Asthma, Insomnia Make Each Other Worse

One of the reasons asthma can present insidiously is it may manifest more at night.   You may not awaken with obvious symptoms of breathing problems, but sleep is disrupted enough to affect daytime function.  This is a problem I see frequently in children and adolescents.  Parents are often surprised to see how effective treating asthma can be at improving sleep quality.  Dr. Susarla

Asthma, Insomnia Make Each Other Worse

• 
  
• 
  
• 
  
• 0
  inShare
  
• Email

If you experience breathing problems, you might need to actively treat those symptoms, or you could find that you’re being kept awake at night. According to a recent Swedish study, asthma sufferers are far more likely to suffer from insomnia than others.

The trial was a large one, with data collected from 25,610 adults in four Swedish cities. The participants were given a questionnaire that asked questions about insomnia, asthma, rhinitis, weight, height, tobacco use, and physical activity. For the purposes of the study, the researchers defined asthma as taking current medication for the condition or experiencing at least one asthma attack during the last 12 months. Of the 25,610 participants, 1,830 people were defined as being asthmatics. Here’s what the researchers found when they compared asthma and sleep quality:

• The prevalence of insomnia symptoms was significantly higher among asthmatics than non-asthmatics

• For those with nasal congestion and asthma, insomnia symptoms were worse

• The risk of insomnia increased with the severity of asthma

• Asthmatics who had three or more symptoms were more than twice as likely to suffer from insomnia

• Nasal congestion, obesity, and smoking also increased the risk of insomnia

Insomnia is a common problem among asthmatics. The researchers concluded by saying that asthmatics should treat their symptoms, including nasal congestion, to make sure that they get a good night’s sleep. Other lifestyle factors, like smoking and obesity, will also increase your chances of suffering from insomnia if you’re an asthmatic.

Read article here.

Can Eating Your Veggies Prevent Asthma?

This is an interesting study, especially for patients/parents who always ask me what can be done "naturally" to prevent asthma.  As always, it is not clear if there is cause and effect.  However, reducing airway hyperresponsiveness, or the tendency for airway to constrict, is on the main goals of asthma therapy.  Dr. Susarla.

Low vegetable intake is associated with allergic asthma and moderate-to-severe airway hyperresponsiveness

Abstract

Background

In recent decades, children's diet quality has changed and asthma prevalence has increased, although it remains unclear if these events are associated.

Objective

To examine children's total and component diet quality and asthma and airway hyperresponsiveness (AHR), a proxy for asthma severity.

Methods

Food frequency questionnaires adapted from the Nurses' Health Study and supplemented with foods whose nutrients which have garnered interest of late in relation to asthma were administered. From these data, diet quality scores (total and component), based on the Youth Healthy Eating Index (YHEI adapted) were developed. Asthma assessments were performed by pediatric allergists and classified by atopic status: Allergic asthma (≥1 positive skin prick test to common allergens >3 mm compared to negative control) versus non-allergic asthma (negative skin prick test). AHR was assessed via the Cockcroft technique. Participants included 270 boys (30% with asthma) and 206 girls (33% with asthma) involved in the 1995 Manitoba Prospective Cohort Study nested case-control study. Logistic regression was used to examine associations between diet quality and asthma, and multinomial logistic regression was used to examine associations between diet quality and AHR.

Results

Four hundred seventy six children (56.7% boys) were seen at 12.6 ± 0.5 years. Asthma and AHR prevalence were 26.2 and 53.8%, respectively. In fully adjusted models, high vegetable intake was protective against allergic asthma (OR 0.49; 95% CI 0.29–0.84; P < 0.009) and moderate/severe AHR (OR 0.58; 0.37–0.91; P < 0.019).

Conclusions

Vegetable intake is inversely associated with allergic asthma and moderate/severe AHR. Pediatr Pulmonol. 2012; 47:1159–1169. © 2012 Wiley Periodicals, Inc.

Read abstract here.

It's been said before, but it warrants reminding that when it comes to sleep disorders, children are not little adults.  Pediatric sleep medicine is a highly specialized field where the specialties of pediatric pulmonology and neurology intersect to help address problems unique to children.  Although polysomnnography, or "sleep studies" are very similar to adults.  The techniques, equipment, scoring methods , and even personnel are highly specialized.

 A long overdue update to the American Academy of Pediatrics Recommendations was recently published specifically addressing the problem of childhood obstructive sleep apnea.  This guideline discusses important symptoms for parents and physicians such as chronic snoring, mouth breathing, and pauses in breathing during sleep.  But it also discusses less recognized features of sleep disorders such as inattentiveness and hyperactivity which can also result from disrupted sleep.  Talk to your pediatrician if you suspect a sleep problem in your child.  Dr. Susarla

AAP Recommendations for Childhood Sleep Disorders

Sleep disturbances, including obstructive sleep apneasyndrome (OSAS), are common in children and can result in significant health problems if left untreated.

In a revised clinical practice guideline, “Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome,” published in the September 2012 Pediatrics (published online August 27), the American Academy of Pediatrics (AAP) recommends that all children or adolescents who snore regularly be screened for OSAS.

Additional symptoms can include labored breathing during sleep, disturbed sleep with frequent gasps, snorts or pauses, and daytime learning problems. It is important for children exhibiting signs of OSAS to get a comprehensive diagnosis by having an overnight, in-laboratory sleep study done.

If left untreated, OSAS can result in problems such as behavioral issues, cardiovascular problems, poor growth and developmental delays. Treatments are available that can result in significant improvements in these complications. Adenotonsillectomy is effective in treating OSAS and is recommended as the first line of therapy. Obesity can be a risk factor, so physicians may recommend weight loss in addition to other therapies in overweight or obese children. Post-operatively, physicians should be aware of the criteria suggesting which patients should be admitted and when other treatment should be considered, such as CPAP.

Read article here.

I love good iconoclastic research that blows up our entire way of thinking about disease. -JR

New Genetic Pathway Behind Neurodevelopmental Disorders Discovered

ScienceDaily (Dec. 6, 2012) — Researchers at the Douglas Mental Health University Institute, have discovered a new genetic process that could one day provide a novel target for the treatment of neurodevelopmental disorders, such as intellectual disability and autism.

The research study, which appears in the December issue of the American Journal of Human Genetics, was led by Carl Ernst, a Douglas Institute researcher, an assistant professor in McGill's Department of Psychiatry and a Canada Research Chair in Psychiatric Genetics. Ernst and his colleagues found that genetic mutations that negatively affect brain development can occur in a gene family of previously unknown function in the human genome.

According to the World Health Organization, neurodevelopmental disorders affect one in six children in industrialized countries. Impairing the growth and development of the brain or central nervous system, neurodevelopmental disorders encompass a broad range of conditions, including developmental delay, autism spectrum disorders and cerebral palsy. People with neurodevelopmental disorders can experience difficulties with language, speech, learning, behaviour, motor skills and memory.

Mutations in genes are thought to underlie many neurodevelopmental disorders, but all genes important for brain development found to date are in a single pathway. Genes are coded in DNA that gives way to RNA, which gives way to protein. Proteins form the functional unit of the body and are the major players in all biological activity. Prior to the current study, all genetic mutations important for neurodevelopmental disorders, occurred in genes that make protein.

The work of Ernst and his research team identified an important shortcut in the process of making functional molecules for brain development. By sequencing the genomes of 200 people with neurodevelopmental disorders and chromosomal abnormalities, and comparing the results to more than 15,000 control samples, the researchers made a surprising discovery: some individuals had mutations in a gene that did not make protein.

"Our discovery tells us that mutations in genes that code only for RNA and do not make protein can have a functional impact and lead to neurodevelopmental abnormalities," Ernst says. "In previous studies of brain development, RNA was just considered a middle player -- one that only served as a template for the production of proteins." ....

more 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.

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.

Asthma Patients Often Depressed

Adjustment to a chronic disease can be difficult.    This study suggests that patients with asthma should be closely monitored for depressive symptoms.  Every effort should be made to reduce the impact of asthma on daily life.

Asthma Patients Often Depressed

ANAHEIM, Calif. -- Depression and asthma appear to go hand in hand, even in patients whose asthma is relatively mild and who report generally good health, a researcher said here.

Analysis of some 13,000 participants in the Cooper Institute Longitudinal Study indicated that a diagnosis of asthma was a risk factor for reports of significant current depressive symptoms with an odds ratio of 1.41 (95% CI 1.16 to 1.65, P<0.001) after adjusting for asthma severity and self-assessment of overall health status.

Asthma and a previous history of depression also were significantly associated, with an odds ratio of 1.65 (95% CI 1.40 to 1.90,P<0.001), Tim Trojan, MD, of the University of Texas Southwestern Medical Center in Dallas, told attendees at the American College of Allergy, Asthma, and Immunology annual meeting.

Associations between asthma and depression have been reported before, Trojan explained, but those studies could not rule out the possibility that patients were simply sad about feeling sick with asthma.

Consequently, he and his colleagues utilized records from the Cooper Institute Longitudinal Study, begun in 1970 by the institute's founder, Kenneth Cooper, MD, the aerobics advocate. The database has unusually detailed information on patients including spirometry values, scores on the Center for Epidemiologic Studies Depression Scale (CES-D), medical history, body mass index, and lifestyle factors such as smoking and drinking status, as well as standard demographics.

Trojan and colleagues analyzed data on 12,944 study participants, including 1,169 with a diagnosis of asthma. Of these, only 187 were on controller medications, suggesting that the sample mostly included people with relatively mild asthma.

About 81% of the overall sample indicated that their health status was good or excellent, as opposed to fair or poor. Current depressive symptoms (CES-D scores of 10 or higher) were present in 11% and a past history of depression in 14%.

Bivariate analyses indicated that the risk of depressive symptoms was significantly increased, not only by a diagnosis of asthma, but also by female gender, hypertension, and current smoking. It was significantly decreased in nonwhites, those with more than a high school education, age older than 50, and current drinking.

Multivariate analysis produced the odds ratio 0f 1.40 for depressive symptoms with an asthma diagnosis. When expressed as an r² correlation coefficient, the value of 0.119 suggested that the relationship was only modest at best, Trojan said.

But a classification analysis based on the association correctly categorized 89.5% of study participants, he said.

The same held true for the association between asthma and depression history. The r² correlation coefficient was 0.110, but the classification analysis categorized 85.7% of participants correctly, Trojan said.

He noted that the study had a number of limitations including the fact that some of the data such as depression history and smoking and drinking status were self-reported, and the Cooper Institute database consists of people who are "mostly white and mostly healthy." Trojan added that they are probably relatively affluent as well, although income data are not collected.

Nevertheless, he said, the study findings "mean that your mild asthmatic ... who doesn't look or feel all that bad still has a significant risk, or could have a significant risk, of having depressive symptoms and should be evaluated for this."

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.

Read article here.

Study Finds Premature Babies More Likely to Have Sleep Apnea

This large study from Australia tells us that something about prematurity predisposes babies to develop obstructive sleep apnea.  This condition is caused by obstruction of the upper airway during sleep that can lead to daytime problems with cognition and behavior.  Dr. Sarat Susarla

Study Objectives:

Investigate the relationship between gestational age and weight for gestational age and sleep apnea diagnosis in a cohort of children aged up to 6 years old.

Design:

A cohort study, using record linked population health data.

Setting:

New South Wales, Australia.

Participants:

398,961 children, born between 2000 and 2004, aged 2.5 to 6 years.

Measurements:

The primary outcome was sleep apnea diagnosis in childhood, first diagnosed between 1 and 6 years of age. Children with sleep apnea were identified from hospital records with the ICD-10 code G47.3: sleep apnea, central or obstructive.

Results:

A total of 4,145 (1.0%) children with a first diagnosis of sleep apnea were identified. Mean age at first diagnosis was 44.2 months (SD 13.9). Adenoidectomy, tonsillectomy, or both were common among the children diagnosed with sleep apnea (85.6%). Children born preterm compared to term were significantly more likely to be diagnosed with sleep apnea (< 32 weeks versus term hazard ratio 2.74 [95% CI: 2.16, 3.49]) this remained even after adjustment for known confounding variables. Children born small for gestational age were not at increased risk of sleep apnea compared to children born appropriate for gestational age, hazard ratio 0.95 (95% CI 0.86-1.06).

Conclusions:

This is the largest study investigating preterm birth and sleep apnea diagnosis and suggests that diagnosis of sleep disordered breathing is more prevalent in children born preterm, but not those who are small for gestational age.

Journal abstract here.