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Tests cut child asthma steroids

July 5th, 2008

Testing the breath and phlegm of children with severe asthma might spare them potentially damaging oral steroid drugs, say scientists

From BBC NEWS

The tests could help spot early the signs of worsening asthma, allowing it to be brought back under control.

Research by Imperial College London suggested the tests cut the use of oral steroids by nearly a third over a three-year period.

A national guideline already recommends the use of sputum tests in adults.

It’s a much more efficient way of making sure children with severe asthma get the treatment they need
Professor Andrew Bush
Imperial College, London

One in 10 children has asthma, making it the most common long-term medical condition of childhood.

Many asthmatic children have a steroid inhaler to help them control the asthma, but if this is not working, then higher doses of steroid are given in tablet or medicine form to get it back under control, and reduce the risk of serious attacks or hospitalisation.

Doctors try to avoid using these “rescue steroids” unless they have to, because if used too frequently, side effects can include growth problems.

The Imperial team’s tests look for signs of increasing lung inflammation – the presence of cells called eosinophils in the sputum, and higher than usual levels of nitric oxide gas in the breath.

These signs could appear before the symptoms of asthma themselves changed.

They compared the progress of children assessed using symptoms and lung function tests – the conventional way – with a group given the sputum and breath tests.

In either case, if doctors judged that the asthma was likely to be worsening, they increased the dose of the steroid inhalers used by the children.

If this failed to improve matters, oral steroids were used.

‘Efficient’

They found that, on average, there was a 29% reduction in the number of courses of oral steroids used by the children in the sputum and breath test group.

A third of the children in that group did not need any courses of oral steroids, compared with 12.5% of those in the conventionally monitored group.

Professor Andrew Bush, who led the research, said: “It’s a much more efficient way of making sure children with severe asthma get the treatment they need.”

His colleague Dr Louise Fleming said that the aim was not only to reduce the number of severe attacks, but to make sure that children were not on too high a dose of inhaled steroids all the time.

Professor Chris Brightling, from the Institute of Lung Health at Leicester University, said a recent guideline had suggested these techniques be used to help control severe asthma in adults.

He said it was likely that children with severe asthma would also benefit.

“These are a measure of the control of inflammation, and this measurement can be an ‘early warning sign’ of an exacerbation of asthma.”

Dame Helena Shovelton, from the British Lung Foundation, which funded the research, said that “targeted treatment” was “good news” for children with asthma.

Household Cleaners, Air Fresheners Linked to Asthma in Adults

May 5th, 2008

From NaturalNews.com

Regular use of household cleaning sprays and air fresheners may increase the risk of adult-onset asthma, according to a new study published in the American Journal of Respiratory and Critical Care Medicine.

Researchers analyzed data from the European Community Respiratory Health Survey, which collected epidemiological data at 22 centers in 10 countries. They followed this up with face-to-face interviews of 3,503 people who did the cleaning in their home and were free of asthma when the study began. Participants answered questions about the frequency of their use of 15 kinds of cleaning products. The researchers then followed up nine years later, using an interview to determine the participants’ current asthma and wheeze levels, and the occurrence of physician-diagnosed asthma and allergy.Those who used cleaning sprays at least once per week were 50 percent more likely to have increased asthma symptoms, wheeze, or asthma medication use in nine years than those who used such products less frequently. Those who used sprays at least four times per week were significantly more likely to have been diagnosed with asthma by a physician than those who used them less frequently.

The strongest association was found with air fresheners, glass cleaners and furniture-cleaning sprays.The researchers found no association between the use of non-spray cleaners, such as solvent stain removers and washing powders, and the incidence of asthma. There was also no apparent asthma increase associated with infrequently used spray products, such as oven cleaners.The researchers concluded that exposure to cleaning products may be responsible for as many as one in seven cases of adult-onset asthma.

In an accompanying editorial, Kenneth D. Rosenman of Michigan State University noted that there is no legal requirement for companies to test products for the tendency to produce certain categories of allergic reactions, including asthma.

Delaying DPT Vaccination May Reduce Incidence of Childhood Asthma

April 24th, 2008

FromMedScape

Childhood asthma is reduced by half when the first dose of diphtheria, pertussis, and tetanus (DPT) is delayed by more than 2 months vs given during the recommended period, according to the results of a retrospective longitudinal study reported in the March issue of the Journal of Allergy & Clinical Immunology.

“Early childhood immunizations have been viewed as promoters of asthma development by stimulating a TH2-type immune response or decreasing microbial pressure, which shifts the balance between TH1 and TH2 immunity,” write Kara L. McDonald, MSc, from the University of Manitoba in Winnipeg, Manitoba, Canada, and colleagues. “Differing time schedules for childhood immunizations may explain the discrepant findings of an association with asthma reported in observational studies. This research was undertaken to determine whether timing of diphtheria, pertussis, tetanus (DPT) immunization has an effect on the development of childhood asthma by age 7 years.”

The investigators analyzed data from the complete immunization and healthcare records of a cohort of children born in Manitoba in 1995, from birth until age 7 years. Using multivariable logistic regression, they computed the adjusted odds ratio for asthma at age 7 years according to the timing of DPT immunization.

Among 11,531 children who received at least 4 doses of DPT, the risk for asthma was halved in children in whom administration of the first dose of DPT was delayed by more than 2 months. For children with delays in administration of all 3 doses, the likelihood of asthma was 0.39 (95% confidence interval [CI], 0.18 – 0.86).

“We found a negative association between delay in administration of the first dose of whole-cell DPT immunization in childhood and the development of asthma; the association was greater with delays in all of the first 3 doses,” the study authors write. “The mechanism for this phenomenon requires further research.”

Limitations of this study include possible ascertainment bias; findings not yet confirmed with the diphtheria, acellular pertussis, tetanus (DaPT) vaccine; and inability to refute the issue of early-life infections as an explanation for the association between delayed immunization and protection against the development of asthma.

“Further study is vital to gain a detailed understanding of the relationship between vaccination and allergic disease, because a perception that vaccination is harmful may have an adverse effect on the effectiveness of immunization programs,” the study authors conclude.

Breast milk helps lungs but not if mom has asthma

November 21st, 2007

From News – Revolution Health

Breast-feeding seems to protect children from asthma later in life, but only when the mother does not have the respiratory disorder herself, U.S. researchers said on Thursday.

They found that breast-feeding for more than four months helped improve lung function in children whose mothers did not have asthma.

But breast-fed children whose mothers had asthma did not benefit and actually showed a significant drop in lung function later in life.

That does not mean women with asthma should stop breast-feeding.

The researchers cautioned that the study, published in the American Journal of Respiratory and Critical Care Medicine, was preliminary and the findings needed more study.

Breast milk is almost always considered best for infants. It can be digested easily and supplies antibodies that can protect babies from bacterial and viral infections, including many of the respiratory tract.

Dr. Theresa Guilbert of the University of Wisconsin-Madison wanted to see if longer breast-feeding — lasting four months or more — improved lung function in children.

She and colleagues at the Arizona Respiratory Center analyzed data from the Children’s Respiratory Study in Tucson, which followed 1,246 healthy infants through adolescence.

Of those, 697 had lung function tests from the ages of 11 to 16 that evaluated air flow and lung volume.

For the most part, breast-fed children with non-asthmatic mothers had better lung volume and no decrease in air flow.

But children of mothers with asthma who were breast-fed four months or more did not show any improvement. In fact, these children had a significant reduction in airflow.

The reason, Guilbert suggested, may be altered lung growth.

Guilbert believes breast milk may contain certain factors that promote lung development, factors that may be impaired in mothers with asthma.

“These findings suggest that growth factors in milk have the potential to modify lung development, which might account for some of the protective effect of breast-feeding,” she wrote.

Researchers found a similar effect in mice born to non-asthmatic mothers who were breast-fed by mothers with asthma. These mice developed airway inflammation.

“It is important to emphasize that the clinical significance of these findings is unknown,” Guilbert wrote.

“Further study is needed to confirm our findings and to determine a biological basis for the relationships observed.”

Children With Asthma Often Suffer Developmental And Behavioral Problems

April 19th, 2007

From ScienceDaily:

Much of the research surrounding childhood asthma has sought new approaches to managing the disease. However, little was done to address other conditions that often appear along with asthma including depression and Attention Deficit Hyperactivity Disorder (ADHD), which can negatively affect a child’s ability to cope. Research completed at the University of Virginia Children’s Hospital asserts that until these extra conditions or “co-morbidities” are addressed, asthma education programs will not be able to help young patients to the fullest. The results will be published in the April 12 issue of The Journal of Developmental and Behavioral Pediatrics.

“We can definitively state that families with asthmatic children not only report higher incidences of ADHD, but also of depression, anxiety and learning disabilities,” said Dr. James Blackman, developmental pediatrician at the Kluge Children’s Rehabilitation Center at UVa Children’s Hospital and lead study author. “If we can manage these co-morbidities, we can better help children with asthma and their families to manage the disease in the healthiest way possible.” Data for the research came from the National Survey of Children’s Health 2003, which was obtained from the Centers for Disease Control and Prevention (CDC) National Center for Health Statistics. The survey results came from telephone polls of households with children. Parents who reported that their child had asthma also were asked to report the severity of their children’s asthma and any behavior problems. Information was gathered on a total of 102,353 children from ages 0-17 years during 2003-2004. The survey results were analyzed using SUDAAN, specialized software for analyzing clustered data.

The study uncovered depression, anxiety, behavioral problems, and learning disabilities as co-morbidities common among children with asthma. The more severe the child’s asthma was, the higher the incidence of these types of problems. More than 10 percent of asthmatic children experienced problems that lasted longer than a year and required counseling or treatment. What’s more, these children often missed ten or more days of school, leading parents and caregivers to worry about their children’s healthy academic and emotional development. “What also is important about this research is that it shows how asthma can lead to psychosocial disadvantages for children in our society,” adds Blackman.

While the medical and research establishment should continue to address the societal problems of poverty and poor education, Blackman believes that children with asthma need to receive tailored and precise treatments addressing their physical and mental and developmental health. This could lead to fewer missed days in school and fewer calls home to parents for behavioral and academic problems. “What we’re hoping to see are improved overall outcomes for this vulnerable population,” he said.

Dr. Perlmutter’s Comment: Again, childhood asthma is preventable to a significant degree. I have some important postings on this site with more information on this topic so search the archives section.