Archive for the 'Asthma' Category

Antibiotic Use In Infancy And The Risk Of Asthma

January 9, 2012

A recent study of 193,412 children from 29 countries reported that children who received antibiotics in the first year of life had an increased risk of having asthma symptoms at 6 to 7 years of age.  The odds ratio for asthma in children who received antibiotics compared to children who did not receive antibiotics in the first year of life was 1.7-1.96.  It is unclear whether this association and increased risk is based upon cause and effect or reverse causation.  In other words, is this the result of the direct effect of antibiotics on the complex balance of the more than 500 species of microbes in the body and a subsequent impact on atopy (allergy) and asthma?  Or, were children who were predisposed to asthma or had early symptoms of asthma, more likely to be given antibiotics in the first year of life because of respiratory symptoms thought to be related to infection?  In any case, the association seems to be real and is definitely of interest.

Note: The content of this blog is for informational purposes only and is not meant as specific medical advice for a specific person.   If you have a medical problem, please contact your doctor.

Asthma and Exercise

January 7, 2012

It is essential for children and adults with asthma to exercise.  Asthma that is not well controlled from an inflammatory perspective will tend to cause symptoms with exercise, particularly aerobic exercise.  The answer is NOT to avoid exercise, it is to get the inflammation under control and continue exercising as if you did not have asthma.

The health benefits of exercise for people with asthma are numerous including improved fitness level, improved quality of life, reduction in the need for medications, fewer emergency room visits and less absenteeism from school (J Allergy Clin Immunol 2005;115:928-34).   On top of that, it is important that children with asthma do not perceive themselves, or are not perceived by others, as being different or in some way disabled.  A sure fired way of having a child feel different is by creating a situation where the child needs to avoid regular play, sports and other exercise.   This may not only result in psychological problems, but may contribute to a tendency for weight gain and obesity.

The American College of Sports Medicine and the American Thoracic Society both recommend exercise for patients with asthma.   In general, most studies show exercising 3-5 times a week for at least 20-30 minutes while reaching 60-75% of age predicted maximal heart rate is helpful in maintaining and improving pulmonary health in asthmatics.  This kind of goal works for adults.  For children, the goal should be to engage in play and sports in the same way as children without asthma.

Note: The content of this blog is for informational purposes only and is not meant as specific medical advice for a specific person.   If you have a medical problem, please contact your doctor.

Vitamin D And Asthma

July 31, 2010

There have been several recent studies that indicate that vitamin D deficiency might have a negative impact on asthma.  The studies have mainly looked at true vitamin D deficiency defined as serum levels of 25-hydroxyvitamin D3 of less than 30ng/ml.  This can be measured by your doctor in a blood test.

Various studies have indicated that vitamin D supplementation in patients with low levels of vitamin D might prevent the development of wheezing in infants and young children, reduce asthma severity in patients with asthma and enhance the response of patients with asthma to inhaled steroids.

Studies looking at cohorts of infants followed from birth have shown that the higher the maternal vitamin D intake during pregnancy, the lower the risk of recurrent wheezing episodes and asthma in childhood.  The effect is felt to be a result of a lower risk of early childhood respiratory infections and wheezing noted in infants of mothers with higher vitamin D intake and infants with higher cord blood levels of vitamin D.

The National Health and Nutrition Examination Survey (NHANES) is a program of studies by the CDC looking at the health and nutritional status of adults and children in the United States.  Analysis of the Third NHANES showed that those with vitamin D deficiency with levels less than 10ng/ml had a higher risk of upper respiratory tract infections compared to individuals with normal vitamin D levels over 30ng/ml.  Also of interest in this survey is the fact that the difference was greatest in people with asthma.  Upper respiratory tract infections are a major cause of exacerbation of asthma in all age groups and a major cause of wheezing episodes in infants.

Several studies have shown that asthmatics with normal levels of vitamin D respond better to in haled steroids compared to asthmatics with vitamin D deficiency.  This enhanced steroid responsiveness would theoretically mean that those without vitamin D deficiency would require less medication than those with vitamin D deficiency to obtain the same level of asthma control.

More studies are needed to fully understand how vitamin D impacts asthma.  For now though, it seems reasonable to me that individuals with 25-hydroxyvitamin D3 levels less than 30ng/ml could benefit from vitamin D supplementation either through changes in dietary habits or the use of vitamin supplements themselves.

Note: The content of this blog is for informational purposes only and is not meant as specific medical advice for a specific person.   If you have a medical problem, please contact your doctor.

Acetaminophen And Asthma

February 11, 2010

Over the past 10 years there have been a number of studies published in the medical literature showing an association between the use of acetaminophen and an increased incidence of asthma. 

There are studies that report that the frequent use of acetaminophen in pregnancy is associated with an increased risk of asthma in childhood.  There is a study that reports that the use of acetaminophen in infants is associated with an increased incidence of asthma at 6-7 years of age.  And, there are studies that show that frequent use of acetaminophen in adults is associated with an increased risk of asthma. 

The incidence of asthma has been rising over the past few decades, and the reason for this has been an ongoing area of medical research.  There are several theories for this rise.  The association between acetaminophen use and asthma as shown through these various studies, is particularly interesting in light of the fact that it was in the early 1980’s that acetaminophen and ibuprofen replaced aspirin as therapy for infants and children with fever.   Infants and children stopped receiving aspirin because of an association between aspirin use and a rare, but severe, neurologic and liver disease called Reye’s Syndrome. 

And so, there is evidence that suggests that the use of acetaminophen might be an important risk factor for asthma development.   I think there is a need for more research in this area to both confirm this apparent association, and help explain it.  A better understanding of this is likely to shed significant light on asthma itself and perhaps impact future therapies.

Cold Air And Asthma

January 7, 2010

I was walking through midtown Manhattan this afternoon in the frigid cold, and I thought today would be a good day to say something about cold air and asthma.   Cold air is a common exacerbating factor for asthma and the impact of the cold air can be worsened by exercise.   If you are on inhaled steroids as a chronic controller medication for your asthma, and you are the type of asthmatic who is affected by cold air, it is sometimes helpful to up your inhaled steroid dose if you know you are going to have exposure to cold air for an extended period of time.  Optimizing your anti-inflammatory medication can take the edge off the cold, so to speak.  Another option is to wear a scarf or bandana around the mouth and nose when outside, thereby humidifying and warming the air before it hits the lungs.  This can prevent the bronchospasm associated with cold air exposure.  Always remember to have your bronchodilator medication with you, in case you need it.