Obama banning medical devices he can"t pronounce (asthma inhalers banned over "environmental concerns")

I must have posted this video several dozen times already, usually associated with his propensity for gaffes:

Asthma Awareness

By Nurse Diane

A few years ago, a friend of mine, my doctor, had an asthma attack.  It was so severe that he was flown to Jackson to the hospital and put in ICU.  He did not survive this attack.  He was a young man, in his 40′s, a well-known physician, married to a nurse.

According to worldasthmaday.org, World Health Organization (WHO) estimates, 300 million people suffer from asthma and it’s the most common chronic disease among children. WHO also notes that asthma affects people in all countries around the world regardless of development although most deaths occur in lower income countries.

Asthma is a chronic disease of the air passages (or bronchial) that lead to and from the lungs that makes breathing difficult. Usually there is inflammation, which results in a temporary narrowing of the passages that carry oxygen to the lungs.

Symptoms vary from person to person and in intensity, but generally include coughing, wheezing, shortness of breath, chest pain or pressure. Asthma sufferers often have recurrent attacks of breathlessness and wheezing. Symptoms may occur several times a day or week and may become worse during physical activity or during the night.

During an attack, the lining of the bronchial tubes swells, causing airways to become narrow and reducing the flow of air in and out of the lungs. These attacks can cause sleeplessness, fatigue, reduced activity and absenteeism from work or school.

The basic causes of asthma are not completely understood, but risk factors for developing the disease include a genetic predisposition along with exposure to particles and substances that irritate the air passages and cause allergic reactions. Some irritants include dust in furnishings, pets, tobacco smoke, chemicals and air pollution.

Other causes include physical exercise, medications (aspirin and beta blockers), cold air and even emotional reactions such as stress, anger and fear.

Today is World Asthma Day.  World Asthma Day is an annual event organized by the Global Initiative for Asthma with a goal to improve asthma awareness and care around the world.  For ways you can help get the news out about asthma, visit this site: http://worldasthmaday.org/support/

Smoking and Asthma

Smoking is bad news for everyone, but especially for kids who have asthma. And yet between 15 and 20 percent of people with asthma still indulge in the habit, even though it makes them wheezier. Pregnant women who smoke increase the risk of the baby being asthmatic and having other respiratory illness. Tobacco smoke contains 4,000 chemicals, present either as gases or tiny particles.

You do not have to smoke yourself to inhale the fumes. Every time you walk into a bar you will get a blast of tobacco and if your asthma is severe you should avoid such places. Other people’s smoking habits can make your life a misery and if you live or work with a smoker there is little or no escape from smoke related risks.Children of smokers are more likely to have wheezy episodes and time off school than those with non smoking parents. It is generally worse when the mother smokes because many children spend more time with their mother than their father.

Keep your home smoke free. Remove all ashtrays and should a guest ask for one, explain that it is necessary to keep your home unpolluted, and suggest they smoke outside. Offer them a nicotine patch if they do not want to go out. It is important to have fresh air circulating throughout your home but beware of room fresheners as they also can be triggers. Open a window back and front of your home for a little while twice a day. Children are much more sensitive to cigarette pollution than adults. Seek out practical information on how to protect them against asthma using new and innovative methods. Look up a website with an alternative solution about how to cure asthma the natural way.

Strategies to Control Asthma

This summary from the NHLBI provides invaluable information to parents of children with asthma.  SS

World Asthma Day and Asthma Awareness Month

Together we can help control asthma.

This World Asthma Day (May 1, 2012) and Asthma Awareness Month (May) the National Asthma Education and Prevention Program (NAEPP) encourages you to discover how.

One of the first steps—whether you have asthma or know someone who does—is to develop a written asthma action plan (AAP) in partnership with your healthcare provider. AAPs that meet the specific needs of a patient include details ranging from how to take medication to reduce airway inflammation, to ways to reduce environmental triggers of asthma such as dust mites or tobacco smoke.

But AAPs don’t stand alone. 

They are part of a comprehensive approach needed to improve asthma care and control. Like diabetes or high blood pressure, managing asthma symptoms requires daily attention and ongoing education.

An APP is just one of  the following six key actions, recommended by the NAEPP, that clinicians, patients, and all others who touch the life of someone with asthma can work together on to seize control of asthma so that asthma doesn’t seize control of asthma patients.

• 
  Use inhaled corticosteroids to control asthma if you have persistent asthma. Your doctor will help you choose the best treatment.


• 
  Use a written asthma action plan to highlight two things: 1) what to do daily to control your asthma, and 2) how to handle symptoms or asthma attacks.


• 
  Assess asthma severity at the initial visit to determine what treatment to start to get your asthma under control.


• 
  Assess and monitor how well controlled your asthma isat follow up visits. Your doctor may need to increase, or decrease your medicine to keep asthma under control.


• 
  Schedule follow-up visits at periodic intervals, and at least every six months.


• 
  Control environmental exposures such as  allergens or irritants that worsen your asthma.

When taken with these other actions, AAPs can help people with asthma live without limits. The NAEPP has identified personalized AAPs as “must-haves” for allasthma patients, particularly those with moderate and severe asthma, a history of asthma attacks, or poorly controlled asthma. 

It may take time to develop and guide a patient through an AAP on the front end, but providing patients with detailed instructions and educating them on how to manage their asthma themselves will ultimately save clinicians time and effort on the back end. And, if followed as one of the NAEPP’s six recommended actions, it could ultimately save lives.

Currently, only about one in three patients with asthma has an AAP to guide them. So, for this World Asthma Day and throughout Asthma Awareness Month, the NAEPP and NACI encourage those without an AAP to get one.

Read more  below:

http://www.nhlbi.nih.gov/health/prof/lung/asthma/naci/news/world-asthma-day.htm

Is it Walking Pneumonia? Bronchitis? Or Asthma?

Sweet Baby Tate has had a cough for weeks now, at least 4.  It was a dry cough at first, and I was doing much the same thing.  It always felt like I had a frog in my throat that needed clearing.  I just thought we were both suffering from allergies.  The weather here unpredictable at best, with rain and wind blowing all the pollen and mold etc about all the time, 30 degrees one day and seriously 83 degrees the next.   As last year it never froze or truly got cold none of the spores died.  So now double the crap is flying about in the air.  People are miserable.

In any event, I just thought we were suffering from allergies.  While we were in Dallas in early January I was on a Z-pac that I requested from my friend as I felt like I had a sinus infection (Note to self who is a pediatric dentist, don’t ask S for a specific antibiotic for something of which you know nothing about; let her choose as apparently a Z-pac is not the drug of choice for a sinus infection.  But I digress.  Are you reading this S?).  I just felt a little gunky and had that strange yucky taste in my throat and was congested.  I suppose it helped as I never got a fever and I felt better a couple of days after we returned.  I mostly didn’t want to get my girl J sick who was possibly going to need to start chemo soon after the weekend (Sadly she got bad news and has finished one round. I’m so sad for her, but I’m positive she’s going to be cured!)

Then Tate started coughing;  the dry cough.  It was  sort of constant, but never seemed to bother him and it would be one hack and then 10 or 15 minutes later another hack.  Nothing concerning though.  He just seemed to always need to clear his throat.  H also had one fantastic screaming fit and became hoarse about 3 1/2 weeks ago.  But the hoarseness has never gone away.  Again I just thought well maybe it was coincidental to the screaming fit, and his little voice was going to be changing.  Now of course when I hear him I can barely remember what he used to sound like, so I’m wondering if there has actually been a change.

However, for about a week and a half now I’ve been given him an anti-histamine at night, usually Benadryl, approved by our allergist, for the cough.  It alleviated the cough and his sniffling while Zyrtec does not.  I’ve been keeping him on his Singulair now almost constantly since September where as last year he got a break November – March.  (I hate him constantly being on medications).  But when he goes off he tends to get a bit of a dry cough (ahhhh…asthma warnings right?.  Sigh)

But then this past Monday his teacher texted me twice saying he had been coughing all day long, so much so that he wasn’t able to nap.  He was doing fine, but poor baby had red eyes and looked so tired.  She asked if she could put a small piece of peppermint in some cold water to have him sip to help soothe his throat.  I gave my blessing of course.  He finally fell asleep after everyone else woke up, and she let him sleep an hour while keeping the other 4 kids sort of quiet, so he could rest (I love her!).  That night Tate told me “Ms. JoAnnie gave me some peppermint water, and it made my throat feel ‘bedder’.  I’m going to give her a little hug tomorrow.”  Not a big hug mind you, a little hug

Monday when I picked him up his cough was very wet and productive sounding and he coughed constantly.  I loaded him up with Benadryl and Singulair and he happily played as usual and went to bed just fine.  Yesterday, Tuesday, I called and made an appointment with his pediatrician for today.

My parents, who are AWESOME!, picked him up from school this morning and took him to his appointment.  I wrote the following note for them to give to his pediatrician…

Dr. R….

Tate’s tantrum behavior stopped about 2 days before his half year birthday on January 23.  It was as if a switch had gone off.  I’ve chalked it up to the half year disturbances.  His sleep went back to normal…which is minimal sleeping and fighting naps and he’s reasonable again.  Thank you so much for calling me and talking me off the roof.

This cough of his doesn’t have me terribly concerned as I’m thinking it’s just a cold.  But it’s been present in one manner or another for the past 2 1/2 weeks.  It was a  constant (all day long) dry cough (and his teacher called me twice concerned) until yesterday evening when it became productive and wet sounding.  He’s been afebrile and no change in behavior.

He takes 4mg Singulair in the evenings, though I ran out and he didn’t have it Friday-Sunday and that is when his cough worsened.  I’ve given him Benadryl (12.5mg) the past 3 evenings to help alleviate it otherwise he coughs all night.  He’s very congested and sniffing right now as he’s trying to go to sleep.  Dr. A said I could give him the Benadryl as it works on his cough better than Zyrtec or Allegra.

He had another skin test about 3 weeks ago and is still allergic to eggs and oranges.

Thanks so much!

(Dr. A is the allergist Dr. R referred us to).

She examined my Tate this morning and diagnosed him with having either walking pneumonia or bronchitis!!!  He had rales in his  chest. She also mentioned that sometimes the first episode of asthma can sound like this. (This was my biggest fear!  Though I wrote in that note I thought he had a cold, I knew it could be asthma simply from the way he was sounding)  She knows I’m desperately praying he doesn’t develop asthma as those medications to treat asthma have so many horrific side effects, but I will do what I need to do.  

She called in a prescription for a Z-pac and if he isn’t better by Monday or Tuesday I need to take him back in.  

I so pray he gets better with the antibiotics which would mean he has pneumonia or bronchitis.  He has more of the symptoms of bronchitis (to me) than walking pneumonia as he has no fever and he has the hoarseness commonly associated with bronchitis.  But who knows?  I just want him to stop coughing and I want him to be fine.  Absolutely fine.

So, if you pray, please pray for my sweet boy.  Pray that he is healed and that he isn’t developing a possible life long condition (asthma).  I’m also praying he continues to be his happy go-lucky train loving self and that he’s completely well soon.  

I do know that if he’s not better by Sunday, I’ll be taking him in to see his pediatrician on Monday myself.  While I’m so very glad my parents are so willing to take him to any and all appointments, I know that if he’s not better, it’s something serious and I need to be there to get all my questions answered.  I’m his mother after all.  

He’ll need his mother.  He deserves his mommy.  

When you’re ‘sick’ (his ped said he could return to
daycare!) Mommy lets you have a hot dog
AND hot cocoa in your Polar Express cup for dinner!

My report on the American Academy of Allergy, Asthma, and Immunology"s 2011 meeting

I attended the AAAAI’s (for short!) 2011 meeting in March.  I thought this was a productive meeting for me.  This is an international meeting of allergists from around the world.

I got to investigate a number of Electronic Medical Record (EMR) systems firsthand.  This helped to crystallize my thoughts of the current status of EMR currently available.

Mannitol challenges seem to have replaced methacholine challenges to test for bronchial hyper-reactivity.  I do not see my practice using them often.

The general plenary sessions were interesting. (photo 1).  Some of the interesting topics: nanotechnology, asthma, studies on sublingual (under-the tongue) immunotherapy, safety of long-acting bronchodilating agents, food allergy, mold exposure.

There were no new medications debuting.

I spoke with allergists from around the world: Japanese, German, Turkey, Finland, Italy, and the U.S.  My conclusion: medical practices and health care systems differ widely, not only within the U.S., but in many countries.

I think there will be some subtle changes in my practice, which should improve my patient’s disease outcomes.

Incidentally, while in California, I visited the Ira F. Brilliant Center for Beethoven Studies, in the San Jose Public Library.  An ultra-fast visit is here and here.  You can see Beethoven’s hair.  A sample was used to discover that high lead levels probably contributed to his death.

The next weekend, I attended the Allergy, Asthma, and Immunology Society of South Carolina’s annual meeting.  This was a smaller scale meeting of allergists from South Carolina with 4 nationally known speakers. The topics included immunodeficiencies, EMR, drug allergies, food allergies, and occupational asthma.  The above comments apply here also.  Both meetings were intellectually stimulating and I think they will benefit my patients.

Study Shows Asthma Medications Prevent Hospitalization When Used Properly

The ICU is one place you don’t want to be if you have asthma.  Research shows that available medications for asthma are highly effective in reducing hospitalizations.  SS

Inhaled Steroids Lead to Big Drop in Asthma Deaths at Texas Hospital: Study

They reduce inflammation in the lungs, improving control of asthma symptoms

TUESDAY, May 15 (HealthDay News) — Patient education and medication compliance contributed to a 74 percent drop in the number of patients with life-threatening asthma admitted to the intensive care unit at University Hospital in San Antonio, Texas, researchers report.

Their review of 30 years of hospital data focused on patients with severe asthma who didn’t respond to standard inhalers.

They found that there were 227 patients admitted to the intensive care unit (ICU) with 280 episodes of life-threatening asthma between 1980 and 2010. One patient died, but the death was from a different cause after the patient’s asthma improved, according to the team at the University of Texas Health Science Center at San Antonio.

“The main reason for the decline in cases is that more of our patients are taking their controller medications, such as inhaled corticosteroids, which reduce the amount of inflammation in the airways,” lead author Dr. Jay Peters, chief of pulmonary diseases at the Health Science Center, said in a university news release.

The researchers also found that insertion of a breathing tube, called intubation, when patients arrived in the emergency department did not lead to longer hospital stays.

“I think our methods of treating patients in the emergency department have improved so much that previous studies of issues with intubation don’t hold up anymore,” Peters said.

The study appears in the journal Respiratory Medicine.

“On the front end, this study reinforces the importance of staying on controller medications,” he said. “On the back end, it shows low mortality for patients in the medical ICU and that we don’t need to be afraid to intubate patients and place them on mechanical ventilation if necessary.”

Read more here

Omalizumab and severe uncontrolled asthma

The recommendations for patients with asthma that is not well-controlled are inhaled corticosteroids (ICS) and long-acting β(2)-agonists (LABAs). Many of these patients, however, continue to have inadequately controlled asthma. In a previous study (Humbert et al. Allergy 2005;60(3):309-16), it was found that the annualized rate of severe exacerbations was reduced by 29% in patients receiving omalizumab in addition to guideline-defined therapy. In a large study in 850 patients aged 12 to 75 years who had inadequately controlled asthma despite treatment with high-dose ICS plus LABAs, with or without other controllers, omalizumab reduced exaberbations by 25% over 48 weeks (Hanania et al. Ann Intern Med 2011;154: 573-8). Are you using omalizumab in patients with severe uncontrolled asthma? We want to hear about your experience.

Things To Know About Allergies And Asthma

By Dr. Chris Cowell

Allergies and asthma may have related reactions but they are really different. Some of the body’s chemicals that are involved in allergies are also involved in asthma. An allergy is an inflammatory reaction to a specific substance. The allergic reactions involve nasal membranes, the eyes, the skin, the tongue, and the breathing airways in severe reactions. The symptoms of allergy includes itchy, stuffy or runny nose, sneezing, red, itchy irritated skin, and burning or watery eyes.

Asthma is a chronic inflammatory lung disease that causes difficulty in breathing. Just like allergies, the substances that trigger allergies can also trigger asthma attacks. If you notice indications of allergy, it means that irritants are present in the air and it can activate asthma symptoms which can lead to asthma attacks. If you have asthma and allergy, your immune system will react to fight off the allergens. Allergens are substances that set off the allergy reaction. The chronic swelling of airways causes the airways to be narrowed causing asthmatic people the difficulty in breathing.

Asthma as a disease is incurable, the treatment can go on for a long time but you should not be worry because it is not contagious. You can have asthma as young as you were a toddler until you reach adulthood. There are lucky individuals who will not experience asthma attacks anymore once they reached adolescence, however there is a big chance of asthma attacks again when they reached adulthood especially if they are expose to smoke or other irritants that trigger asthma symptoms.

Asthma and allergies go hand-in-hand. There are several types of asthma, one of these is allergic asthma that is triggered by allergens such as pollen or mold spores. During an asthma episode, the band of muscle that surround the airways tighten causing them to narrow, the lining of the breathe ways becomes swollen. These will result to asthma symptoms such as frequent cough; breathe shortness, wheezing, and chest tightness.

It doesn’t mean that if you are an allergic person you have the same symptoms every time. You may experience different symptoms every time, or may not experience all the symptoms at all times. Like allergy indications, asthma symptoms may also change from one asthma attack to the next. An attack may be acute during the first attack and chronic during the next attack. If you suffer from allergies and asthma, knowing the allergy-causing substance is the best way to reduce your chance from asthma attacks. As they say, “Prevention is better than cure”, asking help from a doctor is also beneficial to recognize and treat even mild symptoms to help prevent severe asthma attacks and keep your asthma in control.

About the Author:

There are many allergy information institution that educates everyone about allergy and asthma. America’s Allergist offer allergy video care for everyone.

About Asthma

Asthma is a lung condition that causes difficulty breathing, and it’s common among kids and teens. Symptoms include coughing, wheezing, and shortness of breath. Anyone can have asthma, even infants, and the tendency to develop the condition is often inherited.
Asthma affects the bronchial tubes, or airways. When someone breathes normally, air is taken in through the nose or mouth and then goes into the trachea (windpipe), passing through the bronchial tubes, into the lungs, and finally back out again.
But people with asthma have inflamed airways that produce lots of thick mucus. They’re also overly sensitive, or hyperreactive, to certain things, like exercise, dust, or cigarette smoke. This hyperreactivity causes the smooth muscle that surrounds the airways to tighten up. The combination of airway inflammation and muscle tightening narrows the airways and makes it difficult for air to move through.

More than 23 million people have asthma in the United States. In fact, it’s the No. 1 reason kids chronically miss school. And flare-ups are the most common cause of pediatric emergency room visits due to a chronic illness.

Some kids have only mild, occasional symptoms or only show symptoms after exercising. Others have severe asthma that, left untreated, can dramatically limit how active they are and cause changes in lung function.
But thanks to new medications and treatment strategies, kids with asthma no longer need to sit on the sidelines, and parents no longer need to worry constantly about their child’s well being.
With patient education and the right asthma management plan, families can learn to control symptoms and asthma flare-ups more independently, allowing kids to do just about anything they want.

State of the art: Asthma treatment effects on airway remodeling

In this month’s issue, Durrani, Viswanathan, and Busse take a look at what we know – and what we don’t know – about the effects of asthma therapy on airway mesenchymal-epithelial remodeling in asthma (J Allergy Clin Immunol 2011;128:439-448). After summarizing the current information about remodeling mechanisms, Durrani et al. discuss the effects of specific asthma drugs.

Airway remodeling is known to occur in some asthma patients, but the authors point out that it is not linked to any clinical indicators. While remodeling is considered to contribute to the pathology of asthma, the causal relationship has not been confirmed. Typically, remodeling has been considered a response to chronic inflammation and dysregulation of repair mechanisms in the lung, so it has been suggested that treatments aimed at reducing inflammation would impact remodeling. Durrani et al. note that this concept has not held out, in light of evidence that suggests remodeling occurs in parallel with inflammation, as well as clinical data that traditional therapies, such as ICSs, are not effective for all asthma patients. Of interest, they comment that there is new evidence that remodeling is a direct response to increased inflammation during asthma exacerbation, supporting the idea that remodeling and inflammation are concomitant. The authors then focus their review on what is known about effects of asthma therapies on aspects of remodeling, such as airway smooth muscle (ASM) hyperplasia, subepithelial fibrosis, and goblet cell hypertrophy.

Inhaled corticosteroids. Durrani et al. discuss several studies that have reported positive effects of ICSs on elements of airway remodeling, such as decreasing reticular membrane thickening, goblet cell hypertrophy, and vascular remodeling. They note that the same is not true of ASM hyperplasia and epithelial injury and detachment where both positive and negative effects have been observed.

Combination treatments. The authors discuss in vitro studies that have shown that ICS+LABA combination products are more effective than monotherapy with either on matrix deposition in human fibroblasts. Another study reported decreased airway wall thickness and epithelial growth factors in asthma subjects on combination product. The authors are cautiously optimistic about these findings, but note a paucity of research specifically evaluating the effects of ICSs+LABAs and LABAs alone on airway remodeling mechanisms.

Monoclonal antibody therapy. Reviewing studies on omalizumab, mepolizumab, and golimumab, Durrani et al. comment on the lack of direct evidence suggesting that mAb therapy mitigates airway remodeling, even though there are reports of mAb decreasing inflammatory cytokines, eosinophilia, and exacerbations, all of which have been associated with remodeling.

The authors briefly cover other therapies, such as leukotriene antagonists and tyrosine kinase inhibitors, before concluding that pivotal pathways in remodeling need to be identified prior to outcomes research on the clinical impact of remodeling to exacerbation and impairment in asthma.

We asked senior author William W. Busse, MD, from the University of Wisconsin, what he felt the most promising areas are for future research on airway remodeling:

Dr. Busse: As pointed out in our review, there are a number of complicating features which make it difficult to determine the best treatment for processes involved in remodeling. First, as noted, the mechanisms underlying remodeling have not been fully identified making the selection of a target intervention difficult. Second, it is likely for those patients in whom remodeling becomes a part of their disease processes, it begins early in life and is linked to other events in asthma, i.e., injury and repair. Given this information, it is likely that treatment most likely to prevent remodeling will need to begin early in life and in the development of asthma. Since two early life events that are key to asthma development include allergic sensitization and respiratory infections, these two areas are likely to be the best targets. Of these two events, allergic sensitization is emerging to be perhaps the most important and amendable to treatment and, perhaps, prevention.

Asthma

16.4 million Adults and 7 million Children currently have Asthma. Asthma is a common lung disorder in many. An Asthma attack is caused by inflammation of the airway lining and tightening of the muscles around the airway. Due to the swelling of the airway it is hard to pass air and breath. Common symptoms are coughing, wheezing, chest tightening, and shortness of breath. Other more serious symptoms that need immediate medical attention are blue color in the lips, drowsiness, disorientation, rapid pulse, and sweating. Click to see what happens during an Asthma attack!

Asthma can be triggered by numerous things including animal hair, pollen, mold, vigorous exercise, stress, dust, and smoke. A common treatment for these attacks is an inhaler which helps open the airways so air can pass through. There are many different types of inhalers; some that are used to prevent an attack and some that are used to relieve an attack. If the attack is at an untreatable level hospitalization is necessary. The Asthma patient will be given oxygen and medicine intravenously.

Asthma has no known cause. Some people who suffer from Asthma have a family history of allergies. To prevent Asthma attacks one should avoid the common triggers mentioned above. The person should also sustain from scented detergents, rugs, humidity, household leaks, pets, and scented cleaning agents. It is even good to put allergy proof casing around the bedding, and placing filters over all the vents in the house.

There is currently no cure for Asthma but treatments make it managable. Most people who suffer from Asthma can live a normal healthy life. Although, if not treated properly some severe cases of Asthma can result in death.

Google. (2009). Google Health. Retrieved by
https://health.google.com/health/ref/Asthma

Mayo Clinic. (2009). Asthma Attack. Retrieved by
http://www.mayoclinic.com/health/asthma/MM00001

Are there anti-oxidant vitamins to treat allergies or asthma?

My father asked The Allergy Dude recently this question.  What about vitamin E?  Some small trials and retrospective studies have been done to investigate if vitamins can reduce the signs or symptoms of allergic diseases.  The short answer is NO, unfortunately.  In some other diseases, the answer can be yes sometimes.  For example, in age-related macular degeneration (AMD), in moderate and severe cases, the vitamins and mineral zinc helped to prevent further losses.  This link explains the findings of a multi-center trial very well.  AMD involves the retina, which is located in the back of the eye.  Cataracts are located in the lens of the eye, which is in the front, to clarify.  Cataracts are not prevented or slowed in development by any vitamins or minerals. If you know some one with AMD, please share this fact with them.

Asthma Drug - Zyflo-zileuton

Advertorial 

Asthma—-

It’s kind of a common illness. I believe that you probably have family members or friends who have asthma. Like me, I have a few friends who suffer from this disease/illness.

Before we go further into this discussion, let’s talk a little about what asthma is. According to Wikipedia, asthma is the common chronic inflammatory disease of the airways characterized by variable and recurring symptoms, reversible airflow obstruction, and bronchospasm. The symptoms include wheezing, coughing, chest tightness, and shortness of breath. By simple words saying, you will often see asthma patients have difficulty in breathing whenever they had an over vigorous activity (for example, sprint run or over emotional). Though I have never seen a real asthma patient fighting with the asthma attack right in front of my eyes but I have seen quite a number of examples from TV (Er, I think they are more a less the same…)

Now, let’s talk a little about the cause. Asthma is thought to be caused by a combination of genetic and environmental factors. Mmm hmm… Like my boyfriend, he inherited asthma from his father who is also an asthma patient.

Are there any solutions to cure asthma?? Well, I’m not a doctor or a pharmacist; I can’t tell exactly how/what you need to do to cure asthma. However, somebody recommends a product to me which he claims that it’s useful for asthma patients. I’m writing this post to share with you readers about this product. I am not responsible of its effectiveness on individuals but I’m writing this so that people are aware that there’s such product/medicine/supplements/drug or… [well, I don’t know what’s the right term to use].

This product is called the Zyflo-zileuton. It has a very high tech name uh huh. It’s a kind of drug that I think you probably can purchase via drug stores. You can seek your pharmacist to ask for more details about this type of drug… Is it suitable to be consumed by you? Is it risk free? Is it available in the pharmacy store and etc—

The Zyflo-zileuton, or commonly known as the Zyflo by its short name, is a drug that helps prevent asthma attack. Since asthma is an innate disease to some people, I guess one of the effective ways is to avoid from getting the attack. Perhaps, you can try and consider this product. I don’t guarantee its effectiveness but you can try and consult an expert in the drugs field for further confirmation and details.

In conclusion, Zyflo is a kind of drug that helps people with asthma.

Research opportunity: asthma and intellectual disability

The University of Sydney  (Pharmacy Faculty) is conducting research into the use of inhalers by people with an intellectual disability. 


Australian data show that 15% of people with intellectual disability have asthma, and our recent study showed that inhalers are being prescribed. In both residential care settings and the family home, assistance is often provided to people with intellectual disability to take medication.

We are seeking to interview family caregivers and disability support workers who have recently cared for a person with intellectual disabilities who has asthma or uses inhalers. We hope to gain an understanding of carers’ knowledge and training with regard to respiratory medications, as well as any challenges involved.

Please contact Sharon Davis (Ph D candidate, Faculty of Pharmacy) on 02 9114 5119 or 0411 817 299 for more information.

Free Asthma Inhalers, brought to you by Peabody Energy

 

Why Free Inhalers? Because COAL CARES.

Coal Caresâ„¢ is a brand-new initiative from Peabody Energy, the world’s largest private-sector coal company, to reach out to American youngsters with asthma and to help them keep their heads high in the face of those who would treat them with less than full dignity. For kids who have no choice but to use an inhaler, Coal Caresâ„¢ lets them inhale with pride.

Puff-Puffâ„¢ inhalers are available free to any family living within 200 miles of a coal plant, and each inhaler comes with a $ 10 coupon towards the cost of the asthma medication itself.

 

Read more here.

Asthma Stinks

I have adult-onset asthma.  I was diagnosed a few years ago when I was 40.  Before that, I would occasionally have a little asthma when I was around cats, but as I aged I began to have symptoms more often, for no apparent reason, and was eventually diagnosed with the full-blown condition of asthma.  And it’s not a fun disease.  I get very frustrated when I have attacks and often don’t know what causes it.  It can be anything from environmental allergies to a scented candle and before I know it, I’m struggling to breathe.

Yesterday was a particularly frustrating day for me. I was very excited to go my quilt guild meeting and learn how to use my fabric scraps and turn them into an improvisational quilt.  Everyone was asked to bring their scraps and we combined them to share as we worked.  I was digging through quite a few bags, enjoying myself thoroughly.  Then I sneezed.  I figured I had stirred-up some fabric dust and didn’t think anything of it.  Then the all too familiar tightness in my chest began.  I asked that the door to the outside be closed, thinking my exposure to that was causing a problem. But I kept suffering.  Off to the bathroom for a hit on my rescue inhaler.  And that’s when it occured to me-I bet some of the fabric scraps came from houses with animals.  Sure enough, cats and dogs were living with some of my fellow quilters.

I ended up having to go home and do a breathing treatment.  I felt ridiculous.  Sickly.  Weak.  And even guilty because my fellow quilters were worried they made me sick. (Which isn’t true-it’s MY allergy, so it’s MY responsibility!)  It’s unbelievable to me that I have to think about ridiculous things like who has pets and if I’m touching their stuff. 

But enough of my complaining.  I was very motivated to use my fabric scraps more often (pet hair free please) and was wondering….how do you organize your fabric scraps?  Mine are a jumbled mess in a basket by sewing table.  I would like for them to be more organized and would love to get your suggestions.  (I’ll take any hints you have for asthma too!)

Suffer the little children: null link between tylenol and asthma

When little ones hurt, have a high fever and are crying and too miserable to rest or eat, their parents have been able to help them feel better with a few drops of tylenol or panadol. It’s the most-used analgesic around the world and used by parents for more than 50 years. This weekend, parents were frightened by 442 worldwide news reports of a study on more than 205,000 children just published in Lancet, claiming to find a link between acetaminophen use during infancy and asthma in childhood.

All the information was there to recognize that this study actually found no cause for concern, but how many parents understood that? How many babies will be left without pain relief, or worse, how many parents may go back to baby aspirin (putting their baby at risk for Reye’s syndrome) because, sadly, they got caught up in fear?

Per readers’ requests, let’s take a brief look at this study.

See those baloney words: linked to, associated with, correlated to…

Bottom line, this was a data dredge through a massive database of the International Study of Asthma and Allergies in Childhood (ISAAC) looking for correlations. In fact, the huge numbers of children included may have sounded impressive, but was our first clue that this study was most likely done in a computer rather than to have been a clinical trial on real children. Our second clue was the title of the paper, which reported on the association between paracetamol (known as acetaminophen in the United States) use in infancy and the risk of asthma…

These are our quickest and easiest baloney alerts that this report doesn’t warrant any reaction on our part. As we come to understand correlations and what risk factors mean, this study needs no more than a glance before going to line the bird cage.

These epidemiological studies were never meant to be used for anything more than the most preliminary-type of exploration for researchers to search for strong links among data that can be used to begin to form hypotheses that can be later tested in the laboratory and eventually in human clinical interventional trials. As we’ve seen again and again, no matter how “significant” any correlation, doesn’t mean it means anything or will ever hold up to later actual research that’s a fair test of a hypothesis. The only purpose served by publicizing the bazillions of — often meaningless, nonsensical and contradictory — correlations these data dredges scour up, is to provide daily fodder for media sensationalism and special interest groups. Sadly, the public is left to suffer from epidemiological whiplash, as one day’s scare is likely to be reported as good for us the next day, and bad for us again the day after.

Imagine how much less stressed and healthier we’d all feel if the media only reported actual clinical research that had scientific merit and was news we could really use. Since that’s not likely to happen, let’s look more closely at this study because its weaknesses offer additional examples of why this wasn’t a fair test of anything.

Overview of methodology

ISAAC is a database created in 1991, when Phase One began by sending out questionnaires to the parents (or primary caregivers) of 721,601 children in 56 countries. Questionnaires were translated into the local language with back-translated into English. This latest study published in Lancet was led by Richard Beasley, DSc, at the Medical Research Institute of New Zealand, Wellington, on behalf of the ISAAC Phase Three Study Group. It used data from Phase Three of the ISAAC project, which had sent out additional questionnaires asking parents (or primary caregivers) of 6-7 year olds and 13-14 year olds to think back to their child’s first year of life and symptoms of asthma, rhinoconjunctivitis (rhinitis with watery, itchy eyes) and eczema.

The questionnaires also asked the parents about 28 select environmental factors that the ISAAC authors wanted to examine as possible risk factors for asthma and allergies. As the authors explained: “Questions were about age, sex, family size, birth order, antibiotic use in the first year of life, breastfeeding, birthweight, diet, heating and cooking fuels, exercise, pets, socioeconomic status, immigration status, parental tobacco smoke, traffic pollution, and paracetamol use in the first year of life and in the past 12 months of children aged 6–7 years.”

Professor Beasley and colleagues said that they “used parent-reported symptoms [of asthma] rather than doctors’ diagnose [sic] to avoid major diagnostic differences related to access to medical care, language, and medical practice in populations worldwide.”

Already, the quality of the data going in is problematic. Not only was it restricted just to the information the ISAAC authors chose to examine, but it was retrospective and self-reported, subjective information. There was no attempt to validate the information with clinical examinations or examinations of the children’s medical records. Nor were any dosages of the medication recorded or included in the analysis. This is the very weakest of information and is at the greatest risk for recall bias.

As even Dr. R. Graham Barr, M.D., DrPH, assistant professor of epidemiology at Columbia University Mailman School of Public Health in New York wrote in a commentary in the same issue of Lancet:

[A] cross-sectional survey with a retrospectively ascertained primary exposure is not a design on which we prefer to make therapeutic decisions. Recall bias (parents of children with asthma might better remember giving paracetamol in the first year of life) and reporting bias (parents more attuned to their children’s maladies might be more likely to give paracetamol and report the current wheeze) could account for the findings.

Nearly every child on the planet has received this analgesic. As the ISAAC authors also commented in their Discussion Section, fever is common in infants, so most babies would likely have received paracetamol for fever on more than one occasion during their first year of life. But since respiratory illnesses during early childhood (especially respiratory syncytial virus infection) is associated with increased problems with wheezing in children, these infants would also have been more likely to have received paracetamol for their accompanying fever and discomfort than typical little ones.

In other words, respiratory infections and other illnesses accompany the use of acetaminophen in babies. Had the researchers asked about other comfort measures, such as use of humidifers, favorite cuddly toys, or popsicles, the correlations to asthma might have been every bit as significant. Repeated respiratory problems, however, have considerably more biological plausibility for a potentially meaningful link. The tylenol connection just came along for the ride.

As Dr. Barr wrote, underlying respiratory disease, differences in hygiene and the use of other fever medications could also explain the findings.

Epidemiological studies have linked asthma to hundreds of things, but this type of data is not very reliable Dr. Richard Lockey, M.D., professor of Medicine, Pediatrics and Public Health and director of the Division of Allergy and Immunology at the University of South Florida College of Medicine, told ABC News. Dr. Lockey is a past President of the American Academy of Asthma, Allergy and Immunology and former director of the Board of Allergy and Immunology. He said he seriously doubted there is anything to this link.

When enough data is thrown into a computer, odds are it will pull out all sorts of meaningless correlations, just like a popsicle. But no one would try to claim a popsicle causes asthma. Yet, like all such databases, this one has been the source of countless other links with asthma, many of which contradict each other or make no sense at all. Authors from New Zealand, for example, dredged ISAAC and reported children who ate a hamburger more than once a week had a 65% odds ratio of having a history of wheeze and if it was from a fast food restaurant, the odds went up to 141%. But no one would really believe that a hamburger causes asthma. Turkish authors used the database to report a 154% higher odds ratio of asthma among those whose family incomes were below $ 300/month; whereas Brazilian authors used it to report higher risks for asthma associated with wealthier families.

This weekend’s Lancet study, also suffered from exceedingly high attrition rates. Of the original cohort, 89,514 babies (46%) who’d received tylenol for fever during 1^st year of life were lost in follow-up and their parents didn’t complete the questionnaire. Only data on about half (105,041) of the original group of babies who’d received acetaminophen at least once during infancy were included in the multivariate analysis. Were the parents of children with asthma more likely to have completed the questionnaires, seeking answers to their children’s illnesses?

The ISAAC researchers then loaded all this questionnaire data into a computer and applied several different computer models to identify links, calculate odds ratios and adjust for specific confounders. They adjusted for these covariates: maternal education, antibiotic use in the first year of life, ever breastfed, parental smoking, current diet and siblings.

As they stated: “The primary outcome measure was the association between paracetamol use for fever in the first year of life and asthma symptoms at 6–7 years of age, expressed as odds ratios, as measured by the multivariate analysis.”

Results

From their multivariate analysis, they reported a 46% odds ratio (OR=1.46) associated with acetaminophen use in the first year of life and risks of asthma symptoms at age 6-7 years.

Of course, this is an untenable correlation, made even moreso by the use of odds ratios rather than relative risks. This computer-derived correlation, like others under at least 200%, is no better than what might have surfaced for this type of study by a random error or chance, and most likely explained by co-factors. The relative risks derived from epidemiological studies that later prove out in clinical trials to be real, are considerably higher — by several hundred percent! Forty-six percent may sound like a lot, but it’s still a null finding. It’s even less than a hamburger.:-)

In other words, there was no valid link found between acetaminophen usage in infancy and childhood asthma. Without even a tenable link, it’s not a viable avenue to look for a cause, of course.

Professor Beasley and colleagues admitted that their odds ratio “may be overestimates of the risk” because of confounding factors likely to have been present. The authors didn’t report the odds ratios from any of the other 28 questions in the questionnaire, nor did they provide any of the actual (absolute) numbers of children with asthma, to enable us to put these odds into any credible perspective. [Providing only odds ratios, instead of actual numbers, is not valid medical reporting. If 1 child among 1,000 who"d not been given tylenol developed asthma compared to 2 children among 1,000 who"d received tylenol, the risk is double, but clinically meaningless.] By comparison, authors at the Isra University Hospital in Hyderabad reported in the July issue of the Journal of the College of Physicians and Surgeons Pakistan an association between asthmatic children and a parental history of asthma, with an odds ratio of 26.8 — 1,800% the risks associated with acetaminophen in this week’s study.

BTW: The only clinical research the ISAAC authors referenced as support for a potential medical link between tylenol use and asthma was found: “in one randomized controlled trial, paracetamol use for fever in childhood was associated with an increased risk of hospital outpatient attendance for asthma when compared with ibuprofen.” This study had been conducted by doctors from the Slone Epidemiological Unit School of Public Health, Boston University School of Medicine and published in the February 2002 issue of Pediatrics. It was a randomized, double-blind trial where 1,879 asthmatic children were prescribed either low doses of acetaminophen or two different doses of ibuprofen for fever control as needed. The children’s outpatient medical visits and hospitalizations over the next four weeks were obtained from parental questionnaires. A total of 18 children had been hospitalized for asthma during those four weeks, two more in the acetaminophen group compared to the higher ibuprophen dose group, but “there were too few hospitalizations to permit computation of stable dose specific risk estimates.”

The ISAAC authors said “causality cannot be established from a study with this design” and the “evidence is insufficient to advise parents and healthcare workers of the risk-benefit of taking paracetamol in childhood.”

Aubrey Grayson, Medical writer for ABC News, reported on doctors issuing much stronger statements about this ISAAC study, telling parents to not worry or react to it. Dr. Anita Gewurz, M.D., professor of allergy and immunology at Rush University Medical Center, said the study contains serious methodological flaws and the findings should be taken with a grain of salt. Several doctors urged parents not to deny their children relief because of scary news reports:

“Don’t panic or go back to aspirin,” said Dr. N. Franklin Adkinson, Jr., professor in the division of allergy and clinical immunology at the Johns Hopkins Asthma and Allergy Center in Baltimore. “Continue to use acetaminophen until further research is done.”

Parents should also remember that other painkillers are not without their risks. In 1982, the government issued a warning to avoid giving young children aspirin to relieve cold and flu pain. Aspirin use in young children has been linked to the development of Reye’s syndrome — a rare but serious children’s disease that can lead to brain damage, liver failure and death. Acetaminophen has never been linked with the development of Reye’s syndrome, and doctors have since urged parents to choose acetaminophen-based pain relievers to give to their feverish children.

But some doctors worry that many parents may read about the new findings and begin denying their sick children any form of pain relievers. Even worse, parents might begin to choose aspirin over acetaminophen once again — thus possibly placing their children at risk for Reye’s.

“Misrepresenting this will cause unnecessary panic,” said Dr. Peter Catalano, chairman of the department of otolaryngology at the Lahey Clinic in Burlington, Mass. “The science is absent.”

© 2008 Sandy Szwarc

More information

Tylenol has long been the standard remedy for fever and pain in children and to be safe and effective when used as directed. However, like everything, overdoses can be harmful and tylenol overdoses can result in serious liver damage. More information on how much tylenol to give your child and other precautions is available at the Tylenol Dosage Calculator.

More information on paracetamol is available here, and on acetaminophen here.

Study Disclosures:

Funding The BUPA Foundation, the Health Research Council of New Zealand, the Asthma and Respiratory Foundation of New Zealand, the Hawke’s Bay Medical Research Foundation, the Waikato Medical Research Foundation, Glaxo Wellcome New Zealand, the New Zealand Lottery Board, Astra Zeneca New Zealand, and Glaxo Wellcome International Medical Affairs. Richard Beasley received honoraria for lectures and participation in advisory boards, and grant support from GlaxoSmithKline, the manufacturer of paracetamol. All other authors declare that they have no conflict of interest.