Booster Shots

Oddities, musings and news from the health world

Category: asthma

Hey, parents, be on the alert for signs -- early signs -- of an asthma attack

February 12, 2010 | 11:56 am

Inhaler Parents can hope all they'd like. But they can't assume that their children's early asthma-attack symptoms will simply go away. Of course, first they have to learn to recognize the symptoms as such -- and then they have to learn what to do about them.

Researchers at Washington University School of Medicine in St. Louis contacted 101 parents of children who had ended up in the emergency room or an urgent-care situation because of asthma attacks. They wanted to find out what those parents generally notice about their children's symptoms -- and what they generally do about it.

All parents reported that, yes, their kids routinely experienced at least one consistent sign of an impending attack, whether it was a cough, wheezing, shortness of breath, behavior change or the like. But 1 in 4 didn't fear an imminent attack until the symptoms had progressed -- sometimes to the point at which the kids were gasping for breath or experiencing retraction (in which the skin of the chest is pulled in among the ribs of  with each inhale).

Without early treatment, well... that's how you can end up in the ER.
Here's the full study, published recently in Annals Of Allergy, Asthma & Immunology.

The researchers point out that obviously there's some need for education among parents of asthmatic kids. They suggest, for starters, better home use of asthma drugs.

Here's more on asthma in children from eMedicinehealth.

-- Tami Dennis

Photo credit: Getty Images

Let's put vitamin D in the water

January 28, 2010 |  6:11 am

Vitamin D is synthesized in the skin via sunlight. But according to piles of research in recent years, most people aren't getting enough of the nutrient, and deficiencies may contribute to cancer, diabetes and cognitive decline. The latest study links vitamin D deficiency and asthma.

Asthma In a study at National Jewish Health in Denver, researchers found that adult asthma patients with the highest levels of vitamin D in their blood had better lung function compared with people with the lowest levels.  Higher vitamin D levels were associated with an increased response to dexamethasone, an inhaled steroid that many patients use to control their symptoms. The study, published today in the American Journal of Respiratory and Critical Care Medicine, also found that obese asthma patients tended to have lower vitamin D levels.

"Our findings suggest that vitamin D levels influence a number of important features of asthma, including lung function, bronchospasm and therapeutic response to steroids," Dr. Rand Sutherland, chief of the pulmonary division at National Jewish Health, said in a news release. "The next question to answer is whether giving supplemental vitamin D will lead to clinical improvements in patients with asthma. We are developing prospective studies to answer that."

Here's an August 2009 Los Angeles Times story discussing the emerging research on vitamin D deficiency. Maybe adding it to water isn't a great idea, but neither is overexposure to sunlight. Supplements anyone?

-- Shari Roan

Photo credit: Getty Images

Difficult asthma may be due to difficult patients

October 24, 2009 |  6:00 am

Asthma can be a tough condition to treat in certain patients. But according to a new study, the difficulty may sometimes lie with the patients, not the medication.

The study, published in the Nov. 1 issue of the American Journal of Respiratory and Critical Care Medicine, found that people don't always adhere to the prescribed dosages for inhaled and oral asthma medication, even when they say they do. Researchers from Belfast City Hospital and Queen's University Belfast in Northern Ireland analyzed data on 182 people who were referred to a clinic specializing in dealing with difficult asthma cases. None of the participants were suspected of not complying with their doctors' prescriptions, and none said they were noncompliant about their prescriptions during their first visit to the clinic.

Researchers looked at physician prescriptions for a six-month period and compared it to the patients' refill rates. They also checked blood plasma prednisolone and cortisol levels to see if the patients were complying with their doctors' orders and taking their oral medications as prescribed.

Not all were. Only 35% filled less than half of their inhaled combination therapy, and 21% filled more than what was prescribed. A little less than half filled between half and all their prescribed medication.

After examining levels of prednisolone and cortisol in the blood, researchers determined that 45% were not taking prescribed levels of their oral medications. Most admitted as much in follow-up conversations with the researchers. Women were less compliant than men, which researchers believe needs further study.

In a news release, study co-author Dr. Liam Heaney of Belfast City Hospital said, "Of these patients who were referred for assessment and treatment of difficult asthma, many are actually not taking their treatment as prescribed, which would suggest an important first course of action in assessing difficult asthma may actually be verifying the patient's adherence to his or her treatment protocol. Determining whether the patient is taking medications as prescribed is of utmost importance before moving to more aggressive and expensive treatments."

-- Jeannine Stein

Daycare doesn't protect against asthma later

September 8, 2009 | 10:43 am

Daycare The "hygiene hypothesis" is a theory that young children who are exposed to a variety of germs will have a lower risk of developing asthma and allergies later in life. Studies on the hypothesis have been inconsistent. The latest study, published today in the American Journal of Respiratory and Critical Care Medicine, concludes that daycare has no effect on later respiratory illnesses.

The researchers, in the Netherlands, followed nearly 4,000 Dutch children over eight years. Parents completed questionnaires at various intervals of the child's life, from pregnancy to age 8. At that age, more than 3,500 of the children were assessed for specific allergies and asthma. Daycare use was also assessed each year.

The study found that children who started daycare early were twice as likely to experience wheezing in the first year of life compared with those who didn't go to daycare. But as the children became older, the illness pattern shifted. There was a trend for less wheezing among early attendees. By age 8 there was no association between daycare attendance and wheezing. The only children who stood out in the study were those who had early daycare attendance and older siblings. Those children had more than a fourfold higher risk of frequent respiratory infections and more than twofold risk of wheezing in the first year compared with children without older siblings and daycare.

"Children exposed to both early daycare and older siblings experienced most infections and symptoms in early childhood, without a protective effect on wheeze, inhaled steroid prescription or asthma symptoms until the age of eight years," the lead author of the study, Dr. Johan C. de Jongste, said in a news release. "Early daycare merely seems to shift the burden of respiratory morbidity to an earlier age where it is more troublesome than at a later age. Early daycare should not be promoted for reasons of preventing asthma and allergy."

-- Shari Roan

Photo credit: Luis Sinco  /  Los Angeles Times

Obesity linked to brain shrinkage, erectile dysfunction

August 25, 2009 | 12:11 pm

The L.A. Times' science and health staff has recently been accused of an ongoing campaign against fat people. Commenting on a post Monday, reader Big Jim Slade predicted "tomorrow we'll have another fat assault on how breathing the same air as fat people is dangerous...Maybe we should waterboard them, eh?"

Don't shoot us, Big Jim: We're just the messengers!

But for those of you who share Big Jim's sense of persecution, let me say, I feel your pain. If you think it's hard reading our drumbeat of reporting on the health effects of obesity, imagine what it's like for, say, a significantly overweight health reporter to write this stuff on a daily basis. (Trust me, I'd rather be at the gym--though a controversial recent report suggests that won't help me lose any weight either.)

Which brings me to the latest crop of bad news on being obese--and there is just no way to sugarcoat this pair of studies, my friends: being fat makes your brain shrink and, if you are a man, your penis limp.

A new brain-imaging study by researchers at UCLA and the University of Pittsburgh finds that the brains of overweight and obese subjects were on average 4% and 8% smaller, respectively, than the brains of those who were at a healthy weight--evidence, according to UCLA neurology professor and study author Paul Thompson, of "severe brain degeneration."

For the obese--those with a BMI over 30--the news is particularly bad: the areas of significant observed shrinkage were the frontal temporal lobes, the seat of higher-order reasoning and judgment; the anterior cingulate gyrus, key to attention and decision-making as well; the hippocampus, where long-term memories are processed, and the basal ganglia, from which smooth movement is initiated.

Overweight people--those with a BMI over 25--also had shrinkage in the basal ganglia, as well as in the parietal lobe, where we integrate sensory input and position ourselves in space, and in the brain's white matter, which helps speed messages among regions of the brain that must work together for us to function properly.

After virtually weighing and measuring the brains of 94 subjects over age 70, the study authors concluded that the brains of the overweight appeared, on average, eight years older than those of subjects at healthy weight. Brains of the obese appeared 16 years older. While the subjects scanned in the study showed no outward signs of cognitive impairment at the time of the study, the study's authors predicted the premature aging and loss of brain volume they observed would put heavier subjects at greater risk of Alzheimer's disease and other degenerative brain diseases.

Why? Because a big, robust brain under attack by these diseases can often compensate for their ravages for some time--forestalling the onset of symptoms. But a shrunken brain is not so resilient. Memory loss, movement problems and cognitive deficits are far more likely to show up early for overweight and obese patients. This study is published online in the journal Human Brain Mapping.

The current issue of the "journalzine" Obesity and Weight Management--free online this month-- explores another, better-known fellow-traveler of obesity: erectile dysfunction. Erectile dysfunction is a common side effect of high blood pressure and atherosclerosis. Those conditions can lead to blockage of the major arteries that lead to the brain and the heart, causing stroke and heart attack, respectively. But they also can lead to "microvascular disease," including erectile dysfunction, say University of Colorado physician Adam Gilden Tsai and the University of Pittsburgh's Adam Sarwer.

Tsai and Sarwer present the case study of a 48-year-old man whose BMI is 32.6--considered "mildly obese," with erectile dysfunction that is not relieved by the use of tadalafil, the erectile dysfunction medication better known as Cialis.

There is, at least, some good news: A study expected to be published next month in the Lancet by the UCLA-Pitt researchers that observed brain shrinkage is expected to suggest that physical exercise can help spare even the obese some of the consequences of their excess weight. And, the patient with erectile dysfunction was medicated for his high blood pressure and, after dietary counseling, lost 4.6% of his body weight--just under 10 pounds. "The patient has been able to achieve adequate erections with the use of ED medication as needed," the authors report.

Now that's a happy ending.

-- Melissa Healy

FDA investigating link between asthma drug and heart attack, stroke risk

July 16, 2009 |  3:37 pm

An ongoing clinical trial of the asthma drug Xolair suggests that patients taking the medication may have an increased risk of blood clots, heart failure, stroke, cardiac arrhythmias and heart enlargement when compared to patients not treated with the asthma drug, the Food and Drug Administration said Thursday. The agency announced it was assessing the significance of the preliminary findings to determine if further regulatory actions are necessary to protect patients.

Omalizumab, marketed as Xolair, is approved as a treatment for adults and children older than 12 who suffer from moderate to severe asthma complicated by seasonal allergies. The concern over possible side effects has arisen out of a trial comparing 5,000 Xolair users and 2,500 asthmatics not taking Xolair over a five-year period. Xolair was approved by the FDA in 2003, and last year, brought its maker, Genentech, $517 million in revenues.

The FDA said that "interim data" provided by Genentech from that trial "suggests a disproportionate increase in ischemic heart disease, arrhythmias, cardiomyopathy, cardiac failure, pulmonary hypertension, cerebrovascular disorders, and embolic, thrombotic and thrombophlebitic events" among users of Xolair. The agency's announcement emphasized that no causal link between the drug and the adverse events has been established, and advised patients prescribed the drug not to discontinue its use at this time.

The FDA's announcement is termed an "early communication."

Unless the FDA calls a halt to the safety trial, it is expected to continue, with final results expected in 2012. The FDA in 2007 required Xolair's maker to include a "black box warning" -- the agency's highest level of consumer alert -- warning patients that Xolair may cause potentially fatal anaphylactic reactions.

--Melissa Healy

Asthmatics should be prepared -- but shouldn't panic -- during swine flu outbreak

April 29, 2009 |  5:13 pm

A word of advice for asthmatics during the swine flu outbreak: don't panic.

Yes, those with asthma can have a tough time with respiratory illnesses such as flu. But with proper precautions and measures, say health experts, there's no reason to unduly worry.

"Asthmatics aren't necessarily more susceptible than anybody else, but they will potentially get sicker if they get (the flu)," said Dr. Peter Katona, associate professor of clinical medicine at UCLA. Since asthmatics have a compromised immune system and their airways don't work as well as those who don’t have asthma, he said, that can lead to worse symptoms.

Precautions being touted for the general population apply to asthmatics as well, Katona added, including washing your hands and covering your mouth when coughing or sneezing.

All asthmatics should have an action plan from their physician, said Dr. Norman H. Edelman, chief medical officer of the American Lung Assn. An action plan contains information about what to do for various illnesses and stages of symptoms, including what medications to take. If no plan exists a doctor can provide one, but again, Edelman cautions against dashing out in a mad rush. "We don't want to generate panic," he said.

As far as venturing into crowded public places, Edelman said to follow advice from local authorities.

Nancy Sander, founder and president of Allergy & Asthma Network Mothers of Asthmatics, suggested making sure all medications are current and in good supply. "And make certain you know how to use them properly," she added, referring especially to bronchodilators, which allow for better air flow into the lungs.

-- Jeannine Stein

Vitamin D levels may affect asthma

April 24, 2009 |  5:00 pm

Scores of studies in the last few years hint that adequate vitamin D levels may be much more important to human health than previously thought. Many of the studies also suggest that most people don't get enough vitamin D, which is synthesized in the body in response to sunlight and is also found in some foods, such as fish and fortified milk. The latest salvo in the vitamin D debate is a study published today showing that the nutrient may be linked to asthma severity.

Asthma Researchers from Harvard looked at 616 children with asthma in Costa Rica, in a part of the country with high rates of asthma. They found children with lower vitamin D levels were much more likely to have been hospitalized for asthma in the previous year, had more airway hyperactivity and were more likely to use inhaled corticosteroids. The children also had more evidence of allergies.

The study, published in the May 1 issue of the American Journal of Respiratory and Critical Care Medicine, is the first to demonstrate an association between circulating levels of vitamin D and markers of asthma severity and allergy, the researchers said.

"This study suggests that there may be added health benefits to vitamin D supplementation," a co-author of the study, Dr. Juan Celedon, said in a news release.

The researchers said that giving vitamin D supplements to asthma patients who are deficient may help with their asthma control.

"Whether vitamin D supplementation can prevent the development of asthma in very young children is a separate question, which will be answered by clinical trials that are getting underway," Celedon said.

The study took place in a country with abundant sunshine, noted doctors from the University of Aberdeen, Aberdeen, Scotland, in an editorial accompanying the study. The use of sunscreen and efforts to avoid too much sun exposure may be contributing to lower vitamin D levels in people in many parts of the world. And, they say, it's hard to get enough vitamin D from food alone.

-- Shari Roan

Photo credit: Lawrence K. Ho / Los Angeles Times

Statins good for asthma too

March 15, 2009 | 11:23 am

Chalk up one more benefit for statins, the cholesterol-lowering drugs that appear to have a variety of other actions in the body as well. The latest finding is that the drugs can reduce emergency room visits and hospitalizations in asthma patients by a third, apparently by reducing the inflammation that triggers spasms in the breathing passages.

Asthma, which affects as many as 20 million Americans, is caused by inflammation and swelling of the airways and constriction of the muscles of the bronchial passages. It is normally controlled with inhaled corticosteroids, but more severe cases may also require short-acting beta-agonists or rescue medicines, such as Albuterol and Proventil; long-acting beta-agonists, such as Serevent, whose actions can persist for 12 hours or longer; and leukotriene modifiers, such as Singulair, which suppress attacks but don't help once they have begun.

Despite such therapies, there are about half a million hospitalizations and 217,000 emergency room visits for asthma each year, with total hospital costs of about $4.7 billion, accordng to Medco Health Solutions Inc., which provides prescription services for many health insurers.

Statins have long been known to reduce inflammation in addition to their cholesterol-lowering properties. A recent major study showed that the drugs could reduce the risk of heart attack and stroke in people with normal cholesterol levels by reducing levels of C-reactive protein, an inflammation marker that is linked to heart problems.

To explore a potential benefit in asthma, researchers from Medco and Brigham and Women's Hospital in Boston data-mined Medco's records on more than 12 million patients. They identified 6,574 patients who received their first prescription for an inahled corticosteroid in 2006, then monitored their progress for 12 months. All the patients were over 18, with an average age of 61.

Pharmacologist Eric Stanek of Medco reported Saturday at a Washington meeting of the American Academy of Allergy Asthma and Immunology that 29.4% of patients receiving only asthma drugs were hospitalized or had an ER visit during the 12 months of the study, compared with 20.5% of those taking asthma medications plus statins prescribed for other indications. Age, gender and the identity of the asthma medications did not change the findings, he said.

The study was funded by Medco, which is seeking ways to reduce healthcare costs, such as by reducing hsopitalizations. Until the study is replicated, physicians should not prescribe the drugs directly for asthma, said Dr. Robert Epstein, Medco's chief medical officer. But if patients have another medical condition for which statins are appropriate, it couldn't hurt.

-- Thomas H. Maugh II

Asthma and exercise: Not what you think

March 4, 2009 |  7:11 pm

Asthma is generally thought to influence sedentary behavior rather than vice versa: A wheezy child opts to watch TV rather than risk an exercise-induced asthma attack.

A study from Scotland published online by the journal Thorax found the opposite to be true.

The study tracked 3,065 children from 3.5 years of age to 11.5 years. None had signs of asthma at the beginning of the study. About 6% of the children had asthma by age 11.

Those who watched TV for more than two hours a day in early childhood were almost twice as likely to have been diagnosed with asthma by age 11 as those who watched less.

What the researchers were striving to measure was not the effects of TV content (which may make you fat or get you pregnant but not necessarily sicken you, at least not physically) but the effects of sedentary behavior on the development of asthma. Television viewing served as a proxy for being a couch potato.

By limiting the study to children who had no symptoms of asthma at age 3.5, the researchers minimized the possibility that wheezing led children to avoid exercise.

(The data came from a a study of the long-term health of 14,000 children and their parents and dates from the mid-1990s, when personal computers were not in widespread use. So children who were not parked in front of the tube could be presumed to be doing something more active than updating their MySpace page or playing Tap Tap Revenge on their iPod Touch.)

The relationship between physical activity, sedentary behavior and asthma is complicated, the researchers said. One hypothesis is that failure to stretch airway muscles by the kind of regular deep breathing that comes from exercise may contribute to the development of asthma.

The damage appears to occur early. By age 11, pretty much everybody was a couch potato, but asthma rates did not continue to rise in adolescence.

"There may be a critical window for lung development, but we have not pinpointed it," said Dr. Andrea Sherriff of the Faculty of Medicine at the University of Glasgow in Scotland, a co-author of the study, in an e-mail.

Future studies will include a randomized, controlled trial to see if physical activity provides protection from the disease, she said.

-- Mary Engel


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