Author: Dr. Sam Pejham

Can daily asthma medications be reduced safely?

Sam PEjham


In a recent publication in The Journal of Allergy and Clinical Immunology, researchers analyzed asthma outcomes after patients stepped down their daily asthma medicines.

The main findings of the study were that for those who have had “Stable” asthma for at least 1 year, stepping down asthma medicines appears to be as safe as maintaining the same level of medicines.  Very small percentage (only 11%) had problems with their step down approach in 4-5 months post reduction of medication.  The patients who stepped down their asthma medicines, also saved an average of $34 each month compared to those who maintained the same level of medicines.

A great way for asthma patients who have been stable for at least 1 year on daily asthma medicine is to discuss the “Step down” approach with their doctor and along with a peak flow meter to monitor their respiratory status should be able to safely reduce their daily asthma medicines.

Poverty and not Urban Areas may be the reason for higher asthma rates

Asthma rates are essentially identical among black children living in Detroit and rural Georgia, researchers report.

The finding challenges the common belief that living in a city boosts the chances of developing the respiratory condition, the study authors said.

Instead, poverty may be what increases asthma risk, the study results suggested.

“The things these children have in common include high rates of poverty, asthma and being black,” corresponding study author Dr. Dennis Ownby, an allergist-immunologist at the Medical College of Georgia, said in a college news release.

In the study, the investigators analyzed data from nearly 7,300 students at six public high schools in Detroit and more than 2,500 students at four schools in rural Georgia. More than 90 percent of the children in Detroit and 60 percent of the children in rural Georgia are black, the researchers said.

About 15 percent of the students in Detroit had diagnosed asthma and another 8 percent had undiagnosed asthma. The rates were nearly 14 percent and 7.5 percent, respectively, among the students in rural Georgia, the study found.

In both locations, about 74 percent of students qualified for free or reduced-cost lunches and the poverty rate was 23 percent, according to the study published online recently in the Journal of Allergy and Clinical Immunology.

Overall, 10 percent of children in the United States have asthma, but the rate among black children is 20 percent, researchers have found.

The study authors said their findings suggest that asthma is a disease of poverty and poor housing, where children are exposed to high levels of asthma triggers such as mold, fungi, cockroaches, mice, dust mites and tobacco smoke.

It’s estimated that 30 percent to 40 percent of asthma risk is genetic and the rest is environmental, the researchers said.

Childhood Trauma May Raise Odds of Asthma

Children who experience trauma such as divorce, death of a parent or domestic violence are more likely to develop asthma than other kids, new research suggests.

“We know that young children are susceptible to numerous adverse factors that they may be exposed to in the home environment, including cigarette smoking, indoor triggers, and even, as this study shows, dysfunctional families and associated domestic violence,” said Dr. James Sublett, president of the American College of Allergy, Asthma and Immunology, in a college news release.

“It is even more important that these high-risk children are identified and cared for by experts in the management of asthma,” he said.

Researchers surveyed parents of more than 92,000 children under the age of 18. They found that about one-third of the children had experienced at least one traumatic event, most commonly “living with a parent or guardian who got divorced or separated,” study author Dr. Robyn Wing said in the news release.

“The data showed that the more adverse childhood experiences a child is exposed to, the greater the probability he or she will develop asthma,” Wing added.

One in four kids exposed to five or more types of trauma had asthma, compared to 12 percent of those who hadn’t experienced any of these traumas, the study found. It defined these traumas as domestic violence, divorce or separation of parents, living with someone who is mentally ill, living with someone who’s been in jail or prison, and death of a parent or guardian.

About two-thirds of those children in the study hadn’t experienced any of the traumas, and 17 percent had experienced one, the researchers said. The rest experienced more.

The study doesn’t prove that a traumatic event causes asthma, merely that there is an association between the two.

The study was published April 2 in the Annals of Allergy, Asthma and Immunology.

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.

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.

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.

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.

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.

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.

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.