Fast food diet linked to asthma and eczema severity in kids, large study finds

Jan. 16, 2013 — Eating three or more weekly servings of fast food is linked to the severity of allergic asthma, eczema, and rhinitis among children in the developed world, indicates a large international study published online in the respiratory journal Thorax.

The findings prompt the authors to suggest that a fast food diet may be contributing to the rise in these conditions, and if proved causal, could have huge implications for public health, given the popularity of these foodstuffs.

The authors base their findings on data from more than 319,000 13-14 year olds from 107 centres in 51 countries, and more than181,000 six to seven year olds from 64 centres in 31 countries.
All the participants were involved in the International Study of Asthma and Allergies in Childhood (ISAAC), which is a collaborative research project involving more than 100 countries and nearly two million children, making it the largest study of its kind.

The teens and the children's parents were formally quizzed on whether they had symptoms of asthma (wheeze); rhinoconjunctivitis (which produces a runny or blocked nose accompanied by itchy and watery eyes); and eczema; and their weekly diet.

Questions focused particularly on the severity of symptoms over the preceding 12 months -- including frequency and interference with daily life and/or sleep patterns -- and certain types of food already linked to protective or damaging effects on health. These included meat, fish, fruits and vegetables, pulses, cereals, bread and pasta, rice, butter, margarine, nuts, potatoes, milk, eggs, and fast food/burgers. Consumption was categorised as never; occasionally; once or twice a week; and three or more times a week.

After taking account of factors likely to influence the results, the analysis showed that fast food was the only food type to show the same associations across both age groups, prompting the authors to suggest that "such consistency adds some weight to the possible causality of the relationship."
It was associated with current and severe symptoms of all three conditions among the teens -- across all centres in the participating countries, irrespective of gender or levels of affluence.

The pattern among children was less clear-cut, but a fast food diet was still associated with symptoms across all centres -- except for current eczema -- and poorer countries -- except for current and severe asthma.

And this difference might have to do with the fact that children have fewer options about their food choices, suggest the authors.

Three or more weekly servings were linked to a 39% increased risk of severe asthma among teens and a 27% increased risk among children, as well as to the severity of rhinitis and eczema, overall.
On the other hand, fruit seemed to be protective in both age groups across all centres for all three conditions among children -- both current and severe -- and for current and severe wheeze and rhinitis among the teens.

Eating three or more weekly portions was linked to a reduction in symptom severity of between 11% and 14% among teens and children, respectively.

The authors suggest that there are plausible explanations for the findings: fast food contains high levels of saturated and trans fatty acids, which are known to affect immunity, while fruit is rich in antioxidants and other beneficial compounds.

The authors emphasise that their results do not prove cause and effect, but they do warrant further investigation.

"If the associations between fast foods and the symptom prevalence of asthma, rhinoconjunctivitis and eczema is causal, then the findings have major public health significance owing to the rising consumption of fast foods globally," they conclude.

Fast food diet linked to asthma and eczema severity in kids, large study finds  
Source: www.ScienceDaily.com

Acetaminophen linked to asthma in new report

Acetaminophen linked to asthma in new report

Researchers have found that climate change may lead to more asthma-related health problems in children

ScienceDaily (Aug. 30, 2011) — Mount Sinai School of Medicine researchers have found that climate change may lead to more asthma-related health problems in children, and more emergency room (ER) visits in the next decade.

The data, published in the current issue of the American Journal of Preventive Medicine, found that changing levels of ozone could lead to a 7.3 percent increase in asthma-related emergency room visits by children, ages 0-17.

The research team, led by Perry Sheffield, MD, Assistant Professor of Preventive Medicine at Mount Sinai School of Medicine, used regional and atmospheric chemistry models to reach its calculations. They linked regional climate and air quality information to New York State Department of Health records of pediatric, asthma-related emergency room visits in 14 counties that are part of the New York City metropolitan area. Then they simulated ozone levels for June through August for five consecutive years in the 2020s, and compared them with 1990s levels. The researchers found a median increase of 7.3 percent in ozone-related asthma emergency department visits, with increases ranging from 5.2 percent to 10.2 percent per county.

"Our study shows that these assessment models are an effective way of evaluating the long-term impact of global climate change on a local level," said Dr. Sheffield. "This study is a jumping off point to evaluate other outcomes including cost utilization, doctors' visits, missed school days, and a general understanding of the overall burden of climate change on children with asthma."

Dr. Sheffield and her team plan to continue using these models to understand the specific impacts of climate change. The authors conclude that better measures to reduce carbon pollution that contributes to global climate change as well as pollution that forms ozone need to be implemented.

Funding for this study was provided by the National Institutes of Health Research Training Program in Environmental Pediatrics.

Size at Birth May Determine Asthma Risk in Children

                               
Size of baby in womb as an indicator of childhood asthma and allergies

                                (Medical Xpress) -- In a paper published in the American Journal of Respiratory and Critical Care Medicine, the University of Aberdeen team also found links between the rate an unborn baby grows and its chances of developing eczema and hayfever.

                           

Asthma Management Model for Preschoolers Decreases ER Visits and Hospitalizations

Model for Managing Asthma in Preschoolers Leads to Dramatic Drop in ER Visits and Hospitalizations

ScienceDaily (Feb. 25, 2011) — Nearly one in eleven (8.6%) preschool children in the U.S. has been diagnosed with asthma and in some inner city neighborhoods, the figure is closer to one in seven. But, few asthma management programs are designed for parents of preschool children.

The Asthma Basics for Children (ABC) program, established by Columbia University's Mailman School of Public Health and a coalition of community service organizations, educators, parenting programs, and community pediatric providers, addressed this need with a multi-layered approach that offers educational activities to parents and children in 31 Northern Manhattan daycare centers as well as training to community pediatric providers. Following participation in the program, 85% percent of parents reported reducing their child's asthma triggers. The percent of children with asthma-related visits to emergency departments declined sharply from 74% to 47%, as did asthma-related hospitalizations, dropping from 24% to 11%.
Full study findings are published in the February 2011 Journal of Urban Health.

The ABC Program provided multiple opportunities for parents to learn about asthma signs and triggers in health units at the daycare centers. The multi-level intervention involved social workers, peer counselors and trained health educators, as in other community-based asthma coalitions ; but also promoted parent participation by offering flexible workshop scheduling; reinforcing messages to parents through daycare center activities for their children; and adding a provider-education component to improve communication between parents and providers. The Columbia researchers found that parent participation rates in the study exceeded rates found in most other preschool or school-based asthma programs.

"Although emergency room visits and hospitalization rates for this age group are more than twice that of older children with asthma, until we developed the ABC model, only a handful of programs had been designed to promote better asthma management by their parents," said Sally P. Findley, PhD, first author on the paper. "Our study suggests that the benefits of such a program are huge."

The study also found that over a two-week period the percentage of children reporting any daytime symptoms dropped from 78% to 42%, any nighttime symptoms fell from 81% to 49% during one month, and any daycare absences declined from 56% to 38% in the previous six months.

Another key element of the ABC strategy was linking asthma education activities in the daycare setting with improving the quality of asthma care by healthcare providers. Parents in this program confided that they were often reluctant to share concerns with their physician, especially about possible side effects of daily use of medications to control asthma. After participating in the program, 89% found it easier to talk to their doctor, and 80% said they were confident in their ability to manage their child's asthma. In the group without parent training, only 31% had taken at least one step toward reducing triggers, 49% reported that talking to their child's doctor was easier, and 49% expressed confidence in managing their child's asthma. When parents participated in the program, those reporting these behaviors increased to 40%, 62%, and 71%, respectively. Children with both parents and healthcare providers reported the greatest increases in these behaviors: 76%, 82%, and 86%, respectively. The two-pronged strategy of strengthening communication skills of parents and their child's healthcare provider is likely to have contributed to the changes in asthma management behaviors, improved confidence, and improved asthma control, observes Dr. Findley.

Asthma control outcomes improved progressively as the child's exposure to ABC's multi-layered interventions increased. "This study show that you can improve asthma outcomes for preschoolers with an approach that integrates activities for children, parents, teachers, and healthcare providers, noted Dr. Findley, clinical professor of Sociomedical Sciences and Population and Family Health at the Mailman School. "The greatest impact occurs when you combine education interventions at all of these levels."
The project was funded by the CDC's Controlling Asthma in America's Cities Project after an assessment by the Northern Manhattan Community Voices Collaborative, an academic-community partnership, documented the need for an asthma intervention targeting local preschoolers.

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Columbia University's Mailman School of Public Health, via EurekAlert!, a service of AAAS.

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Journal Reference:

1. Sally E. Findley, Gloria Thomas, Rosa Madera-Reese, Natasha McLeod, Sreelata Kintala, Raquel Andres Martinez, Benjamin Ortiz, Elizabeth Herman. A Community-Based Strategy for Improving Asthma Management and Outcomes for Preschoolers. Journal of Urban Health, 2011; 88 (S1): 85 DOI: 10.1007/s11524-010-9479-8

Babies Who are Given Antibiotics Have a 50% Increased Risk of Developing Asthma by Age 6

Early Antibiotic Use Can Lead to Increased Risk of Childhood Asthma, Study Suggests

ScienceDaily (Jan. 27, 2011) — When babies are given antibiotics, their risk of developing asthma by age 6 may increase by 50 percent. This relationship between antibiotic use in babies less than six months old and risk of developing asthma was documented in a study conducted by Norwegian University of Science and Technology (NTNU) researcher Kari Risnes.

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The research was conducted while Risnes was a visiting researcher at Yale University, and resulted in the recent online publication of the article in the American Journal of Epidemiology.
"Asthma is a very common disease. At the same time, about one-third of infants in our study were treated with antibiotics by the time they were six months old. This proportion is about 30 per cent in other Western countries," says Risnes.
The Yale study followed 1400 children and mothers from the beginning of pregnancy until the children were six years old.
"We found that the risk that children would have asthma as six year olds was 50 per cent higher when they had been given antibiotics as a baby. That is a significant increase," Risnes says.
While previous research has suggested an association between asthma and antibiotics, those studies may have been biased because antibiotics are used to treat respiratory tract infections that could themselves be early symptoms of asthma.
The study sought to eliminate this bias by excluding children who were treated for respiratory infections from the study. The study also considered a long list of other risk factors -- such as whether or not the mother, father or a sibling had asthma. That aspect also brought a surprise, Risnes said.
"We actually found that the relationship between antibiotic use in the first six months of life and asthma was particularly strong in children from families without a history of asthma," said Risnes.
"What we think is that antibiotics interfere with the beneficial bacteria found in the gut. These bacteria aid in helping the baby's immune system to mature. When the bacteria are affected, it can cause the child to have an "immature" immune system, which in turn leads to allergic reactions," says Risnes.
She believes that the results should remind doctors and policymakers of the consequences of overuse of antibiotics. While in Norway, for example, the policy is to limit the prescription of antibiotics "this is an additional reminder to doctors and parents that we should avoid unnecessary use whenever possible," she said.

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by The Norwegian University of Science and Technology (NTNU).

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Journal Reference:

1. K. R. Risnes, K. Belanger, W. Murk, M. B. Bracken. Antibiotic Exposure by 6 Months and Asthma and Allergy at 6 Years: Findings in a Cohort of 1,401 US Children. American Journal of Epidemiology, 2010; 173 (3): 310 DOI: 10.1093/aje/kwq400

Low levels of vitamin D are associated with lower lung function and greater medication use in children with asthma

Low Vitamin D Levels Associated With More Asthma Symptoms and Medication Use

ScienceDaily (Apr. 20, 2010) — Low levels of vitamin D are associated with lower lung function and greater medication use in children with asthma, according to researchers at National Jewish Health. In a paper published online this week in the Journal of Allergy & Clinical Immunology, Daniel Searing, MD, and his colleagues also reported that vitamin D enhances the activity of corticosteroids, the most effective controller medication for asthma.

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"Asthmatic children in our study who had low levels of vitamin D were more allergic, had poorer lung function and used more medications," said Dr. Searing. "Conversely, our findings suggest that vitamin D supplementation may help reverse steroid resistance in asthmatic children and reduce the effective dose of steroids needed for our patients."

The researchers examined electronic medical records of 100 pediatric asthma patients referred to National Jewish Health. Overall, 47 percent of them had vitamin D levels considered insufficient, below 30 nanograms per milliliter of blood (ng/mL). Seventeen percent of the patients had levels below 20 ng/mL, which is considered deficient. These levels were similar to vitamin D levels found in the general population.

Patients low in vitamin D generally had higher levels of IgE, a marker of allergy, and responded positively to more allergens in a skin prick test. Allergies to the specific indoor allergens, dog and house dust mite, were higher in patients with low vitamin D levels. Low vitamin D also correlated with low FEV1, the amount of air a person can exhale in one second, and lower FEV1/FVC, another measure of lung function. Use of inhaled steroids, oral steroids and long-acting beta agonists were all higher in patients low in vitamin D.

"Our findings suggest two possible explanations," said senior author Donald Leung, MD, PhD. "It could be that lower vitamin D levels contribute to increasing asthma severity, which requires more corticosteroid therapy. Or, it may be that vitamin D directly affects steroid activity, and that low levels of vitamin D make the steroids less effective, thus requiring more medication for the same effect."

The researchers performed a series of laboratory experiments that indicated vitamin D enhances the action of corticosteroids. They cultured some immune cells with the corticosteroid dexamethasone alone and others with vitamin D first, then dexamethasone. The vitamin D significantly increased the effectiveness of dexamethasone. In one experiment vitamin D and dexamethasone together were more effective than 10 times as much dexamethasone alone.

The researchers also incubated immune-system cells for 72 hours with a staphylococcal toxin to induce corticosteroid resistance. Vitamin D restored the activity of dexamethasone. "Our work suggests that vitamin D enhances the anti-inflammatory function of corticosteroids,' said Dr. Leung. "If future studies confirm these findings vitamin D may help asthma patients achieve better control of their respiratory symptoms with less medication."

This study comes on the heels of another paper by National Jewish Health faculty, which showed that low levels of vitamin D in adult asthma patients are associated with lower lung function and reduced responsiveness to corticosteroids.

Severe asthma in early childhood may lead to premature loss of lung function

Children With Severe Asthma Experience Premature Loss of Lung Function During Adolescence, Study Finds

ScienceDaily (Jan. 20, 2011) — Severe asthma in early childhood may lead to premature loss of lung function during adolescence and more serious disease during adulthood, researchers at Emory University School of Medicine report. Early identification and treatment of children with severe asthma is important to help stem asthma progression.

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In an article available online in the January issue of the Journal of Allergy and Clinical Immunology, Anne M. Fitzpatrick, PhD, and W. Gerald Teague, MD, and colleagues report on their study of how airflow limitation changes throughout childhood and how this affects disease severity later in life. Fitzpatrick is an assistant professor of pediatrics in Emory University School of Medicine. Teague, who was formerly at Emory, currently is at the University of Virginia School of Medicine.

"Severe asthma in children is a challenging disorder," says Fitzpatrick. "It is important for physicians to identify those children with severe asthma who are at risk for lung function decline. With early identification, physicians can customize treatment plans and educate families on lifestyle changes that may help children with severe asthma breathe easier as they grow older."

Severe asthma in children is characterized by serious respiratory complications despite treatment with high doses of inhaled corticosteroids (ICS). Although there are similarities between children and adults with severe asthma, recent research has shown that the limitation of airflow is not as significant in children as in adults. This raises questions about the course of severe asthma in childhood and the critical developmental time frame during which loss of lung function occurs.

The authors used data from children with mild-to-moderate and severe asthma who were enrolled in a long-term National Heart, Lung, and Blood Institute Severe Asthma Research Program. The children were ages 8-11 years at the first evaluation and 11-14 years at the follow-up visit. Comparing measurements of symptoms, medication use and lung function, the researchers analyzed changes in the children's respiratory health over an average three-year period.

The authors found that children with severe asthma reported a higher frequency of daily symptoms and hospitalization during the previous year despite higher doses of ICS and controller medication, and that they had significantly lower lung function when compared to children with mild-to-moderate asthma. Additionally, they noted that daily asthma symptoms such as coughing and wheezing and sensitization to aeroallergens during the initial evaluation were strong predictors of declines in lung function of more than one percent per year.

The authors conclude that children with severe asthma have a premature loss of lung function during the adolescent years that is associated with an increased frequency of wheezing and asthma symptoms and greater allergic sensitization during childhood. Further studies are needed to determine whether the loss of lung function is due to a slower rate of lung growth or to progressive changes in the lung tissues, and to explore the mechanisms that control the responses of severely asthmatic children to ICS treatment.

New Research Suggests that Bacteria May Cause Asthma Attacks in Children

Bacteria to Blame in Asthma Attacks in Children, Research Suggests

ScienceDaily (Oct. 7, 2010) — Doctors have long known that viral infections can bring about asthma attacks and the shortness of breath, coughing, and wheezing associated with them. But while viral infections cannot be treated, scientists at the Danish Paediatric Asthma Centre (DPAC) at the University of Copenhagen and Gentofte Hospital have discovered that treatable bacterial infections can also cause asthma attacks. The discovery could revolutionize treatment.

"We found a significant relationship between bacterial infections and acute asthma attacks -- above and beyond the expected relationship between viral infections and attacks," says Hans Bisgaard, a professor of pediatrics at the DPAC.

The study examined 361 children between the ages of four weeks and three years to determine the presence of viral and bacterial infections during severe asthma attacks. The results conclude that the number of attacks was just as high in children with bacterial respiratory infections as in those with viral infections.

Using antibiotics to treat asthma attacks?

"This indicates that bacteria can exacerbate asthma symptoms even if they aren't infected with a virus," Professor Bisgaard says. "The findings open up an entirely new method for treating severe asthma attacks. We can't treat viral infections, but scientists will now look into whether treatment with antibiotics can help children when they have an asthma attack if they are also suffering from a bacterial infection."
"Being able to use antibiotics to treat asthma attacks in children would be revolutionary," Professor Bisgaard says.

The effects of antibiotics in treating asthma attacks will now be examined in large-scale, clinical study by the DPAC.
The research has been published in British Medical Journal on 4 October 20

Signs of a Pending Asthma Attack

Asthma Early Warning Signs

• A runny nose, headache, or itchy chin often precedes an asthma attack.
• Trouble sleeping and feeling tired are other typical signs.
• So are dark circles under the eyes and less tolerance for exercise.
• Frequently, people get moody before an asthma attack starts.

A Persistent Cough

Signs of an asthma attack vary from one attack to the next. One time there may be little or no coughing before an attack. The next time, there may be a persistent cough, especially at night.

The cough is typically dry and hacking. (Sometimes, however, the cough may be wet and productive.)
Avoid taking cough medicine. Cough medicine won’t help the asthma.

Chest and Neck Retractions
When it’s hard to breathe, the tissue in the chest and neck may sink in with each breath. This is called retraction.
Retractions indicate that not enough air is getting into the lungs, and are signs of a medical emergency. Call 911 or see a doctor immediately.
In children other signs of deterioration in breathing are:

• poor appetite
• fatigue
• decreased activity

Go to WebMD to learn about more signs of a pending asthma attack here: 
Signs of a Pending Asthma Attack

Parents often wait too long to treat children's asthma symptoms

Parents often wait too long to treat children's asthma symptoms

Radiologists Develop Asthma Imaging Method

January 1, 2009 — Radiologists developed a new method for viewing the lungs of asthma sufferers. The method uses a polarized helium-3 gas--making it visible during an MRI. The patient inhales the helium-3 and undergoes an MRI, where doctors can see how far the atoms in the gas can travel in the lungs. This gives an image of what airways are blocked and what parts of the lungs ventilate. The black areas of the image indicate portions of the lung where air does not reach--areas where the helium-3 atoms could not travel.

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Immune cells that prevent development of asthma identified

ScienceDaily (2009-11-30) --According to the great paradigms of immunology, asthma, an allergic disease of the respiratory system, should always develop upon exposure to airborne antigens that are constantly being inhaled. However, the fact that 94 % of the Western population does not develop the disease suggests that as yet undefined mechanisms protect the respiratory tract from developing an allergic response.

Read Full Article

New insights into allergy-related disorders in children

ScienceDaily (2010-01-31) -- Allergies and asthma are a continuing health problem in most developed countries, but just how do these ailments develop over the course of a childhood? In a population-based study designed to help answer this question, researchers in Norway found that 40 per cent -- or two of five -- of nearly 5,000 two-year-olds had at least one reported allergy-related disorder.

Read Full Article

The Use of Inhalers Might Make Asthma Worse

                                Discovery opens new avenues for treatment of poorly controlled asthma

                                (PhysOrg.com) -- A new study at the University of Leicester is probing why asthma relief inhalers might actually make asthma worse- and what can be done about it.

                           

Growing Up with Asthma: Advice from Jo Frost, Star of “Supernanny”

Growing Up with Asthma: Advice from Jo Frost, Star of “Supernanny”

Exposure To Traffic And Indoor Pollutants Puts Some Kids At Higher Risk For Asthma Later

Exposure To Traffic And Indoor Pollutants Puts Some Kids At Higher Risk For Asthma Later

New research presents strong evidence that the "synergistic" effect of early-life exposure to both outdoor traffic-related pollution and indoor endotoxin causes more harm to developing lungs than one or the other exposure alone.

Environmental health scientists at the University of Cincinnati (UC) College of Medicine have shown that children exposed to both high levels of traffic-related particles and indoor endotoxin during early life are six times more likely to experience persistent wheezing than children exposed to low levels of traffic and indoor-related pollutants.

They report their findings in the Dec. 1, 2009, edition of the American Journal of Respiratory and Critical Care Medicine. This is believed to be the first study to look at the combined effects of traffic-related exposures and sampled endotoxin in children during infancy as an indicator of asthma later in life. Endotoxin, a component of bacteria thought to trigger an immune response in humans, was measured from dust samples collected prior to age 1.

Based on a long-term study of children deemed at high risk for allergies later in life, UC environmental health researchers have found that 36 percent of the children studied who were exposed to high levels of both traffic-related pollution and indoor endotoxin demonstrated persistent wheezing at age 3, an early warning sign of asthma and other pulmonary conditions. Only 11 percent of children exposed to low levels of both indoor and outdoor allergens experienced wheezing; 18 percent of children exposed to low levels of indoor endotoxin and high levels of traffic-related particles experienced persistent wheezing. Endotoxin exposure alone appeared to have little effect.

"There is a clear synergistic effect from co-exposure to traffic-related particles and endotoxin above and beyond what you would see with a single exposure that can be connected to persistent wheezing by age 3," explains Patrick Ryan, PhD, lead author of the study and a research assistant professor of environmental health at UC."These two exposure sources - when simultaneously present at high levels - appear to work together to negatively impact the health of young children with developing lungs."

To conduct this study, Ryan and his colleagues utilized land-use regression modeling to calculate study participants' exposures to traffic-related particles, such as diesel exhaust. The model was designed to capture exposures at locations where the child spent more than eight hours a week between birth and age 3; for example, in their homes or at day care.

"Traffic-related particles and endotoxin both seem to trigger an inflammatory response in the children monitored in this study. When put together, that effect is amplified to have a greater impact on the body's response," adds Ryan. "The earlier in life this type of exposure occurs, the more impact it may have long term. Lung development occurs in children up through age 18 or 20. Exposure earlier in life to both endotoxin and traffic will have a greater impact on developing lungs compared to adults whose lungs are already developed."

This research is part of the Cincinnati Childhood Allergy and Air Pollution Study, a long-term epidemiological study examining the effects of traffic particulates on childhood respiratory health and allergy development. Funded by the National Institute of Environmental Health Sciences, the study began in 2001 and is led by Grace LeMasters, PhD, of the UC Department of Environmental Health. Study participants were chosen based on family history and residence's proximity to a major road.

UC's LeMasters, David Bernstein, MD, James Lockey, MD, Tiina Reponen, PhD, Linda Levin, PhD, Sergey Grinshpun, PhD, Manuel Villareal, MD and Jeff Burkle were co-authors of the study. Gurjit Khurana Hershey, MD, PhD, of Cincinnati Children's Hospital Medical Center also participated in the research study.

Source: Amanda Harper
University of Cincinnati Academic Health Center

Helping Preschoolers To Achieve Asthma Control

Helping Preschoolers To Achieve Asthma Control

Asthma is the commonest chronic disease in children and a major reason for admissions to hospital, yet inadequate asthma control is present in 26% to 45% of children, states a review http://www.cmaj.ca/embargo/cmaj071638.pdf in CMAJ (Canadian Medical Association Journal).

The review incorporates the latest scientific information that has come out of randomized controlled trials since the Canadian Pediatric Asthma Consensus Guidelines were published in 2003. It was produced as an initiative of the Canadian Thoracic Society.

The review provides key points for distinguishing between transient asthma and chronic asthma in preschoolers and information on managing both types.

For children with intermittent asthma, using inhaled corticosteroids only during attacks does not appear to be effective. Regular therapy with inhaled steroids should be used for children with more severe intermittent or persistent symptoms. Treatment with leukotriene receptor antagonists during the viral season may help to reduce symptoms and visits to health care providers. The possibility of another condition should be considered if children do not respond to optimal therapy.

The authors state that more research is needed to evaluate effectiveness of treatments in young children.

Source: Kim Barnhardt
Canadian Medical Association Journal

Asthma A Significant Risk Factor For Complications In Children With H1N1

Asthma A Significant Risk Factor For Complications In Children With H1N1

A new study on pediatric H1N1 influenza admissions has found that asthma is a significant risk factor for severe disease in children with pandemic H1N1 compared with the seasonal flu. The study (http://www.cmaj.ca/cgi/rapidpdf/cmaj.091724), led by researchers from The Hospital for Sick Children (SickKids) in Toronto, Ontario, is published online in CMAJ (Canadian Medical Association Journal). This is the second largest study on the topic published to date. It looked at the charts of 58 children admitted to SickKids between May 8 and July 22, 2009 and compared them to 200 children admitted with seasonal influenza between 2004 and 2009. Every year, the hospital admits about 40 children under 18 years of age with seasonal influenza. Twenty-two per cent of children admitted with H1N1 had asthma compared with 6% of those admitted with seasonal influenza. Asthma was determined as a prior diagnosis of asthma or reactive airways disease, or a history of wheeze with the use of inhalers. Almost half of all admissions to the ICU for H1N1 influenza were children with asthma. The children with H1N1 influenza were older than those admitted for seasonal flu, with significantly more over the age of 5 years. Many children (49 or 84%) presented with fever and cough, with or without additional symptoms and 37% (21 children) had gastrointestinal symptoms such as vomiting and/or diarrhea. The median duration of hospital stay for both H1N1 and seasonal influenza was 4 days. "The most striking finding in our study was the high prevalence of asthma among children admitted with pandemic H1N1 influenza compared with those admitted in previous influenza seasons," write Dr. Upton Allen from The Hospital for Sick Children and coauthors. "Asthma has been identified as a significant risk factor for admission with pandemic H1N1 influenza, present in 21%-30% in the larger samples." None of the children admitted with pandemic influenza died compared with 1 death (0.4%) over 5 years in those admitted for seasonal influenza. Principal investigator Dr. Dat Tran and co-authors found that severity of asthma was broad and that children with mild asthma were also at risk. They conclude that children with mild asthma should be vaccinated for H1N1 and considered for antiviral therapy.

Source: Kim Barnhardt Canadian Medical Association Journal

A Risk Factor In Childhood Asthma Symptoms May Be Mother's Depression

A Risk Factor In Childhood Asthma Symptoms May Be Mother's Depression

Asthma symptoms can worsen in children with depressed mothers, according to research from Johns Hopkins Children's Center published online in the Journal of Pediatric Psychology. Analyzing data from interviews with 262 mothers of African-American children with asthma - a population disproportionately affected by this inflammatory airway disorder - the Hopkins investigators found that children whose mothers had more depressive symptoms had more frequent asthma symptoms during the six-months of the study. Conversely, children whose mothers reported fewer depressive symptoms had less frequent asthma symptoms. Researchers tracked ups and downs in maternal depression as related to the frequency of symptoms among children. "Even though our research was not set up to measure just how much a mom's depression increased the frequency of her child's symptoms, a clear pattern emerged in which the latter followed the earlier," says senior investigator Kristin Riekert, Ph.D., a pediatric psychologist and co-director of the Johns Hopkins Adherence Research Center. But while maternal depression appeared to aggravate a child's asthma, the opposite was not true: How often a child had symptoms did not seem to affect the mother's depressive symptoms, an important finding that suggests maternal depression is an independent risk factor that can portend a child's symptoms, researchers say. Past studies have shown that children with chronic health conditions fare worse if their primary caregiver is depressed, but none have teased out the exact interplay between the two. "Intuitively, it may seem that we're dealing with a chicken-egg situation, but our study suggests otherwise," Riekert says. "The fact that mom's depression was not affected by how often her child had symptoms really caught us off guard, but it also suggested which factor comes first." Researchers did not study why and how a mother's depression affects a child's asthma status, but because depression often involves fatigue, memory lapses and difficulty concentrating, it can affect a parent's ability to manage the child's chronic condition, which can involve daily, and sometimes complex, drug regimens and frequent visits to the doctor. "Mom is the one who must implement the doctor's recommendations for treatment and follow-up, and if she is depressed she can't do it well, so the child will suffer," says lead investigator Michiko Otsuki, Ph.D., a behavioral medicine fellow at Johns Hopkins at the time of the study, now at the University of South Florida St. Petersburg. Investigators say their findings should prompt pediatricians who treat children with asthma to pay close attention to the child's primary caregiver - whether or not it is the mother - and screen and refer them for treatment if needed. "We ask these parents if they are smokers all the time, so maybe it's time to start asking them if they are coping well emotionally," said co-investigator Arlene Butz, Sc.D., a pediatric asthma specialist at Johns Hopkins Children's Center. "Doctors are trained to pick up on subtle clues, so if they see a red flag in mom, they should follow-up with a depression screener and referral if needed." Treating depressed mothers whose children are at high-risk for asthma complications will likely benefit both mother and child, researchers say, while providing a clear treatment target to help reduce the burden of asthma in the United States. Asthma is the country's leading pediatric chronic illness, affecting 6.5 million children under the age of 18, according to the CDC. The Hopkins study included only mothers but investigators believe a similar pattern would emerge regardless of who the primary caregiver is. Researchers caution that the mothers in their study were screened for depression with a standard questionnaire, which is a reliable detector of symptoms but not a firm diagnosis. The Hopkins findings came from a high-risk, inner-city population and thus cannot be statistically extended to other ethnic and socioeconomic groups, but researchers say the effect of caregiver depression on a child's asthma likely transcends demographics.

The research was funded by the National Heart Lung Blood Institute.

Other Hopkins researchers involved in the study included Michelle Eakin, Ph.D., Lisa Arceneaux, Psy.D., Cynthia Rand, Ph.D. Source: Ekaterina Pesheva Johns Hopkins Medical Institutions