Booster Shots

Oddities, musings and news from the health world

Category: asthma

Ancestry, not just race, is important to personal medical history

July 7, 2010 |  2:00 pm

Doctors often ask patients to list their race -- white, Latino, African American, Asian, Native American -- to help them provide better healthcare. They do this because loads of medical research shows that the incidence of certain diseases and treatment success can vary somewhat from race to race.

But the more important question may be: What is your genetic ancestry?

Asthma genetic ancestry race A study released Wednesday in the New England Journal of Medicine examined the accuracy of a lung function test and how race and ancestry played a role in the test's accuracy. A lung function test measures damage to the lungs caused by asthma or other disease. However, the definition of "normal" lung function is known to vary substantially by race. For example, doctors have long known that vital lung capacity (the maximum amount of air that can be expelled after maximum inhalation) is 6% to 12% lower in blacks compared with whites and Native Americans.

Researchers looked at data from more than 3,000 patients that included their lung function test results, standard information on race and additional information on genetic ancestry that was obtained through genotyping. The study found that standard race categories don't capture the extent of ancestral diversity and, thus, may limit the amount of information available to a doctor in making a diagnosis or ordering treatment. Instead, many people have a rich and diverse genetic background that does not lend itself to a simple classification, such as "white" or "Asian."

For example, when using genetic ancestry data, the study showed a strong link between African ancestry and lung function measurement in both men and women. According to the findings, for 6.4% of people in the United States who identify themselves as African American, the actual percentage of African ancestry would be 15% higher or lower than average -- a difference that would result in an incorrect estimation of lung function test, and possibly, mistakes about the severity of lung disease. About 2.1 million self-identified African Americans have asthma. But based on the study conclusions, the severity of the asthma would be misclassified in about 4% of those patients.

"When we force patients into an individual box, such as 'African American' or 'Caucasian,' we're missing a lot of genetic information," senior author of the study Dr. Esteban G. Burchard, of UC San Francisco, said in a news release. "This study provides new evidence that genetic ancestry correlates to physiological measures. With it, we're one step closer to personalized medicine."

On a more practical level, the study points to the need for improvements in measuring lung function in some people. In an editorial accompanying the paper, authors noted: "Refinements are needed for poorly represented or misrepresented populations and for persons of mixed ancestry, who represent an increasing proportion of the U.S. population."

-- Shari Roan
Photo: Getty Images


Black and Latino males twice as likely to have poor health

June 30, 2010 |  8:17 am

Black Latino Men health Given the inequality in healthcare in the United States, it's no surprise that some groups of people suffer far worse health outcomes than people with better resources. But if there is one group that has been especially overlooked in this equation, it's black and Latino boys. The major factor in their poor health, according to a new report by the California Endowment, is where they live. Growing up in poor and stressful neighborhoods with limited healthcare resources leads to poor health.

According to the findings in the report:

  • The odds of poor health outcomes for boys and men of color are more than two times higher than for white boys and men in California.
  • Latino boys are 4.1 times more likely than white boys to suffer from post-traumatic stress disorder.
  • African-American boys are 2.5 times more likely.
  • Latinos are 3.1 times more likely to have limited access to health care and 4.8 times more likely to lack health insurance.
  • Asthma disproportionately affects children who live in poorer neighborhoods.
    Black young men have a homicide rate 16 times greater than that of young white men.
  • African-American and Latino children are 3.5 times more likely to grow up in poverty compared to whites.

Poorer neighborhoods mean less access to stores selling health foods, fewer parks and safe places to run and play in and fewer social networks to promote health and safety.

The California Endowment has launched a 10-year initiative, called Building Healthy Communities, to improve the health of men and boys of color by making strategic improvements in the communities and neighborhoods in which they live. In the report, the group identifies a handful of successful programs to improve the lives of men of color already in place in the state that could be applied on a larger scale -- and why implementing these programs statewide cannot wait.
-- Shari Roan

Photo credit: Carlos Chavez  /  Los Angeles Times

Even healthy children may show asthma-like symptoms during exercise

May 19, 2010 |  1:35 pm

Exercise-induced asthma is a well-known condition in both adults and children. But a new study finds that kids with no history of asthma may exhibit asthma-like symptoms after bouts of intense exercise.

H6zdcykf The study, presented at the American Thoracic Society's international conference in New Orleans this week, included 56 healthy children, average age 15. Researchers from UC Irvine and Miller Children's Hospital in Long Beach gave each child two exercise tests -- one at a constant work rate, the other a progressive test usually done to measure aerobic capacity.

After testing for pulmonary function, 45% of the study participants had at least one abnormal result. That was seen in 14% of participants after the constant work rate test, in 20% after the progressive test, and 11% had at least one abnormal result after both tests. No substantial differences were found in the number of abnormal outcomes in the two tests.

Decreases in pulmonary function can occur when heavy exercise triggers an inflammatory response, constricting bronchial tubes.

"We did not expect to see pulmonary function abnormalities after short periods of heavy exercise in such a large number of healthy children in our subject population," said Dr. Alladdin Abosaida, lead author of the study, in a news release. "We speculate that either the inflammatory response to exercise or cellular changes that may occur as the result of dehydration of the airway surface, or both, led to mild airway obstruction."

Abosaida added that more research is needed to discover why this type of lung dysfunction might be occurring in children.

-- Jeannine Stein

Photo: Healthy children may experience asthma-like symptoms during exercise, according to a new study. Credit: Wally Skalij / Los Angeles Times

High-fat foods may trigger airway inflammation, study finds

May 16, 2010 |  2:31 pm

People with asthma are familiar with typical triggers such as exercise, allergies and smoking that can bring on inflammation. Add to that list high-fat meals, which may also increase inflammation in airways, according to a new study.

E5xbvfgw Australian researchers did tests on 40 people with asthma who were randomly assigned to eat different meals. One was a high-fat meal of fast food hamburgers and hash browns that came in at 1,000 calories, with 52% of calories from fat. The other was a 200-calorie low-fat meal of reduced fat yogurt with 13% of calories from fat. Included in the high-fat test group were 16 obese people; the rest of the study participants were not obese.

Before and after the meals, sputum samples were taken from the test subjects to be analyzed for inflammatory markers. Those who ate the high-fat meals showed a significant boost in airway neutrophils compared with those who ate the low-fat meal. Neutrophils are a common type of white blood cell found in the body's airways while an asthma attack is happening, as well as afterward. Those who ate the high-fat meal also showed an increase, compared with the low-fat group, in a gene expression that is another marker for inflammation.

Eating the high fat meal also prompted a suppressed response to albuterol, a bronchodilator that increases air to the lungs. The obese and nonobese participants in the high-fat group did not differ in their responses.

"The observation that a high-fat meal changes the asthmatic response to albuterol was unexpected as we hadn't considered the possibility that this would occur," said Lisa Wood, a research fellow at the University of Newcastle in Australia, in a news release. Wood, lead author of the study, added, "We are designing more studies to investigate this effect. We are also investigating whether drugs that modify fat metabolism could suppress the negative effects of a high fat meal in the airways. If these results can be confirmed by further research, this suggests that strategies aimed at reducing dietary fat intake may be useful in managing asthma."

The study was presented at the American Thoracic Society's international conference in New Orleans this week.

-Jeannine Stein

Photo: High-fat meals may trigger airway inflammation responses in those who have asthma. Credit: Anacleto Rapping / Los Angeles Times

How NOT to help your lungs: natural medicine with lead

May 3, 2010 |  9:34 am

The FDA is warning consumers not to buy or consume a product called Vita Breath after a sample of the product was shown to contain 10,000 times the recommended limit for lead in candy. Vita Breath is marketed as an herbal supplement for people with asthma. It "supports healthy Lung Energy and Respiratory system," according to the website selling it (for $65 a bottle of 60 -- roughly a month's supply).

The New York Department of Health and Mental Hygeine conducted the first test of Vita Breath after a patient turned up with lead poisoning in New York and reported taking it and two other herbal supplements. The FDA says it has obtained samples of the product and is testing them.

Vita Breath is manufactured by American Herbal Lab Inc. of Rosemead, Calif., and it's marketed on the Internet and at health fairs around the country. The FDA recommends that anyone who has taken the product — especially children, who are particularly vulnerable to lead poisoning — get tested. Lead poisoning doesn't always show symptoms but can damage internal organs and the nervous system over time. But stomach pain, nausea, vomiting, diarrhea, weight loss and bloody or decreased urine output all are signs of acute poisoning.

— Melissa Healy

Free asthma screenings coming to a town near you

May 2, 2010 |  8:00 am

Asthma Los Angeles-area allergists will conduct free asthma screenings as part of the Nationwide Asthma Screening Program beginning Tuesday in Marina del Rey. The program is a yearly event sponsored by the American College of Allergy, Asthma and Immunology. It's a great opportunity for people who have limited health resources to be checked for this pernicious illness. More than 23 million Americans have asthma. Many people have the disease and yet have never been diagnosed and treated.

"With the right diagnosis and treatment, including medication, anyone with asthma can be active, Dr. John Winder, chair of the Nationwide Asthma Screening Program, said in a news release. "No one should accept anything less. If you've experienced these symptoms or just want to make sure you have good control of your asthma, attend a free screening and find relief."

The screening will include a 20-question questionnaire, a lung function test and a consultation with an allergist.

Upcoming screenings include:

  • Tuesday, 9:30 a.m. to 5 p.m., at Marina del Rey Medical Offices, 4650 Lincoln Blvd., Marina del Rey
  • May 7, 9 a.m. to 5 p.m., Bravo Pharmacy at Superior Grocers, 7316 S. Compton Ave.
  • May 25, 12 p.m. to 1:30 p.m., Calle Mayor Middle School, 4800 Calle Mayor, Torrance

Click for a list of asthma screening locations and dates and for more information on asthma.

-- Shari Roan

Photo: A woman listens to instructions before taking her lung function test at a free asthma screening. Credit: American College of Allergy, Asthma and Immunology

FDA phasing out asthma inhalers using CFC propellant

April 13, 2010 | 11:01 am

The Food and Drug Administration said Tuesday it is taking a long-expected step and phasing out the production and sale of asthma inhalers using chlorofluorocarbons as a propellant. The chlorofluorocarbons, commonly known as CFCs, were once widely used in a variety of applications, especially as refrigerants, because of their inertness, but they have been shown to damage the Earth's ozone layer, which protects life from the damaging effects of the sun's ultraviolet rays. Most uses of the chemicals have already been abandoned. Medical devices employing them are among the last to be affected.

Four of the seven devices using CFCs are no longer being made, but they are being banned to prevent their reintroduction. The rest will be forbidden after the end of 2013. Patients using inhalers will be able to buy alternative inhalers containing the same drugs but using different propellents — most notably hydrofluoroalkane, which is destroyed in the atmosphere before it can reach the ozone layer.

The devices that are no longer being made and whose sale will be forbidden after June 14 are:

  • Tilade Inhaler, made by King Pharmaceuticals
  • Alupent Inhalation Aerosol, made by Boehringer Ingelheim Pharmaceuticals
  • Azmacort Inhalation Aerosol, made by Abbott Laboratories
  • Intal Inhaler, made by King Pharmaceuticals

The three products whose sale will be permitted until Dec. 31, 2013, are:

  • Aerobid Inhaler System, made by Forest Laboratories
  • Combivent Inhalation Aerosol, made by Boehringer Ingelheim Pharmaceuticals
  • Maxair Autohaler, made by Graceway Pharmaceuticals

The agency cautioned against buying any of the banned products over the Internet because they are often mislabeled or do not contain effective ingredients.

Information on inhalers that do not use CFCs can be found here.

— Thomas H. Maugh II

Rodent of the Week: Could patients with severe asthma benefit from bone marrow transplants?

March 19, 2010 |  7:00 am

Rodent Cases of severe, therapy-resistant asthma are on the rise worldwide, and new strategies are needed to treat the estimated 100,000 people who die of asthma every year. Researchers from the National Institutes of Health and their colleagues are exploring a radical solution – bone marrow transplants.

Scientists know the transplants have the potential to reset the immune system and calm an overactive inflammatory response. They’re already used to treat patients who develop acute graft-versus-host disease following an organ transplant. Asthma also involves excessive inflammation, prompting the airways to constrict and the lungs to secrete mucus. Why not reboot the immune systems with a bone marrow transplant?

To test their theory, the researchers gave the transplants to asthmatic mice that were allergic to ragweed. Then, when the mice were exposed to ragweed, their allergic and asthmatic symptoms (measured by chemical levels in their blood) decreased significantly. The scientists concluded that the bone marrow transplants helped the mice by restoring a healthy balance of immune system cells known as Th1 and Th2.

The results were published online this week in Proceedings of the National Academy of Sciences.

Dr. Eva Mezey, who heads the adult stem cell research section at the National Institute of Dental and Craniofacial Research in Bethesda, Md., told HealthDay that “it’s very likely that the intervention would work in humans.”

But she emphasized that more research is needed before bone marrow transplants could be tested in people with severe asthma. For instance, although the mice got their bone marrow through an intravenous injection, human patients might do better with an aerosol because it could deliver the cells directly to the lungs, she said.

— Karen Kaplan

Photo credit: Advanced Cell Technology Inc.

The air is sick, and so are we

March 2, 2010 | 12:00 pm

We Southern Californians tend to forget that we don't breathe healthful air. More Californians live in areas that don't meet federal air quality standards than residents of any other state. Despite many efforts to improve air quality in the last two decades, the air remains polluted. People who live near freeways or inland have especially poor air quality.

Living this way has consequences. According to a report released Tuesday by the RAND Corp., air pollution in California caused more than $193 million in hospital-based medical care from 2005-07. These were costs related to cases of pneumonia and asthma triggered by poor air quality.

The report estimates that high levels of ozone and particulate matter caused nearly 30,000 emergency room visits during the study period. The biggest problem created by pollution is asthma attacks among children under age 17 -- an estimated 12,000 emergency room visits attributed to air pollution.

The report is titled "The Impact of Air Quality on Hospital Spending."

-- Shari Roan

Photo: Los Angeles skyline. Credit: Nick Ut  /  AP

The FDA warns against taking certain asthma medications alone [Updated]

February 18, 2010 | 10:45 am

Asthma patients should not take inhalable long-acting beta-agonists such as Advair, Symbicort, Serevent and Foradil unless they are also taking inhalable steroids, the Food and Drug Administration warned Thursday. Most patients are already taking both types of drugs together, but the FDA fears that those who take only the one drug have an increased risk of hospitalization and death. The FDA will require drug manufacturers to conduct new studies to explore the safety of the drugs when used in conjunction with inhalable steroids.

The warnings are part of a new safe-use initiative by the agency. The drug labels will be changed to reflect the warning, and physicians will be asked to educate patients about the change.

The warning does not apply to those who take the drugs, commonly called LABAs, for treating chronic obstructive pulmonary disease.

Advair and Symbicort are both combination drugs that include corticosteroids, but the FDA said inhalable steroids should be used even with them. The LABAs relax muscles in the lung's airways, improving a patient's ability to breathe freely and reducing asthma symptoms. Inhalable steroids are the primary medication used to control asthma, and the LABAs are used when the condition cannot be controlled with steroids alone. LABAs do not affect sudden-onset symptoms.

The new warning is based on a meta-analysis of clinical trials that shows that the drugs, used alone, increase the risk of adverse events, including death. The agency said there is not enough information available to determine if there is a risk when they are used in conjunction with inhalable steroids.

The agency's recommendations include:

-- The drugs should only be used in conjunction with an inhalable corticosteroid.

-- The drugs should be used long-term only in patients whose asthma cannot be adequately controlled on steroids alone.

-- LABAs should be used only for the shortest period of time required to achieve control of asthma symptoms and then discontinued.

-- Children should use a combination product such as Advair or Symbicort to ensure that they receive both classes of drugs.

[Updated 1 p.m.: A previous version of this post stated that the FDA recommended that children should use a combination product in conjunction with an inhalable steroid. The recommendation was that children should use  a combination product such as Advair or Symbicort to ensure that they receive both classes of drugs.]  

"The risks of hospitalization and poor outcomes are of particular concern for children," Dr. Diane Murphy, director of the FDA's Office of Pediatric Therapeutics said in a statement. "Parents need to know that their child with asthma should not be on a LABA alone."

-- Thomas H. Maugh II


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