Cleaner Air Could Reduce Asthma, IBS, Diabetes Rates

If you have asthma, know the symptoms of heart disease and other inflammatory diseases so you can treat them early.


The Environmental Protection Agency announced new rules that will require coal-burning power plants to limit emissions of toxic air pollutants that are known to exacerbate asthma. That's great news for the 8 percent of Americans who suffer from the breathing disorder. And according to a new study being presented at this week's annual meeting of the American Academy of Allergy, Asthma and Immunology, it could lead to fewer rates of other inflammatory diseases. The authors of the study found that people with asthma are more likely to suffer from cardiovascular disease, diabetes, irritable bowel disease (IBS), and rheumatoid arthritis than people with healthy lungs.

THE DETAILS: The authors used data from 2,392 people enrolled in an asthma study in Rochester, Minnesota, half of whom had asthma and the other half did not. They compared the incidence of irritable bowel disease, rheumatoid arthritis, diabetes, and coronary artery disease among those with asthma and those without, and found that with each disease, people with asthma had higher rates. The relationship was strongest with coronary artery disease, in which people with asthma had a 59 percent higher incidence, and with diabetes, in which people with diabetes had a 68 percent higher incidence. Rates of irritable bowel disease and rheumatoid arthritis also increased in asthma patients, but, says lead author Young J. Juhn, MD, pediatrician at the Mayo Clinic in Rochester, the associations weren't as strong.

WHAT IT MEANS: Though it may seem logical to think that an inflammatory condition like asthma would be accompanied by other inflammatory conditions, such as diabetes and cardiovascular disease, Dr. Juhn says his results came as somewhat of a surprise, based on the way our immune systems work. "Our immune systems have something called T-helper cells. T-helper 1 cells determine pro-inflammatory conditions, such as coronary artery disease, irritable bowel disease, rheumatoid arthritis, and diabetes, while T-helper 2 cells are considered to play a very important role in determining allergic disorders, such as asthma," he says. Because our immune systems work to maintain a balance between the two types, he adds, it would stand to reason that people with asthma would actually have lower rates of those diseases. But that's not what his study found. "At this point, we think there may be some common immune mechanisms underlying this association," he says, most likely something genetic or environmental.

Dr. Juhn's study is one of very few analyzing the relationship between asthma and other inflammatory diseases, so he says that doctors are still in the early stages of understanding what all this means, especially when it comes to solving the problem. "If we find that the association isn't genetic, then, potentially, controlling your asthma may be helpful in reducing your risk of these other pro-inflammatory conditions," Dr. Juhn says. "But if it the underlying mechanism is genetic, the association may be independent from asthma control."

The most important thing to remember, Dr. Juhn says, is that if you do have asthma, pay attention to any out-of-the-ordinary symptoms you may experience. "This study could be very important for early detection," he says. "If patients experience nonspecific chest pain, their doctors may think it's just their asthma, but it could be the beginning of heart disease."


To help you out, here's a list of some common symptoms associated with each condition.


• Coronary artery disease: Chest pain and shortness of breath are the two primary signs of coronary artery disease, which, unfortunately, makes it easy to confuse with asthma. However, pay attention to where you feel pain. Coronary heart pain may be felt under your breastbone, or in your neck, arms, stomach, or upper back. The condition is also accompanied by weakness and fatigue. The most serious symptom is, of course, having a heart attack. And check out these other six unusual signs of heart disease, such as excessive snoring and sexual dysfunction.

• Diabetes: People with type 2 (adult-onset) diabetes typically exhibit very few symptoms, but those who do may notice things like unusual thirst or hunger, blurred vision, frequent infections, and tingling or numbness in your hands or feet. A blood-glucose test will tell your doctor whether you have diabetes, and recently, doctors developed an easy online test that will allow you to assess your diabetes risk based on things like family history and weight. It doesn't include asthma as a potential risk factor, but the test should help you figure out if you're already at an increased risk.

• Rheumatoid arthritis: This is a disease that's stumped a lot of doctors, as the causes of RA remain unknown and symptoms can be vague and sporadic. But you might have rheumatoid arthritis if your joints ache or swell or are tender to the touch (it usually begins in the smaller joints, such as those in your hands and feet), you feel firm bumps of tissue under the skin on your arms, or have morning stiffness that lasts longer than the morning.

• Irritable bowel disease: If you experience a lot of abdominal discomfort, cramping, or bloating, you could be suffering from irritable bowel disease or the less-severe irritable bowel syndrome, or IBS. As with rheumatoid arthritis, there isn't a known cause, but it is an autoimmune condition that seems to be exacerbated by environmental causes, including stressful jobs.


Reduce your risk from heart disease and asthma. Eat lots of Vitamin C and Vitamin D rich foods and fruits.

Dry Powder Inhaler for Deep, Consistent Drug Administration

New inhaler delivers significantly more drug to the deep lung, regardless of strength of breath Dry Powder Inhaler

Cambridge Consultants and Sun Pharma Advanced Research Company Ltd develop a high performance, easy to use dry powder inhaler

Cambridge Consultants, a leading technology product design and development firm, has developed a new high efficiency, easy to use dry powder inhaler in collaboration with Sun Pharma Advanced Research Company Ltd ("SPARC"), one of India's leading pharmaceutical research companies. The inhaler has a uniform delivery profile that ensures the full intended metered dose of the drug is administered to the deep lung, regardless of the strength of the patient's intake of breath.

The device employs a novel de-agglomeration engine to separate the drug from the lactose 'carrier' particles. Based on a highly efficient airway design, the patented drug separation mechanism has successfully completed clinical trials and demonstrated that it is capable of delivering significantly more of the drug to the deep lung than traditional inhalers. In practice, this will minimise side effects from drug build-up in the back of the throat, reduce non-systemic load and wastage, and means almost 50% less active drug needs pre-loading into the device in comparison to a standard inhaler.

This step change in inhaler technology is a reliable and easy to use device, particularly for patients with impaired lung function or those using the inhaler during an asthma attack – overcoming any patient concerns about the ability to use the device effectively.

In addition to its novel drug delivery mechanism, the device integrates a number of user-friendly design features. These include a numerical dose counter to indicate at a glance how many more doses are left in the inhaler before it runs out, a luminous feature to enable users to find the device in the dark and a small pop-out 'braille' button which activates when there are only a few doses remaining. The device gives audible and tactile feedback to indicate the delivery and completion of user steps. The device also features a unique palm-held form, designed to discreetly house the complex dose carriage and delivery system yet remain comfortable to hold and use.

Mr Dilip S. Shanghvi, Chairman and Managing Director of SPARC, commented, "Our search for the right design expertise for this project was global, but Cambridge Consultants stood out to us because of its excellent track record in medical device development. The partnership has worked incredibly well and has enabled us to take the product from initial requirement to market in half the time that such projects usually demand."

Phil Lever, Commercial Director at Cambridge Consultants, added, "We're delighted that SPARC chose to work with us on the technically challenging project as we feel this is a strong endorsement of the world-class development skills we offer, and we are very proud of the inhaler that has been developed as a result of this collaborative partnership." Cambridge Consultants and SPARC are now working together to ready the device for manufacture and the commercial launch is expected in 2011.

Cambridge Consultants will also be demonstrating the device at the Drug Delivery to the Lungs (DDL) 21 conference, Edinburgh International Conference Centre, 8th-10th December 2010.


Notes for editors:

Cambridge Consultants develops breakthrough products, creates and licenses intellectual property, and provides business consultancy in technology critical issues for clients worldwide. For 50 years, the company has been helping its clients turn business opportunities into commercial successes, whether they are launching first-to-market products, entering new markets or expanding existing markets through the introduction of new technologies. With a team of over 300 engineers, designers, scientists and consultants, in offices in Cambridge (UK) and Boston (USA), Cambridge Consultants offers solutions across a diverse range of industries including medical technology, industrial and consumer products, transport, energy, cleantech and wireless communications.

Throughout 2010, Cambridge Consultants celebrates its 50th year in business. Created by three Cambridge graduates in 1960, the company has grown into a leading technology business, renowned worldwide for its ability to solve technical problems and provide innovative, practical solutions to commercial issues. In 2009, the company was awarded the prestigious Queen’s Award for Enterprise in International Trade. For more information visit: www.CambridgeConsultants.com

Cambridge Consultants is part of Altran, the European leader in innovation and high technology consulting. The Group’s 17,500 consultants, operating worldwide, cover the entire range of engineering specialities, including electronics, information technology, quality and organisation. Altran offers its clients ongoing support throughout the innovation cycle, from technology watch, applied basic research and management consulting to industrial systems engineering and information systems. The Group provides services to most industries, including the automotive, aeronautics, space, life sciences and telecommunications sectors. Founded in 1982, Altran operates in 20 priority countries. In 2008, it generated a turnover of €1,650 million. For more information visit: www.altran.com

About SPARC

Sun Pharma Advanced Research Company Ltd (NSE: SPARC, BSE: 532872) is an international pharmaceutical company engaged in research and development of drugs and delivery systems. More information about the company can be found at www.sunpharma.in.




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Forest Pays Almirall $75M Up Front as Part of Second Respiratory Therapies Agreement

Forest Laboratories is paying Almirall $75 million up front as part of a U.S. development, marketing, and distribution agreement for the latter’s once-daily, long-acting beta2 agonist, LAS10097. The deal covers development of LAS100977 in combination with an undisclosed corticosteroid for the treatment of both asthma and chronic obstructive pulmonary disease (COPD), using Almirall’s Genuair® inhaler. LAS10097 has already completed Phase IIa trials in asthma patients.

Under terms of the deal, Forest will be responsible for U.S. regulatory approval and commercialization of the LAS100977-based therapy. Almirall will receive milestone payments and sales-based royalties on top of the up-front fee.

The deal represents the second major respiratory therapies collaboration between the companies. In April 2006 Almirall and Forest signed a $60 million up front deal to develop, market, and distribute Almirall’s inhaled, long-acting muscarinic antagonist, aclidinium bromide, in the U.S. The drug is an anticholinergic bronchodilator, selective M3 muscarinic antagonist for the treatment of COPD.

The companies had originally anticipated filing an NDA in the fourth quarter of 2009 or the first quarter of 2010. However, in March 2009 the companies announced that after consultation with FDA, additional clinical studies with aclidinium bromide will need to be conducted to provide further support for the selected regimens, including higher and/or more frequent doses. EU filing of aclidinium bromide by Almirall is currently projected for 2011.

Commenting on the deal, Howard Solomon, chairman and CEO at Forest, said, “with the addition of LAS100977, Forest rounds out a broad COPD pipeline that was recently augmented with Daxas® (roflumilast) and will also gain access to the larger asthma market with a once-daily inhaled corticosteroid/LABA combination.”

P.S. Boost your natural immunity against Asthma by eating Vitamin C and Vitamin D rich foods and fruits.

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Smoke a testing time for asthmatics

THE National Asthma Council Australia is urging people with asthma in bush fire zones, or those planning summer holidays in the country, to ensure they have considered their asthma as part of their total summer survival plan.

“People with asthma are at particular risk from bush fire smoke, especially the very young and older people,” National Asthma Council Australia Director,Associate Professor Peter Wark.

“The best protection, where possible, is avoiding exposure to high levels of smoke and ensuring your asthma is well controlled from day-to-day.

“This means seeing your doctor to make sure you have an appropriate written asthma action plan to help you manage your asthma over summer as well as making sure you regularly take your preventer puffer,” Professor Wark said.

“If you live in a high risk fire zone, you should also ask for a prescription for a second emergency inhaler, which you should have ready to take with you if you evacuate.

“Keep your back-up medication with your most precious papers or photographs to ensure it goes with you if you decide to leave.”

The National Asthma Council Australia also stressed the need to follow the manufacturer’s storage recommendations for medications during the hotter summer months.

“Keeping a back up inhaler in your glove box may seem like a good idea, but the extreme heat may render your medication ineffective, or worse still, some medication canisters could explode under the intense heat conditions that will occur in cars this summer.”

People who live in built up areas also need to plan for days of smoke haze as winds can move bush fire smoke and harmful airborne particles over great distances.

Bushfire smoke contains particles of different sizes, water vapour and gases, including carbon monoxide, carbon dioxide and nitrogen oxides, which can trigger asthma symptoms, such as wheezing, coughing or chest tightness

Larger sized air-borne particles, containing burning debris, contribute to the visible haze when a fire is burning.

They are generally too large to be breathed into the lungs, but they can cause irritation to the lungs, throat and nose.

Finer particles and gases, however, are small enough to be breathed into the lungs.

“This is why we are cautioning people with asthma across Australia to be vigilant about their health as the 2009/10 bushfire season unfolds and Australia heats up.”

P.S. Boost your immunity against asthma by eating Vitamin C and Vitamin D rich foods and fruits.

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What is Chronic Obstructive Pulmonary Disease

COPD (Chronic Obstructive Pulmonary Disease) is a chronic disease of the lung that covers several conditions including Chronic Bronchitis or Emphysema.

Chronic Bronchitis results from an inflammation of the airways of the lung. The term chronic refers to the fact that the condition is present for a long time and bronchitis means inflammation of the bronchi or air passages of the lung. You can find the anatomy of the lung on any well-researched website, but I will give a brief summary here.

The air passages begin with the trachea in the neck which branches into the left and right main stem bronchi. These bronchi continue to branch into smaller bronchi or bronchioles until they end up in the microscopic air sacs or alveoli. It is the alveoli that oxygen and carbon dioxide are exchanged with a rich network of small blood vessels or capillaries. The bronchioles and bronchi are responsible for delivering the oxygen to the alveoli and for carrying the carbon dioxide from the alveoli to the outside. These air passages are more than just tubes — the linings are composed of cells and structures that serve many functions for lubricating the airways and removing debris from the airways. These cells can be damaged by infections or toxins like inhaled poisons or smoking. When these cells are irritated by various stimuli, they form mucus which can plug up the airways and make air movement difficult. In addition, the airways have muscles in the walls and these muscles will contract or dilate the airway depending on what kind of pressure is placed on them.

When we breathe in, our diaphragmas act like an accordion and pull air into the airways. When we breathe out, we squeeze our chests and the airways by pushing our diaphragms up to force the air out. This pressure to force the air out causes the bronchi to become narrow and slows down the speed of the air escaping from the lungs. If the airways are already partially blocked by mucus, or if the muscles are contracting due to irritation, the air cannot escape from the lungs as well, and we feel short of breath or you will hear a wheezing sound as the air tries to escape through narrow tubes.

Emphysema, on the other hand is a disease of the alveoli or air sacs, where the lining of the sacs become destroyed by specific enzymes or infections, and the small air sacs become larger and larger as the walls or membranes between them become destroyed. They tend to lose their elasticity and are unable to squeeze the air out of them as effectively. In addition, the walls or membranes contain the capillaries or small blood vessels that carry the oxygen to the tissues and remove the carbon dioxide from the tissues, so air exchange becomes compromised and we feel short of breath, because not enough oxygen is being delivered to our tissues. In severe cases we can actually see our fingernails turn blue from lack of sufficient oxygen. When there is not enough oxygen in the blood, the blood becomes dark or blue, like in our veins. When there is enough oxygen in the blood the blood becomes a bright red, like in the arteries.

Chronic Obstructive Pulmonary Disease or COPD is a combination of Chronic Bronchitis and Emphysema. The treatment is therefore three fold.

* Remove the toxins from the lungs. This is done by avoiding irritants like smoke, perfumes, dust, or allergens from the environment. In addition, direct toxins like cigarette, cigar or pipe tobacco smoke should be immediately discontinued.

* Treat the constriction of the airways with medicines that can open up the airways. These are called bronchodilators and are usually in inhalers or nebulizers, but can also be in cough medicine, or pills.

* Treat the inflammation of the airways with inhaled anti-inflammatory medications, or by pills or injections. These medications are derivatives of cortisone. Frequently in severe episodes you will be treated with doses of Prednisone tablets for short period of time, or injections of cortisone.

The treatment of COPD is therefore a combination of bronchodilators and cortisone as well as discontinuing smoking, treating any infections and avoiding an environment of smoke.

The prognosis varies depending on the severity of the condition, and this can be determined by doing pulmonary function tests to see how well you can breathe. A simple test that can be done in the office is the PEFR (Peak Expiratory Flow Rate). This is a simple flow meter that patients with COPD can obtain from the pharmacy to test the amount of airway restriction that is present. A more detailed test can be done by a pulmonary specialist, which we do have here in Nassau.

If caught early enough, like any other disease, the prognosis is excellent. I have seen patients with severe COPD who require oxygen all the time, still smoke even with the oxygen being administered. Those are extreme cases but, as you can see, the prognosis can vary widely depending on the severity of the disease and the compliance of the patient with prescribed treatment.

P.S. boost your asthma immunity by eating Vitamin C and Vitamin D rich foods and fruits.

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Sufferer finds relief with steroid puffer

Until a new job in a new climate brought Stacey Fell to Dubai in 2005, the Briton thought little about her asthma.

There was the occasional bout of breathlessness during the summer in the UK, when her hay fever flared up. But in the UAE, her respiratory ailment was worse than ever.

Ms Fell, 29, saw several doctors after a persistent cough developed. She had chest X-rays as well as tests for allergies.

Eventually, she learnt that her asthma was aggravated by the local humidity, smoke, dust and air-conditioning.

“I noticed it was progressively getting worse,” said Ms Fell, who works in a bank. “There was a tightness in the chest and a feeling of compression.”

Diagnosed when she was 13, Ms Fell is among roughly 900,000 asthmatics living in the UAE.

About 15 per cent of the population here is believed to have the condition one of the highest rates in the world.

The World Health Organisation has warned that the prevalence of the lung disease is increasing worldwide by 50 per cent every decade, mainly affecting children.

It now afflicts 300 million people and may worsen due to pollution and climate change.

Asthmatics in the UAE may suffer more than in other countries, according to specialists, who say the humid climate and construction dust aggravate symptoms.

“I have a lot of my patients who are absolutely fine when they’re outside the UAE,” said Dr Bassam Mahboub, a pulmonologist and member of the Emirates Respiratory Society. “Once they come here, they start coughing and get the symptoms.”

Another respiratory specialist in the capital, Dr Zouhair Harb, said asthmatics now dominate his practice, accounting for “65 to 75 per cent” of his patients. For general practitioners in the US, the figure is about 20 per cent.

Ms Fell’s condition deteriorated so much that she sought out a chest specialist last week.

Previously, Ms Fell relied only on a Ventolin “rescue” inhaler during an asthma attack. Her doctor later prescribed a Symbicort inhaler that includes a dose of steroids to reduce inflammation in her airways, preventing symptoms.

“Now the routine I’m on at the moment, in the morning I’ll take two puffs of Symbicort, at lunchtime I’ll take two puffs of the Ventolin, and in the evening I take two puffs again of Symbicort.”

The inhaled steroids have made a difference for Ms Fell, but a recent study showed that only 5.5 per cent of asthmatics in the UAE used preventive therapies.

Dr Mahboub, who helped author the study, advised asthmatics to follow Ms Fell’s lead. “We need all asthmatics to be on controlled medications,” he said.



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Asthmatics shun prevention

Asthmatics are endangering their lives and draining the health system of millions of dirhams annually by over-relying on “rescue” medications instead of preventive treatments, according to the region’s largest study of the disease.

The Asthma Insights and Reality in the Gulf and the Near East study found that only 5.5 per cent of the 200 asthmatics surveyed across the Emirates used preventive treatments such as inhaled steroids.

That figure is “shockingly low”, according to Dr Zouhair Harb, a lung specialist working in Abu Dhabi.

The report, released last month, interviewed 1,000 asthmatics in the UAE, Jordan, Kuwait, Lebanon and Oman between January 2007 and March 2008.

The study showed that more than 31 per cent of asthma sufferers surveyed had been hospitalised or sent to emergency rooms during the period, although most of the admissions had been preventable. Another 48 per cent fell back on emergency bronchodilators to bail themselves out of asthma attacks.

It concluded: “[Regional] asthma morbidity is high, with an unacceptably high reliance on the use of emergency or rescue care.”

Ignorance about the respiratory disorder, which constricts the airways, “places a great burden on the healthcare system and society as a whole, with substantial loss of time from work and school”, it added.

Patient denial is also to blame, the researchers said.

Dr Bassam Mahboub, who led the UAE surveys at the University of Sharjah, said most asthma-related fatalities occurred because patients “don’t perceive themselves as having a disease, so they stop medication”.

He is now studying the economic impact that poorly managed asthma has on the health sector, which he estimates to be in the “hundreds of millions” of dirhams.

“We actually need a majority of our asthmatic patients to be on the controlled medications,” said Dr Mahboub, a member of the Emirates Respiratory Society. “So 5.5 per cent is way too low.”

The findings are particularly grim given that the UAE has one of the highest rates of asthma in the world; doctors estimate that 15 per cent of the population suffers from the condition.

The European average is about seven per cent, based on 2004 figures from the Global Initiative for Asthma.

And in 2005, the prevalence of asthma in the US was just under eight per cent, according to the American Academy of Allergy, Asthma and Immunology.

“But it’s especially hard [in the UAE], where you have a lot of dust and dependence on airconditioning,” said Dr Harb, of the Advanced Cure Diagnostic Centre in Al Bateen. “That’s a lot of wear and tear on the airways.”

The Lebanese-American lung specialist was dismayed by the study’s finding that fewer asthmatics in the UAE than in any of the countries surveyed were proactively treating their illness.

“In a perfect world, I would be expecting 100 per cent of asthmatics [to use preventive inhalers],” he said. “Really 5.5 per cent in the UAE is quite low. Shockingly low.”

Dr Harb estimated that 30 to 50 per cent of asthmatics in the most developed countries use the recommended steroid therapies.

According to the report, nearly 30 per cent of Lebanese patients use preventive inhalers. Roughly 19 per cent of Kuwaitis are also on controlled treatments.

Quick-relief medications such as bronchodilator puffers reopen clogged airways during bouts of breathlessness. But daily steroid therapy prevents the attacks from happening in the first place.

“[The patients] have a choice between two medicines,” Dr Harb said. “A rescue medication will work within five minutes and the maintenance one will work maybe over a week. They’re going for the quick gratification, the immediate remedy, which isn’t the right remedy.”

Overusing the emergency devices can stress the lungs and cause long-term problems.

Fixed doses of preventive steroids control inflammation in the lungs, said Dr Asif Sattar, a pulmonologist at City Hospital in Dubai.

“It seems people in Dubai tend to use emergency departments more and tend not to follow up with their physicians regularly,” he said. “Well-controlled asthmatics shouldn’t need to use their reliever at all.”

Dr Sattar said patients might dismiss preventive treatments because they might not realise they have a chronic disease.

There may also be negative connotations associated with the idea of taking steroids, although the inhaled steroids are safe, he said.

Dr Ashraf al Zaabi, the head of the respiratory division at Zayed Military Hospital, hoped the study would better inform physicians and patients about the importance of preventive therapies.

“This low compliance with the controlled medication is not surprising,” he said. “But there are explanations.”

For one, he said “especially younger patients tend to get fed up with taking medicines” over a long period of time.

Dr al Zaabi also noted that half of the UAE respondents in the study were Emiratis, while the remainder were mostly other Arabs and South Asians.

“A lot of those guys can’t afford the Dh200 or Dh300 medications, so that might explain the low percentage, with those non-nationals perhaps not having health insurance.”

Unlike in the UK, many asthma medications in the UAE can be purchased over the counter. In some cases, patients who self-medicate might buy only rescue puffers.

“We know that asthmatics tend to have poor perception of the control over their condition, so patients sometimes delay seeking medical advice until they are really bad,” he said.



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CHEST: Lower Doses Benefit Pediatric Asthma Patients

In children who are hospitalized with asthma, a reduced-dose steroid regimen has no effect on hospital stays, and low-dose albuterol treatment is associated with a lower risk of metabolic acidosis than high-dose treatment, according to research presented at the 75th annual international scientific assembly of the American College of Chest Physicians, held from Oct. 31 to Nov. 5 in San Diego.

In one study, Courtney Edwards, of Kosair Children's Hospital in Louisville, Ky., and colleagues compared outcomes in children who were hospitalized with status asthmaticus, 152 of whom received a maximum steroid dose of 240 mg/day and 141 of whom received a maximum dose of 60 mg/day. No difference was found in the median length of stay between the high-dose and low-dose groups (2.01 versus 1.98 days).

In a second study, Muhammad A. Rishi, M.D., of the Yale School of Medicine in Bridgeport, Conn., and colleagues studied 201 children admitted to the pediatric intensive care unit with a diagnosis of severe acute asthma. Compared to low-dose albuterol treatment, they found that high-dose treatment was associated with increased heart and respiratory rates and a significantly higher rate of metabolic acidosis (43.3 versus 8.3 percent).

"We conclude that lower dose inhaled corticosteroids may be helpful in most children admitted with status asthmaticus," Edwards and colleagues conclude. "Further prospective studies are needed to confirm our findings."

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Asthma remains a chronic ailment affecting children

The impact of childhood asthma on the health care system is considerable. As one of the most chronic ailments among children, asthma is a frequent cause of emergency room visits and hospitals admissions.

Chronic asthma is one of the most common long-term children’s diseases. Statistics indicate that approximately one to two percent of all children will develop chronic asthma during their childhood, while 15 to 20 percent of all children will show signs of wheezing, despite not having chronic asthma.

Saudi Gazette spoke to Dr. Mohammed Barzanji, a pediatrician and allergy specialist at Dr. Soliman Fakeeh hospital who said: “There are many factors why children become asthmatic, including exposure to cigarette or pipe smoke, pollution, dust and exercise or exertion.” He pointed out that exercise should still be encouraged, with asthmatic symptoms being treated by medication.

The real problem lies with the fact that many parents have a lack of knowledge of asthma symptoms. Dr. Wid Kattan from the King Abdulaziz University described asthma as “bronchial asthma that is related to airway hypersensitivity, which causes reversible obstruction of the airways.” This means that an individual with bronchial asthma is oversensitive to things in the environment like dust; this causes an immune reaction, leading the airways in the lungs to narrow, constricting air flow.

“The most characteristic symptom is wheezing in which whistling and coughing sounds are heard as the child breathes, particularly while exhaling,” explained Dr. Kattan.

The most important thing in the management of asthma is a prevention of the factors that can cause attacks - such as inhalation of dust and pollen and severe exercise - though these vary from child to child.

A mother of two asthmatic children in Jeddah, Basma Hassan Mohammed, shared her experience with Saudi Gazette. “My eldest son developed asthma when he was a year old and I wasn’t aware of the symptoms until a doctor told me that he will get these attacks frequently,” she said. “Each time he used to get this attack, he was hospitalized for at least three days until I learned to use the inhaler correctly and at the necessary time.”

Dr, Kattan added that the correct use of medication will prevent children from getting more of such attacks. The most common medication is, of course, the steroid inhaler, but he pointed out that most parents are fearful of administering it to their children on a regular basis. “I must point out that every child is different though, so some children who experience very mild symptoms only require occasional medication,” he remarked. It is therefore, necessary to consult with the doctor on a regular basis.



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Asthma inhaler may not work for many children, study shows

Those with gene variant and using inhaler daily 30% more likely to have asthma attack than those who do not.

The most commonly-prescribed asthma inhaler may not work for a significant proportion of children who use it to relieve their symptoms every day, a new study shows.

Researchers from the Universities of Brighton and Dundee have found that children with a particular gene change do not get the benefit they should from Salbutamol – the "blue" inhaler most often prescribed by GPs – which goes under the brand name Ventolin.

One million children have asthma. The researchers say that 100,000 of them may have the particular form of gene that prevents the inhaler working when used daily.

The authors of the study say that no child should stop using the inhaler, which works for many. But they say more research needs to be done to find out whether there are alternative treatments that will work better for those with the gene change – in which case genetic testing might become routine.

The research, led by Prof Somnath Mukhopadhyay at Brighton and Prof Colin Palmer at Dundee, involved nearly 1,200 children and is published in the Journal of Allergy and Clinical Immunology. It found that a specific change, called the Arg16 variant, in the gene that makes the body molecule that binds Salbutamol, may cause the medicine to be less effective as a reliever when used at least once a day. Salbutamol is used to relieve the symptoms of an asthma attack. Children are often on long-term medication as well.

Those who had the gene variant and used an inhaler daily were 30% more likely to have an asthma attack than those who did not. Those with a double copy of Arg16 were twice as likely not to respond to the drug.

Researchers said it was possible that the presence of this gene change in young people with asthma and who were taking Salbutamol frequently could be worsening their health and driving up healthcare costs.

Mukhopadhyay said: "Salbutamol via the blue inhaler is effective 'reliever' treatment in most children but it is common experience among doctors that a proportion of children do not seem to respond to this medicine as well as others.

"Some of these children could progress to develop asthma attacks with wheeze and cough that leads to days off school, visits to GPs, courses of oral steroids and, often, hospital admissions, despite the use of concurrent controller medication.

"Our study shows that common gene changes may predict the children with asthma who will have a worsening of symptoms with this commonly used medicine. We need to find out if alternative reliever medication will provide better asthma control in these children."

But he stressed that children should continue using the inhaler as their doctor has directed until more research has come up with alternatives. "Our work does not alter current consensus guidelines for the treatment of asthma," he said.

Palmer said the research was "just scratching the surface" of the move towards using genetic information to give people personalised medicine – the drugs that will work best for them. It is known that not all drugs work on all people.

"This study gives us a better understanding as to who is at risk of poor asthma control using these drugs," said Palmer. "However, this information is not useful if we do not have a better treatment for these children.

"We now need to determine if other medications might be more effective in the children with the Arg16 variant."


P.S. protect yourself naturally against asthma by eating lots of Vitamin C and Vitamin D rich foods and fruits.



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Inhaled Steroids Still Most Effective Treatment for Asthma

Children who have been prescribed steroidal inhalers to control asthma symptoms should continue to use them, despite questions raised by a medical study concerning their long-term benefits.

The study, published in the New England Journal of Medicine in 2006, found strong evidence that steroidal inhalers effectively control symptoms in toddlers at high risk for chronic asthma. However, the study found, the treatment did not ultimately prevent children from developing the disease.

"Most experts agree inhaled steroids are the most effective treatment for chronic asthma," said Dr. Jamshed F. Kanga, a pediatric pulmonologist at Kentucky Children's Hospital and professor of pediatrics and chief of pediatric pulmonology in the University of Kentucky College of Medicine. "The question we don't yet know the answer to is whether treatment for a long period of time will result in the disease being cured."

Kanga says that although the study raised some interesting questions for further study, it has not changed treatment guidelines.

"Asthma is a serious disease and children with chronic asthma should be on controller therapy," Kanga said.

Diagnosing asthma

Kanga says diagnosing asthma in young children can be difficult because symptoms are often very similar to those of viral infection. However, if the symptoms become more chronic and persistent, then a diagnosis of asthma should be considered.

Treatment options

Once a diagnosis of asthma is made, Kanga says, the symptoms need to be controlled and treated to prevent damage to the airway. Asthma medication falls into two groups: rescue or reliever medication and controller medication.

Rescue medication is a temporary treatment and does not address inflammation in the airways. These medications are taken at the first sign of asthma symptoms, such as wheezing. Rescue medications work quickly to relax muscles surrounding the airways, making it easier to breathe almost immediately. If needed, rescue medications are sometimes taken before exercise to help prevent asthma symptoms. The most common rescue medication is albuterol, which is sold under many brand names.

The second type of medication, controller medication, addresses inflammation in the airways. These medications are used every day in an effort to keep asthma under control. When taken daily, controller medications reduce inflammation in the lungs, helping to reduce and even prevent symptoms of asthma. Inhaled corticosteroids, the same drug tested in the journal study, are a common controller medication. Leukotriene modifiers, mast cell stabilizers and long-acting bronchodilators are also examples of controller medications.

Inhaled corticosteroids: risks, benefits, alternatives

"The best medications we have to treat chronic asthma are inhaled steroids," said Kanga. "Although there is a lot of concern that in children long-term steroid use leads to a decrease in growth, most experts agree the benefits outweigh any potential short-term growth decrease. Most three- to five-year studies show only a slight growth difference. That difference often disappears as the child ages."

Minimizing side effects

Nonsteroidal controller medications such as Singulair (montelukast) are the latest drug treatment option to become available. There is not yet enough data to determine if they are better than corticosteroids, Kanga says, but they do provide an alternative for children with mild asthma. If growth is a concern, it is also possible to give a lower-dose steroid.

"In our clinic, all patient heights are monitored closely," Kanga said. "If a child is in good control, we always try to cut back the dose of their inhaled steroid. We attempt to optimize treatment by monitoring the inflammation of the airways with a regular lung function test, every three to six months."

Spirometry is a simple lung function test that can be performed on children 5 and older. A nitric oxide monitor is another way to measure inflammation in the airway to help ensure the patient is receiving the correct dose of steroids and thus the optimal treatment.

Future of asthma treatment

Doctors once thought children would 'outgrow' their asthma; however, long-term follow-up has shown that many childhood asthma patients continue to have asthma as adults. Longer studies are needed, Kanga says, to address the important question of whether treatment helps with long-term obstruction.

"It is important to remember asthma is still underdiagnosed and often inappropriately treated," Kanga said. "To optimize your treatment, talk with your doctor about appropriate medications. We want every child to be able to live a normal life and participate in sports. We have very good medications today and most children with asthma can lead a very normal life."



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What You Should Know About Asthma Pediatric Cases

What You Should Know About Asthma Pediatric Cases

Asthma in children is one of the most trying experiences that parents may have while their children are still very small. Asthma pediatric cases are very common nowadays because of the many triggers in the environment, as well as in the food that our children eat everyday. More often than not, children who are living in the city are often the hardest affected by asthma pediatrics due to the smoke emitted from vehicles and other pollutants in the air.

Common Symptoms in Asthma Pediatric Cases

If you are a parent with very young children who have asthma, taking note of the common symptoms of asthma pediatric cases is very important. Unlike adolescence and adults, very young children often cannot express what they feel very well. In most cases, they will just appear to be irritable and cry a lot, and it is really hard to tell what is wrong with them. Since your child could not aptly express what he or she is feeling at the moment, you will need to be very perceptive.

To determine the first signs and symptoms of asthma pediatric attack in you child, you should note the common signs and symptoms of the disease. Note that most asthma pediatric cases have different signs and symptoms. To determine what are the early signs and symptoms of pediatric asthma in your child, you will need to take notes of what happened during the last time your child had an attack.

Is There Such a Thing as a Pattern for Asthma Pediatric Episodes?

Technically, each child may have some unique experiences with asthma pediatric episodes. However, if you are a very keen observer, in most cases, asthma pediatric attacks on very young children follow a pattern. For instance, every time your child is exposed to smoke, he or she will start sneezing followed by coughing. After a few hours of coughing, he or she will start wheezing and getting out of breath. If you have noticed this pattern in your child, chances are this will happen every time he or she is exposed to smoke.

Preventing Asthma Pediatric Episodes

Recognizing the triggers of your child’s asthma is very important. Knowing what triggers asthma in your child would help you prevent such attack. For instance, if you observe that your child would react strongly towards smoke, then, make sure that he or she is not exposed to smoke to prevent an attack. Knowing what to prevent can mean everything in the case of asthma.


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Rising Heat, Humidity Raise Risk of Asthma Flares

Although many parents already know that changes in the weather can cause their children's asthma symptoms to flare up, a new study backs up their intuition.

If the humidity levels in the air rose by more than 10 percent or if the temperature increased by more than 10 degrees Fahrenheit in a single day, more children ended up in the emergency department of a Detroit hospital reporting asthma symptoms, the new research found.

"Parents need to be mindful of days when there are dramatic changes in temperature or humidity. A child's asthma may flare more on those days," said study senior author Dr. Alan Baptist, director of the University of Michigan asthma program, in Ann Arbor.

The findings were published in the September issue of the Annals of Allergy, Asthma & Immunology.

As many as 9 million children in the United States have asthma, according to the background information in the study. There are numerous known triggers that can exacerbate the inflammatory airway disease, including viral infections, air pollution, exposure to tobacco smoke and airborne allergens, such as pollen, the study authors noted.

Baptist said that another asthma trigger reported by many parents is weather changes. While some past studies have looked at this phenomenon, Baptist and his colleagues pointed out that none of the previous studies controlled for air pollution and airborne allergens.

For the current study, the researchers reviewed data from two years of emergency department admissions for asthma at Children's Hospital of Michigan in Detroit. During the study time period -- Jan. 1, 2004 through Dec. 31, 2005 -- more than 25,000 youngsters between the ages of 1 and 18 were admitted for an asthma exacerbation, according to the study. That works out to about 35 children a day, according to Baptist.

The researchers then reviewed weather data for that time period, along with data on airborne allergens and air pollution. And, their statistical model was designed to control for these factors, Baptist added.

"A 10 percent increase in humidity two days before the admission day was associated with one additional visit to the emergency department," said Baptist. "For temperature, an interday change of 10 degrees one day before the admission resulted in two additional visits."

Although previous studies have found an association between barometric pressure and asthma symptoms, the current study found no link.

Asked why weather changes might affect asthma symptoms, Baptist said, "Asthma, at its core, is inflammation of the airways, and maybe these changes could be triggering more inflammation. But, it's really unknown why temperature and humidity changes exacerbate asthma, and it should be looked at further."

"This study brings up good discussion points, but I don't think this is going to be strong enough evidence to change practice," said Dr. Shean Aujla, a pediatric pulmonologist at Children's Hospital of Pittsburgh.

Aujla said that cold air is a known trigger for asthma, and confirmed that many parents say a change in weather triggers their children's asthma symptoms.

Until more research is done, she recommended focusing on each child's individual symptoms. "If your child is going outside to play and having persistent symptoms, they should use their albuterol inhaler whether or not it's humid," said Aujla.

And, she added, very few children need to stay inside because of their asthma and weather changes. "Unless a child has very severe asthma, I wouldn't say stay indoors," she said.



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Asthma May Start in the Womb

Children born in areas of heavy traffic areas could be at greater risk of developing asthma due to genetic changes brought on by pollution and acquired in the womb, a new study suggests.

In a study of umbilical cord blood from New York City children, researchers found a change in a gene called ACSL3 that is associated with prenatal exposure to chemical pollutants called polycyclic aromatic hydrocarbons (PAHs), which are byproducts of incomplete combustion from carbon-containing fuels, resulting in high levels in heavy-traffic areas.

Exposure to PAHs has previously been linked to diseases such as cancer and childhood asthma.

Researchers say this finding provides a potential clue for predicting environmentally related asthma in children — particularly those born to mothers who live in high-traffic areas like Northern Manhattan and South Bronx when pregnant.

The genetic alterations are called epigenetic changes, which may disrupt the normal functioning of genes by affecting their expression but do not cause structural changes or mutations in the genes.

"Our data support the concept that environmental exposures can interact with genes during key developmental periods to trigger disease onset later in life, and that tissues are being reprogrammed to become abnormal later," said Shuk-mei Ho, University of Cincinnati researcher and lead author of a paper on the results published in the Feb. 16 issue of the journal PLoS ONE.

http://www.livescience.com/common/media/video/player.php?videoRef=040907Staying_clean

Too Clean?

Just to confuse things, scientists also say a super-clean lifestyle can lead to more allergies in children.

The researchers analyzed umbilical cord white blood cell samples from 56 children for epigenetic alterations related to prenatal PAH exposure in Northern Manhattan and the South Bronx. The mothers' exposure to PAHs was monitored during pregnancy using backpack air monitors.

The researchers found a significant association between changes in ACSL3 methylation — a gene expressed in the lung — and maternal PAH exposure. ACSL3 also was associated with a parental report of asthma symptoms in the children prior to age 5.

"This research is aimed at detecting early signs of asthma risk so that we can better prevent this chronic disease that affects as many as 25 percent of children in Northern Manhattan and elsewhere," said Frederica Perera, co-author on the paper from Columbia University Mailman School of Public Health.

More research is needed to confirm the findings, the scientists said. If the study is confirmed, changes in the ACSL3 gene could serve as a novel biomarker for early diagnosis of pollution-related asthma.

"Understanding early predictors of asthma is an important area of investigation," said study team member Rachel Miller of the Columbia Center for Children's Environmental Health. "because they represent potential clinical targets for intervention."


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