Antibiotics in Infancy Linked to Childhood Atopic Asthma

An association between antibiotic treatment in the first week of life and atopic asthma in childhood found in a long-term study suggests an immune-mediated effect, possibly from early disturbance of gastrointestinal microbiota, according to researchers.

Emma Goksor, MD, PhD, University of Paediatrics, University of Gothenburg, Gothenburg, Sweden and colleagues explained that disturbed microbiota can affect the development of the immune system, thereby becoming a risk factor for asthma and allergies.

"Antibiotic treatment is known to affect the gastrointestinal microbiota and treatment of this kind during a vulnerable period of life could therefore have long-term effects," researchers wrote.

The researchers conducted a longitudinal cohort study of over 5,000 Swedish children born in 2003. Parents answered periodic questionnaires about their children from age 6 months through 12 years, with 76% of parents responding at 12 years. Additional information about the pregnancy and delivery were obtained from medical records.

The questionnaire at 6 months elicited information on admission to a neonatal ward during first week of life and treatment with antibiotics. At 12 months, it queried such factors as duration of breastfeeding, introduction of different foods, kinds of pets and dampness (defined by damage) at home. At 12 years, questions addressed the current health of the child, airway symptoms, food and environment allergies, and presence of eczema and/or rhinitis.

Asthma was categorized depending on age of onset and duration and persistence of symptoms. The researchers considered history of allergic rhinitis at 12 years in distinguishing between atopic and non-atopic asthma.

Current asthma was reported in 6.4% of the children at 12 years of age, with 65% having atopic asthma and 35% non-atopic asthma.  Current allergic rhinitis was reported in 52% of the children with current asthma and in 78% of those with atopic asthma. The cumulative prevalence of asthma to age 12 years was 14%, of which 30% had transient symptoms and 38% had late-onset symptoms. Relatively few (4%) reported persistent asthma.

Goksor and colleagues reported from multivariate analysis of risk and protective factors that treatment with antibiotics during the first week of life was an independent risk factor for atopic asthma, but not for non-atopic asthma at 12 years of age (adjusted odds ratio[aOR] 2.2; 95% Confidence Interval [CI]; 1.2-4.2) versus 1.4 (0.5-3.4). ...

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Large Study: No Link Between Vitamin D, Lung Cancer Risk

The "largest and most comprehensive observational study to date" provides no evidence of an association between serum vitamin D concentrations and risk for subsequent lung cancer and thus does not support the idea that vitamin D is protective.

In a study by an international research group, pooled analysis of circulating vitamin D concentrations in prediagnostic blood from 5000 case-control pairs showed there was no dose-response relationship between select concentrations of vitamin D and lung cancer risk overall (odds ratio [OR], 0.98).

There was also no evidence of an association between vitamin D and lung cancer risk with respect to sex, age, smoking status, or histology, say Paul Brennan, MD, of the International Agency for Research on Cancer (IARC), in Lyon, France, and colleagues.

The analysis, embedded within the larger Lung Cancer Cohort Consortium (LC3) project, which involves more than two million participants from 20 cohorts in Asia, Australia, Europe and North America, was published online on April 2 in the Annals of Oncology.

"We interpret this to mean that vitamin D supplementation is unlikely to prove broadly effective for the primary prevention of lung cancer, regardless of whether or not you smoke," Brennan told Medscape Medical News. "The most important way to protect oneself against lung cancer is to stop smoking or never begin smoking," he added.

Unlike previous studies that relied on participants' self-reported tobacco use, this analysis identified recent tobacco exposure using measures of serum cotinine, a nicotine metabolite found in blood, the study authors note.

"Our results are important because many prevention strategies are still focused on vitamin D supplementation as a protective measure against a number of diseases, including cancer," said Brennan in a statement issued by the IARC.

Lung cancer remains the number one cause of cancer death globally. It accounts for nearly 1.7 million deaths annually and 20% of all cancer deaths overall. Although the primary cause of lung cancer is tobacco exposure, the lifetime risk for lung cancer among former smokers remains high, and never-smokers are also at risk.

"Given the high incidence of lung cancer worldwide, it is vital to prioritize efforts to reduce tobacco smoking and to identify additional preventive measures that may help to reduce the risk of the disease," said Christopher Wild, PhD, director of IARC, in the statement. "However, despite previous...

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Did Barbara Bush Suffer from COPD? A Doctor Explains.

Former First Lady Barbara Bush died on April 17, 2018, two days after spokespeople said that she had decided not to seek additional medical treatment. CNN had reported that Barbara Bush had COPD.

Beginning of interview:

I am a respiratory disease physician and professor at the University of Pittsburgh School of Medicine, and I direct the COPD clinical and research programs. My research has been inspired by real clinical problems when facing my lung disease patients whom I have worked with over the past 30 years.

COPD is a chronic respiratory condition that results in cough and shortness of breath. It often gets worse. It affects up to 16 million people and is the third-leading cause of death in the United States behind heart disease and stroke. It further results in 6 percent of all deaths worldwide.

The disease is most commonly caused by tobacco smoking and is thus often preventable. Mrs. Bush smoked cigarettes for decades, she wrote in her biography, but quit in 1968. One-fourth of cases occur in nonsmokers, in part due to other environmental exposures. COPD is often undiagnosed because of its slow onset. Also, people often assume that their coughing is “smokers’ cough,” or old age. Women are more likely than men to be diagnosed with COPD.

COPD includes several different conditions, including emphysema and chronic bronchitis. They can occur separately or together.

Normal lungs have bronchial tubes that branch like a tree into smaller and smaller tubes, which end in tiny elastic air sacs called alveoli. These fill up as we breathe in and snap back empty when we exhale.

In COPD, the airway tubes narrow due to inflammation, increased mucous production and, eventually, scarring, which is known as chronic bronchitis. Further, the walls of the alveoli can break down, as do small bubbles coalesce to form larger bubbles. This is known as emphysema. As a result, they do not snap back as easily when a person exhales. They have less ability to transfer oxygen into, and remove carbon dioxide from, the blood.

These different processes result in a prolonged and incomplete exhalation, and air remains trapped in the lungs when the next breath begins. As the condition progresses, it becomes increasingly hard to breathe. This results in more fatigue, a decreasing ability to exercise, declining activity and a lower quality of life.

Many COPD patients develop recurrent chest colds, often requiring hospitalization and rising medical...

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Exposure to traffic air pollution increases risk of asthma

Researchers from the French Institute of Health and Medical Research are reporting that outdoor air pollution is causing more widespread asthma symptoms.

According to the study, long-term exposure to traffic and ozone significantly increases the risk of asthma attacks, and also increases the need for asthma medication and treatment.

“It is very well known that short-term exposure to air pollution is associated with increased asthma symptoms, hospitalizations and use of asthma medication, but studies on the associations between long-term exposure to outdoor air pollution and asthma among adults are still scarce,” explained lead author Anaïs Havet.

“We wanted to try and better understand the underlying biological mechanisms associated with outdoor air pollution and increased asthma symptoms, asthma attacks or medication use, as up to now they were largely unknown.”

For their investigation, the experts obtained cohort study information on 608 French adults, including 240 individuals who had asthma with respiratory symptoms, asthma attacks, or increased medication use in the previous 12 months. The research team used this data to estimate the impact of long-term exposure to heavy traffic, particulate matter, and ozone.

The researchers also examined the link between asthma, exhaled 8-iso, and outdoor air pollution. A high concentration of 8-iso can cause contraction of the airway muscles, which makes it hard to breathe.

The study revealed that 8-iso concentration, high traffic intensity, and ozone exposure increased the risk factors in individuals who currently had asthma. Furthermore, the risk of future asthma was significantly increased by 8-iso levels and particulate matter.

“For the first time in adults, we found associations between long-term exposures to outdoor air pollution, exhaled 8-iso concentration and current asthma,” explained Havet.

“Based on this, we think that 8-iso is a marker related to one of the underlying biological mechanisms by which outdoor air pollution increases the risk of experiencing asthma symptoms, asthma attacks or the need for use of asthma medications.”

Even though air pollution is much lower in western Europe than in regions of Latin America or Asia, the levels are still threatening to respiratory and lung health.

“Efforts should be made to limit air pollution emissions, with more emphasis on moving towards cleaner cities with fewer cars and more efficient public...

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Regular Aspirin Use May Slow COPD Progression

Regular aspirin use was associated with a more than 50% reduction in emphysema/chronic obstructive pulmonary disease (COPD) progression in an elderly cohort over a decade in a longitudinal analysis of data from a large lung study.

The association was seen across aspirin doses and was greatest in older study participants with significant airflow obstruction.

"These findings, along with supportive results in animals, suggest that further study of aspirin and platelet activation in emphysema may be warranted," Carrie Aaron, MD, of Columbia University, New York City, and colleagues wrote in the journal CHEST.

They noted that platelet activation reduces pulmonary microvascular blood flow and contributes to inflammation, which has been shown to be important in the pathogenesis of COPD/emphysema.

"We hypothesized that regular use of aspirin, a platelet-inhibitor, would be associated with slower progression of emphysema-like lung on computed tomography (CT), and slower decline in lung function," the researchers wrote.

To test the theory, they examined data from the Multi-Ethnic Study of Atherosclerosis (MESA) Lung Study, which assessed the percentage of emphysema-like lung below-950 Hounsfield units ("percent emphysema") on cardiac and full-lung CT.

Spirometry was conducted during 2004-2007 and repeated in 2010-2012 in accordance with American Thoracic Society-European Respiratory Society guidelines following the MESA Lung protocol; all exams were reviewed by one investigator.

At the time of the participants' first spirometry measurement, airflow obstruction was defined as pre-bronchodilator FEV1/FVC <0.70 and restrictive ventilatory defect as FVC<lower limit of normal and FEV1/FVC≥0.7.
Regular aspirin use was defined as 3 or more days per week and mixed effects models adjusted for demographics, anthropometry, smoking, hypertension, ACE-inhibitor use, C-reactive protein, sphingomyelins, and scanner factors.

The analysis included 4,257 participants from the MESA Lung Study. Their mean (±SD) age was 61±10 years, 54% were ever-smokers, and 22% used aspirin regularly.

Among the main findings:
On average percent emphysema increased 0.60 percentage points over 10 years (95% CI 0.35 to 0.94).
Progression of percent emphysema was slower among regular aspirin users compared to non-aspirin users (fully adjusted model: -0.34% per 10 years, 95% CI -0.60 to -0.08; P=0.01).

Results were similar in ever-smokers and for doses of 81 mg and...

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Champion Women's Heart Health With Better Data

The journey to better women's heart health starts with having more data, said Nanette Kass Wenger, MD, MACC, MACP, FAHA, professor of cardiology at Emory University School of Medicine, during the Simon Dack Keynote Lecture, which opened the 67th Scientific Session of the American College of Cardiology.

Years before “Go Red for Women” and the red dress pin became symbols of the campaign to end heart disease and stroke in women, Nanette Kass Wenger, MD, MACC, MACP, FAHA, wasn’t going red. For the Emory University professor of cardiology, it was more like seeing it.

Wenger, founding consultant of the Emory Women’s Heart Center, gave the Simon Dack Keynote Lecture to open the 67th Scientific Session of the American College of Cardiology, and her talk, “Understanding the Journey: the Past, Present, and Future of CVD in Women,” revealed the uncomfortable truth: recent declines in cardiovascular death (CV) for women have been possible because science is finally paying attention to them.

Back in the 1970s, when Wenger began educating the public about women’s vulnerability to heart attacks—and the effects of alcohol, smoking, and some medications—CV disease was seen as “man’s disease.” For example, the first conference for women on coronary heart disease by the Oregon Heart Association in 1964 had been about men, specifically husbands, and what wives could do to keep them healthy.

But the data didn’t lie. Starting in early the 1980s and peaking in 2000, the gap in CV deaths between men and women kept getting wider—as the new millennium started, about 500,000 women died each year, compared with about 440,000 men. Since then, numbers for both have fallen, and in 2013, the death total for women from CV causes fell below that of men, with both below 428,000. “We are delighted to be in second place, and we hope to stay there,” Wenger said.

It took a “paradigm shift,” Wenger said, and it started with the idea that medical research had to include women as research subjects to see if outcomes would be different in women. “This change in mindset—the advent of gender-specific medicine—has had a stunning outcome,” she said. Too often, Wenger said, the only studies specific to women were what she calls “bikini medicine,” those limited to the breast, ovaries, or the female genital area.

Conference Identifies Gaps

A breakthrough came in January 1992, when the National Heart, Lung, and Blood Institute...

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Athletes with asthma tend to do better at the Winter Olympics

But it's not really clear where the advantage comes from.

From cross-country skiing to speed skating, the Winter Olympics is full of breathless feats of endurance. And for a large number of Olympic athletes, the breathlessness isn’t just over who will win the next medal—it’s from asthma.

But if you think the condition could hold Olympians back, think again: Athletes with asthma are more likely to win medals than their competitors.

Up to one in four winter Olympians have asthma, a condition that constricts the airways and makes it difficult to breathe normally. That’s no surprise to John Dickinson, a professor at the University of Kent’s School of Sport and Exercise Sciences. He’s studied asthma in elite competitors for years and says that the number of athletes with the condition can skew even higher in endurance sports: up to 70 percent in swimmers and 50 percent in cross-country skiers.

Endurance sports might attract athletes who have asthma, he says, but they can also cause breathing problems in and of themselves. Normally, people breathe through their nose, which warms and humidifies the air, filtering out gnarly particles and noxious chemicals along the way. But during endurance events, says Dickinson, most athletes temporarily turn into mouth-breathers.

“You get unconditioned air going into the airway,” he says. This, in turn, wreaks havoc on the lungs, drying out their air sacs and fueling inflammation. Asthma can result—and as his research with athletes shows, it often does.

These athletes manage to make it to the Olympics despite all that wheezing and coughing, and even outperform challengers without asthma. That’s especially true during the Winter Games.

In a 2012 literature review, asthma expert Kenneth D. Fitch crunched the numbers. He found that during the Salt Lake City Winter Games in 2002, 5.2 percent of athletes had asthma, but that group won 15.6 percent of the medals. He observed the same effect in Torino in 2006 (7.7 percent of athletes with asthma won 14.4 percent of the medals) and Vancouver in 2010 (7.1 percent of athletes with asthma won 11.8 percent of the medals).

Could athletes’ asthma inhalers explain their dominance? Dickinson has spent years trying to find out.

Consider a salbutamol inhaler, one of the most common types. (You may know it as albuterol or Ventolin.) It’s a beta-2 agonist inhaler that relaxes the bronchial passages, making it easier for people with asthma to...

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Matters of the Heart: Understand your risk for heart disease

Your heart (and your patient’s hearts), one of the most important organs in your body, receives recognition this month. Not for all of the hard work it does each and every day pumping blood throughout your body, but to raise awareness of heart disease.

The American Heart Association reports that 1 in 3 Americans die from heart disease with 92.1 million adults living with some form of it. Show your heart some love this month by learning the risk factors and what you can do to lower risk.

While some factors, like genetics, aren’t modifiable or controllable, it’s important to protect yourself against heart disease by identifying your risks and assessing your health status.

“Being overweight, inactive, smoking, high stress, and family history increase the risk of heart disease and heart attack,” said George Waters, board certified cardiologist at Sturdy Cardiology Associates.

If you have an unhealthy diet chock full of saturated fat, salt and cholesterol, you’re putting yourself at risk for the development of heart disease and obesity. Even more so, if you don’t engage in physical exercise, you have an increased risk of high blood pressure, high cholesterol, risk of blood clots and heart disease.

It is incredibly important to embrace the goal of encouraging your patients to quit smoking and we can help. MD Spiro is here to work with you on your smoking cessation programs to help assist in having your patients quit for good this time!

Knowing the symptoms of a heart attack and identifying your risk are the first steps in prevention.

“You must also work to incorporate healthy lifestyle habits,” Waters said. “Eating a healthy low-saturated fat diet, getting regular exercise, quitting smoking, and seeing your doctor on a regular basis are all important steps in prevention.”

Be sure to include fresh fruits, vegetables, fish, whole grains, nuts and legumes into your diet while limiting sodium, sugar-sweetened beverages, processed meats and saturated fats.

Commit to a small goal of physical exercise each day — 30 minutes of aerobic exercise a day as well as strength and stretching workouts can improve heart health.

If you are a smoker, quit. Quitting smoking reduces your risk for heart attack each year you remain a nonsmoker.

As a primary care provider, it is important to market to your patients to schedule their annual exam and provide them the tools to quit smoking. These exams will provide the monitoring...

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