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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.

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.

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.

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.

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.

Top 5 biggest mistakes parents make about their children’s asthma

 1)   My child does’t have asthma, he just coughs a lot at certain time of the year or wheezes when he gets a cold.   Parent’s have a negative connotation about what asthma means.  Today over 8 percent of the population in US has been diagnosed with asthma and that rate is higher among women and children.  If your child suffers from seasonal/allergic/viral illness related cough and feels short of breath, he may be suffering from asthma.  Proper diagnosis and treatment can make a big difference in their overall health and less missed school days.

2)  I don’t hear a wheeze.  So it can’t be asthma.  This is a common misconception among parents of asthmatic children and may delay start of treatment and increase chance of ER visits and hospital admissions.  For those with asthma, a cough is usually a sign to start their medication to help with their breathing.  Any delay in doing so may cause worsening of symptoms.

3)  My child won’t be able to play sports because of his asthma.  Currently there are numerous medications that should allow most asthmatics to play sports and/or do normal activities without feeling short of breath.  Your can take the asthma control test to see if your symptoms are well controlled.   If your symptoms are not well controlled, talk to your doctor to adjust your medication to achieve better symptom control.  Your physician would benefit from your asthma history if you can provide him with more detail about your symptoms.  There are free smart phone applications such as AsthmaMD which can be used at home to track your daily symptoms and allow you to share this information with your physician.

4)  I don’t want to give my child steroids.  Current inhaled corticosteroids (ICS) have  very little systemic side effects and there have been numerous studies to show that chronic use of ICS is safe for children.  Since Asthma is an inflammatory condition, according to NIH guidelines, any form of persistent asthma would benefit from use of anti-inflammatory medication such as ICS.  These medications play an important role to reverse and/or prevent an inflammation from starting, and may prevent future lung damage.

5)  My child hasn’t needed an inhaler for over 6 months. So he must have outgrown his asthma.  Data has shown that many asthma related ER visits can be avoided if the right medications are given early.  Many children improve their asthma at some age; however, just because they haven’t had an attack for a few months does not mean that they have  outgrown their condition.  Asthma usually has triggers which include, respiratory viruses, allergies, exercise, pollen, pollution, etc. which can cause an exacerbation of symptoms.  So it is best to have an inhaler ,which is not expired, readily available for emergencies even if you haven’t had an asthma attack for a long time.

 

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.