What to know about stress-induced asthma
Stress is a common trigger of asthma symptoms. Stress and anxiety can also cause asthma attacks.
Asthma is a condition in which the airways become inflamed, making it difficult to breathe. Symptoms typically come and go with triggers, such as irritants, humid weather, and exercise.
According to Asthma UK, 43% of people with asthma report that stress can trigger their symptoms. Managing stress and anxiety can help minimize asthma flare-ups.
In this article, we look at the link between stress and asthma in more detail.
Stress and asthma
When a person feels stressed, they may experience more frequent and severe asthma symptoms.
When a person feels stressed, they may notice that their asthma symptoms flare up. Periods of stress can increase the severity, frequency, and duration of asthma symptoms.
Stress can cause people to become more sensitive to their asthma triggers. Common triggers include pet dander, pollen, humidity, and cold, dry air.
Stressors might include work, school, or family stress. Significant life changes and traumatic experiences can also cause stress.
Stress can make inflammation worse, and it can trigger shortness of breath or breathing difficulties, all of which can exacerbate asthma symptoms.
If a person can manage their asthma, they are less likely to experience stress or anxiety related asthma.
Stress can also indirectly cause asthma flare-ups. A person who is stressed may experience certain emotions, such as anger and irritation, more strongly. Strong emotions can trigger asthma symptoms.
A person who experiences stress for prolonged periods may feel more anxious. Anxiety can trigger panic attacks that can, in turn, cause an asthma attack.
People may also sometimes find that stress leads to unhealthful habits, such as smoking or drinking alcohol. These habits can trigger asthma.
Symptoms of stress-induced asthma
People may notice that their normal asthma symptoms worsen when they feel overly stressed or anxious. This feeling can be temporary, such as before an exam, or it can be due to chronic stress, which occurs over an extended period.
Asthma symptoms are similar regardless of the trigger. Common symptoms of asthma include:
tightness in the chest
trouble breathing
rapid breathing
shortness of breath
Managing stress with asthma
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CVS directs initiative combating youth smoking toward teen e-cigarette use

CVS Health and its foundation are directing their focus on cutting teen tobacco smoking toward a key driver of the worsening problem: e-cigarettes.

Already, CVS was in the midst of a five-year, $50 million initiative called "Be the First" in an effort to be the nation's first tobacco-free generation. Monday, the retailer announced it—along with the Aetna Foundation—will give more than $10 million to organizations around the country to support prevention and education programs with a particular focus on vaping.

“The spread of e-cigarette use among youth jeopardizes the progress made in reducing smoking over the last two decades,” said Troyen Brennan, M.D., chief medical officer for CVS Health, in a statement.  “By collaborating with experts and aggressively investing in innovative strategies, we believe that we can help reverse this disturbing trend.”

The 2018 National Youth Tobacco Survey found 3.6 million middle and high school students indicated they were current e-cigarette users. That was more than double the total number from the previous year. It represented a 78% increase among high school students and 50% increase among middle school students. 

The problem was concerning enough for former Food and Drug Administration Commissioner Scott Gottlieb to declare a youth vaping crisis when he led the agency. "All the dramatic gains we've made in reducing smoking rates in this country, particularly among young people, will be reversed as a result of these products," he warned during an event in March.

In 2014, CVS announced it would no longer sell tobacco products in its stores as its sought to ramp up its role in the U.S. healthcare marketplace. In 2018, CVS completed a $69 billion acquisitionof insurance giant Aetna.  Both companies have said the deal will generate more than $750 million in savings in the first two years by reducing medical costs, closing gaps of care, optimizing sites of care and providing localized services for patients with high-cost chronic conditions. 

Among the projects aimed at reducing teen smoking that will receive grant funding this year: 

  • The CVS Health Foundation is investing in a multiyear, multi-million dollar collaboration with Discovery Education to create and distribute education materials to help middle and high school students learn about the risks of e-cigarette use. The resources will be available at no cost to every school district in the U.S.
  • A new two-year, $2 million grant...
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Telehealth Rehabilitation Lowers Hospital Readmissions After COPD Exacerbation, Study Finds

Video telehealth rehabilitation reduced the rates that patients with chronic obstructive pulmonary disease (COPD) had to be readmitted within 30 days after they were hospitalized for a pulmonary exacerbation, according to a study.

The findings were published in the American Journal of Respiratory and Critical Care Medicine in a study titled “Video Telehealth Pulmonary Rehabilitation Intervention in COPD Reduces 30-day Readmissions.”

According to the researchers, hospitalizations as a result of exacerbations in COPD patients are linked with respiratory morbidity and high healthcare costs, and accounts for nearly two-thirds of the total COPD healthcare costs. About one in five patients with COPD are readmitted within 30 days after hospital admission.

Although several hospitals have started intervention programs to lower the number of readmissions, the attempts have had minimal to modest success. However, studies have shown that pulmonary rehabilitation (multidisciplinary services aimed at improving the quality of life in patients) managed to reduce readmissions by 56%.

Consequently, researchers at the University of Alabama at Birmingham (UAB) tested the effect of a program using video telehealth rehabilitation.

The team enrolled COPD patients that were hospitalized for acute exacerbations, and identified through a daily hospital census (hospital-admitted patients). Except for specific conditions preventing them from participating in the exercises, all patients were included regardless of disease severity.

For 12 weeks, the patients attended a real-time video-conferencing intervention with 36 exercise sessions, following guidelines for conventional pulmonary rehabilitation. A physiologist provided the exercises that were based on outpatient exercise assessments, and adapted to the patient’s baseline functions.

Through the regimen, including stretching, breathing, and aerobic exercises, the goal was to reach heart rates between 60% and 80% of the maximum baseline recorded in a six-minute walk test.

Results showed a significant decrease in the 30-day all-cause readmissions among COPD patients who participated in the telehealth intervention (6.2% readmission), compared with patients who did not participate (18.1% readmission).

“Participating in an exercise program soon after hospitalization for an acute exacerbation of COPD is associated with a substantially lower readmission rate within 30 days of discharge,” Surya P....

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Apple acquires asthma-monitoring start-up Tueo Health

Tueo Health has developed technology that can alert parents or caregivers about potential asthma-related issues in sleeping children to help better manage the child's asthma.

As part of its continuing efforts in healthcare, Apple has purchased Tueo Health, a small Redwood City based startup focused on monitoring asthma in sleeping pediatric patients.

The deal, first reported by CNBC, serves to bolster the tech giant’s intellectual property in the healthcare space as it continues to roll our more health-oriented features in its hardware products.

Tueo Health has developed technology that can alert parents or caregivers about potential asthma-related issues in sleeping children to help better manage the child’s asthma.

Other notable healthcare acquisitions by Apple include the 2016 purchase of personal health data startup Gliimpse – which led to some of the foundational technology behind its Apple Record System – and its 2017 acquisition of sleep tracking company Beddit.

As sleep becomes potentially a bigger part of the company’s health monitoring ambitions, it’s easy to see how Tueo Health technology could be incorporated into Beddit sleep monitors or new sleep tracking features in a new version of the Apple Watch.

Bloomberg reported that Apple will overhaul its Health app with hearing health and menstrual cycle tracking in its iOS 13 update, which will be announced at the company’s Worldwide Developers Conference in June.

Tueo Health was founded in 2015 and raised a $1.1 million seed round in 2017 led by Launchpad Digital Health. According to patent records, Apple acquired the company’s core technology that year and later the entire company. The company’s lead executives are listed as employees of Apple on their LinkedIn pages starting in 2018.

Pulmonary chronic disease management has seen a flurry of activity in recent years. One of the largest digital health acquisitions in the past year was ResMed’s $225 million acquisition of COPD and asthma management startup Propeller Health in 2018.


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Disease pathways lead to possible new treatment for severe asthma

Here’s a sobering thought: Nearly half of Americans with severe asthma do not respond to conventional drugs, leaving them with few ways to minimize the often-debilitating symptoms of the chronic disease. But researchers at NHLBI have developed a new treatment that has the potential to dramatically change that: A synthetic peptide that mimics the work of a protein, called apolipoprotein, that appears to reduce inflammation in the lungs and improve their ability to function normally.

The researchers made the discovery by studying the pathways of asthma, leading them to conclude that, despite the similarity in patient’s symptoms, the severe form of the disease could have several genetic root causes, each resulting in different responses to treatment.

Microscopic images of the lungs of mice.

Effect of the 5A apoA-I mimetic peptide on the lungs and the airway hyperreactivity in mice with asthma.

About 25 million people in the United States suffer from asthma, which is marked by inflammation and narrowing of the airways and causes wheezing, coughing, chest tightness and shortness of breath. It affects people of all ages, but it most often starts during childhood—seven million children have the disease—and it disproportionately affects minorities and families living at or below the poverty line. The condition can greatly reduce a person’s quality of life and is a major contributing factor to absences at school and work. Severe asthma attacks may require emergency room visits and hospitalizations, and they can be fatal.

In an effort to understand why some people respond to some asthma medications and others do not, researchers started with the basics. “By studying the pathways of the disease, we identified a new biological mechanism that leads to asthma,” explained Stewart J. Levine, M.D., Chief of the NHLBI Laboratory of Asthma and Lung Inflammation.

About half asthmatics have type 2-high asthma, while the others have type 2-low asthma. Type 2-high asthma is caused by an increase in the lungs and blood of inflammatory cells called eosinophils, Levine explained. But people with type 2-low asthma do not have these increased levels of eosinophils. This suggests, he said, that their asthma develops through other pathways—for instance, neutrophils, another type of inflammatory cell.

These differences, it turns out, have profound implications for treatment. For some patients with severe type 2-high asthma, standard medications,...

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UCSF Research Finds Medicaid Could Save $2.6 Billion Within a Year if Just 1 Percent of Recipients Quit Smoking

The Median State Would Save an Estimated $25 Million in Medicaid Expenditures, Says UCSF Research

Reducing smoking, and its associated health effects, among Medicaid recipients in each state by just 1 percent would result in $2.6 billion in total smoking Medicaid savings the following year, according to new research by UC San Francisco.

The median state would save $25 million, ranging from $630.2 million in California (if the smoking rate dropped from 15.5 percent to 14.5 percent) to $2.5 million in South Dakota (if the rate dropped from 41.3 to 40.3 percent), the research found.

The study, by Stanton A. Glantz, PhD, director of the UCSF Center for Tobacco Control Research and Education, is published April 12, 2019 in JAMA Network Open

“While 14 percent of all adults in the U.S. smoke cigarettes, 24.5 percent of adult Medicaid recipients smoke,” said Glantz. “This suggests that an investment in reducing smoking in this population could be associated with a reduction in Medicaid costs in the short run.”

Total Medicaid costs in 2017 were $577 billion.

“There is no question that reducing smoking is associated with reduced health costs, but it’s commonly assumed that it takes years to see these savings, which has discouraged many states from prioritizing helping smokers quit,” said Glantz.

“While this is true for some diseases, such as cancer, other health risks such as heart attacks, lung disease and pregnancy complications respond quickly to changes in smoking behavior. So reducing the prevalence of smoking would be an excellent short-term investment in the physical health of smokers and the fiscal health of the Medicaid system,” he said.

Glantz derived state-by-state percentages of Medicaid recipients who smoke based on data from the 2017 Behavioral Risk Factors Surveillance System, which provides the percentage of smokers among the population of each state, and the 2017 National Health Interview Survey, which identifies Medicaid recipients in four major regions in the United States (Northeast, Midwest, South and West).

He then estimated potential Medicaid savings based on a previous research finding which showed that a 1 percent relative reduction in smoking prevalence is associated with a reduction of 0.118 percent in per capita health care spending.

Glantz noted that the study looked only at the potential savings from reducing the total number of Medicaid recipients who smoke. But even if each smoker...

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Circassia’s Duaklir Approved by FDA for Maintenance Treatment of COPD

Circassia announced that the U.S. Food and Drug Administration (FDA) approved its medication Duaklir for the maintenance treatment of chronic obstructive pulmonary disease (COPD). The company plans to launch the therapy in the United States in the second half of 2019.

Duaklir is a combination of two long-acting bronchodilators: aclidinium bromide (400 mcg) and formoterol fumarate (12 mcg). It is administered twice daily, via the Pressair inhaler, a plastic device which automatically delivers the medication upon inhalation.

The two bronchodilators increase the caliber of the airways by relaxing smooth muscle tone.

Smooth muscle is a type of muscle that surrounds the airways, and that is not under voluntary control. It is regulated by sympathetic and parasympathetic nerves — parasympathetic nerves, acting through muscarinic receptors, constrict it, whereas sympathetic nerves, acting through beta-adrenergic receptors, relax it.

Aclidinium bromide is a long-acting muscarinic antagonist (LAMA); it blocks muscarinic receptors, thereby preventing airway constriction. Formoterol fumarate is a long-acting beta agonist (LABA); it activates beta-adrenergic receptors, thereby promoting airway relaxation.

The FDA approval was based on positive results from three Phase 3 studies — ACLIFORM (NCT01462942), AUGMENT (NCT01437397), and AMPLIFY (NCT02796677) — and on the phase 4 ASCENT study (NCT01966107), which specifically showed that the therapy was effective at reducing COPD exacerbations.

“With guidelines recommending combined LAMA and LABA therapy for a number of COPD patient groups, we believe Duaklir will make an important contribution to the treatment of this debilitating disease,” Michael Asmus, Circassia’s vice president, U.S. medical affairs, said in a press release.

“Duaklir’s approval is based on a broad clinical database, including data demonstrating a reduction in the risk of COPD exacerbations driven by its aclidinium component, and we look forward to making this new therapeutic option available to patients across the United States,” Asmus said.

According to Circassia, Duaklir will be the only twice-daily LAMA/LABA medication in the U.S. with COPD exacerbation data included in its prescribing information.

Steve Harris, chief executive of Circassia, said: “We are delighted with the FDA approval of Duaklir, which we believe will provide a valuable treatment option for the significant number of patients with...

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Vitamin D may protect against pollution-associated asthma symptoms in obese children

Over 6 million American children have the lung condition.

A new study finds vitamin D may be protective among asthmatic obese children living in urban environments with high indoor air pollution. The study out of Johns Hopkins University School of Medicine, funded by the National Institute of Environmental Health Sciences (NIEHS), part of the National Institutes of Health, was published in The Journal of Allergy and Clinical Immunology: In Practice.

“The research team has identified many factors that make children susceptible to health problems from air pollution throughout Baltimore’s inner city,” said Kimberly Gray, Ph.D., administrator for the Children’s Environmental Health Research Centers program at NIEHS.

According to the Centers for Disease Control and Prevention, one in 12 children in the U.S. have asthma, which totals 6.1 million children nationally. Additionally, asthma disproportionately impacts urban minority populations, such as black children. Higher indoor air pollution, from sources such as cigarette smoke, cooking, burning of candles, and incense, is linked to greater respiratory problems, including worsening of asthma symptoms and more hospital visits.

“Asthma is an immune-mediated disease,” said Sonali Bose, M.D., lead author of the study and assistant professor of medicine, pulmonary, critical care, and sleep medicine at the Icahn School of Medicine at Mount Sinai, and adjunct faculty at Johns Hopkins. “From previous scientific studies, we knew that vitamin D was a molecule that may influence asthma by impacting antioxidant or immune-related pathways.”

Bose explained that at the time the study was being conceived, researchers were seeing vitamin D deficiencies across the U.S. “It became very clear that African-Americans were at higher risk for vitamin D deficiency, particularly black children,” she said. “We were also noticing a heavy burden of asthma in inner city minority children. It seemed as though vitamin D deficiency and asthma were coincident and interacting in some way.”

The study tested three factors – air pollution levels in homes, blood vitamin D levels, and asthma symptoms – in 120 school-aged children with preexisting asthma in the Baltimore area. One-third of the study participants were also obese. The children were evaluated at the start of the study and three times over the next nine months.

Overall, they found that having low blood vitamin D levels was related to...

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