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Managing Asthma

Daily Dose

Asthma

1:30 to read

May is Asthma Awareness Month and I am certainly seeing many patients whose asthma and wheezing is getting the best of them right now. With all of the major weather changes across the country, pollen counts through the roof, and upper respiratory viruses still circulating, there are quite a few triggers to set off wheezing.

 

Asthma is a chronic lung disease and affects more than 6 million children in the United States. Asthma causes wheezing and chest tightness in some, while it may only cause nighttime cough and cough with exercise in others. There is not one single presentation to asthma and the diagnosis is best made with a good history and physical exam.  Although asthma is a chronic disease you may only have attacks when something is bothering your lungs (triggers).

 

The biggest challenge I see as a pediatrician is teaching both parents and children to recognize their triggers and to know what their medications are. Every patient should have an asthma action plan, but in some cases, a child may have only wheezed once..and their parents received an inhaler or a nebulizer but really does not know what to do if their child wheezes again.

 

If your child has wheezed before, and you have a family history of wheezing, your child has a greater chance of wheezing again.  You should have a discussion with your pediatrician about how to recognize wheezing in your child. At the same time, if you have ever received a medication for wheezing, make sure you know the name or names of the medication. I see many parents who come in to the office and they may have been seen at an ER or urgent care when they were noted to be wheezing. They received an “inhaler”, but the parent has no clue as to the name of the inhaler (they may say, “it is blue”), and they don’t understand how the medications work.

 

The two points I try to make with every patient I see with wheezing:  

#1  Know the names of the medications that you have

#2  Know what the medications do

 

There are two issues with asthma, lung inflammation and broncho spasm (narrowing of the airways). So…there are two medications commonly used to treat these issues.  Inhaled steroids (there are tons of brands) are used as a preventative and decrease inflammation, while albuterol (again tons of brands) is a broncho-dilator and opens up the narrowed airways.  I see too many patients that bring in a bag full of medications, from numerous doctors and still don’t understand what their medications are used for, when to use them and that several of their inhalers, while having different names, are actually the same medicine.

 

Lastly, children with divorced parents need to have inhalers available at both homes. I think it is too complicated to try and have parents hand the inhaler or medication back and forth and think they will not forget or lose the medication.  Ask your doctor to have meds for both houses.

Seeing that is is Asthma Awareness month, get your medications out and make sure that they are not expired and if you don’t understand how or when to use them, make an appointment with your pediatrician and get an asthma action plan in place. Be prepared!  

Parenting

Winter at Home: Managing Dry Indoor Heat

1:45

Once winter starts settling in, the home furnaces are cranked on, followed by itchy skin, upset sinuses and cracked lips. What fun.

It’s also when the home is sealed tight, trying to prevent heat loss.

While some areas of the country are still experiencing warmer weather, many are feeling the effects of old man winter.

Dry winter air leeches moisture, leaving your family’s skin as dry and cracked as a salt flat and sinuses as parched as the Sahara in summer. Adults and kids may wake up with a bit of a bloody nose as well.

You also start noticing static electricity while brushing your hair or petting the family pet.  Clothes start acting funny as well, sticking to you like saran wrap. It’s literally shocking.

Here are a few tips to help you combat dry indoor air, preserve the moisture in your family’s skin and nasal passages, and avoid pet-induced static shocks this winter.

In the winter, the cold air that seeps into your home from the outside has a lower humidity -- meaning that it carries very little moisture. You crank up the heat inside your house, which adds warmth but doesn't increase the amount of moisture in the air.

Because wintertime humidity is so low, what little moisture that is around is quickly sucked up into the air. Moisture also evaporates from your body, leaving your skin, nose, and throat parched.

One way to combat all this dry air is using a humidifier. Running a humidifier in your home will add moisture to dry, heated air. The moist air will help keep your skin, mouth,  and nose lubricated, and helps prevent those nasty static shocks. Your goal is to aim for a comfortable home humidity level of between 30% and 50%. Don't crank up the humidifier higher than that, though, or you could develop another problem – mold, fungi, dust mites,  and other tiny critters. Make sure to keep your humidifier clean so that it doesn't send dust and germs spewing into your house.

Sinuses often take a beating during the winter. Cold, dry air pulls moisture from your mouth, and nose, leaving your nasal passages dried out and your throat dry. Dry nostrils are more likely to crack and give you a nosebleed.

Why do kids and adults get sick more often during the winter months? Because your nose needs gooey mucus to trap viruses and other icky invaders before they can get you sick, dry nostrils can also make you more vulnerable to colds, sinus infections, and the flu. That's especially a problem in winter, when bacteria and viruses can tend to linger longer in the dry air after someone coughs or sneezes.

When you turn up the thermostat in your home, your heating system kicks up clouds of dust, pollen, and other allergens that can inflame your sinuses. Cold, dry air plus those allergens can also irritate your airways. For some kids with asthma, cold and dry air can lead to a narrowing of breathing passages and trigger an attack.

One way to help add moisture back is by keeping hydrated. Keep your skin and mouth moist by drinking water throughout the day. Don’t like water? Try putting in a little tea or juice to add flavor. It’s a little easier to drink more water in the summer, because …well… you’re sweating more, triggering a thirst attack. It takes a little more effort in the winter to keep hydrated but the pay-off is just as valuable.

You may also find yours or little ones fingers developing cracks and dealing with dry itchy skin in the winter because cold air sucks out the skin’s moisture. While it’s tempting, taking hot showers can worsen dry, itchy skin by removing the natural layer of oil that preserves and protects the skin's moisture. Something we seem to have plenty of in the summer.

To help your skin out, shorten your shower time. Make sure that your child’s bath water or shower is warm, but not hot and he or she is using a gentle soap. Fifteen minutes should be the maximum time spent in the shower and even shorter if you’re clean sooner.

Alas, don’t forget to put a moisturizer on your child or have some available for your older kids. A thick oil-based moisturizer is best. The oil in the product will lock moisture into the skin and keep it from drying out. Moisturizers come in different forms, but ointments will provide the most protection for dry skin.  Make sure to apply moisturizing sunscreen with a minimum SPF 30 to exposed skin before going outside. Also apply a lip balm or petroleum jelly to protect against chapped lips. Help keep the nasal passageways moist by using saltwater (saline) drops or rubbing a little petroleum jelly into each nostril gently with a cotton swab.

There are some advantages to winter – you can dress in layers (you can only take so much off in the summer), walking is easier than when you’re dripping sweat and snow covered trees have a certain mystique and beauty to them. Other than that, winter is pretty brutal to our skin and nasal passages- but we can fight back by keeping hydrated, using creams to soften our skin and adding more moisture to the air while we hunker down; cozy and warm with our family indoors.

Story source: Lisa Bernstein, MD, http://www.webmd.com/women/home-health-and-safety-9/dry-indoor-air?page=2

Your Child

New Studies Look At Childhood Asthma

1.45 to read

2 new studies take a look at childhood asthma. One suggests that antibiotics given to babies in the first year of life may increase a child’s chances of getting asthma by age 18, while the other study cautions that childhood food allergies may be a predictor of asthma later in life.2 new studies take a look at childhood asthma. One suggests that antibiotics given to babies in the first year of life may increase a child’s chances of getting asthma by age 18, while the other study cautions that childhood food allergies may be a predictor of asthma later in life

Antibiotic Use and Childhood Asthma Pediatricians have cautioned parents about taking antibiotics, and giving their children antibiotics, without a true medical need. Now a study appearing online in the journal Pediatrics, suggests that infants who take antibiotics during the first year of life may be at a slightly increased risk of developing asthma by age 18. In a separate analysis, the children of women who took antibiotics during pregnancy were nearly 25% more likely to have asthma compared to mothers who did not take the drug. Asthma can be a life threatening condition. Nine million children under age 18 in the U.S. have asthma, according to the American Academy of Allergy, Asthma & Immunology. Here’s how the study was conducted. Researchers gathered data from 22 previous studies between 1950 and 2010. Two of the 22 studies looked at antibiotic exposure during pregnancy while 19 studies evaluated antibiotic exposure during the first year of life. One study assessed antibiotic exposure during both time periods. Other studies have shown that infants who receive antibiotics are at an increased risk for developing asthma by age 7, and the more courses of the drug given that first year, the greater the risk. This review analyzed the results of studies using over 600,000 participants. It also grouped studies according to design type to see how the results were affected. When all 20 studies were grouped together, researchers found that infants who took antibiotics during their first year of life were about 50% more likely than babies who never received the drugs to be diagnosed with asthma. Researchers also analyzed studies where children who were treated with antibiotics for respiratory infections, were removed.  The respiratory infections skewed the overall results because of the possibility that the infections themselves might be a precursor to asthma. In studies that adjusted for these respiratory infections, a child who took antibiotics was 13% more likely to be diagnosed with asthma than a child who never took the medication. The researchers say they are not suggesting that early antibiotic exposure causes childhood asthma, but that even a slight increase in risk may be a good enough reason to avoid the unnecessary use of antibiotics during pregnancy and the first year of life. Food Allergies and Childhood Asthma Infants and toddlers often have some type of food allergy, while teens and adults are more prone to dust, ragweed and mold allergies according to U.S. researchers. A preliminary release of the Quest Diagnostics Health Trends Report, Allergies Across America, is based on laboratory testing from more than 2 million U.S. patient visits. In this report the findings reveal a pattern of allergen sensitivity consistent with the "allergy march," a medical condition by which allergies to foods in early childhood heighten the risk for the development of additional and more severe allergy-related conditions - including asthma- later in life. "Allergy and asthma often go hand in hand, and the development of asthma is often linked to allergies in childhood via the allergy march," Study investigator Dr. Harvey W. Kaufman says in a statement. "Given the growing incidence of asthma in the United States, our study underscores the need for clinicians to evaluate and treat patients, particularly young children, suspected of having food allergies in order to minimize the prospect that more severe allergic conditions and asthma will develop with age." The most common foods responsible for allergic reactions are eggs, cow's milk, peanuts, soya, fish and shellfish in children and peanuts, tree nuts, shellfish and fish in adults. Substances that are used as food additives and preservatives can also affect individuals. Although a causal link has not been determined, increased awareness of the heightened risks of having both childhood asthma and allergen sensitivity plus good patient-parent education and management of both conditions, can lead to improved health and medical outcomes.

Your Child

Recall: More Than 590,000 Albuterol Inhalers

1:30

Adults and children with breathing problems often rely on metered dose inhalers to open their airways, allowing them to breathe more easily. Albuterol (Proventil, Proair, Ventolin) is a medication called a bronchodilator, commonly found in rescue inhalers for acute asthma attacks.

GlaxoSmithKline is recalling more than 590,000 albuterol inhalers. Three lots of Ventolin HFA 200D inhalers have been voluntarily recalled due to a potential issue with the delivery system, a spokesman for the British pharmaceutical company said.

The affected lot numbers are 6ZP0003, 6ZP9944 and 6ZP9848. The devices have been recalled from hospitals, pharmacies, retailers and wholesalers in the United States.

The recalled inhalers may not release the correct dose of medication due to a defective delivery system. Albuterol opens airways in the lungs to treat common conditions such as asthma and chronic obstructive pulmonary disease.

The company said it had received an elevated number of product complaints about a bulging of the outside wrapper, indicating a leak of the propellant that delivers the medicine.

The U.S. Food and Drug Administration has approved the voluntary "Level 2" recall, which only affects products in the United States, GSK spokesman Juan Carlos Molina said.

The defect does not pose a danger to patients, so they are not being asked to return inhalers they have already purchased. However, if the devices are not relieving symptoms, patients should seek medical attention right away.

GSK said it was trying to identify the root cause of the problem and would take corrective action. Patients whose inhalers are among the affected lots can contact GSK’s customer service center at 1-888-825-5249.

Story sources: Robert Jimison, http://www.cnn.com/2017/04/06/health/albuterol-inhaler-recall/

Your Child

Low Pollen Levels Can Trigger Asthma

2.00 to read

Asthma in children has been on the increase since the 80s and the current estimated number of American children with asthma is between 6 and 9 million. It is the leading cause of chronic illness in kids under 18 years old. If your child is sensitive to pollen, a new study suggests that even low levels can increase the chances of an asthma attack. . 

Yale and Brown University researchers tracked more than 400 children with asthma, as well as the daily pollen levels near each child's home, over the course of five years. Researchers found that there was a 37% increase in respiratory symptoms in children who were sensitive to pollen- even though pollen levels were very low- and they were taking daily medications to control their asthma.

“In some respects, it's common sense that if a child is asthmatic and allergic to pollen, when they're exposed to pollen, they would bear some risk of asthmatic symptoms," said lead author Curt DellaValle, of the Yale School of Forestry and Environmental Studies.

"The biggest thing, though, is seeing these effects even with the lowest levels of pollen," he told Reuters Health. "It leads us to believe that parents of these asthmatic children should be aware that even when pollen levels are low, their children will experience asthmatic symptoms."

The study also revealed data that surprised researchers. Pollen-sensitive kids that were part of the study had fewer symptoms when ragweed – a major irritant- was at high levels. DellaValle said it may mean that the children's parents reacted to high pollen reports and took extra precautions.

"It suggested that they modified their children's behavior by keeping them inside, in air conditioning or by using air filters," DellaValle said.

Here’s how the study worked:

DellaValle's team recruited 430 children with asthma between the ages of four and 12 in New York, Connecticut and Massachusetts between 2000 and 2003. Each kid's mother kept a calendar tracking her child's asthma symptoms and use of asthma medications. The researchers also tested the children's blood for sensitivity to pollens from trees, grass and weeds.

To get a better picture of realistic pollen exposures, every year during the Northeast's pollen season -- generally from late March to early October -- the researchers used a model to analyze the amount of pollen within 1.2 miles of each child's home. They also tracked daily and seasonal weather, foliage, when pollen seasons began and ended and peak pollen periods.

Among kids with sensitivities to particular types of pollen, even small amounts in the air could trigger asthma symptoms.

Children not on maintenance medication who were sensitive to grass pollen, for example, wheezed, coughed and had trouble breathing and other nighttime symptoms when they were exposed to more than two grains per cubic meter of grass pollen.

Kids on daily maintenance therapy and sensitive to weed pollen could have similar symptoms and a need for rescue medication at pollen levels above six to nine grains per cubic meter.

Among the kids sensitive to weed pollen, low-level exposures raised their risk of symptoms by 37 percent. That compared to a 23 percent rise in risk during the highest weed-pollen periods -- hinting that kids may have stayed indoors when pollen levels were known to be high, the researchers note.

Pollen levels were not tied to an increase in asthma symptoms in kids without allergies to specific pollens.

Parents with asthmatic children often follow pollen reports and adjust their children’s outdoor activity accordingly. This study shows that even low levels of pollen can affect a sensitive child’s breathing and general health.

Although there is no cure for asthma, it can be managed with proper prevention and treatment. There is often a genetic compound.

Asthma symptoms can be mild or severe, and many children’s symptoms become worse at night.

Symptoms may include:

- Frequent, intermittent coughing.

- A whistling or wheezing sound when exhaling.

- Shortness of breath.

- Chest congestion or tightness.

- Chest pain, particularly in younger children.

- Trouble sleeping caused by shortness of breath, coughing or wheezing.

- Bouts of coughing or wheezing that get worse with a respiratory infection, such as a cold or the flu.

- Delayed recovery or bronchitis after a respiratory infection.

- Trouble breathing that may limit play or exercise.

- Fatigue, which can be caused by poor sleep.

If your child experiences any of the above symptoms, make sure he or she is seen by a pediatrician or family doctor. 

 

 

Sources:

http://www.reuters.com/article/2011/12/01/us-pollen-levels-idUSTRE7B02HG...

http://www.mayoclinic.com

Your Child

The Eczema, Allergies and Asthma March

1:45

Eczema refers to a number of different skin conditions in which the skin becomes red and irritated and sometimes has small, fluid filled bumps that ooze.

The most common cause of eczema is atopic dermatitis (sometimes called infantile eczema), which affects older kids as well as infants.

Children with eczema may eventually get food allergies, hay fever, or asthma. But you can take steps to soothe the itch and possibly cut the risk of allergies.

While most experts don't think eczema is purely allergic, it's clearly connected to allergic conditions like food allergies, hay fever, and asthma.

·      Up to 80% of kids with eczema get hay fever or asthma later in childhood.

·       35% of adults with asthma or nasal allergies had eczema as kids.

·      If a mom has allergies, there's almost a 1 in 3 chance that her baby will have eczema.

·      37% of kids with moderate to severe eczema also have food allergies.

For some kids, eczema and allergies develop in a specific order, as they get older. It starts with eczema, then food allergies, then asthma, and then hay fever. It's called the allergic march.

But just because your child has eczema doesn't mean they'll get these other conditions. It just means there's a higher risk.

There are several things that can increase a child’s risk of being part of the allergic march.  Kids who get eczema at a young age may be more likely to have allergies or asthma later. Kids with worse eczema symptoms may be more likely to get allergies or asthma.

You can do some things that might lower your child's chances of worsening eczema, asthma, or allergies. The evidence isn't clear, so talk to your doctor or your child's pediatrician. Depending on the situation, the doctor might recommend:

Breastfeeding your baby: It might lower the risk of eczema, later allergies, or asthma.

Diet changes: If your baby has a high risk of allergic problems, some doctors recommend changes in diet. Breastfeeding for at least 4 months can help protect your child. “Hydrolyzed” formula might help protect formula-fed babies.

Other ways to keep your child's eczema under control include:

Get allergy testing. If you can pin the problem on a specific allergen, you can figure out ways to avoid it.

Use a moisturizer. Go for thick creams and ointments that stop the skin from drying out.

Keep fingernails short. Your child will do less damage to the skin from scratching.

Avoid irritants. Always use unscented soap and laundry detergent. Stay away from cigarette smoke.

Watch for problems. If your child's eczema seems to be getting worse -- or if they get allergy symptoms, like congestion or a runny nose -- see a doctor. The sooner you get treatment, the sooner your child will feel better.

In many cases, eczema goes into remission and symptoms may disappear altogether for months or even years.

For many kids, it begins to improve by the age of 5 or 6; others may have flare-ups throughout adolescence and early adulthood.

In some kids, the condition may improve but then restart as they enter puberty, when hormones, stress, and irritating skin products or cosmetics are introduced. Some people will have some degree of dermatitis into adulthood, with areas of itching and a dry, scaly appearance.

Eczema is not contagious, so there's no need to keep a baby or child who has it away from siblings, other kids, or anyone else.

Story sources; http://www.webmd.com/skin-problems-and-treatments/eczema/child-eczema-14/allergies?ecd=wnl_prg_050116&ctr=wnl-prg-050116_nsl-promo-4_title&mb=HJinmVxrQQBBWXaWABbkR%40HnVev1imbCiW2HnNaB9FE%3d

http://kidshealth.org/en/parents/eczema-atopic-dermatitis.html#

 

 

 

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Asthma

Managing Your Child's Asthma

Your Teen

Acetaminophen, No Threat To Child's Liver

2.00 to read

With more than eight million American kids taking the drug every week, acetaminophen is the nation's most popular drug in children. It's toxic to the liver in high doses, and can be fatal if taken in excess. Very rarely, adults may also get liver damage at normal doses, so doctors had worried if the same was true for kids. Concerns about liver injuries in children who take the common painkiller acetaminophen, sold as Tylenol in the U.S. are unfounded, researchers said on Monday. "None of the 32,000 children in this study were reported to have symptoms of obvious liver disease," said Dr. Eric Lavonas of the Rocky Mountain Poison and Drug Center in Denver. "The only hint of harm we found was some lab abnormalities." With more than eight million American kids taking the drug every week, acetaminophen is the nation's most popular drug in children. It's toxic to the liver in high doses, and can be fatal if taken in excess. Very rarely, adults may also get liver damage at normal doses, so doctors had worried if the same was true for kids. "This drug is used so commonly that even a very rare safety concern is a big concern," said Lavonas, whose findings appear in the journal Pediatrics. Some researchers suspect there is a link between long-term use of acetaminophen and the global rise in asthma and allergies, but the evidence is far from clear at this point. For the new report, researchers pooled earlier studies that followed kids who had been given acetaminophen for at least 24 hours. There were no reports of liver injuries leading to symptoms such as stomachache, nausea or vomiting, in the 62 reports they found. Ten kids, or about three in 10,000, had high levels of liver enzymes in their blood, which usually means their livers have been damaged. In most cases, however, those elevations were unrelated to acetaminophen. And even if they were caused by the drug, they don't indicate lasting damage, according to Lavonas. "Acetaminophen is extremely safe for children when given correctly," he said. "Parents should not be afraid to give acetaminophen to their children when they need it, but they should be very careful about giving the right dose." "If you suspect that you have given a child an overdose, call your state's poison center," he added. The Rocky Mountain Poison and Drug Center receives funding from McNeil Consumer Healthcare, the Johnson & Johnson subsidiary that sells Tylenol, but the researchers said the company did not support this study.

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