Asthma may affect as many as one out of ten children in the US.  During the fall months and in to winter we see a tremendous increase in the number of children with active symptomatic asthma.  A respiratory viral infection is a rather frequent co-conspirator responsible for a higher number of children suffering with worsening asthma.  Other important factors include a change in weather, cooler, drier air as well as increased exposure to indoor allergens. Another issue is children who are given less medication during the later summer and early fall now more than ever need a provider directed asthma regimen to prepare for cold and flu season as well as winter. 

According to a study presented at a meeting held by the American College of Chest Physicians it was observed that October and November are the peak months for children’s asthma, including ER visits, hospitalizations as well as needed asthma medication. Make it an ideal time to review asthma “action plan” (including the proper use of a peak flow meter) with your physician or health care provider at:

http://www.nhlbi.nih.gov/health/public/lung/asthma/asthma_actplan.htm

What are some symptoms that may indicate that your child’s asthma may not be well controlled?

• Recurrent and persistent cough
• Cough as a result of exposure to pets, exercise and even laughing
• Wheezing
• Trouble breathing or catching your breath
• Tightness of the chest and “congestion”
• Worsening asthma after cold virus and sinus infections
• Nighttime cough
• Increased use of quick reliever “rescue” inhalers

Why are more children suffering from asthma?

Read on in an upcoming blog in order to assist you in reducing asthma symptoms in your child.  Don’t forget the flu shot!   

Dr. Clifford W. Bassett is an assistant clinical professor of medicine at the Long Island College Hospital and on the faculty of NYU School of Medicine.  He is the current vice chair for public education committee of the American Academy of Allergy, Asthma and Immunology.  No information in this blog is intended as medical advice to any reader or intended to diagnose or treat any medical condition.

There has been much debate surrounding the dramatic increase of asthma in the United States and throughout the world over past several decades.

A study released by a group of researchers from New Zealand published in the September 20, 2008  issue of the The Lancet found an association between paracetamol use in infancy (known as acetaminophen in the U.S., and a very commonly used non-aspirin containing analgesic) and childhood risk of asthma, allergy and eczema in children at 6-7 years.  The authors suggested  the use of this commonly prescribed pain reliever and fever reducer might be a risk factor for the development of childhood asthma. 

 There has been an increased use of these non-aspirin containing analgesics over the past five decades, especially in children.  Additionally, the researchers reported those children that were given more frequent doses were more likely to develop asthma on a risk adjusted basis. 

 It is important to note that approximately, and this is just an estimate,  about 10 percent of adults and children with asthma find aspirin and non-steriod anti-inflammatory drugs (NSAIDS) actually worsen their asthma.  Aspirin “intolerance” appears to be more common in those patients with moderate to severe asthma, particularly individuals that also have nasal polyps and sinus disease. 

Another study reported in the journal Thorax found at least in adult women that aspirin may reduce asthma risk.  The authors cautioned  their findings were “still not enough to recommend taking aspirin regularly.”  Separately, the incidence of asthma is increasing and other asthma researchers believe another cause for this possibly is an association with obesity and dietary factors. 

In any event I have not observed any issues with acetaminophen analgesics in our allergy and asthma patient population when used in appropriate dosages and for the correct reasons.  Obviously more work and further studies are needed to explain the explosion of new cases of asthma, both in adults and children.

Dr. Clifford W. Bassett is an assistant clinical professor of medicine at the Long Island College Hospital and on the faculty of NYU School of Medicine.  He is the current vice chair for public education committee of the American Academy of Allergy, Asthma and Immunology.  No information in this blog is intended as medical advice to any reader or intended to diagnose or treat any medical condition.

If you have a child with allergies or asthma – this is a very good time to review your “allergy action plan” for the upcoming school year.  First, if your child has asthma - learn about asthma triggers, including exercise associated asthma.

Second, more than 2 million children have allergies to one or more foods, making it imperative to incorporate a savvy avoidance and elimination diet 24/7 both at home and at school.  If you need help, enroll in the Food Allergy and Anaphylaxis Network at www.foodallergy.org.

Third, seasonal allergies and indoor allergies can cause a decrease in learning in the classroom. As a result, your child may require proper attention and pre-treatment before they head to the classroom.

Here are some more tips to get you started:

– All children with a history of severe allergy or allergic emergencies should have an auto-injector with epinephrine immediately available to them and appropriate school personnel. A written plan of action should be in place.

– If your child has asthma – work with your child’s physical education staff to allow for safe and enjoyable athletic activities during the school year. It is very important to provide time for a warm up and adequate cool down as well as have available drinking water during exercise.

– Wear protective eyewear on windy days to reduce pollens and molds entering the eyes.

– Work with your family doctor and/or allergist to get proper allergy treatment for environmental allergies that may be aggravated by exposure to indoor allergies such as pet dander (cat hair is often present in high levels in schools, and is usually from exposure to clothing).

– For kids allergic to food, always plan ahead with safe snacks for school and reinforce “reading food labels.” 

Let’s make the school year a safe, successful and fun-filled experience, especially if your child has allergies or asthma. Learn more at www.acaai.org and www.aaaai.org.

Dr. Clifford W. Bassett is an assistant clinical professor of medicine at the Long Island College Hospital and on the faculty of NYU School of Medicine.  He is the current vice chair for public education committee of the American Academy of Allergy, Asthma and Immunology.  No information in this blog is intended as medical advice to any reader or intended to diagnose or treat any medical condition.

Alert: FDA Advises Patients to Switch to HFA-Propelled Albuterol Inhalers Now

The U.S. Food and Drug Administration is encouraging asthma patients to speak with their physicians and health care providers about the “switch” to HFA-propelled rescue inhalers (albuterol).  These environmentally friendly inhalers will replace the old CFC propelled inhalers that are harmful to the ozone layer. 

The FDA is encouraging patients to talk to their health care providers now about switching to HFA-propelled inhalers.  The new inhaler may give some patients a perception of a softer mist as compared to the old CFC inhalers.  The medication (albuterol) is exactly the same, and has not changed. 

The phase-out of CFC-propelled inhalers is the result of an international environmental treaty: the Montreal Protocol on Substances that Deplete the Ozone Layer and the U.S. FDA mandated these inhalers been phased out by the end of 2008.

Again, many patients have already been transitioned to the new propellant in their rescue inhalers and may not have even noticed the change. Talk with your provider or asthma specialist to learn more about asthma triggers and optimal control.

Dr. Clifford W. Bassett is an assistant clinical professor of medicine at the Long Island College Hospital and on the faculty of NYU School of Medicine.  He is the current vice chair for public education committee of the American Academy of Allergy, Asthma and Immunology.  No information in this blog is intended as medical advice to any reader or intended to diagnose or treat any medical condition.

As we approach the Olympic Games in Beijing, China this week is time to take note if you find yourself “breathing heavy” during or after exercise.  This may a sign of more than just good aerobic activity.  Exercise-associated asthma can be the culprit; in many cases you may not realize you have this form of intermittent asthma.  Symptoms such as coughing or difficulty breathing during or shortly after exercise are commonly seen. 

In the past several Olympic Games up to one-fifth of athletes have a history of EIA (exercise induced asthma).  It certainly does not keep these elite athletes sidelined.  EIA may be triggered by “oversensitivity” to changing conditions including temperature, humidity as well as air quality, during the workout.  

Strategies in dealing with EIA

·         Hydrate with water before, during and after exercise

·         Warm up with a decent stretch and light exercise

·         Give yourself an adequate period for a “cool down” when done

·         Control your allergies and asthma triggers (especially on high pollen count days)

·         Check out the air quality index (pollution and ozone levels) before you exercise outdoors

·         Pre-treat with inhaled medication as advised by your doctor (after your diagnosis is confirmed) to prevent symptoms

Additional info and tips on “exercise induced asthma” can be found at www.aaaai.org/patients/publicedmat/tips/exerciseinducedasthma.stm.

Dr. Clifford W. Bassett is an assistant clinical professor of medicine at the Long Island College Hospital and on the faculty of NYU School of Medicine.  He is the current vice chair for public education committee of the American Academy of Allergy, Asthma and Immunology.  No information in this blog is intended as medical advice to any reader or intended to diagnose or treat any medical condition.

Dr. Bassett

 

As we are going through our summer rainy season in many areas of the country I thought it would be an appropriate time to discuss a little know asthma phenomenon.  After a rainstorm pollen grains can be washed away lowering pollen counts and giving some allergy sufferers temporary relief.  However, a number of pollen grains, in particular grass pollen levels, may actually increase as much as 50 fold! It is thought that in some cases, these higher amounts of allergy causing particles, when inhaled, may bring on an asthma attack.  This has been categorized as “thunderstorm associated asthma” and it is indeed a paradox. 

A recent study published in the journal Thorax looked at millions of ER visits during a decade in Atlanta.  The study found that following a thunderstorm there were many more individuals seeking ER care for worsening asthma.

Other theories have looked at air quality and pollution that may be affected by rain and thunderstorms.  The relationship between thunderstorms and an increase in the number of emergency room visits for asthma has been identified in many studies throughout the world; however most doctors and patients may not be aware of this phenomenon. 

So for the 20 million Americans with asthma according to the American Academy of Allergy, Asthma and Immunology, the next time there is a thunderstorm, make it an opportunity to pay close attention to your symptoms and stay one step ahead for proper and timely asthma treatment.   This underscores the importance of having an “asthma action plan” for optimal asthma prevention and management.

Dr. Clifford W. Bassett is an assistant clinical professor of medicine at the Long Island College Hospital and on the faculty of NYU School of Medicine.  He is the current vice chair for public education committee of the American Academy of Allergy, Asthma and Immunology.  No information in this blog is intended as medical advice to any reader or intended to diagnose or treat any medical condition.

Dr. Bassett

Do fish oils protect against asthma?

One of the major components of asthma is airway inflammation (swelling of the lung passages).  It appears that supplementation with fish oils may provide a natural “anti-inflammatory” benefit in asthma.  EPA and DHA are some of the more important components of fish oils and they block some of chemicals responsible for chronic asthma. 

Studies out of Japan indicated fish oil supplements reduced asthma symptoms and severity in children.  Researchers from Australia also reported eating oily fish (i.e. Atlantic salmon, trout) was associated with lowering the risk of a child from developing asthma as well as a reduction in asthma severity. 

And now prenatal exposure to various fish oils may have a protective effect against asthma.   My colleague Dr. Roberta Lee, Medical Director of the Center for Health and Healing Director in New York City, stated “I have observed great clinical improvement using fish oil supplements as an adjunctive  therapy to standard allergy and asthma care.”  There is a huge need to further study this in preventing asthma and to complement standard treatment in larger controlled trials.  

Dr. Clifford W. Bassett is an assistant clinical professor of medicine at the Long Island College Hospital and on the faculty of NYU School of Medicine.  He is the current vice chair for public education committee of the American Academy of Allergy, Asthma and Immunology.  No information in this blog is intended to diagnose or treat any condition.

Dr. Bassett

Allergy season in many areas of the US has had a big impact on all of allergy sufferers, particularly on children.  As children often spend a larger amount of time outdoors during the summertime they may be more so affected by the onslaught of daytime seasonal pollens and mold spores.  

 If one parent has allergies there is at least a 25 to 33 percent chance of the child developing allergies and the risk goes up over 50 to 75 percent if both parents are allergic sufferers.  So family history is a key factor in whether or not your children will develop seasonal allergies, indoor allergies and/or asthma.

 Recent studies have looked at impaired sleep as a result of poor breathing due to congested nasal and sinus passages during the night.  This may have a direct impact on daytime behavior and performance in the classroom.  Fatigue and daytime drowsiness may also be a sign of sleep disturbances that occur due to poorly controlled allergies.

Some suggestions I typically discuss with the parents of children suffering from seasonal allergies are:

  * Change clothes after spending time in the park where pollens are plentiful

  * Washing hair and taking a bath later in the day after being outside on a “high pollen day

  * Pre-treat to prevent daily symptoms during peak seasonal pollen periods

  * Vacation at peak allergy times by a body of water such as a lake, river or by the beach, where pollen levels are typically lower

* Ask your pediatrician or allergist if your child should be on “anti-inflammatory” nasal sprays to reduce congestion from seasonal allergies that may assist in better quality sleep at night

Be proactive and develop a sensible allergy management program for your child to successfully combat seasonal allergy triggers!  Learn more at www.acaai.org and www.aaaai.org.

 Dr. Clifford W. Bassett is an assistant clinical professor of medicine at the Long Island College Hospital and on the faculty of NYU School of Medicine.  He is the current vice chair for public education committee of the American Academy of Allergy, Asthma and Immunology.  No information in this blog is intended to diagnose or treat any condition.

Dr. Bassett

In the July issue of American Journal of Respiratory and Critical Care Medicine researchers found “consistent positive associations” between the amount of nuts eaten during pregnancy, including peanuts, and respiratory symptoms (i.e. shortness of breath, wheezing) in their children through the first 8 years of age. 

The study which took place at Utrecht University in the Netherlands interviewed over 4,000 pregnant women with and without a history of allergy and asthma.  Daily ingestion of nuts in these women increased the likelihood that their child would have “wheezing” and shortness of breath, compared to those mothers who rarely consumed nuts.  The researchers felt it was too soon to recommend a nut restricted diet during pregnancy, and agreed these results should be confirmed by future research. 

I have generally adopted the practice of recommending that women with a strong history of asthma and allergic conditions (i.e. hives, food allergy, seasonal allergies, eczema) should consider a nut restriction during pregnancy. 

Dr. Clifford W. Bassett is an assistant clinical professor of medicine at the Long Island College Hospital and on the faculty of NYU School of Medicine.  He is the current vice chair for public education committee of the American Academy of Allergy, Asthma and Immunology.  No information in this blog is intended to diagnose or treat any condition.

Pack your bags and leaving your allergies behind!

Its vacation time and thoughts of relaxation and anticipation may be first on your mind. Remember if you or a household member has allergies and/or asthma it is important to prepare ahead. 

Certainly the following strategies are helpful to many vacation-goers:

    ** Bring an adequate supply of daily medications and go onto the National Allergy Bureau at www.aaaai.org/nab to check out the pollen levels at your desired destination

   ** Plan your outdoor activities wisely, especially when pollen levels rise and consider doing the “indoor thing” if you are particularly affected by air pollutants such as ozone

   ** Take a vacation by the sea (i.e., by the beach, lake or shore) where pollen counts are lower

   ** Take the sunglasses (the bigger the better) to block pollens from entering into the eyes and lids

   ** Learn if the hotel you will be visiting has “green rooms” that are more environmentally and allergy friendly

   ** Take your dust-proof allergy covers for pillows and mattresses to provide top notch indoor protection from pesky (but invisible) dust mites

   ** Don’t let the bugs bite! Avoid excess fragranced products, creams, hair care products and colognes which attract stinging insects especially if you have a history of reactions to them (bright colors may also attract them)

   ** Get a pre-trip check-up with your allergist and take the opportunity to get your allergy “tune up” and review your “go to” allergy medications before leaving home

   ** If you suffer from pet allergies request an animal-free room as well as talking to your host when visiting friends

   ** Be a label detective when eating out of the home if you have food allergies (bring safe snacks for those affected)

    ** Bring along some moisturizing nasal saline spray, especially for prolonged air travel (cabin air is dry and may irritate nasal passages)

   ** Make sure your favorite sunscreen is “kind” to your skin before using it on yourself and children 

Be safe and be prepared!

Dr. Clifford W. Bassett is an assistant clinical professor of medicine at the Long Island College Hospital and on the faculty of NYU School of Medicine.  He is the current vice chair for public education committee of the American Academy of Allergy, Asthma and Immunology.  No information in this blog is intended to diagnose or treat any condition.