keeping up with daily asthma treatments before spring allergies hit. During spring allergies, daily asthma management is critical to help reduce inflammation in the large and small airways of the lungs and control asthma.” While inflammation can be a defense mechanism for the body, it can also be harmful if it occurs at the wrong time or lingers when it is no longer needed. When allergens, like pollen, are inhaled, the body can mistake them for an invader and attack them. When this occurs, the body produces chemicals that cause inflammation around the allergen to isolate and destroy it. The airways of people with asthma are even more sensitive to allergens, which can cause the inner linings of the airways to become inflamed, leaving less room for air to move through. Additionally, the muscles surrounding the airways tighten up and the mucus glands in the airways may produce thick mucus, which can further block the large and small airways. While asthma is a chronic condition and has many triggers beyond just spring allergens, it can be successfully managed and may not hinder people from doing the things they enjoy. A new website, www.GetSmartAboutAsthma.com, offers tips about managing asthma and inflammation in the large and small airways. The website also offers downloadable materials, like a symptom tracker, doctor discussion guide and asthma diary, so that patients can track their own asthma symptoms and triggers, during spring allergy season and throughout the year. Read article here.

No Blood Test Yet for Asthma

Asthma is a syndrome diagnosed on the basis of history, physician findings, and some amount of office based testing.  As of yet, there is no blood test that can accurately predict asthma. Fortunately, "non-invasive" testing is available to assist in making the diagnosis. Dr. Susarla

Severe childhood asthma blood test hopes dashed

Blood eosinophil counts do not reliably reflect airway eosinophil concentrations in children with severe, therapy-resistant asthma, and therefore cannot be used to make therapeutic decisions, researchers report.

The findings are a disappointing set back in the development of a blood test to substitute more invasive techniques to measure airway inflammation, which has previously shown promise for adults with severe asthma.

"Our data suggest that if blood eosinophilia is present, it is highly probable that airway eosinophilia ([bronchoalveolar lavage] and biopsy) is also present, but if the blood eosinophil count is normal, it is not possible to predict whether airway eosinophilia is present," say Sejal Saglani (Imperial College London, UK) and colleagues.

The study, reported in Allergy, included 88 children aged 6-17 years with severe, therapy-resistant asthma. Patients underwent blood tests, exhaled nitric oxide measurement, sputum induction, bronchoalveolar lavage, and endobronchial biopsy.

Of 86% of children with normal blood eosinophil counts, 84% had evidence of airway eosinophilia detected either by bronchoalveolar lavage or endobronchial biopsy.

Conversely, all 12 children with elevated blood eosinophil levels had eosinophilia on brochoalveolar lavage, and nine had biopsy eosinophilia.

The authors showed that blood eosinophil levels of more than 0.2 x 10⁹/L predicted eosinophilia on bronchoalveolar lavage or endobronchial biopsy with negative predictive values of only 65% and 33%, respectively.

Saglani and colleagues explain that the management of severe, therapy-resistant asthma is optimal when guided by inflammatory phenotype in adults. While there is currently no comparable evidence to support this premise in children, the authors say that treating children on the basis of airway inflammation could avoid unnecessary treatment with increasingly potent anti-inflammatory medications.

However, their current results suggest that invasive methods will continue to be needed to determine pediatric inflammatory phenotypes.

"As peripheral blood counts are not reliable in characterizing airway inflammation in severe asthmatic children exposed to high dose inhaled and maintenance oral steroid therapy, bronchoscopy with [bronchoalveolar lavage] should be considered," they conclude.

Read article here.

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Health Tip: Does Asthma Affect Your Sleep?

Take medications as your doctor prescribes

By Diana Kohnle

Friday, January 25, 2013

(HealthDay News) -- Asthma can affect your sleep, as symptoms often worsen at night.

The National Sleep Foundation offers this advice to help control asthma and enjoy a better night's sleep:

• Take all medications as prescribed, at the same time each day.
• Use a peak flow meter regularly to monitor changes in lung function.
• Learn what your asthma triggers are, and take steps to avoid those triggers.
• Get plenty of sleep each night.
• Ask your doctor about the potential benefits of an anti-inflammatory medication.

HealthDay

Junk food linked to asthma and eczema in children

Asthma is a complex chronic medical condition with many genetic and environmental contributors.  Although food exposure does not suggest cause, research like this is certainly relevant and deserves attention.  Dr. Susarla

The high saturated fat levels in food such as burgers lower children's immune systems, it is believed.

A research project involving more than 50 countries found that teenagers who ate junk food three times a week or more were 39 per cent more likely to get severe asthma. Younger children were 27 per cent more at risk.

Both were also more prone to the eye condition rhinoconjunctivitis, according to The Sun newspaper

But just three weekly portions of fruit and vegetables could cut that risk by 14 per cent in the younger group and 11 per cent among the teens, it is believed.

Researchers from New Zealand's Auckland University looked at the diets of 181,000 youngsters aged six to seven and 319,000 aged 13-14.

The scientists then asked if the children had allergy symptoms.

They wrote in the journal Thorax, where the study is published: "Fast food may be contributing to increasing asthma, rhinoconjunctivitis and eczema.

"Regular consumption of fruit and vegetables is likely to protect against these diseases."

In the UK alone 1.1 million children already suffer with asthma and one in five get eczema.

The team of researchers warn that their results do not prove cause and effect.

Read article 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.

Yes this does seem... fishy.  There could be other reasons to explain this association.  We will have to wait and see.  Dr Susarla.

Does Eating Fish During Infancy Cut Asthma Risk?

FRIDAY, Nov. 16 (HealthDay News) -- Adding fish to babies' diets during the first year of life might reduce their risk of asthma later on, a study by Dutch researchers suggests.

This window of protection appears to occur between 6 months and 12 months of age. Adding fish to the diet before that or not at all in the first year seems to carry an increased risk of wheezing and shortness of breath, the researchers said.

"This study provides insight into what the optimal timing of introduction can be for fish," said lead study author Jessica Kiefte-de Jong, from the pediatrics and epidemiology departments at Erasmus Medical Center in Rotterdam.

[See: Top Recommended Infant Formulas]

"The results may assist health care workers about the recommendations regarding the introduction of complementary feeding in infants," she added.

Pediatricians may not agree with the findings, however. One expert objects to feeding children fish at such a young age because of potential harms.

"I have never heard that fish is a preventive against asthma," said Dr. Antonio Rodriguez, director of pediatric pulmonology at Miami Children's Hospital.

"There is a danger of an allergic reaction feeding fish to children under 1 year of age," he said. "In addition, there is always concern about the toxicity of mercury in fish."

This is why fish is not fed to infants, he said.

Kiefte-de Jong agreed that before parents start introducing fish to their infants these findings need confirmation in a real clinical trial. She also said the researchers aren't quite sure why eating fish at this age might benefit children's lung health.

[See: Top Recommended Children's Multivitamins]

For the study, published online Nov. 12 in the journal Pediatrics, the research team collected data from a population-based study of more than 7,200 children born between April 2002 and January 2006 in Rotterdam.

Reviewing questionnaires on overall diet, the researchers looked at when parents introduced fish to their infants' diets. They also looked at symptoms of asthma that developed at ages 3 and 4 years.

Children who started eating fish at 6 to 12 months had a significantly lower risk of wheezing when they were 4 years old compared with children who began eating fish later, Kiefte-de Jong's group found.

For children who started eating fish earlier -- or not at all -- within the first year, the risk for wheezing increased at 4 years, they noted. The risk of shortness of breath increased slightly as well.

The researchers acknowledged that other factors besides when the children started eating fish might have influenced the children's breathing ability at preschool age. And the study did not prove that the introduction of fish during the first year of life prevented asthma later on.

Read article here.

Smokers' Kids Don't Get a Break in Cars

The conventional wisdom is probably not enough.  A home smoke-free policy is important, but it is not enough if cigarette smoke exposure occurs in other places, like the car.  Children with asthma and recurrent respiratory infections are especially susceptible.  Dr. Susarla

Smokers' Kids Don't Get a Break in Cars

Most parents who smoke don't make strong efforts to protect their kids from it in the car, a trial-based survey showed.

Less than a third reported having a policy of keeping the car smoke-free, said Jonathan Winickoff, MD, MPH, of Massachusetts General Hospital for Children in Boston, and colleagues.

Nearly half of those who had no such policy said they smoked with their child in the car, the group reported in the December issue ofPediatrics.

While there is "no safe level of exposure" to tobacco smoke, secondhand smoke inside a vehicle is especially problematic.

"Studies have shown that smoking one cigarette in a confined space such as inside a car creates unsafe levels of respiratory suspended particles," Winickoff's group pointed out.

Rolling the window down doesn't help much. One experiment showed that air quality was still as bad as in a smoky bar, and that residual toxins remain on surfaces in the car even when a cigarette isn't actively lit.

Aside from raising their risk of cancer, exposure contributes to children's risk of lower respiratory infections, sudden infant death syndrome, and ear infections as well as worsening asthma.

The researchers examined exit interviews with smokers who served as controls as part of the larger Clinical Effort Against Secondhand Smoke Exposure, a pediatric office-based intervention trial.

Among the 795 parents with a car who were interviewed, 73% said they or someone else had smoked in the car in the prior 3 months. The researchers reported that of the 562 parents who did not have a smoke-free car policy, 48% smoked in the car when their children were present.

Fewer than one in three parents (29%) reported having a smoke-free car policy. Only 24% reported having a strictly enforced (no tobacco in the prior 3 months) smoke-free car policy.

By comparison, 57% of the parents reported having a strictly enforced policy of no smoking in the home.

Smoke-free cars tended to go along with smoke-free homes, as 82% of smokers with a strictly-enforced car policy stuck to such a strategy at home too.

However, the association didn't go the other direction. Most parents (66%) who kept their kids from being exposed in the home didn't do so for the car, "suggesting that parents may not recognize tobacco smoke exposure in cars as an important exposure source for their children."

Conversations with pediatricians on the topic appeared to be uncommon.

Although about one in five parents reported having been asked about their smoking status, just 14% had been asked about whether smoking was allowed in their vehicle, and 12% were advised to have a policy of no smoking in the car.

After adjustment for other factors, smokers with an infant under 1 year of age were 64% more likely to have a strict no smoking in the car policy.

Lighter smokers (≤10 cigarettes per day) were substantially more likely to forgo smoking in the car, with an adjusted odds ratio of 3.59. However, having more than one smoker in the home lowered the chances of a strictly enforced smoke-free car policy by 44%, with an aOR of 0.56.

"Childhood tobacco smoke exposure in confined spaces should be considered an intervention priority in the pediatric setting because children's exposure to tobacco smoke is involuntary, and no one other than the child's healthcare provider may have the opportunity to advocate for smoke-free cars," the researchers concluded.

They cautioned that the study results were based on self-reporting that may have been subject to recall and response bias and without implying causality.

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The potential of household mold to cause respiratory disease has sometimes been sensationalized.  However, there is definitely an association with asthma.  This new research suggests that having household mold exposure in infancy may increase risk for asthma later in life.  Dr. Sarat Susarla

Infants Exposed to Specific Molds Have Higher Asthma Risk

ScienceDaily (Aug. 2, 2012) — In the United States, one in 10 children suffers from asthma but the potential environmental factors contributing to the disease are not well known. Cincinnati-based researchers now report new evidence that exposure to three types of mold during infancy may have a direct link to asthma development during childhood.

These forms of mold -- Aspergillus ochraceus, Aspergillus unguis andPenicillium variabile -- are typically found growing in water-damaged homes, putting a spotlight on the importance of mold remediation for public health.

Lead author Tiina Reponen, PhD, and colleagues report these findings in the August 2012 issue of theJournal of Allergy and Clinical Immunology, the official scientific publication of the American Academy of Allergy, Asthma and Immunology.

In a long-term population study of nearly 300 infants,, researchers from the University of Cincinnati (UC), U.S. Environmental Protection Agency (EPA) and Cincinnati Children's Hospital Medical Center assessed allergy development and the respiratory health of children annually for the first four years of life then again at age 7 -- an early age for objective diagnosis of asthma in children. The team also monitored home allergens and mold. All infants enrolled in the study were born to at least one parent with allergies.

They found that 25 percent of children whose parents had allergies were asthmatic by age 7. Among the multiple indoor contaminants assessed, only mold exposure during infancy emerged as a risk factor for asthma at age 7.

"Previous scientific studies have linked mold to worsening asthma symptoms, but the relevant mold species and their concentrations were unknown, making it difficult for public health officials to develop tools to effectively address the underlying source of the problem," explains Reponen, who is a professor in the UC College of Medicine's environmental health department.

The UC-based team used the environmental relative moldiness index (ERMI), a DNA-based mold level analysis tool, to determine that exposure to Aspergillus ochraceus, Aspergillus unguis and Penicillium variabile was linked to asthma development in the high-risk study population. The ERMI tool was developed by the EPA to combine analysis results of 36 different types of mold into one index that describes a home's cumulative mold burden.

"This is strong evidence that indoor mold contributed to asthma development and this stresses the urgent need for remediating water damage in homes, particularly in lower income, urban areas where this is a common issue," says Reponen. "Therapeutics for asthma may be more efficient if targeted toward specific mold species."

Children included in this study were part of the Cincinnati Childhood Allergy and Air Pollution Study (CCAAPS), a long-term population-based study of more than 700 children from the Greater Cincinnati area. CCAAPS looked at the effects of environmental particles on childhood respiratory health and allergy development. Participants were identified during infancy as at high risk to develop allergies based on family medical history

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