Mar 26, 2015
Dr. Sam Pejham
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Depression During Pregnancy Linked to Child’s Asthma Risk

There is a new study from Denmark about the effect of maternal depression during pregnancy and its effect on their offspring.

Depression affects between 7 percent and 13 percent of pregnant women
Children born to mothers who had depression were 25 percent more likely to develop childhood asthma, the findings revealed.
However, more than 80 percent of the women in the study who were prescribed antidepressants were given one of a newer class of drugs known as selective serotonin reuptake inhibitors (SSRIs). And those medications were NOT linked to any increased risk for asthma in the child.
SSRIs are the most commonly prescribed medications for depression. Some examples of SSRIs include Zoloft (sertraline), Prozac (fluoxetine) and Celexa (citalopram).
But it was a different story when the researchers looked only at older antidepressants, known as tricyclic antidepressants. They were linked to the same level of increased risk for asthma as depression during pregnancy, the researchers said. In the study, roughly 8 percent of the women took the older medications.
Some examples of these older antidepressants include Norpramin (desipramine), Tofranil (imipramine) and Pamelor (nortriptyline).
Conclusion, if you are pregnant and have a diagnosis of depression there is evidence that by taking SSRI type antidepressants you may reduce the chance of your Child suffering from childhood asthma.
Sep 18, 2014
Dr. Sam Pejham
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Can drinking from bottled water during pregnancy increase risk of Asthma in the newborn?

According to a new study from Columbia University, exposure in the womb to household chemicals known as phthalates might increase a child’s future risk of developing asthma. Children had nearly an 80 percent increased risk of developing asthma between age 5 and 11 if their mothers were exposed during pregnancy to high levels of two phthalates (pronounced thal-ates), the researchers found. The two phthalates were butylbenzyl phthalate and di-n-butyl phthalate, according to the study.

“The prenatal period tends to be when the child is most vulnerable, and in our study we did see a significant increase in asthma risk with prenatal exposure,” said lead author Robin Whyatt, a professor of environmental health sciences.

Phthalates are a type of chemical used to make plastics more flexible and harder to break, according to the U.S. Centers for Disease Control and Prevention.

“Phthalates are everywhere. They are in an amazing number of products. You name it, you’re going to find them,” said Dr. Patricia Vuguin, a pediatric endocrinologist at Cohen Children’s Medical Center in New Hyde Park, N.Y. “That’s why their potential impact is kind of scary.”

There has been other studies which raised concerns about Phthalates. Prior research has linked phthalates to other allergic diseases, such as eczema, according to Vuguin. Other research, including two studies recently presented at the International Federation of Fertility Societies and the American Society for Reproductive Medicine annual meeting, has found an association between phthalates and reproductive difficulties.

Whyatt suggested that pregnant women avoid storing and microwaving food in recyclable plastic containers. They also should avoid using scented products, which use phthalates to help “stick” the scent to the air freshener or laundry detergent. It is also important to limit drinking from plastic bottle water, specially if left in heat (inside the car in a hot day) to reduce the Phthalate intake.

May 28, 2014
Dr. Sam Pejham
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Good Asthma Management can save children from Anxiety and Depression

There was previously evidence that had shown increased mental health problems such as anxiety, depression and low self esteem among asthmatic children, but now Dutch researchers have demonstrated that children who manage their asthma well are not any more likely to have mental health problems.  Most likely the original studies included those patients who did not take their controller medication daily and were not well controlled.  When kids take the necessary medicines, they don’t appear to be any worse off psychologically than other children.

In their study, All the children filled out age-appropriate questionnaires meant to assess depression, anxiety and self-esteem. They also answered questions about how well they controlled their wheezing and symptoms.

On the whole, asthmatic kids and their healthy peers scored about the same on the psychological assessments, the authors write in the journal Archives of Disease in Childhood. Between 10 and 20 percent of kids in both groups showed signs of depression, anxiety or low-self esteem.

But kids with poorly controlled asthma tended to score higher on the anxiety questionnaire than kids with well controlled asthma.

“It was sort of common sense that if you are doing well with any kind of chronic illness you won’t have the psychological risks,” Dr. Andrew Ting told Reuters Health by phone.

“If you can work with kids and their parents to agree on daily use of inhaled corticosteroids and appropriate use of rescue medications when necessary, you can really control most asthma,” he said.

A rescue inhaler, like Albuterol, helps to relax the airways during an asthma attack. Children with persistent asthma should also be using a corticosteroid inhaler, like Advair, every day to help reduce airway inflammation and lower mucus levels, he said.

But many children don’t use their daily inhaler, Brand said. “In order to insure adherence, you need to invest in the relationship with kids and their parents,” which is more common in western Europe than in the U.S., he noted.

In order to help children and their families achieve better adherence to their daily medications and better manage their asthma, they can use AsthmaMD mobile App.

“The question is, how do you do that in today’s medical economic climate, how do you carve out the time to make that kind of a relationship with the patients?” Ting said.

It’s impossible to really encourage patients to adhere to a good action plan in a five to ten minute doctor’s visit, he said. At Mount Sinai they have a social worker go over the asthma management plan with patients in more detail outside of a doctor’s appointment, but many places don’t have that resource.  Another way would be to use AsthmaMD mobile app, which is the only application that includes an easy to use action plan that is interactive and gives immediate feedback to the patient.

“If parents find out that their kids have asthma symptoms that keep occurring it is possible that the child is not taking their medication at all,” Brand said. “If they deny the disease and don’t take the meds, they will be suffering more.”

Kids might be less likely to use their inhalers in front of friends because of the social stigma, Ting said, but if they take their corticosteroid every day it is less likely that they will have to do that.

With proper medication use, and monitoring using apps like AsthmaMD, kids should be able to play sports and activities and be at no increased risk of anxiety or depression.

Feb 21, 2014
Dr. Sam Pejham
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Mother’s Diet can help prevent some cases of Asthma and Allergies.

U.S. researchers who looked at more than 1,200 mother-child pairs between 1999 and 2002 found that greater intake of peanuts, milk and wheat during early pregnancy was tied to reduced rates of midchildhood allergies and asthma. The findings were published in The Journal of Allergy and Clinical Immunology.

Analysis of the data found that higher consumption of peanuts by pregnant women in their first trimester was associated with a 47 percent decreased odds of peanut allergic reactions in mid-childhood.

Higher consumption of milk in the first trimester of pregnancy was associated with a 17 percent decrease in chance of mid-childhood asthma.

In the second trimester, higher wheat consumption was associated with a 36 percent decrease in the odds of allergic skin reactions in mid-childhood.

Feb 18, 2014
Dr. Sam Pejham
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Mystery Solved on why some asthma patients don’t respond to their medication!


At lease this question has been partially answered by a new study out of UK.  Passive smoke exposure among children with severe asthma was associated with lower levels of HDAC2 enzymes, making them less sensitive to inhaled steroid treatment, according to a small U.K. study in CHEST Journal. Those exposed to secondhand smoke in the home had almost half the enzyme levels compared with children living in nonsmoking households.  This study is yet another reason to stop smoking for parents specially if their children have asthma.

Dec 26, 2013
Dr. Sam Pejham
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Can Use of Antibiotics During The First 2 Years Of Life Increase Chance of Asthma?

According to a recent published article in UK, the answer is YES!  They found that the children who had taken antibiotics during the first two year of their lives had much higher chance of being diagnosed with Asthma by age 7.5 years.  They also found the chance of Asthma diagnosis was higher the more rounds of antibiotics a child takes during this time.  So please be sure to discuss the need to use antibiotics with your physician and try to avoid using these medications to treat viral colds and illnesses.

Jun 28, 2013
Dr. Sam Pejham
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When will my child outgrow his asthma?

In a recent article published in Lancet, researchers evaluated 880 patients with asthma and determined those with certain genetic predisposition were much more likely to have more severe asthma which lasted into adulthood.  An additional interesting finding was that this genetic predisposition was independent of family history of asthma.  So just because there is family history of severe asthma, it doesn’t mean that your child would have the same and vice versa.

James T C Li, M.D., Ph.D., answering a question for the Mayo Clinic about children outgrowing asthma, said, “In some children, asthma improves during adolescence and young adulthood. For others, symptoms go away only to return a few years later. Many children with asthma never outgrow it.”

Based on the debilitating effect of asthma, parents should take all the precautions to manage their child’s asthma and not count on them to outgrow it.  This generally means to follow an asthma action plan provided by your physician and track your asthma by using tools such as free AsthmaMD mobile app.

May 31, 2013
Dr. Sam Pejham
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Q: Can Asthma make your child fail in school?

A: “Yes, if it is not well controlled” was the answer found by a new study at Brown University’s Alpert Medical School in Providence, R.I.  Researchers found the more asthma symptoms in a child, the lower his or her quality of schoolwork.  After measuring the children’s asthma severity using spirometry and following their peak flow measurements over time, they found that those who poorly managed the symptoms of asthma had lower grades than children who had their asthma under control.

When it came to sleep, children experiencing bad asthma symptoms couldn’t get enough sleep and their academics consequently suffered.

The frequent struggles with asthma were higher in urban children from low socioeconomic backgrounds primarily because they reside closer to risky environmental pollutants that may contribute to asthma and poor health. Children from these families are also at risk if they don’t visit parks for cleaner air.

The Natural Resources Defense Council found that pollutants such as smog, sulfur dioxide from burning coal, and diesel exhaust could trigger asthma.

The researchers hope that controlling asthma symptoms and gaining better sleep through interventions could significantly improve children’s school performances especially in these populations.

One of the easiest methods to track asthma symptoms and peak flow measurements is by using the FREE AsthmaMD mobile application and sharing your data with your physician for better asthma control and better school performance.

Apr 1, 2013
Dr. Sam Pejham
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How do I know if my child or I suffer from Asthma?

Asthma is a chronic condition and can present itself at any age.  Initially it could be mistaken for other conditions such as bronchitis, recurrent colds, chronic cough, poor exercise tolerance, allergies, etc.  Here are some signs that should raise concerns about possibility of asthma for you to discuss with your physician:

1)   Recurrent nigh time coughing:  The body’s circadian rhythm (your body’s clock) at night releases less adrenaline and corticosteroids, which have protective effect against airway inflammation.  So if your cough is worse between 2-4am it may be nocturnal asthma.

2)   Feeling short of breath during exercise:  There are different triggers for asthma.  Exercise is one of the common triggers.  If you develop a cough while exercising it may be due to exercise-induced asthma.

3)   Recurrent Bronchitis:  Viral illnesses are another common trigger for asthma and are sometimes over treated with antibiotics.  If you have been diagnosed with recurrent bronchitis, ask you physician to do a pulmonary function test for you to determine your chance of having asthma, and hopefully avoid receiving unnecessary antibiotics.

4)   Coughing during the allergy season.  Seasonal allergies are a major trigger for both childhood and adult asthma.  If your symptoms are not controlled with allergy medicines alone, you may also have an underlying asthma diagnosis.

5)   Wheezing:  If you have felt short of breath, wheezing, and/or having retractions (pulling in of the skin between ribs when you breath), there is a strong possibility that you suffer from asthma.

If you or your child has any of the above signs and symptoms, be sure to discuss them with your physician.  There are tests, such as a pulmonary function test (PFT) that can be administered in the office to determine your risk of suffering from asthma.  Properly managed asthma should help avoid urgent visits to ER, and improve your quality of life.


Article written by Dr. Sam Pejham, director of Tri-Valley Pediatrics and Assistant Clinical Professor of UCSF School of Medicine, and the Co-Founder of AsthmaMD.

Mar 22, 2013
Dr. Sam Pejham
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Traffic pollution may increase children’s risk of chronic asthma

BASEL, Switzerland, March 22 (UPI) – Fourteen percent of chronic childhood asthma is due to exposure to traffic pollution near busy roads, researchers in Europe say.

Lead author Dr. Laura Perez of the Swiss Tropical and Public Health Institute said until now, traffic pollution was assumed to only trigger asthma symptoms, but the research did not account for chronic asthma caused by the specific range of toxicants found near heavily used roads.

The researchers used data from existing epidemiological studies which found that children exposed to higher levels of near-road traffic-related pollution also had higher rates of asthma, even when taking into account a range of other relevant factors such as passive smoking or socioeconomic factors.

The study, published in the European Respiratory Journal, found 14 percent of asthma cases across the 10 European cities could be attributed to near-road traffic pollution.

“Air pollution has previously been seen to trigger symptoms but this is the first time we have estimated the percentage of cases that might not have occurred if Europeans had not been exposed to road traffic pollution,” Perez said in a statement.


About AsthmaMD

In the fight for managing asthma, researchers and patients now have a new tool in the form of an iPhone application, AsthmaMD.

The free application allows users to easily and quickly log their asthma activity, their medications, causes of their asthma in the form of a diary. Users may share the diary and a color graph chart of their asthma activities with their physicians to be included in their medical records.

AsthmaMD is available as a free download for iPhone/iPod users.

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