| | ASTHMA |
 Asthma is a common lung disorder characterized by episodes of cough, wheeze and shortness of breath. Asthma is caused by inflammation of the lining of the small airways in the lungs (bronchioles) which leads to spasm or narrowing of these tubes. This spasm triggers asthma symptoms. Asthma may develop at any age, but most commonly presents in early childhood or mid-adulthood. Most cases that occur in childhood improve greatly over time and with appropriate treatment. Asthma that develops in adulthood typically responds well to treatment but is less likely to be outgrown.
Approximately one person in ten has asthma and 34.1 million Americans have been diagnosed with asthma. Asthma has a strong genetic component and often runs in families. Individuals with allergic conditions such as food allergies, eczema and hay fever are at increased risk for the development of asthma as are individuals who have immediate family members with asthma. For reasons that are not completely clear, the incidence of asthma and other allergic diseases has been steadily rising over the past several decades.
Asthma severity varies greatly from very mild to debilitating. Unfortunately, asthma can be fatal and over 4,000 Americans a year die from asthma. For the vast majority of asthmatics, however, asthma can be well controlled. As a chronic disease, asthma requires vigilance to maintain such control. |
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Symptoms
Common symptoms of asthma include one or more of the following:
• Coughing
• Wheezing
• Chest tightness
• Shortness of breath
• Decreased exercise tolerance
Individuals with asthma may have one or more triggers for their asthma. Common asthma triggers include:
• Viral upper respiratory infections
• Environmental allergens such as pollens, dust, mold, and animal dander
• Irritants such as cigarette smoke, perfumes/cologne, and cleaning solvents
• Emotional stress such as laughing and crying
• Exercise
• Cold air/humid air
• Fluctuations in hormone levels such as seen in pregnancy or with menses
• Sinusitis
• Acid reflux
• Obstructive sleep apnea
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Diagnosis
Asthma is usually suspected when the characteristic symptoms occur, especially at nighttime, with exercise, with colds or with allergy flare-ups. A favorable response to asthma medicines is suggestive as well. Definitive diagnosis and optimal treatment of each individual case requires not only periodic exams, but also measurement of lung function, starting by five or six years of age. This accomplished with spirometry which measures the amount and rate of air flow from the lungs. Often spirometry is performed before and after the use of a bronchodilator medication such as albuterol. This medication will cause a characteristic rise in air flow confirming asthma. Other tests such as a methacholine challenge or measurement of exhaled nitric oxide can also assist in the diagnosis of asthma. In a methacholine challenge, spirometry is performed before and after inhaling increasing doses of methacholine. In contrast to albuterol, methacholine will cause airflow to drop in asthmatics. Exhaled nitric oxide is a gas normally found in the breath, but increased amounts of this gas indicate asthmatic inflammation in the airways. Just as crucial as these tests, is an individual’s response to treatments and long term lung function trend. Since allergies are a common trigger in up to 85% of individuals with asthma, allergy skin testing is an integral part of the initial evaluation of asthma in order to optimize treatment. Chest x-rays, blood work and other tests are rarely needed for the diagnosis and management of asthma, unless other medical problems are suspected. Some examples of other medical conditions that can cause or aggravate asthma include chronic sinusitis, acid reflux and sleep apnea. If these conditions are suspected, further testing and treatment may be needed to optimize treatment and outcomes.
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Treatment
Avoidance of allergens and irritants: Depending on the person’s history and the results of any allergy testing, specific measures to reduce exposure to the substances to which one is allergic is a vital part of asthma management. This will help reduce the amount of medications needed to control asthma.
Treatment of underlying medical conditions: Chronic sinus problems, acid reflux (heartburn), obesity, and other conditions may cause or aggravate asthma. It is important that these problems be addressed in order to have ideal control of asthma. Since viral infections are common triggers of asthma, yearly flu vaccinations are recommended for patients with asthma.
Medications: There are two basic categories of asthma medications- relievers and controllers. Relievers are commonly called rescue inhalers or bronchodilators, which temporarily relieve symptoms by relaxing constricted bronchiole tubes. These are typically used only when needed. Controllers are anti-inflammatory medications, which prevent or heal the inflammation inside the bronchiole tubes. These are generally used every day as a preventive medication. Most patients with asthma will require a bronchodilator (ex. Albuterol or Xopenex) for occasional, as-needed, use. In patients with more persistent or chronic asthma, daily preventive therapy with an anti-inflammatory controller medication is necessary. Occasionally, patients with milder asthma will require anti-inflammatory therapy for short periods as with respiratory infections, or during their allergy season. Most patients, however, do best with year-round use of these preventive medications.
Allergy Immunotherapy Injections: Allergy injections are the most effective long-term preventive strategy for the treatment of allergies. For many individuals, allergies are a significant trigger of asthma and aggressive control of their allergies can decrease the amount of asthma symptoms these individuals experience. Immunotherapy (allergy shots) help build up your immunity to the exact items to which you are allergic. They can improve asthma directly by reducing the sensitivity of the lungs to inhaled air-borne allergens which can contribute to airway inflammation. They can indirectly improve asthma by reducing inflammation of the nasal and sinus passageways, thereby re-establishing the normal filtration and humidification of inspired air that is so important for lung health. Furthermore, control of environmental allergies can decrease the amount of infections, which are a major asthma trigger, one experiences. The length of treatment depends on the nature and severity of the allergy.
Patients whose asthma symptoms interfere with work, school, recreation, or sleep and who are allergic to substances that are hard to avoid should seriously consider injections for long-term control.
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How We Can Help
As the nation’s largest medical practice solely dedicated to the treatment of asthma and allergies, Allergy Partners provides you and your family with expert asthma care. Our physicians will combine an in depth medical history and physical examination with state of the art diagnostic testing to establish whether or not you indeed have asthma. We will also aggressively identify and treat underyling triggers or conditions so that your asthma can be better controlled with the least amount of medication necessary.
Interventions such as environmental allergen avoidance, immunotherapy, weight loss, and regular exercise can dramatically decrease the amount of symptoms individuals with asthma experience and reduce the amount of medication they require. Regular follow up in 3-4 month intervals is common to ensure that symptoms are under proper control and to adjust therapy as necessary.
At Allergy Partners, we recognize that no two people are the same and that optimum asthma care requires a comprehensive, personalized treatment plan. We look forward to working with you.
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More Information:
For more information on this condition, please visit: |
National Institutes of Health Asthma Guidelines
American Academy of Allergy, Asthma and Immunology
American Lung Association
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By Michael Smith, North American Correspondent, MedPage Today Published: May 01, 2012
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco.
Action Points
- Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
- More than half of kids with asthma are still exposed to second-hand tobacco smoke.
- Point out that the exposure is associated with more doctor visits, disturbed sleep, and restrictions on activity.
More than half of children with asthma are exposed to second-hand tobacco smoke, researchers reported.
The exposure is associated with more doctor visits, disturbed sleep, and restrictions on activity, according to Lara Akinbami, MD, and colleagues at the CDC in Atlanta.
On the other hand, exposure to second-hand smoke is not associated with missing school or wheezing during exercise, Akinbami reported at the annual meeting of the Pediatric Academic Societies in Boston.
National asthma guidelines have advised patients with asthma to avoid tobacco smoke for decades, Akinbami said, but "it's still a problem, and kids are still having impacts," she told MedPage Today.
Overall, Akinbami said, exposure to second-hand tobacco smoke has been falling because of increased awareness of the dangers, but it has not been clear if that's true among the subpopulation of asthmatic children.
To help fill that gap, she and colleagues turned to interview and laboratory data from the National Health and Nutrition Examination Surveys from 2003 through 2010.
The survey consists of health interviews and examinations at a mobile center. Participants are asked about demographic characteristics, smoking in the household, personal smoking habits (if they are 12 or older) and asthma history.
As well, blood samples were taken to assess serum cotinine, which measures exposure to second-hand smoke and personal use of tobacco.
All told, Akinbami reported, they analyzed data for 972 children, ages 6 to 19, who had been diagnosed with asthma by a doctor and reported having current asthma at the time of the survey.
They defined exposure to tobacco smoke as a serum cotinine level of at least 0.05 micrograms per deciliter. Children who reported use of cigarettes, cigars, or pipes were excluded from the analysis.
More than half (53%) of the asthmatic children had exposure to second-hand smoke, Akinbami reported.
In a multivariate analysis, adjusting for differences in age, sex, race, and poverty, exposure to environmental tobacco smoke was associated with a 20% increase in the risk of having one or two visits (compared with none) to a physician's office or emergency department because of wheezing in the past year. The increase was significant at P<0.05.
The trend was similar for more visits and for healthcare use overall, but the confidence intervals on the adjusted risk ratios included unity.
Smoke exposure was associated with a 40% increase in the risk of having limitations on activity, which was also significant at P<0.05. And there was a 40% increase in the risk of having one or more nights a week of disturbed sleep (compared with none) owing to wheezing, significant at P<0.05.
On the other hand, there was no significant increase in the risk of missing school owing to asthma or of wheezing during exercise.
The risk factors for asthma in children, Akinbami said, appear to "align with the risk factors for exposure to second-hand smoke," such as poverty and living in multifamily dwellings.
While advising parents of asthmatic kids to limit exposure to smoke is "a simple message, it's not a simple change to make," she said.
"The bottom line is that these families need more support to really remove this risk from children with asthma," she said.
"The findings are not surprising," commented Jonathan Winickoff, MD, of Massachusetts General Hospital in Boston. "There's a long history of noticing an association between tobacco smoke exposure and both incidence and severity of childhood asthma."
But, Winickoff told MedPage Today, parents "may not know how to protect their child from tobacco smoke exposure."
Many smoking parents, he said, might not be aware of the persistence of their tobacco smoke, whose fine particles cling to surfaces long after a cigarette has been extinguished.
This "third-hand smoke" can elevate cotinine levels in children, said Winickoff, who speaks for the American Academy of Pediatrics on tobacco issues.
Strategies such as not smoking when the kids are around or smoking in the basement don't work, he said, adding there is "really only one safe action that parents can take -- quit smoking."
And even if parents don't smoke themselves, children may still be exposed to second-hand or third-hand smoke because the family lives in multi-unit buildings where other people smoke.
The authors are employees of the CDC.
Primary source: Pediatric Academic Societies
Source reference:
Akinbami LJ, et al "Impact of tobacco smoke exposure on children ages 6-19 years with asthma in the US, 2003-2010" PAS 2012; Abstract 4340.2.
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Allergy shots are one of (if not the) most effective treatments for allergic rhinitis (hay fever), allergic asthma and flying insect allergy. Treatment with allergy shots can reduce your need for medications, make asthma easier to control, and give relief from allergy and sinus symptoms. In children, allergy shots may reduce the risk of developing asthma later in life and reduce the risk of developing additional allergies. So what does this mean in terms of health care costs? Are the medical benefits of shots outweighed by its expense?
In a 7-year retrospective (looking back in time) analysis of children newly diagnosed as having allergic rhinitis, investigators compared medical costs incurred during the 6 months before starting shots to the costs for these same children that were incurred during the 6 months after completion. The per-patient 6-month total health care costs were significantly lower in the 6-month period after completion compared to the time preceding shot initiation. Interestingly, in this study only 16% o f patients completed the recommended 3 years of treatment. Even with that low completion rate, a significant savings was seen.
The same investigators subsequently conducted a similar 10-year retrospective study. One of the main differences in this study is that they compared the 18 month health care costs of a group of patients receiving shots to a similar group that did not. Children who received shots incurred significantly lower per-patient health care costs compared to the children who were treated with medications alone. A parallel study has been conducted with adults and similar, significant reductions in 18-month health care costs have been reported. In these patients the cost savings was approximately 41%!
Allergy shots are not only the most effective treatment for certain allergic diseases, but they are also more cost effective than medications alone. That is a win-win situation!
As always, you can also follow us on Facebook for daily pollen counts, office information, and more.
Jonathan Mozena, MD |
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| After a recent tragedy in Chesterfield, Virginia, where a 7 year old girl died from a peanut allergy, http://www.wtvr.com/news/wtvr-chesterfield-student-death-20120103,0,4150762.story We wanted our patients to know that we are here to advocate, and help you overcome any boundries in regards to caring for children with food allergies. If at any time you feel that your child's school needs education regarding a food allergy. or if you need help managing your child's food allergy action plan, please do not hesitate to contact our office. Food allergies are very serious, and can be life-threatening, or even fatal, and we want to be sure that all of our patients have the tools and resources they need to reduce the chances of a tragedy like this from occuring. |
| Allergy Partners is the nation’s largest single-specialty medical practice dedicated to the evaluation and treatment of allergy, asthma and immunology. All Allergy Partners physicians have specialized training and years of experience in the field. By working together, our physicians are able to provide state of the art care to all of our patients using the latest technology and applying best practices.
We recognize that allergies, asthma and allergic diseases present in myriad ways and that no two patients are the same. To that end, our goal is to apply our collective knowledge and resources to provide each and every patient comprehensive, personalized, and compassionate care. When visiting one of our physicians, you can expect a detailed medical history, a thorough physical exam, and appropriate diagnostic testing. Based on this information, you and your doctor will work together to devise a treatment plan that not only addresses your symptoms, but aims to improve your quality of life. We appreciate the opportunity to work with you and your family to improve your health and well being. |
| Learn more about the hidden triggers at the gym that you can avoid. The Asthma and Allergy Foundation of America (AAFA) estimates that up to 80% of people with allergic asthma will experience symptoms when they engage in strenuous exercise.
How to Avoid Triggers at the Gym
- Avoid saunas and pools if they are using irritating chemicals
- Use your own latex-free exercise mats
- Take an antihistamine before entering the gym to prevent a reaction from chemicals used inside
- Try to choose high-quality natural fabric when buying workout gear
- Use your inhaler as directed before you exercise
- Warm up and cool down properly so you don't overtax your respiratory system
- Skip your workout when feeling sick
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| Welcome to our blog
site! Stay tuned to get the latest news. We will share tips and techniques
for living with and managing your Allergies & Asthma. We look forward to
sharing useful resources with our patients! |
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