HOUSTON -
Using over-the-counter medications with children can be tricky, but doing so while battling the sniffles and sneezes of allergy season can be fatal.
Two days before Valentine’s Day, Kimber Brown was fighting a nasty bug. Her grandmother gave her a couple of over-the-counter medications. The 5-year-old died the next morning.
Dr. Chris Barnett, a compounding pharmacist, said mixing OTC medications to treat multiple symptoms can be complicated.
“It is just a reminder that it is important to be diligent about checking your medications and make sure you know exactly what you are giving and when. Combination products can be much easier and simpler, but you may be getting more than you bargained for and you may be doubling up on ingredients,” said Dr. Barnett.
Brown’s autopsy showed she had two times the limit of dextromethorphan, which is found in cough syrups, in her system.
The girl also had a high level of the drug cetirizine, which is an antihistamine found in the allergy medication Zyrtec. The coroner found it was the mixing of the two drugs that killed her.
“It is heart breaking because you can see it so easily happening to yourself. Moms, fathers, parents, we want to fix it. We want the kids to feel better and I would say right around 4 in the morning, we also want to get some sleep,” Lisa Carey, a mother of four, said.
Carey is a Houston mother whose children range in ages from 5 to 23-years-old. Carey said she can understand how night-time desperation leads to grabbing whatever might work.
“Sometimes, we are willing to try anything. We will look at the label and say, ‘Well maybe this will work,’ or maybe this will finally give them some relief,” Carey said.
Carey writes theÂ
Money Saving Parent blog. She said it is easy to see how a tight family budget can leave some parents playing doctor with symptoms that seem manageable.
“You may not have that $ 189 for an doctor’s office visit, so you do look at what can I do in the house and what can I use over-the counter,” Carey said.
What to avoid
Barnett warns parents to remember the situation can be about more than what the child has taken in that one moment. If the child is being treated for allergies, asthma or even eczema, those medications can cause a doubling up effect.
“If children have medications they take every day, whether it is prescription or over-the-counter, those have a potential to interact with those short-term drugs you are using to treat symptoms from a cold or the flu,” Barnett said.
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Whooping Cough Scare In Middle School
Most kids vaccinated, but many adults are not
   Pertussis, the highly infectious bacterial disease also known as whooping cough, has made an appearance at the East Hampton Middle School, where one case was reported last week. A letter from the Suffolk County Department of Health was almost immediately put up on the East Hampton Union Free School District’s Web site, and was given to staff and parents at all the schools in the East Hampton system.
   Dr. Gail Schonfeld of East End Pediatrics said on Tuesday that she has diagnosed four cases in the last three weeks, including a 3-month-old infant who was admitted to the hospital but eventually recovered.
   Most children have been vaccinated against the illness, and the vaccine is reported to be 95 percent effective. However, when a child, particularly a baby, gets infected with pertussis, the results can be very serious and sometimes fatal.
   Pertussis is spread through the air by the cough of an infected individual. A course of antibiotics is usually helpful, while cough syrups and elixirs are not.
   According to the Suffolk County Department of Health, in a letter that is posted on the East Hampton School District’s Web site, “A person with pertussis is infectious for 21 days from the start of the cough or until he/she has been on five full days of appropriate antibiotic therapy. Children and adults may be susceptible and still develop pertussis even if they are up to date with their vaccinations, as immunity to pertussis wanes over the years.â€
   Whooping cough earned its name by the distinctive whooping sound made by someone with the illness as they attempt to draw in breath. “In between coughing fits, a patient could feel pretty good,†Dr. Schonfeld said. “But when they start coughing, they can’t stop. There is really thick mucus that blocks the airways, so there is a feeling of not being able to breathe.â€
   Patients with pertussis often have other cold-like symptoms: fever, nausea, a runny nose. But it is the whooping and gasping for air that are the surest signs. In other countries, it is sometimes known as the “100-day cough.â€
   According to the Web site for the World Health Organization, in 2008, 16 million people were affected worldwide and 195,000 children died from the illness.
   “Pertussis has been with us a long, long time,†Dr. Schonfeld said on Tuesday. “Only 10 percent of the cases were diagnosed until recently, but now we have a test that’s fairly accurate.†The test involves a “skinny little Q-tip†being inserted way back in the throat. “It’s not a really pleasant sensation,†she said.
   Up until 2005, she continued, there was no vaccine approved for children over 7 years old. Therefore, many adults could have the disease without knowing it. “If a cough lasts for more than a month in an adult, one-third of the time it’s pertussis,†Dr. Schonfeld said. Only a small percentage of adults in the U.S. have been vaccinated, but there is currently a campaign in progress to encourage adults — particularly those who spend time around a newborn — to get immunized.
   Another unpleasant fact: Getting pertussis once does not bring immunity to the illness. “You can get it more than once,†Dr. Schonfeld said.
Prolonged occurrences of coughing can have simple and complex causes. Â Don’t ignore this if it persists. SS
Cough that lasts may be sign of underlying problem
Medical Edge from Mayo Clinic April 5, 2012
DEAR MAYO CLINIC: What could cause aÂ
cough that lasts for months? I take
antihistamine tablets and use nasal saline spray, but still cough throughout the day and at night.
ANSWER: Coughing is a normal reaction to irritants in your respiratory system. Coughing forcefully expels foreign bodies, mucus and other irritants, such as pollution, from your throat and clears them from your airway.
However, when a cough lasts too long, it may be a sign of an underlying problem or disease. Moreover, coughing itself becomes a problem. The forces exerted on your body by persistent coughing can result in direct physical problems — such as damage to your vocal cords, rupture of small blood vessels in your airway, fainting spells, hernias or even broken ribs. It can also harm the quality of your life, sleep and social life.
When a cough lasts longer than six to eight weeks, it’s considered a chronic cough. Diagnosing the cause can be time-consuming, but is usually a critical first step which involves systematically eliminating probable causes through history taking, testing and trying different treatments. Common causes of chronic cough include:
1. Postnasal drip. This is a sensation of mucus trickling from the back of your nose down into your throat. It may be due to hay fever, allergies or irritants. How postnasal drip causes a cough is still not clearly understood. In some cases, this sensation may not even be noticed. In chronic cough, postnasal drip may be due to inflammation of your nasal passages including your sinuses.
2. Asthma. While unusual, asthma can present with only a cough. This is known as cough variant asthma. It doesn’t necessarily mean that you will develop chronic asthma withwheezing.
3. Gastroesophageal reflux disease (GERD).With GERD, stomach acid, digestive enzymes and bile back up (reflux) into your esophagus. It may reach up to the voice box. In severe cases, reflux material may get into the lungs. These substances are irritating to your respiratory tract and can trigger a cough.
Coughing itself may cause acid reflux, turning it into a vicious cycle. While heartburn is common in reflux, not everyone with reflux experiences it. Hoarseness, throat clearing, the sensation of a tickle in the throat and cough — usually when in an upright position — may be associated with GERD affecting the throat. This is called laryngopharyngeal reflux (LPR).
4. Pertussis. Chronic cough may be due to an unrecognized case of whooping cough (pertussis).
5. Angiotensin-converting enzyme (ACE) inhibitors. Taken to lower blood pressure, drugs in this class include enalapril (Vasotec), lisinopril (Zestril) and others. Chronic cough can occur long after these drugs have been started. And, it may take two to three weeks for a cough to improve after stopping these medications.
6. Lung disorders. Chronic cough can be caused by airway damage called bronchiectasis, and by a condition that causes asthma-like symptoms, but with normal lung function (eosinophilic bronchitis).
In smokers, persistent cough and phlegm production (chronic bronchitis) is common. Throat or lung cancer may be suspected in a smoker or former smoker who has a chronic cough that changes abruptly or lasts for more than one month following smoking cessation, or if they cough up blood or note a change in their voice.
Usually, chronic cough can be stopped by treating an underlying cause. In about 90 percent of cases, the underlying cause is postnasal drip, asthma or GERD. If sinus disease or reflux is suspected, response to treatment may help determine the cause. Sometimes, there can be more than one cause that needs to be addressed.
Depending on your diagnosis, treatment may include:
1. Antihistamine allergy medications and decongestants. These are standard treatments for postnasal drip. If you can identify a trigger that causes symptoms, avoiding that trigger may be helpful. Nasal corticosteroid sprays also may be of value.
2. Inhaled asthma medications. These reduce inflammation and spasms and open your airways.
3. Drugs to suppress stomach acid. These help manage acid reflux. Additional measures for reducing acid reflux include losing weight if you’re overweight, eating meals three to four hours before lying down for bed or elevating the head of your bed a few inches.
4. Antibiotics. If your coughing is suspected of being caused by a bacterial infection, such as a persistent sinus infection or a lung infection, antibiotics may help.
5. Not smoking and avoiding secondhand smoke. In addition to causing chronic bronchitis, smoking irritates your lungs and can worsen coughs from other causes.
If no cause for your cough is found, or if the cause can’t be effectively treated, drugs may be prescribed to suppress the cough, loosen mucus or relax airways. — Kaiser Lim, M.D., Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minn.
(Medical Edge from Mayo Clinic is an educational resource and doesn’t replace regular medical care. E-mail a question to medicaledge@mayo.edu , or write: Medical Edge from Mayo Clinic, c/o TMS, 2010 Westridge Drive, Irving, TX 75038. For more information, visit www.mayoclinic.org.)
No doubt ADHD is real, but it can be confused with other conditions including sleep disorders. Â SS 
“My child is having trouble at school. The teacher says I should ask about ADHD.â€Â  Sound familiar to you? It should.
The diagnosis of ADHD is being made more frequently than ever before. In 2010, a whopping 10 million children were diagnosed with ADHD, which is a 66 percent increase from 10 years ago! What concerns me is that many are being incorrectly diagnosed with ADHD by busy pediatricians who don’t take the time to ask some important questions.
I once had a hyperactive 9-year-old patient with sleep apnea who snored so badly that he would stop breathing dozens of times each night. An operation by the ENT (Ear, Nose and Throat) surgeon cured his apnea and improved his behavior.
So what is ADHD? It stands for “Attention Deficit Hyperactivity Disorder.â€Â Children with ADHD can be impulsive and often have trouble waiting their turn. They are often forgetful, sloppy with schoolwork and chores, and have short attention spans. They are fidgety, squirmy and can be excessively talkative. Parents describe them as being so active that they seem to be “driven by a motorâ€. I know what you’re thinking … don’t all children act like this? Yes, but children with ADHD have severe symptoms that impair the child’s functioning, specifically, their ability to do well in school, make friends and avoid injury due to reckless behavior.
While ADHD treatment is generally safe and very effective, it is important to make sure that we are treating the right condition. With that being said, here are some important questions to consider before visiting your pediatrician:
Does your child get a restful sleep every night? Unlike adults who become groggy and slow after a bad night of sleep, children can become hyperactive and rowdy. Inform your doctor of any sleep disturbances such as frequent nightmares, fidgetiness, bedwetting, trouble falling asleep or trouble staying asleep. Make sure your child gets at least 8-10 hours of sleep each night.Â
Does your child behave violently? Do they do things just to spite you? Violent behavior is not a criteria for ADHD. The real question is where did your child learn this behavior? At least once a month I see a child for “ADHD†who lives in a home where one parent is emotionally or physically abusing the other. Children are like sponges that can easily pick up on violent tendencies from their parents, television, movies and video games. Other possibilities to explain violent behavior include oppositional defiant disorder and conduct disorder.
Is your child easily embarrassed? Does he or she have low self-esteem? Is your child a worrier? Again, these are not part of the ADHD criteria. Your child might have depression or anxiety. I know it sounds strange to think that a young child could have depression, but it is more common than you may think.
Does your child misbehave only in school? If so, are there specific teachers, students or situations that seem to elicit this behavior? Perhaps your child has a learning disability? Perhaps vision or hearing problems make it difficult for your child to concentrate in school? Maybe your child is being bullied? All of these can be terribly distracting for a young child and can contribute to poor behavior. School problems may warrant an evaluation by the child’s school for learning disabilities and a hearing and vision screening by your pediatrician.
Want to really impress your doctor? Fill out the “Vanderbilt†ADHD assessment tool. There is a parent form and a teacher form. Your doctor will score the sheet. This very simple tool can help determine whether your child has ADHD or something else.
Are you concerned about your child’s behavior? Has anyone told you that your child should be evaluated for ADHD? Please share your experiences.
Mario Cruz is is an assistant professor of pediatrics at Drexel University College of Medicine and an academic pediatrician at St. Christopher’s Hospital for Children.
Posted by Mario Cruz, M.D. @ 6:53 AMÂ
http://www.philly.com/philly/health/Think-your-child-has-ADHD-Think-again-.html?cmpid=138896554
Read more:Â http://www.philly.com/philly/health/Think-your-child-has-ADHD-Think-again-.html?cmpid=138896554#ixzz1rG6nyNBK
The search continues for the perfect home asthma test… the pediatric lung specialist is still the gold standard. Â SS
iSonea begins recruiting for pediatric asthma trial
iSonea, makers of the WheezoMeter, has begun recruiting for a post-market study of its asthma monitoring device for children under the age of 12 years old. The company aims to determine the device’s ability to accurately assess wheeze rate in a group of pediatric patients. The study is expected to include about 95 participants and will be based in Folsom, California,
according to the clinical trial’s listing on clinicaltrials.gov.
iSonea’s core offering today is a medical device called the WheezoMeter, a point of care, handheld device that “analyzes 30 seconds of breath sounds using advanced signal processing algorithms to detect, quantify and objectively document the presence of wheeze and its extent,†according to iSonea’s website. The company is currently seeking an over-the-counter (OTC) status for the WheezoMeter from the FDA. Last month iSonea announced plans toÂ
leverage Qualcomm’s 2net platform for home health devices.
“Asthma impacts more than 7 million children in the United States, and the number of children expected to be diagnosed with this chronic condition continues to climb at alarming rates,†Dr. Jonathan Freudman, medical director for iSonea, stated in a company release. “This study is an important milestone for iSonea. In the pediatric asthma population, it is challenging to accurately monitor and manage asthma symptoms in patients using conventional techniques. The WheezoMeter has the potential to meet a critical unmet need for better, easy to use monitoring tools for young asthma patients.â€
At the HIMSS event in February, iSonea demonstrated its device as part of the Qualcomm Life booth. While the company’s setup included an image of an iPhone app called Asthma Sense (pictured), the app is not yet available for download from Apple’s AppStore.
In the future, iSonea hopes to become hardware agnostic and create smartphone peripherals that work like its WheezoMeter today. Assuming the FDA grants the Wheezometer OTC status based on the bench validation study the company currently has underway, iSonea CEO Michael Thomas said the company plans to create smartphone-based versions of the medical device for iPhone, Android, and BlackBerry devices. Thomas told a journalist in Australia last year that since there were about half a billion smartphones sold the world over in the past year, and there are expected to be about 1 billion smartphones sold in 2015, the smartphone has become the most efficient way for iSonea to get its technology to the 300 million people worldwide who have asthma.
Early detection leads to prompt treatment of symptoms… which reduces emergency room visits and hospitalizations. Â A good line of communication with a pediatric asthma specialist is the key. Â S Susarla
Reducing Hospital Admissions for Asthmatics
ScienceDaily (Apr. 4, 2012) — Children with moderate or severe asthma attacks who are treated with systemic corticosteroids during the first 75 minutes of triage in the Emergency Department (ED) were 16% less likely to be admitted to hospital. This highlights the importance of adopting a strategy to rapidly identify and begin treating children with moderate or severe asthma attacks directly after triage, according to a team of investigators working at the Sainte-Justine University Hospital Center (UHC), the University of Montreal, McGill University and the Research Institute of the McGill University Health Centre (RI MUHC).
“We knew that corticosteroids could help avoid hospital admissions and relapses. However, just how delays between ED admission and administration of the treatment impacted outcomes remained unclear,” says Dr. Sanjit K. Bhogal, the lead author of a new study published in Annals of Emergency Medicine and graduate of the Department of Epidemiology, Biostatistics and Occupational Health at McGill.
“Our study demonstrates that, to be effective in preventing hospital admission, treatment with corticosteroids should be administered within 75 minutes of triage, regardless of patient age,” says the senior author Dr. Francine Ducharme, who supervised the study while she was a McGill and RI MUHC researcher based at the Montreal Children’s Hospital.
According to Dr. Ducharme, now pediatrician and researcher at Sainte-Justine UHC, “in fact, the earlier the treatment is given within this time frame, the more effective it is, hence the advantage of starting treatment right after triage. Furthermore, beginning early treatment reduces ED stay by almost 45 minutes for patients who will be discharged from the ED.”
The challenge now is to ensure that the severity of the asthma attack is flagged at the triage stage in order to initiate treatment immediately. In fact, it seems that patients who are treated “too late” were due, for the most part, to not been given high triage priorities or to physicians not being able to assess them early enough. ED congestion did not significantly impact on the time frame for administering corticosteroids.
“Given the findings of the study, the need to implement a nursing strategy that involves identifying the severity of the child’s condition and beginning treatment as soon as a patient arrives in the ED, seemed obvious,” said Dr. Ducharme, who is also clinical epidemiologist at the Sainte-Justine UHC, where the study data were compiled and analyzed. Dr. Ducharme also holds the Academic Chair in Clinical Research and Knowledge Transfer in Childhood Asthma at the Sainte-Justine UHC Research Center and is a full professor in the Faculty of Medicine of the University of Montreal.
The pediatric respiratory assessment measure (PRAM) scale, developed by Dr. Ducharme’s team, was used to identify the degree of severity of the asthma attack and to rapidly initiate the severity-specific treatment recommended by asthma guidelines. At the Sainte-Justine UHC, Dr. Ducharme’ s team has now develop a teaching module that will allow training of the triage nurses, ED physicians, and respiratory therapists to implement severity-specific guidelines and, whenever possible, to avoid patients being admitted to hospital.
The educational module will be available online by the end of 2012 on the University of Montreal’s website. It is eagerly awaited by health institutions in Ontario and Alberta, as well as in several institutions in the US, which have decided to adopt the proposed treatment protocol based on the PRAM scale and who wish to receive training. The tool is an offspring of the integration of research, education and health care. As such, it will make it possible to transfer the knowledge acquired through the study to the EDs around the world, for the direct benefit of patients and their families.
Sleep does not come easily for some children
By Paul Swiech pswiech@pantagraph.comÂ
Sleep disorders are more prevalent among children than most people realize, according to two Central Illinois sleep medicine specialists.
Sometimes, sleep disorder symptoms in kids are misdiagnosed and treated as other health conditions, including behavior disorders, meaning the underlying problem isn’t addressed.
Sometimes, an untreated sleep disorder exacerbates symptoms of another medical condition, including attention deficit hyperactivity disorder.
“Thirty to 40 percent of kids 9 to 12 years old have difficulty falling asleep or staying asleep at least three days a week,” said Dr. David Koh, a pulmonologist and critical care physician with Illinois Heart & Lung Associates, part of Advocate Medical Group. Koh figures the prevalence among children younger than 9 is similar.
While those children have sleep problems that should be addressed, not all have a diagnosable sleep disorder. Dr. Humam Farah of OSF Critical Care, Pulmonary and Sleep Medicine, said 4 percent of children have a sleep disorder.
Koh, medical director of the Midwest Center for Sleep Medicine, said the increasing numbers are partly because of improved diagnoses but he also thinks that more children have sleep disorders than a generation ago.
Farah, medical director of the Sleep Center of Central Illinois, said increased obesity is one reason for the increase. Obesity results in fat in the upper airways. Narrowed airways interrupt breathing and sleep and decrease oxygen to the brain.
Some children inherit a sleep disorder, such as restless leg syndrome (RLS) and periodic limb movement disorder.
RLS is a neurological condition characterized by the irresistible urge to move the legs, according to the RLS Foundation. The urge to move the legs is often accompanied by unpleasant sensations in the legs that worsen during periods of rest or inactivity and at night.
Periodic limb movement disorder is a rhythmic twitching of the legs after falling asleep, Koh said.
Both conditions prevent deep sleep and wake people up at night.
While RLS is generally associated with older adults, 2 percent of children have the condition. When either parent has RLS, the prevalence among children increases to 16 percent, Koh said.
In addition, many children with RLS or periodic limb movement disorder also have low iron levels, Koh said.
RLS is worsened by stimulants such as caffeine or chocolate.
When people are sleep-deprived and stressed, that increases the body’s desire for fatty foods. Increased consumption of fatty foods prompts weight gain.
Sometimes, increased stress on the cardiovascular system prompts the kidneys to produce more urine, resulting in bed-wetting.
But many parents don’t recognize their child has a sleep disorder. Instead, they focus on the daytime symptoms of lack of sleep: irritability, declining academic performance, weight gain and a wet bed.
Some children with a sleep disorder are assumed to have a behavior disorder. Others are diagnosed with ADHD.
Indeed, some have ADHD with a sleep disorder. Thirty percent of children treated for ADHD have a diagnosable sleep disorder, Koh said. When those 30 percent of children are treated successfully for their sleep disorder, about half of them are able to be weaned off their ADHD medicine.
Children who have trouble falling asleep and staying asleep should be taken to their pediatrician, Koh and Farah said. The pediatrician may refer them for a sleep study. The two sleep centers in Bloomington perform overnight sleep studies.
Some children are diagnosed with sleep apnea, a common disorder in which a person has pauses in breathing or shallow breathing while sleeping. Sleep is interrupted. Left untreated, sleep apnea increases long-term risk of heart disease and stroke.
For children, a common treatment for sleep apnea is removing enlarged tonsils or adenoids.
Some children are treated with continuous positive airway pressure masks, which supply a steady stream of air through the nose or mouth during sleep, Farah said.
Weight loss is a key for overweight children, Farah said.
For children diagnosed with RLS or periodic limb movement disorder, medicine such as Mirapex can lessen the symptoms and improve sleep, Koh said. Iron supplements can help boost iron levels.
Sleep tips
Newborns need 16 to 18 hours of sleep a day, toddlers 6 months to 1 year old need 14 hours of sleep a day, children ages 1 to 3 need 12 hours of sleep a day, preschoolers need 11 to 12 hours of sleep, school-age children ages 5 to 13 need 9 to 10 hours of sleep a day and teenagers need 9 hours of sleep a day. Many children and teens don’t get that much sleep. Here are tips for children to get a better night’s sleep:
— Don’t have caffeine and limit chocolate, which are stimulants.
— Don’t eat a meal or exercise at least two hours before bedtime.
— Try to go to bed and get up about the same time each day.
— No videos (television, video games, computer games) within two hours of bedtime.
— No electronics (televisions, computers, cellphones) in children’s rooms at night.
— For young children who are older than 6 months, make sure they fall asleep in the same position in which they will wake up. In other words, don’t let them fall asleep in your arms. Instead, go through your bedtime routine (bath, bedtime story, etc.), then put them to bed, wish them good night and leave their room. If they get up and come into your room, direct them back to their room politely but unemotionally. They should learn to fall asleep on their own.
— For children who want some light, dim nightlights are OK.
— For older children, don’t tell them “Go to sleep.” You can’t force someone to go to sleep. Instead urge them to go to bed and relax.
Read more:Â here
Recurrent wheezing in infants should not be ignored. Â Here is more evidence that signs of asthma may be present in even very young children and infants. Â SS
Lung Function Deficits in Babies May Lead to Future Asthma
Joanna Broder
March 30, 2012 — In the future, scientists may want to explore ways to prevent childhood asthma long before it fully evidences itself, by focusing on neonates and young babies.
New research suggests that lung function deficits related to future asthma may develop before birth, in infanthood, and in early childhood, suggesting that asthma research could target prevention at these times.
Hans Bisgaard, MD, head of the Danish Pediatric Asthma Centre in Copenhagen, Denmark, and colleagues presented the results of their study in an articleÂ
published online March 29 in theÂ
American Journal of Respiratory and Critical Care Medicine. The authors found that children who develop asthma by age 7 years have respiratory problems as infants, including increased bronchial responsiveness and deficits in lung function.
“It seems that lung function changes associated with asthma occur very early in life and maybe even before birth,” Dr. Bisgaard, who is also a professor of pediatrics at the University of Copenhagen, said in a news release. “This may explain the lack of effect from early intervention with inhaled corticosteroids and should direct research into the pathogenesis and prevention of asthma towards the earliest phases of life.”
The authors of the study, which is the most comprehensive prospective study yet of the association between early childhood asthma and lung function from birth to school age, note that it is unclear which comes first: the development of asthma or the development of deficits in lung function.
“These questions are important for the direction of research into the origins and prevention of asthma,” they write. “[S]hould we expect genetic or prenatal programming of the disease; or is there an early window of opportunity to prevent airway remodeling during early symptoms?”
In the study, the researchers analyzed the interaction between asthma and lung function growth from neonatal age to age 7 years in the Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), a prospective clinical study of a birth cohort of 411 children.
“Previous research on the relationship between neonatal lung function and the development of asthma has been conflicting,” Dr. Bisgaard said in the news release. “Our study shows that children with asthma by age seven already had significant airflow deficits and increased bronchial responsiveness as neonates. Lung function deficits also progressed throughout childhood in our study, suggesting a potential opportunity for early intervention.”
The newborns were enrolled in the first month of life and were assessed at 6-month intervals. Additional visits were arranged when there was an onset of respiratory symptoms.
The diagnosis of asthma was based on daily diary cards and health visits every 6 months during the first 7 years of life.
The researchers analyzed the interaction between asthma and lung function growth from neonatal age to age 7 years by measuring neonatal spirometry and bronchial responsiveness to methacholine through forced flow-volume measurements. They also measured lung function through spirometry when the child turned 7 years old, using a pneumotachograph, which records the rate of airflow to and from the lungs.
The results showed that children with asthma at age 7 years had experienced a significant airflow deficit as newborns (forced expiratory flow rate [FEF]50Â reduced by 0.34 Z score by 1 month;Â PÂ < .03). This deficit worsened significantly through early childhood (FEF50Â reduced by 0.82 Z score by age 7 years;Â PÂ < .0001).
“We found that approximately 40% of the airflow deficit that was associated with asthma in our study was present at birth, while 60% developed through early childhood along with the disease,” Dr. Bisgaard said in the news release. “This indicates that both prenatal and early childhood mechanisms are potential intervention targets for the prevention of asthma.”
Further results showed that bronchial responsiveness to methacholine, which leads to narrowing of the airways, was also significantly related to the development of asthma. Reactivity of the neonatal airway was a stronger predictor of asthma than neonatal lung function, the research showed.
“This airflow deficit progressed in the first 7 years of life suggesting that disease mechanisms are operating both before and after birth,” the authors write.
One limitation is that the study used a homogenous study sample, which might limit the generalizability of results to other populations, according to written materials from the American Thoracic Society.
The Lundbeck Foundation, the Pharmacy Foundation of 1991, the Augustinus Foundation, the Danish Medical Research Council, and the Danish Pediatric Asthma Centre provided the core support for the study. The authors have disclosed no relevant financial relationships.
Am J Respir Crit Care Med. Published online March 29, 2012.Â
Abstract
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