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Study: Children & Secondhand Smoke Exposure

Study: Secondhand smoke exposure increases readmission of children with asthma to hospitals

A new study, published in the journal Pediatrics, raises the possibility that measuring tobacco exposure could be used in the clinical practice to target smoking cessation efforts and reduce the likelihood of future hospital admissions.
 
Researchers at Cincinnati Children’s Hospital Medical Center and Penn State Milton S. Hershey Children’s Hospital measured cotinine in the blood and saliva of more than 600 children.  Cotinine is produced after that chemical nicotine enters the body.  Measuring cotinine in people’s blood is the most reliable way to determine exposure to nicotine for those exposed to environmental tobacco smoke (ETS).
 
Measuring this exposure can be used to target interventions before discharge with caregivers, counseling, and contacting the primary care physician.  The study’s intent was to understand hospital readmission causes.  The scientific analysis of actual secondhand smoke demonstrated a readmission risk more than twice that of children who were not exposed.  
 
Certainly there could be a financial incentive for insurance companies to help caregivers to quit smoking, rather than pay the downstream costs of a future asthma readmission.  Help your patients to stop smoking in this New Year!  You can get paid for Smoking Cessation Counseling.  Call on our MD Spiro experts to learn more about how you can use CO breath testing in smoking cessation counseling in your practice or visit www.mdspiro.com. 
 
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Take Care of Your Asthma
When you have asthma, the flu and cold season is more worrisome than for those without suffering with asthma.  Viral illnesses can worsen asthma symptoms and the flu can also cause severe lower respiratory infections in asthmatics.  This is because people with asthma have swollen or sensitive airways, and influenza can cause further inflammation of the airways and lungs.  Influenza can lead to pneumonia and other acute respiratory diseases.  Asthma attacks can be caused by “triggers” such as airway infections, allergies, pets, smoke, mold, chemical irritants, and air pollution, amongst many others.
 
 “When someone with asthma breathes in a trigger, the insides of the airways make extra mucus and swell even more. This narrows the space for the air to move in and out of the lungs. The muscles that wrap around your airways can also tighten, making breathing even harder. When that happens, it’s called an asthma flare-up, asthma episode or asthma ‘attack,’” according to the American Lung Association.  There are other triggers as well.  Exercise is a key to maintaining a healthy lifestyle.  However, the type of exercise, location, and potential irritants in that location can worsen your asthma.   
 
People with exercise-induced asthma have airways that are overly sensitive to sudden changes in temperature and humidity, especially when breathing colder, drier air, according to the American Academy of Allergy, Asthma and Immunology (AAAAI).
 
During strenuous activity, people tend to breathe through their mouths. Mouth breathing allows cold, dry air directly into the lungs, without benefit of the warmth and moisture that nose breathing supplies. As a result, air is moistened to only 60-70% relative humidity. Nose-breathing, meanwhile, warms and saturates air to about 80 to 90% humidity.
 
As practitioners, it is important for you to monitor the health of your patients, their exercise program, and ensure spirometry is part of your patient monitoring and diagnosis.  For more information on spirometry and asthma in your practice, visit www.mdspiro.com.
 
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(HealthDay News) -- Taking medications as prescribed and avoiding triggers can help keep asthma under control, but you should look for warning signs that your asthma may be worsening.
 
The U.S. National Heart, Lung, and Blood Institute mentions these potential signs that asthma is getting worse:
 
  • Your symptoms become more severe or occur more frequently. Or they affect you more at night and interfere with sleep.
  • Symptoms are causing you to restrict usual activities or miss school or work.
  • Your peak flow number has decreased from your personal best, or your results fluctuate significantly from day to day.
  • Asthma medications appear to become ineffective.
  • You're using a quick-relief inhaler more frequently.
  • You've visited the emergency room or doctor due to an asthma attack.
If you have any of these symptoms, see your doctor without delay.
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Asthma exacerbations decreased by 87% in patients treated with an investigational agent that targets the interleukin-4 (IL-4) receptor, results of a placebo-controlled phase II trial showed.
 
Dupilumab was associated with an exacerbation rate of 6% compared with 44% in the placebo group.
 
Measures of lung function and asthma control also improved significantly in the dupilumab arm, and treatment with the monoclonal antibody was associated with a reduction in biomarkers of Th2-driven inflammation.
 
The drug was generally well tolerated; the most common adverse events were injection-site reactions, nasopharyngitis, nausea, and headache, as reported online in the New England Journal of Medicine and simultaneously at the American Thoracic Society meeting.
 
"This study targeted those individuals who, on the basis of eosinophil levels in their blood, seemed to have evidence for Th2-type asthma," principal investigator Sally Wenzel, MD, of the University of Pittsburgh, told MedPage Today. "By using this drug that blocks this pathway, we observed a really robust response compared with placebo in patients with moderate to severe asthma."
 
"The drug improved exacerbations, improved lung function, improved symptoms, and improved asthma control."
 
To read the entire article, visit here.
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Researchers at the University of Wisconsin have identified a potential new risk factor for obstructive sleep apnea: asthma.
 
Using data from the National Institutes of Health (Heart, Lung, and Blood Institute)-funded Wisconsin Sleep Cohort Study, which has been following approximately 1,500 people since 1988, researchers found that patients who had asthma were 1.70 times (95%>
 
"This is the first longitudinal study to suggest a causal relationship between asthma and sleep apnea diagnosed in laboratory-based sleep studies," said Mihaela Teodorescu, MD, MS, assistant professor of medicine at the university, who will present the research at ATS 2013. "Cross-sectional studies have shown that OSA is more common among those with asthma, but those studies weren't designed to address the direction of the relationship."
 
The connection between asthma and obstructive sleep apnea (OSA) was even stronger among participants who developed asthma as children. Childhood-onset asthma was associated with 2.34 times (95%>
 
The researchers also found that the duration of asthma affected the chances of developing sleep apnea. For every five-year increase in asthma duration, the chances of developing OSA after eight years increased by 10 percent. Participants in the Wisconsin Sleep Cohort, who were all between the ages of 30 and 60 in 1988, complete in-laboratory polysomnography, clinical assessments and health history questionnaires every four years. For the asthma-OSA study, the researchers focused on 773 cohort enrollees who did not have OSA (apnea-hypopnea index <5) when they joined the study and then determined whether their sleep apnea status had changed after eight years.
 
For the rest of this article, read here.
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A little of this root could help you breathe easier

 

It may be time to spice up your asthma treatment. A few components of ginger root appear to relax the airway tissues that tighten up during an attack, finds research presented at the American Thoracic Society’s International Conference held in Philadelphia during May 17-22, 2013. 
 
The walls of the airways that carry oxygen to and from your lungs are lined with a type of muscle tissue called airway smooth muscle, or ASM, according to the research. Using ASM in a laboratory setting, a team from Columbia University simulated an asthma attack by dousing samples with a compound designed to tighten them up. Next, the researchers exposed the asthmatic tissue to mixtures containing three different ginger molecules. Here’s what they discovered: All three ginger components significantly relaxed the ASM tissue, which translates to wider airways and easier breathing during an asthma attack, the research shows.  
 
Read the entire article here.
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May is a great month to renew your commitment to asthma, as we mark National Asthma and Allergy Awareness Month and World Asthma Day on the 7th.
 
Media will be looking for stories to cover, so give them a call and invite them out to your facility to see all the good things you’re doing to help asthma patients breathe easier. Then take a few moments to review all the asthma-related resources available to you through the AARC as well.
 
As you can see, we have an impressive array of programs, from those aimed at boosting your own knowledge of asthma, to those designed to help your organization gain recognition for its asthma education programs, to those you can use to reach out to your community.
 
Visit the AARC website for more information on how to reach out in your community here.
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More attention should be given to patients who have chronic obstructive pulmonary disease (COPD) and concomitant asthma, after a study showed that nearly one-fifth of patients with COPD fall into this subtype.
 
Patients with overlap of the two conditions experienced poorer symptom control, had lower quality of life (QoL), and took part in less physical activity compared with other patients with COPD, despite having similar forced expiratory volume in 1 second (FEV1) values and less exposure to smoking.
 
"Clear diagnostic criteria and management guidelines for this phenotype must be developed and prospectively validated, and this phenotype should be incorporated in phenotype-guided management of COPD," say authors Marc Miravitlles (Vall d'Hebron University Hospital, Barcelona, Spain) and colleagues.
 
The study included data on 3885 participants aged 40-80 years who were part of the population-based EPI-SCAN study. Overall, 385 participants had COPD, defined as a post-bronchodilator FEV1/forced vital capacity ratio of less than 0.7, of whom 67 (17.4%) had also been diagnosed with asthma.
 
The authors found that patients with overlap COPD-asthma were more likely to be women (55.2 vs 24.2%), to never have smoked (56.7 vs 19.5%), and have a significantly higher body mass index (29.1 vs 27.8 kg/m2) than non-overlap patients. However, spirometry and 6-minute walking test results were similar between the two groups.
 
Read the entire article here.
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