Asthma symptoms vary depending on a few major factors, one of them being seasonal change. With spring time approaching and children going outside to play in warmer weather, it is important to review prevention methods. A recent article posted by Dr. Michael Rosenthal on Delaware online provides a good overview. Spring brings with it a slew of new triggers that can impact asthma. These include air pollution, pollen and increased exposure to animals. Thus, medication adherence is especially important during this time as it could prevent dangerous symptoms.
“Childhood asthma is the most common chronic disease in children, and can occur year-round. Now that spring has arrived and children are heading outside to play, it’s a good time to consider the impact and dangers of this disease, as well as how to protect against asthma attacks.
Asthma is a chronic lung disease that inflames and narrows the airways, causing wheezing, shortness of breath and coughing. The smaller airways within the lungs have a hard time moving air in and out, making breathing difficult.
Causes of asthma range from genetics to allergens and pollutants. No cure for asthma exists, although some children have fewer symptoms as they get older only to have it recur later in life due to certain triggers.
More than 7 million children nationwide have asthma. The disease accounts for more hospitalizations than any other childhood illness and more than 3,000 childhood deaths each year.
Aside from the health problems, asthma can affect learning and school performance. Among children ages 5 to 17, it is the leading cause of absences from school related to a chronic illness. Children with asthma miss an average of eight days per year, according to the Asthma and Allergy Foundation of America.
Given that asthma is activated by triggers unique to each individual, the way to control it is by keeping those triggers at bay. For example, if your child’s asthma is triggered by indoor air pollution, you should not smoke in the house or anywhere near them (or, better yet, don’t smoke at all!) Lingering environmental tobacco smoke will only exacerbate their asthma. Other indoor triggers include pet hair, cockroaches, dust and mold.
Outdoor air pollution also can be a trigger. Pollen that comes from trees and grass and high ozone levels during the summer can exacerbate your child’s asthma. If that is the case, you should limit your child’s outdoor activity on days when the pollen count is high or when ozone levels are up. Easy-to-use air quality “apps” like the one from the American Lung Association for your smartphone or tablet can be helpful guides.
Medication is another way to control asthma. Anti-inflammatory medications lower mucus production and airway reactivity. These medications should be included as part of the treatment of all children with recurrent and persistent asthma. Bronchodilators also can be used to relax the muscles in the airways, making it easier to breathe. Some of those medications are also defined as “rescue inhalers” and should be kept within reach for easy access if an attack comes on.
It is important to identify the early signs of worsening asthma to help prevent a severe attack. Those warning signs include wheezing, tightness in the chest and severe coughing (especially at night). It’s important to pay attention to these warning signs so you can ensure your child takes their medications as soon as possible.
It’s also important to work with your child’s health-care provider to establish an asthma action plan. The plan will have instructions on what to do if asthma symptoms get worse. The plan also should cover what to do if an attack occurs, such as which medications to use, when to call the doctor’s office, and when a visit to the emergency department is warranted. You also should encourage your child to speak up at school to their teacher or school nurse if they experience the warning signs of an oncoming attack.
Partner with your physician to help you and your child identify the triggers, recognize the warning signs of an oncoming asthma attack and create an asthma action plan. No cure exists for asthma yet, but the proper use of the right medications can greatly diminish the dangers of this disease and lead to a happy, normal childhood.
Dr. Michael Rosenthal is chair of the Department of Family & Community Medicine at Christiana Care Health System.”
The original article can be found here.
Geckocap is a better method to manage your child’s asthma medication. Find out more here
Christingasner/iStockphoto/Thinkstock (Taken from original article)
A recent article published by Science Magazine covered a study completed in the University of Lausanne in Switzerland regarding the effect of a high fiber diet on asthma. High fiber diet has already been linked to managing irritable bowel syndrome and Crohn’s disease. Researches are now trying to see if it provides any benefit for those suffering from asthma.
The study involved taking two separate groups of mice, one group feeding on a high fiber diet and the other feeding on a low fiber diet. After two weeks, the mice were exposed to an allergenic and their reactions were observed. They found that the mice with a high fiber diet were much less susceptible to a strong reaction. This research could pave the way towards developing a diet catered specifically to asthma and allergy sufferers.
The fiber consumed in fruits and vegetables seems to help quiet the overzealous immune system activity that leads to such conditions as irritable bowel syndrome, Crohn's disease, and possibly even colon cancer. Now it appears that a diet rich in fiber may also fend off asthma, an inflammatory condition that constricts the airways of the lung, by changing the way some immune cells are produced in the bone marrow.
When we eat plentiful fruits and vegetables, the bacteria that occur naturally in our intestines help us digest the fiber. The microbes take "soluble" fiber such as pectin—found in apples, pears, berries, citrus fruits, and onions—and ferment it into specific types of fatty acids that interact with immune cells, helping keep inflammation in check. Whether this anti-inflammatory effect extends beyond the digestive tract is less clear. But the fatty acids in question are able to circulate through the bloodstream, perhaps hooking up with immune cells throughout the body.
That could mean that dietary fiber influences other inflammatory diseases, such as asthma. It's known that asthma has increased in westernized countries since the 1960s, during which time the amount of fiber consumed has also declined. Moreover, asthma is not as common in less well-developed areas, such as Africa, where fruits and vegetables form a bigger part of the diet.
To test a possible link, immunologist Benjamin Marsland of the University of Lausanne in Switzerland and colleagues put a group of mice on a low-fiber diet. After 2 weeks, the researchers had the animals sniff an allergen derived from dust mites (a key trigger of human allergy and asthma). These mice showed exaggerated asthmatic responses, including inflammatory compounds in the lungs and the constricted airways that cause the wheezing and shortness of breath so familiar to asthmatic patients.
On the other hand, mice that ate a diet rich in pectin for 2 weeks before getting the dust mite extract showed a reduced inflammatory response. Levels of the immune cells known as eosinophils, and of the antibody immunoglobulin E—both usually increased in allergies and asthma—were almost halved, and the mice showed less constriction of their airways.
To see if the gut bacteria were responsible for the fiber-mediated benefits, the scientists analyzed the feces of mice on normal, low-, and high-fiber diets. In the animals given pectin, the kinds of bacteria best able to produce the anti-inflammatory fatty acids were about twice as prevalent as those of other bacteria more common in a low-fiber diet. On closer examination, the researchers found proportionally higher amounts of the fatty acids not only in the stool of the pectin-eating mice, but also in their blood.
Were the fatty acids in the bloodstream telling the immune system to back off, and was this message enough to call off an asthma attack? To find out, the researchers injected the mice with propionate, one of those fatty acids. After 2 weeks, the rodents again showed reduced inflammatory markers and less constriction of the airways in response to the dust mite treatment, the team reports online today in Nature Medicine. What's more, key immune cells called dendritic cells behaved differently. Dendritic cells can either scale down immune system activity or ramp up the response, depending on the signals they send to other types of immune cells. In mice on a high-fiber diet, the dendritic cells were less able to turn on the so-called effector cells, which are key players in allergic asthma in mice and humans.
In the final phase of the experiment, the researchers found that the mice given propionate were actually producing more of the immature "precursor" cells that develop into the dendritic cells that protected against asthma. "Our study is the first to show that diet can influence the production of immune cells in the bone marrow, which could have major implications given that immune cell precursors leave the bone marrow and spread to tissues throughout the body, including the lung," Marsland says.
According to Gary Huffnagle, an immunologist at the University of Michigan, Ann Arbor, researchers had expected that if compounds produced by bacteria did influence asthma, they would do so in lung tissue. The chain of events connecting dietary changes, altered metabolism of gut bacteria, a shift in immune cell production in the bone marrow, and relief of asthmatic inflammation is an exciting development, he says. “No one has ever put that all together before. The study is a beautiful convergence of observations."
Rigorous scientific work needs to be done, Marsland believes, to test whether dietary supplements including purified propionate, or some similar fatty acid, might be beneficial for people with asthma or for those who don't have access to fruits and vegetables. In the meantime, he says, a balanced diet rich in fiber is the best way to get the anti-inflammatory benefit.
Check out the article here.
Geckocap is a better method to manage your child’s asthma medication. Find out more here
Children’s Medical Center and a New Asthma Initiative
A blog on the Dallas section of BizJournals recently covered a new collaboration between Children’s Medical Center and a non-profit research and development firm called PCCI.
The collaboration includes two major projects which aim to develop predictive modeling and networking technologies to alleviate health concerns in children. The first project deals specifically with chronic asthma. One of the most difficult factor to assess in healthcare is risk. Thus, striving to better understand risk factors in children with chronic asthma could significantly reduce future health problems.
Children’s Medical Center is partnering with nonprofit research and development firm PCCI on two new projects that use predictive modeling and networking technologies to keep children healthier.
The first project focuses on helping children with chronic asthma, which is the third-leading cause of pediatric hospital re-admissions nationally and a significant cause of admissions and re-admissions at Children’s Medical Center.
Dallas-based PCCI, a non-profit affiliate of Parkland formerly called Parkland Center for Clinical Innovation, is building predictive, analytic models to help identify children with risk factors indicating a high likelihood for asthma. I wrote about PCCI’s work in April and about a similar collaboration between PCCI and Arlington-based Texas Health Resources in May.
Asthma is one of the most common chronic diseases afflicting the young, affecting more than 50,000 children in Dallas County alone, said Summer Collins, Children’s Medical Center vice president of population health data strategies. It’s a leading reason for school absenteeism, yet it’s a health problem that can be significantly reduced by improving treatment and awareness of environmental triggers, she said.
“Asthma is a high priority at Children’s and is something that we are excited to be working with PCCI on,” Collins said.
Predictive modeling can be used to comb through information within the electronic medical record and identify asthmatic children with higher risk factors, allowing health care and social services providers to proactively address treatments and triggers, Dr. Anand Shah, vice president of clinical services for PCCI, told me in an interview.
Check out the blog post here:
Geckocap is a better method to manage your child’s asthma medication. Find out more here
Kids with asthma and allergies could benefit from owning a dog.
Rachel Starr, 7, of Boston gets some help from her dog, Violet as she tries to build an igloo on the Boston Common on December 15, 2013. (Jessica Rinaldi For The Boston Globe) (Taken from the Boston Globe)
The Boston Globe recently published an article on their blog covering a study that researched potential health benefits from having a dog at home. Results showed that a specific bacteria, carried by dogs, has a positive effect on immune systems in young children. Thus, it becomes less likely that they will develop allergies and asthma.
The study examined mice exposed to dust from a dog-free home and from a dog owners house. The later were less susceptible to developing reactions from common allergens. The research, currently in early stages, could potentially provide a new method in coping with asthma and allergies.
"While allergies to pet dander certainly keep many families from owning dogs, it turns out having man’s best friend as a pet might actually protect babies from developing allergies and asthma in the first place. A new study conducted with mice could explain the reason why: dust from homes with dogs has a higher amount of beneficial bacteria. This helps establish a balanced immune system in a child that’s less likely to attack harmless allergens.
Previous research suggests that the establishment of certain gut bacteria in the intestinal tracts of newborns could affect their development of asthma later in childhood. Certain harmful bacteria associated with the use of antibiotics, for example, were found by European researchers to increase a child’s risk of asthma, while living with a dog or cat in the house was found in other studies to decrease the risk.
'We wanted to see which organisms were protective,' said study co-author Susan Lynch, an associate professor of medicine at the University of California San Francisco. She and her colleagues exposed some young mice to both dust from a dog owner’s home as well as dust from a dog-free home. Then, they exposed the mice to common allergens. The researchers found that those exposed to dog dust were less likely to have allergic reactions and inflammation in their breathing passages (a sign of asthma) than those exposed to the regular dust. The results were published this week in the journal Proceedings of the National Academy of Sciences.
Researchers identified a particular bacteria in the dog dust—Lactobacillus johnsonii—and found that giving it to the mice protected them against respiratory virus infections, though not as well as the dog dust itself.
Likely, other beneficial bacteria also exist in this dust, and Lynch said future studies will try to determine what those are. 'Lactobacillus could play an important role in structuring a healthy bacteria biome in the gut early in life,' Lynch said, 'but we have no actual evidence of that yet.'
In other words, it’s way too early to be looking for a probiotic supplement with Lactobacillus johnsonii or other kinds of 'good' bacteria to prevent allergies and asthma in kids, or to treat those who already have it."
Here are some useful links:
The study
The Boston Globe blog post
Geckocap is a better method to manage your child’s asthma medication. Find out more here
Gamification's Next Target: The Healthcare Industry
Contrary to popular belief, the practice of gamification has played a critical role in the airline, military and other industries for quite some time. The healthcare industry is its most recent target, where it is focusing on adherence and patient engagement. A recent “white paper” report on the Inner City Fund International, or ICFI, website examined the growing trend of healthcare gamification.
Download the report here.
Geckocap is a better method to manage your child’s asthma medication. Find out more here
Asthma Medication for Children is Usually Administered Wrongly
Non-adherence is one of the most significant issues in the medical asthma community. Such a problem can be caused by the lack of a fundamental understanding of administering asthma medication. A recent study from the Childrens Hospital at Montefiore, found that only 1 out of 169 caregivers accurately performed the ten step national guideline for asthma medication delivery. In addition, only 4% were able to carry out five of the steps. The study, conducted in the Bronx, New York, aims to use educational and demonstrational strategies in order to alleviate such discrepancies in treatment.
Regular Education Could Improve Administering Technique and Help to Reduce Hospitalizations and Healthcare Costs
NEW YORK (October 24, 2013) – The majority of caregivers who administer their child’s asthma medication frequently use the incorrect technique, leading to poor health outcomes, according to new research from The Children’s Hospital at Montefiore (CHAM). The study, published in the Journal of Asthma, found that only one of 169 caregivers accurately carried out 10 steps outlined in national guidelines as the appropriate method to deliver adequate medication for asthma management. Robust education efforts and training of caregivers could help to improve outcomes, reduce hospital admissions and healthcare costs.
Children with asthma usually depend on their caregivers to administer their medication, often via inhaler. To ensure the appropriate dose is inhaled, a spacer, which is a chamber with a mask that holds the medication and is placed between the inhaler and the child’s mouth, is often utilized. This approach is commonly prescribed for kids with asthma in the U.S., where as many as 7 million children suffer from the condition.
Investigators monitored caregivers’ administering technique using a 10-step checklist and determined that if caregivers conducted seven or more steps accurately, they had a good technique; however if they administered six or fewer steps correctly, the technique was deemed poor. Five of the 10 steps were deemed essential for adequate delivery of medication.
“As only one caregiver could do all steps accurately and fewer than four percent were able to complete five essential steps, we believe that regular education efforts would be beneficial to caregivers and their children,” said lead author Marina Reznik, M.D., M.S., attending physician, Department of Pediatrics, CHAM, and assistant professor of Pediatrics at Albert Einstein College of Medicine. “We also learned that caregivers whose children had been admitted for asthma in the past year were more likely to exhibit correct use, suggesting they had been retrained during the hospitalization and as a result were better able to perform the steps.”
Researchers surveyed and evaluated 169 caregivers of urban minority children, aged between two and nine years old, with persistent asthma whose doctor prescribed the medication to be taken via inhaler on a daily basis. By taking the medication daily, the goal is to control the underlying inflammation of the airways, reducing asthma symptoms and preventing attacks. Caregivers were asked questions to determine how well the child’s asthma was controlled and whether they had been instructed and/or shown by a medical professional how to administer the medication properly.
More than 90 percent of caregivers said they had received a verbal explanation of how to administer the medication, but only 54 percent were asked by a medical professional to demonstrate that they could actually do it themselves.
This first-of-its-kind study was conducted in the Bronx, a region where rates of asthma are high and low-income Hispanic and African American children are largely affected. Sufferers in this area frequently experience exacerbations that require hospital care and intense therapy.
“Our study results further support the fact that caregivers need regular demonstration and evaluation of the correct technique, which could lead to improved clinical outcomes as well as reduced hospitalizations and healthcare costs. We want to keep our kids healthy and education will help make that happen,” said Dr. Reznik.
