Winter is worse time for people with asthma

Asthma symptoms may remain dormant for some time before surfacing during a high risk time period.  Winter and "virus season" often uncovers asthma that may not be adequately controlled. Dr. Susarla

Winter is worse time for people with asthma 

(CNN) — Asthma affects more than 22 million Americans of all ages.

It can be challenging, even dangerous, for asthmatics who don't take proper care of themselves.

And the wintertime poses its own set of triggers.

Gayle Richardson is breathing easier these days, now that she has her asthma under control.

But certain things trigger her condition, especially this time of year.

“I have more issues with asthma in the wintertime because of the colds and the flu virus that are floating around, if I get something like that, it will definitely have a stronger effect on me,” Richardson explained.

This is common in people with the chronic lung condition, says Dr. Stanley Fineman:

“Because the asthmatic has airways that are very hyper-sensitive, they're already inflamed, so the virus does more damage in the asthmatic patients than they would do in somebody who doesn't have asthma.”

Inflamed and swollen lungs can make it difficult to breathe.

To minimize attacks during winter, Dr. Fineman offers advice to patients.

Most importantly, know your triggers.

Cold air can exacerbate the condition, as can windy weather.

But also, stay on long-term control medication.

Remember indoor irritants too, things like: smoke, scented candles and fireplaces.

He recommends a flu shot for everyone with the condition.

And his final tip to keep healthy could be the simplest.

Good hand washing and good hygiene is also important.

Read article here.

Take your child's word for it on asthma, study finds

Many parents may be surprised by the subtlety of their child's asthma symptoms.  This frequently leads to underestimation of asthma severity.  Dr. Susarla

Take your child's word for it on asthma, study finds

SAN ANTONIO -- Children's perceptions of living with asthma may differ significantly from their caregivers' perceptions, which means both should be interviewed when they visit the doctor's office, a new study from UT Kids San Antonio and the Center for Airway Inflammation Research (cAIR) shows.

The study analyzed the agreement between 79 children and their caregivers on health-related quality-of-life questionnaires. The children ranged in age from 5 to 17. Fifty-three were classified as having acute asthma and 26 had refractory, or treatment-resistant, asthma.

Include children

"The take-home message is that children need to be included in the communication process with health care providers, and physicians need to elicit the child's perspective on their illness, health status, asthma symptoms and what is being done to treat their illness," said senior author Pamela Wood, M.D., Distinguished Teaching Professor of pediatrics in the School of Medicine at The University of Texas Health Science Center at San Antonio.

UT Kids is the clinical practice of the Department of Pediatrics. cAIR is a newly established research center at the Health Science Center's South Texas Research Facility that focuses on controlling and preventing acute and chronic airway diseases. The director is Joel Baseman, Ph.D.

Encouragement needed

Study lead author Margaret Burks, M.D., a 2013 graduate of the School of Medicine who is now an intern at Vanderbilt University, said children should be empowered to take control of their asthma. "Encouraging an environment where children can talk freely with their caregiver is important, and can start with allowing the child to participate in the office visit," Dr. Burks said. "It is important that children feel that their response to their disease is valued, not only by their physician but by their caregiver, as well."

Children were asked to rate their own limitations on activity, while caregivers were asked to rate the effect that the children's limitations had on family activities. "Overall, children viewed themselves as less impaired, in comparison to how caregivers viewed the limitations that the asthma placed on the family," Dr. Wood said.

Overcome barriers

Parents may not want to acknowledge a lack of communication when they go to a doctor's office. "I think there is often a concern in the minds of caregivers about how they appear to the physician," Dr. Burks said. "Caregivers may not want to seem out of touch with their child's day-to-day health, and, in such fear, they may dominate the conversation at the office visit. Our study demonstrates that it is helpful to gain insight from both the caregiver and the child."

Describing life with asthma to a health care provider can be an inexact science, to be sure. "There is no gold standard," Dr. Wood said. "We can't use a thermometer to measure quality of life."

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.

Does IVF Increase Risk for Asthma?

The cause of this association is not clear, but premature infants especially under 30 weeks gestation seem to be more prone to develop asthma symptoms like recurrent wheezing.  Dr. Susarla

Fertility treatment 'asthma link'

Continue reading the main story

In a study of more than 13,000 UK children, five-years-olds were about twice as likely to have asthma if they were not conceived naturally.Children born after fertility treatments, such as IVF, may have a slightly higher chance of developing asthma, research suggests.

The children were also more likely to need medication, which could be an indication of more severe asthma.

The findings were published in the journal Human Reproduction.

The researchers, at the Universities of Oxford and Essex, analysed data from children born between 2000 and 2002.

Researcher Dr Claire Carson said 15% of all the children in the study had had asthma at the age of five, but this proportion had risen to 24% among the 104 of them born through assisted-reproduction technologies.

She said it was interesting that the pattern had emerged, but far too soon to say if IVF treatment resulted in higher rates of asthma. Other explanations, such as genetics, may explain the association.

Dr Carson told the BBC that parents should not be put off IVF.

"Assisted reproduction technologies offer a chance to become a parent when there isn't another option," she said.

"For the majority of children asthma is quite manageable."

Malayka Rahman, from the charity Asthma UK, said: "This study suggests that there might be an association between IVF treatment and asthma developing in children, but the sample size for this study is small and currently the research in this area generally is not conclusive.

"Those considering IVF should speak to their GP about the benefits and health risks in order to make an informed decision."

Read article here.

RSV (respiratory syncitial virus) early in life seems to uncover the potential of developing asthma later in life.  It is still unclear why.  Some researchers have uncovered the role of immune system alterations that may explain this increased risk.  Dr. Susarla

How childhood virus leads to adult asthma

U. PITTSBURGH (US) — The normal immunity babies receive from breast milk is disabled by a common childhood virus, raising the risk of developing allergic asthma later in life.

Early in life, regulatory T cells, or Treg, play an important role in the establishment of immune tolerance, which can prevent the immune system from triggering an allergic reaction to antigens such as pollen and dust, write senior authors Anuradha Ray and Prabir Ray, both professors of medicine and immunology at the University of Pittsburgh School of Medicine.

“We know that recurrent infections by respiratory syncytial virus (RSV) that require hospitalization in early life increase the risk for asthma in adult life,” notes Anuradha Ray. “But, until now, it hasn’t been clear why this happens.”

“So we went from ‘bedside to bench’ to better understand the immunological impact of early, repeated RSV infection and to see if it affects Tregs,” explains lead author, Nandini Krishnamoorthy, postdoctoral associate, Division of Pulmonary, Allergy, and Critical Care Medicine.Allergens and biologic molecules that suppress the immune system are transferred from mothers to infants via breast milk, which induces protective regulatory Tregs in the infants help block the development of allergic diseases later in life, such as asthma.

As reported online in the journal Nature Medicine, the research team first fed newborn mice with breast milk from their mothers, who in turn had been exposed to the egg-white protein ovalbumin every other day for 10 days, to see if the babies would become tolerant to the protein.

The newborn mice were weaned after 21 days, and then some of them were infected with RSV several times for the next three weeks to mimic human infection. In the sixth week, the young mice were challenged with ovalbumin.

Mice that had not been infected with RSV did not have an immune response to the ovalbumin, to which they had been exposed through their mothers’ milk, indicating they had developed tolerance for it. Those that had been repeatedly infected with RSV, however, had increased immune cell infiltration in their airways and increased mucus production when challenged with the egg protein.

In another experiment, Treg cells were isolated from either the RSV-infected or uninfected mice and transferred into ovalbumin-exposed animals, which were then challenged with the protein. The cells from the uninfected mice, but not those from the infected ones, potently prevented airway inflammation and other markers of allergic reaction.

RSV also promoted the production of regulatory proteins called cytokines that foster inflammation, as well as triggered other changes in the cellular microenvironment altering the function of Treg cells.

“So without the suppressive function of the Tregs, the mice developed inflammatory immune responses to the ovalbumin allergen and developed asthma-like symptoms,” says Prabir Ray, who initiated the study.

“If the memory Tregs are crippled early in life, an important protective mechanism against allergens is lost, which increases susceptibility to asthma.”

“These studies suggest a link between early RSV viral infection and the development of adult allergy via direct effects of the virus infection on the very important regulatory T cell,” says Mark T. Gladwin, chief of the Division of Pulmonary, Allergy and Critical Care Medicine.

“From a clinical standpoint, efforts to control RSV infection or to enhance activation of regulatory T cells with breastfeeding and other strategies appear to be a promising approach to reducing our current asthma and allergy epidemic.”

Researchers from Emory University, Vanderbilt University, and Children’s Healthcare of Atlanta contributed to the study, which was funded by the National Institutes of Health.

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.

Hot Sticky Summer Days Can Pose Risks for Children With Asthma

In Houston, we experience a high number of ozone days during the summer.  For some children and adolescents, prolonged outdoor exposure can trigger asthma attacks.  Watch for "ozone alert" days.  Dr. Susarla

Avoiding asthma dangers on hot, humid days

It’s been hot all week -- okay, make that all summer -- in Boston, with air quality alertsissued as the temperature and humidity level climb. Poor air quality can pose particular dangers for those who have asthma and other lung diseases.

Hot humid air traps ozone and particulate matter, which can irritate the lining of lung airways, triggering wheezing and breathing difficulties in asthma patients, according to Dr. Elliot Israel, director of the respiratory therapy department at Brigham and Women’s Hospital.

“For some patients, irritation builds over time and they experience problems after several poor air quality days, but for others it takes just one blast,” Israel said.

Asthma sufferers shouldn’t run around outdoors on humid days that hit 90 degrees or above, Israel recommended. “Don’t do a 40-minute run if that’s what you usually do. Stick with a 10-minute run in the morning and a 10-minute run in the evening.”

In fact, he offers that same advice for anyone during hot sticky weather. Humidity increases the possibility of heat-related illnesses because our body’s cooling mechanisms don’t work as well on humid days. Instead of our sweat evaporating, as it would in dry heat, it clings to our skin, trapping heat.

But it’s tough to tell a 9-year-old with asthma that he can’t play capture the flag or soccer at an outdoor summer camp for days on end.

On “yellow” air-quality days like today -- which means the air quality is acceptable for most but may pose some problems for those with lung conditions -- kids with asthma can probably continue their normal actitivities but should keep their inhaler on hand just in case they need to use it more. But if it’s a hazardous air quality day -- an orange or red on the air quality index -- they should head for sitting activities in the shade and stick to indoor exercise in an air conditioned facility, Israel recommended.

An estimated 4,500 Americans die every year from asthma attacks, including former Globe reporter Anthony Shadid.

“Commonsense is what’s needed on those bad air days,” he said, “and an ounce of prevention is worth a pound of cure.” Those who experience an aggravation of their lung condition due to the heat -- uncontrolled wheezing, shortness of breath, or an inability to speak in complete sentences -- should seek immediate medical attention.

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

What's in a Wheeze?

The search continues for the perfect home asthma test... the pediatric lung specialist is still the gold standard.  SS

iSonea begins recruiting for pediatric asthma trial

By: Brian Dolan | Mar 28, 2012   

iSonea, makers of the WheezoMeter, has begun recruiting for a post-market study of its asthma monitoring device for children under the age of 12 years old. The company aims to determine the device’s ability to accurately assess wheeze rate in a group of pediatric patients. The study is expected to include about 95 participants and will be based in Folsom, California,according to the clinical trial’s listing on clinicaltrials.gov.

iSonea’s core offering today is a medical device called the WheezoMeter, a point of care, handheld device that “analyzes 30 seconds of breath sounds using advanced signal processing algorithms to detect, quantify and objectively document the presence of wheeze and its extent,” according to iSonea’s website. The company is currently seeking an over-the-counter (OTC) status for the WheezoMeter from the FDA. Last month iSonea announced plans to leverage Qualcomm’s 2net platform for home health devices.

“Asthma impacts more than 7 million children in the United States, and the number of children expected to be diagnosed with this chronic condition continues to climb at alarming rates,” Dr. Jonathan Freudman, medical director for iSonea, stated in a company release. “This study is an important milestone for iSonea. In the pediatric asthma population, it is challenging to accurately monitor and manage asthma symptoms in patients using conventional techniques. The WheezoMeter has the potential to meet a critical unmet need for better, easy to use monitoring tools for young asthma patients.”

At the HIMSS event in February, iSonea demonstrated its device as part of the Qualcomm Life booth. While the company’s setup included an image of an iPhone app called Asthma Sense (pictured), the app is not yet available for download from Apple’s AppStore.

In the future, iSonea hopes to become hardware agnostic and create smartphone peripherals that work like its WheezoMeter today. Assuming the FDA grants the Wheezometer OTC status based on the bench validation study the company currently has underway, iSonea CEO Michael Thomas said the company plans to create smartphone-based versions of the medical device for iPhone, Android, and BlackBerry devices. Thomas told a journalist in Australia last year that since there were about half a billion smartphones sold the world over in the past year, and there are expected to be about 1 billion smartphones sold in 2015, the smartphone has become the most efficient way for iSonea to get its technology to the 300 million people worldwide who have asthma.

Read more below:

http://mobihealthnews.com/16797/isonea-begins-recruiting-for-pediatric-asthma-trial/

Early Detection of Asthma Flare-Ups Reduces Hospitalizations

Early detection leads to prompt treatment of symptoms... which reduces emergency room visits and hospitalizations.  A good line of communication with a pediatric asthma specialist is the key.  S Susarla

Reducing Hospital Admissions for Asthmatics

ScienceDaily (Apr. 4, 2012) — Children with moderate or severe asthma attacks who are treated with systemic corticosteroids during the first 75 minutes of triage in the Emergency Department (ED) were 16% less likely to be admitted to hospital. This highlights the importance of adopting a strategy to rapidly identify and begin treating children with moderate or severe asthma attacks directly after triage, according to a team of investigators working at the Sainte-Justine University Hospital Center (UHC), the University of Montreal, McGill University and the Research Institute of the McGill University Health Centre (RI MUHC).

"We knew that corticosteroids could help avoid hospital admissions and relapses. However, just how delays between ED admission and administration of the treatment impacted outcomes remained unclear," says Dr. Sanjit K. Bhogal, the lead author of a new study published in Annals of Emergency Medicine and graduate of the Department of Epidemiology, Biostatistics and Occupational Health at McGill.

"Our study demonstrates that, to be effective in preventing hospital admission, treatment with corticosteroids should be administered within 75 minutes of triage, regardless of patient age," says the senior author Dr. Francine Ducharme, who supervised the study while she was a McGill and RI MUHC researcher based at the Montreal Children's Hospital.

According to Dr. Ducharme, now pediatrician and researcher at Sainte-Justine UHC, "in fact, the earlier the treatment is given within this time frame, the more effective it is, hence the advantage of starting treatment right after triage. Furthermore, beginning early treatment reduces ED stay by almost 45 minutes for patients who will be discharged from the ED."

The challenge now is to ensure that the severity of the asthma attack is flagged at the triage stage in order to initiate treatment immediately. In fact, it seems that patients who are treated "too late" were due, for the most part, to not been given high triage priorities or to physicians not being able to assess them early enough. ED congestion did not significantly impact on the time frame for administering corticosteroids.

"Given the findings of the study, the need to implement a nursing strategy that involves identifying the severity of the child's condition and beginning treatment as soon as a patient arrives in the ED, seemed obvious," said Dr. Ducharme, who is also clinical epidemiologist at the Sainte-Justine UHC, where the study data were compiled and analyzed. Dr. Ducharme also holds the Academic Chair in Clinical Research and Knowledge Transfer in Childhood Asthma at the Sainte-Justine UHC Research Center and is a full professor in the Faculty of Medicine of the University of Montreal.

The pediatric respiratory assessment measure (PRAM) scale, developed by Dr. Ducharme's team, was used to identify the degree of severity of the asthma attack and to rapidly initiate the severity-specific treatment recommended by asthma guidelines. At the Sainte-Justine UHC, Dr. Ducharme' s team has now develop a teaching module that will allow training of the triage nurses, ED physicians, and respiratory therapists to implement severity-specific guidelines and, whenever possible, to avoid patients being admitted to hospital.

The educational module will be available online by the end of 2012 on the University of Montreal's website. It is eagerly awaited by health institutions in Ontario and Alberta, as well as in several institutions in the US, which have decided to adopt the proposed treatment protocol based on the PRAM scale and who wish to receive training. The tool is an offspring of the integration of research, education and health care. As such, it will make it possible to transfer the knowledge acquired through the study to the EDs around the world, for the direct benefit of patients and their families.

http://www.sciencedaily.com/releases/2012/04/120404101953.htm

Asthma Signs in Early Infancy

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

Lung Function Deficits in Babies May Lead to Future Asthma

Joanna Broder

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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