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Encouraging Your Child to Use a Nebulizer

A nebulizer can be an effective method for giving your child his/her asthma medicine.  Typically, you’ll only need to use one for five to ten minutes to get a full dose.  All your child needs to do is stay still with the facemask strapped to their face (or holding the mouthpiece in their mouth, depending on the type of nebulizer you have) and breathe in normally.

Now, some parents may read this and think, “Ah, but there’s the problem.”  And indeed, it can be hard to get some children to stay still for five to ten seconds, much less minutes.  Also, holding a device up to their face for that length of time could potentially make them uncomfortable.  Here, then, are a few tips for persuading your child to use their nebulizer as often and as regularly as they need.

 

Routine

Set a specific time each day for your child to take their medicine and stick to it.  This will help condition your child to using the nebulizer regularly.

 

Positive Reinforcement

Praise your child for using the nebulizer correctly.  Remind them how using it will help keep them healthy and enable them to do more things.  You could also give them a small treat after they’ve finished using it.  Another good idea is to engage in some activity to make the time that your child is using the nebulizer more pleasant (read to your child, play some music, watch a DVD or a TV show, etc.).  If your child is older, encourage them to help you set up the nebulizer so they’ll feel more responsible and in control.

 

Make It Fun

If your child shows some reluctance, you can make a game out of using the nebulizer.  For instance, pretend that the facemask is a scuba mask or a jet pilot’s mask.  Encourage your child to decorate the nebulizer with stickers and possibly draw on it using non-toxic markers.  Of course, you should be careful not to do anything that could potentially damage the compressor, hose or facemask/mouthpiece.  Also, don’t do anything to the inside of a facemask.

 

Using a nebulizer doesn’t have to be a chore.  With a bit of planning and creativity, you help your child grow comfortable with using one and managing their respiratory problems.

 

Ken Stanfield is a writer and blogger who specializes in respiratory health and healthcare. He currently writes for the nebulizer systems supplier justnebulizers.com

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When Allergies Attack [Infographic]

Are you the 1 in 5 people that suffers from allergies? You’re not alone. Over half of the U.S. population test positive for at least one allergen. It should come as no surprise when 100% of U.S. households have detectable levels of pet dander and that indoor pollution can be between 2 and 100 times worse than outdoor pollution. When you consider that we spend nearly 90% of our time indoors, that’s a lot of caughing, sneezing and dry, itching eyes.

 

 

Infographic authored by Oransi LLC. To view the original post, check out the original Asthma & Allergy Infographic.

 

TAGS: allergies, asthma, infographic, health

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May 3 is World Asthma Day 2011

From the US Dept of Health and Human Services:

May 3 is a day to reflect on the impact of Asthma, a chronic lung disease that affects
people of all ages. In the United States, more than 22 million people are known
to have asthma. Nearly 6 million of these people are children. Read more about
the conditions of asthma and what is being done to improve the lives of those with the disease.

Read more about asthma research.

 
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NYC: No smoking in parks and beaches

“My world gets smaller everyday”, an old song goes. I can imagine that smokers are feeling this way these days. Especially in New York City. It all started with smoking bans in restaurants and bars in 2002. In 2011, the smoking bans will include parks and beaches as well. To be exact, the 1700 parks and the miles of beach of New York City, as well as the pedestrian malls and Plazas around Times Square, according to a report in The New York Times.

This means that cigarettes smokers are restricted more and more in terms of places where they can smoke.

The legislation was heavily and heatedly debated in the NY City Council. The pro group are supporting the rights of non-smokers. Here are what the supporters of the ban have to say:

• “Their [non-smokers] health and their lives should not be negatively impacted because other people have decided to smoke.”
• “This summer, New Yorkers who go to our parks and beaches for some fresh air and fun will be able to breathe even cleaner air and sit on a beach not littered with cigarette butts.”

The contras were not necessarily smokers but fear that this ban will “set a dangerous precedent”.

• ·         “Once we pass this, we will next be banning smoking on sidewalks, and then in the cars of people who are driving minors and then in the homes.”
• ·         “We’re moving towards a totalitarian society if in fact we’re going to have those kinds of restrictions on New Yorkers.”

But how bad is the exposure to second-hand smoking to warrant such drastic measures? A New York City health department study in 2009 analyzed levels of cotinine, a nicotine by-product, in blood samples of new Yorkers. The results showed that 56.7% of non-smokers in the city have high levels of cotinine. This is significantly much higher than the national average of 44.9%. Those of Asian ethnicity or ancestry are especially susceptible – with 68.7%.

The study went on to report that smoking incidence in New York is lower that in other parts of the US due to strict indoor smoking bans. New Yorkers, however, though exposed to lower levels of smoke, are exposed more frequently due to the tight spaces typical of an urban setting. Research studies have shown that exposure indoors and outdoors does not significantly differ if the smoker is within 3 feet away.

The grounds for the legislation, therefore is public health. Recent evidence indicates the second hand or passive smoking has strong adverse effects on the health of non-smokers. These effects include increased risk for heart disease and stroke, asthma and cancer.

The legislation will be implemented by the NYC Department of Parks and Recreation. Those who break the law will be fined.
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Call for Action to Breastfeed

Everybody knows that breastfeeding is the best and benefits both mother and child. Yet, although 75% of mothers initiate breastfeeding, only 13% stick it out up to 6 months. The reason for this are obstacles that undermines a mother’s good intentions. Some of these obstacles are:

• lack of support at home
• absence of family members who have experience with breastfeeding
• a lack of breastfeeding information from health care clinicians
• a lack of time and privacy to breastfeed or express milk at the workplace
• an inability to connect with other breastfeeding mothers in their communities.

The US Surgeon General’s office recently launched the “Call to Action to Support Breastfeeding” which is aimed to remove some of these obstacles.

Why breastfeed?

Studies have shown that breastfeeding makes healthier babies and healthier (and happier) moms. According to the Call the Action:

“…breastfeeding protects babies from infections and illnesses that include diarrhea, ear infections, and pneumonia. Breastfed babies are also less likely to develop asthma, and those who are breastfed for six months are less likely to become obese.  Mothers themselves who breastfeed have a decreased risk of breast and ovarian cancers.”

Mothers who breastfed were also reportedly less prone to postpartum depression.

Here are the steps proposed by Call to Action:

• Communities should expand and improve programs that provide mother-to-mother support and peer counseling.
• Health care systems should ensure that maternity care practices provide education and counseling on breastfeeding.  Hospitals should become more “baby-friendly,” by taking steps like those recommended by the UNICEF/WHO’s Baby-Friendly Hospital Initiative.
• Clinicians should ensure that they are trained to properly care for breastfeeding mothers and babies.  They should promote breastfeeding to their pregnant patients and make sure that mothers receive the best advice on how to breastfeed.
• Employers should work toward establishing paid maternity leave and high-quality lactation support programs.  Employers should expand the use of programs that allow nursing mothers to have their babies close by so they can feed them during the day.  They should also provide women with break time and private space to express breast milk.
• Families should give mothers the support and encouragement they need to breastfeed.

Breastfeeding used to be a taboo topic. Thanks to breastfeeding celebrity moms like Angelia Jolie and Salma Hayek, breastfeeding has actually become “hip.” The most recent breastfeeding celebrity is baby Flynn born to Miranda Kerr and Orlando Bloom. His photo was so popular that the website where it was posted crashed. Was it really the baby or was it the mom?
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Your smoke is hurting your children badly

Cigarette smoking gives out toxic compounds that are all-pervading and long-persisting. And it is now fully clear that it is not only the smoker but also the all the people around them that are affected by smoking-related toxicity.  I am referring to second-hand or even third-hand smoking also known as environmental smoke.

Current estimates indicated that almost 90 million non-smoking Americans are still exposed to the toxic chemicals coming from another person’s cigarette. The sad thing is, a large number of people exposed to environmental smoke are children and exposure occurs within the 4 walls of home.  And their exposure to cigarette-associated toxins is clearly evident in their blood. According to the director of the Centers for Disease Control and (CDC) Dr. Thomas Frieden:

“Virtually no kids who live with smokers – only 1 to 2 percent – actually are smoke-free when we tested their blood for toxins caused by tobacco smoke.”

This statement is based on data from National Health and Nutrition Examination Survey data from 1999 to 2008. Exposure to second-hand smoke was measured in terms of levels of cotinine, the primary nicotine metabolite in the blood serum. Cotinine is detectable in blood samples even days after exposure.

The results showed that about 88 million non-smokers aged 3 or older are exposed to second-hand smoke and showed cotinine levels of ≥0.05 ng/mL. Prevalence of exposure was highest among

• males
• non-Hispanic blacks
• children aged 3 to 11 years old
• adolescents aged 12 to 19 years old
• those in households below the federal poverty level
• those in households with at least 1 smoker

Since 2007, the prevalence of exposure to second-hand smoke has declined probably as a consequence of smoking bans and increased public awareness. However, it still remains a major public health concern.

What are the health effects of second-hand smoke?

“Secondhand exposure to tobacco smoke causes heart disease and lung cancer in nonsmoking adults and sudden infant death syndrome, acute respiratory infections, middle ear disease, exacerbated asthma, respiratory symptoms, and decreased lung function in children. [And]  no risk-free level of secondhand smoke exposure exists.”

How can we make sure that our family especially our children are not exposed?

“The only way to protect nonsmokers fully is to eliminate smoking in indoor spaces. Continued efforts at smoking cessation and comprehensive statewide laws prohibiting smoking in workplaces and public places are needed to ensure that all nonsmokers are protected from this serious health hazard. Health-care providers should educate patients and parents about the dangers of secondhand smoke and follow clinical care guidelines to help smokers quit.”

The complete report is published at CDC’s Morbidity and Mortality Weekly Report.

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Potential Health Hazards of the Gulf Oil Spill

The biggest oil spill in history might be over but the consequences remain and will persist for a long, long time. We are all aware of the detrimental effects of the spill on plant and animal life and the environment. However, less is known about the potential health hazards of the spill. Medscape interviewed Dr. Vikas Kapil, Associate Director for Science for the Deepwater Horizon Oil Spill Response at the CDC in Atlanta, Georgia. Here are some info from the interview:

Who are at greatest risk?

• Workers at the spill who help in the cleaning up operations are the ones most at risk.
• People residing on the shoreline close to the spill may also be at risk, though to a much lesser degree.

What are the potential hazards?

Here are some of the potential sources of hazards of the oils spill:

• Chemicals such as
  Benzene, toluene, ethylbenzene, xylenes, and other VOCs
  Oil mist
  Naphthalene and other polycyclic aromatic hydrocarbons.
• Particulate matter (PM) that may be produced when crude oil is intentionally burned before it reaches the shore. PM exposure poses health risk to people with asthma, chronic obstructive pulmonary disease, or heart disease.
• ·         Physical hazards that would include
  •Heat stress due to the high temperatures and humidity;

•Ergonomic hazards that can cause injury to the musculoskeletal system;

•High noise levels;

•Sun exposure and dehydration; and

•Injuries due to slips, trips, and falls on slippery walking and working surfaces.

• ·         Health hazards associated with dispersants used to break down the oil, which can cause:
  •Defatting and drying of the skin and possibly dermatitis, as a result of prolonged contact with the skin;

•Chemical pneumonitis, if aspirated into the lungs;

•Respiratory irritation as a result of repeated and prolonged inhalation exposure to vapor; and

•Eye irritation as a result of repeated and prolonged exposure.

What are the preventive and safety measures that one should take to avoid these hazards?

• Oil spill workers should strictly use protective gear and follow safety procedures.
• ·         People who may be exposed to burning oil smoke and PM are given the following advice:
  •They can choose to leave the area. Those at greatest risk of breathing smoke should evacuate.

•They can limit their exposure to smoke by remaining indoors and using an air conditioner to filter the air. If available, air conditioning units should be set to “recirculation mode.” Those without access to an air conditioner may wish to evacuate until the smoke is completely gone.

•They should refrain from physical exertion. Physical activity that places extra demands on the lungs and heart — exercise or physical chores, indoors or outdoors — should be kept to a minimum.

• Dust masks, bandanas, or other cloths — even if wet — will not protect against smoke inhalation.

The EPA is continuously monitoring the air quality in the area. Water supplies, however, are not at risk for contamination. The Department of Health and Human Services has set up an oil spill distress helpline

Other resources that you can check out:

CDC: 2010 Gulf of Mexico Oil Spill.

HHS Oil Spill Distress Helpline

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Is your home making you ill: the Sick Building Syndrome

Is something in your home making you sick? Being bothered by the constant “musty” smell?

If this is the case, then check your bathrooms and cellars and anywhere else that might be cool and damp. These are the places where molds and mildew abound.

And molds produce spores and toxins that get into the air that can make people sick. Mold spores are responsible for a lot of hay fever cases in the autumn and winter time, spores which can be outdoor as well as indoor.

Indoor molds and Sick Building Syndrome

Sick Building Syndrome (SBS) refers to a situation in which building occupants experience health problems while inside a particular building. Human health issues typically associated with SBS range from allergy attacks and asthma to more complex medical problems involving exposure to toxins.

SBS can be caused by molds, dust and other allergens that may be present inside a building.

Molds after the flood

Food waters recede but the damage lasts for a long time. As if water damage to your home and furniture is not enough, flood aftermath brings a lot of health problems. Molds are one of the major problems after a flood that can cause structural damage to a building as well as its occupants. In the period shortly after Hurricane Katrina, household levels of molds even surpassed levels found in some agricultural environments.

According Dr. H. James Wedner, professor of medicine and head of the Division of Allergy and Immunology at Washington University School of Medicine in St. Louis:

“Mold loves water. When your building is flooded, it’s very difficult to dry it out quickly and completely, and that allows mold to grow. Walls made of Sheetrock soak up water far above the floodline, and mold can be hidden under wallpaper, carpet and floorboards and in ceiling tiles, furniture and clothing.”

The results are increased incidence of allergies and asthma among flood victims.

Ways and means to avoid mold development in your home

Dr. Wedner gives the following tips to those dealing with a flooded building:

• dry it out quickly — mold will grow almost immediately in wet conditions;
• cool it down — mold likes warmth as well as humidity;
• remove wet materials — wet Sheetrock can’t be repaired and must be taken out;
• clean anything that has been wet — that includes clothing, which should be dry cleaned;
• throw away anything that can’t be thoroughly cleaned — that favorite couch might have to go;
• hire a professional to clean affected areas of the building with appropriate materials — often a solution of 10% bleach is used

Even if your home has not been flooded, these tips also apply. Bathrooms are especially susceptible to mildew since they often get wet. In the winter time, bathrooms are also well-heated. The result is an environment ideal for the molds to thrive in.

My strategies are air, dry and cool.

• After a bath or shower, I turn off the heater, open the bathroom windows wide open for 5 to 10 minutes until the room is dry.
• Optimize the drying time by scheduling bathroom use optimally. My 2 kids take turns in the shower in evenings, after which I immediately start the drying procedure.
• Leave a window open. In the laundry room in the cellar, I often leave a window tilted so the dry the dampness from the laundry. I only close it when it goes subzero in the winter time.
• Check signs of dampness and molds regularly, including hidden corners and curtains.

Check before your buy or build

When building a house, talk with your architects and engineers about installations that can prevent mold development.

When buying a ready structure, ask a professional to check for molds. One way is the mold seeking technique: Mechanical engineers are using radio waves to obtain 3D images of the inside of basement walls. If there’s water inside the wall, those waves will reflect the energy much more specifically than dry material will. The new tool helps make sure mold is not making itself at home in your house.

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Your food allergy increases your risk for an asthma attack

What do kids, men and African-Americans have in common? Well, they are the segments of the American population who are highly susceptible to food allergies.

Recent estimates by an NIH-funded research show that 7.6 million Americans – that’s 2.5% of the country’s population – have food allergies. And of these over 7 million people, the majority are children, non-Hispanic blacks and males.

In order to estimate the prevalence of food allergies, the study used a nationally representative sample and analyzed specific immunoglobulin E (IgE) or antibody levels to measure sensitivity to common food items including peanuts, milk, eggs and shrimps.

According to NIH News:

 “The hallmark of food allergy is production of IgE antibodies to a specific food protein. Once IgE antibody is made, further exposure to the food triggers an allergic response. IgE levels are often high in people with allergies.”

The study was very comprehensive and covered all age groups and took into account, ethnicity, gender, and medical history.

The actual food allergy prevalence measured by the study is:

• children 1 to 5 years – 4.2% (highest)
• adults over 60 (lowest)

In terms of types of food allergies:

• peanut, 1.3%
• milk, 0.4%
• egg, 0.2%
• shrimp, 1.0%

In addition, food allergies seem to worsen asthma.  People with asthma and food allergies have to be extra careful because they have almost a 7-fold chance of having severe asthma attack compared to those with asthma only. According to lead author Dr. Andrew Liu of the National Jewish Health and the University of Colorado School of Medicine in Denver:

“This study provides further credence that food allergies may be contributing to severe asthma episodes, and suggests that people with a food allergy and asthma should closely monitor both conditions and be aware that they might be related.”

The study results are very invaluable since “the national prevalence and patterns of food allergy (FA) in the United States are not well understood”, according to the authors.  Dr. Linda Birnbaum, director of the National Institute of Environmental Health Sciences (NIEHS):

“Having an accurate estimate of the prevalence of food allergies is helpful to public health policy makers, schools and day care facilities, and other care providers as they plan and allocate resources to recognize and treat food allergies.”

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Pollen and Mold Counts

Spores of molds and pollens of plants are the most common airborne allergens that can cause hay fever, asthma, and other allergic reactions. Depending on where you live and the time of the year and the weather conditions, the type and number of pollens and molds in the air we breathe vary. There is where pollen and mold counts come in handy.

Only certified agencies can count pollen and mold levels in the air. The American Academy of Allergy, Asthma and Immunology (AAAAI), in cooperation with the National Allergy Board (NAB) provides official figures on pollen and mold counts. Their data is based on data collected by more than 85 counting stations all over the US.

How does pollen and mold counting work?

The Saint Louis County Health Services tells us the following:

Counters use air sampling equipment to capture airborne pollen and mold. Recently, the Environmental Health Laboratories switched from using a rotorod impaction device to using a Burkard slit-type volumetric spore trap. The rotorod sampled only at specific time intervals while the Burkard is able to continuously sample over a 24 hour period. The device is mounted on the roof of a centrally located County building away from any obstructions. It uses suction to pull air through a slit-type opening. Inside the slit is a greased, flat surface (a collection tape) that advances in increments over time. This greased surface collects any particles that are sucked in with the air. How are pollen and mold counted? The collection tape is removed from the sampling device and brought to the laboratory. Here it is stained and prepared for analysis. The sample can then be magnified 400 times to count the pollen grains. For some mold spores, the sample must be magnified 1000 times to be seen and counted. Using the exposure time, the volume of air sampled, and the number of pollen grains or mold spores counted, calculations can be made to determine the number of particles per cubic meter of air sampled. This is the number reported by the laboratory.

How can you use these counts in managing your allergies?

The AAAI has come up with recommended definitions of low, moderate, high and very high concentration levels of molds and pollens. These levels represent outdoor exposures only. Based on these levels, comparison between different areas and regions can be done. These counts are also useful in the management and treatment of allergies due to airborne allergens.

Other resources on airborne allergens:

•  Traveling with  Allergies and Asthma Tip
• Outdoor Allergens Tip
• Allergy Forecast by Zyrtec

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Mommy’s diet and baby’s wheezing

One of my sons developed wheezing when he was a couple months old. Wheezing is that high-pitched whistling sound that his nose made when he had a cold. His twin brother did not.

He was started on inhaled medications which he had to use during attacks. I used to dread the coming of the cold months when kids would surely catch the colds. Because I knew that for him, it would not be just ordinary sniffles. Several times he was also diagnosed with acute respiratory tract infection that was luckily caught early before it developed into full-blown pneumonia. When he was 2, his wheezing progressed into asthma.

But as he grew older, his condition improved. He hadn’t had a wheezing/asthma attack in over 3 years until a couple of weeks back (see other post on this).

The causes of wheezing that eventually lead to asthma are many and complex. Allergies, family history, and maternal diet during pregnancy are just some of the few factors that have been linked to wheezing. Some studies (source: Reuters), for example, have reported that children of pregnant women “who eat more fish, apples, omega-3 fatty acids and vitamins D and E seem to have relatively lower risks of the breathing problems.” However, the findings were not conclusive as it wasn’t clear what exactly are the benefits of these foods. Some experts suggest that it is not specific food stuffs that do the job but the mom’s overall dietary pattern.

Researchers decided to delve further and conducted a survey of 1,376 mother-child pairs. The moms were asked to complete a questionnaire during their first and second trimesters concerning their diet during pregnancy. The babies were monitored for wheezing rates till age 3. Diets of the moms could be broadly classified as

• “Mediterranean”-style diet — typically high in fish, fruits and vegetables, olive oil, nuts and whole grains
• ·         A “prudent” diet, rich in fruits and vegetables, whole grains, fish, poultry and eggs.
• ·         The “Western” pattern — included relatively high amounts of red and processed meats, high-fat dairy, sweets and refined grains like white bread.

Eighteen percent of the children developed recurrent wheezing within the first 3 years of life. However, the incidence of asthma was not linked to any specific diet pattern.

So does this mean we can eat anyway we want during pregnancy? Wrong! A healthy pregnancy diet is highly important even if it is not linked to asthma.

A study, for example, has linked high intake of diet soda to premature delivery. Another study showed that children who were born during food shortage period have a higher risk for abnormal blood sugar levels and eventually diabetes.

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Giving asthma medicine to kids: it’s not that easy as you may think

“Mom, I can’t breathe,“ gasped my son when I picked him up from football practice on Wednesday evening. I checked his vitals (my hand on his forehead for body temperature, my fingers on his wrist for pulse rate). No fever, slightly racing pulse, labored breathing with a wheezing sound. He was having an asthma attack.

He hasn’t had that for over 3 years now and not this bad so I wasn’t prepared for it. At home, I checked his inhaler and found the drug has expired in June 2010. Also, I couldn’t find the mask that went with it. So I administered his asthma medicine directly into his mouth that night and took him to the doctor first thing in the morning where we got a inhaler and a delivery device. When I asked the doctor about direct delivery into the mouth, he said that such method does not work effectively on kids.

What people see on films about asthmas and inhalators are people simply sticking the stuff into their mouths  and press.

In real life, administering asthma drugs, especially in kids, is not that straightforward and there are too many delivery devices out there to confuse not only the adults but most especially the pediatric patients.

A study by British researchers noted:

“…when a child with asthma taking prophylactic steroids is seen in clinic or the accident and emergency department for the first time the parents are often unsure which inhalational devices the child uses. If the child is not taking steroids by nebulisation the clinician has a 1 in 125 chance of guessing the correct combination of inhalation device, drug, and strength of inhaler that the child is using. It should be possible to devise a simple prescribing strategy that would avoid this confusion. “

The researchers also pointed out that these devices are distributed as promotional products from asthma drug manufactures and may not have been really tested for effectiveness. Those devices which are marketed as such may provide insufficient information to help doctors make “an informed choice.”

Another problem, according to a recent review, is that

“…there are no inhalers on the market that have been specifically designed to meet the unique needs of children because most inhalers were developed for adults and then used for the treatment of children following minor modifications.”

An ideal device for kids should be easy to use and delivers consistent doses of the drug without being too expensive.

I decided to do some research on the different delivery devices.

Nowadays, the most common delivery devices for asthma medications for kids are the so-called spacer devices and our doctor gave my son one of these. They may or may not come with a mask. As a baby, my son had to use a spacer with a mask. I was lucky that he didn’t refuse it. I have heard of kids refusing to have the device covering their mouth and noses. The new device that the doctor gave us has no mask but a mouthpiece that my son could place in his mouth (see blue device in the picture). In addition, he also gave my son a practicing piece of the next delivery device, a much smaller one (see red device in the picture) for older kids.

My son’s spacers, with or without mask have some disadvantages, as follows:

• They are big and bulky and wouldn’t easy fit in a child’s schoolbag, much more a jacket pocket.
• They are made of plastic, creating problems of static charge that causes dose variability. Our doctor instructed me to wash the spacer in detergent at least once a week to overcome this problem.

The other device that he is practicing on (and he is doing a good job!) and is much smaller and can fit easily in his jacket pocket. Hopefully, he will be able to use this small device soon.

The other common device used is the nebulizer which allows delivery of big doses, especially during severe attacks. Fortunately, my son hasn’t had to use this so I never had the chance to check it out although it seems to be even bulkier and more complicated to use than the spacers. I’ll do some research on the nebulizers and update you next time.

In the meantime, check out the following resources:

Using spacer devices during more severe asthma attacks

www.patient.co.uk/health/Inhalers-for-Asthma.htm

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It’s September: know your autumn allergens

Autumn is almost here. And although we mainly associate hay fever with springtime, autumn or fall is actually the season for hay fever, when grass and grains are cut to be turned into straw and hay. Aside from grass pollens, autumn (and also winter) months are peak season for molds (a type of fungus), another major cause of hay fever. According to emedicine:

• Molds are a type of fungus that has no stems, roots, or leaves.
• Mold spores float through the air like pollen until they find a hospitable environment to grow.
• Molds grow both outdoors and indoors.
• Outdoors, they thrive in soil, vegetation, and rotting wood.
• Indoors, molds (usually called mildew) live in places where air does not circulate freely, such as attics and basements, moist places such as bathrooms, and places where foods are stored, prepared, or discarded.

Researchers at the University of California at Berkeley recently published report that babies born during the autumn months which is the high mold season have the a higher likelihood to developing wheezing as early as age 2.

According to lead author Kim Harley, associate director of health effects research at UC Berkeley’s Center for Children’s Environmental Health Research:

“In our study, we took a different tack to understand the link between month of birth and asthma by considering ambient concentrations of fungal spores and pollen, which follow distinct seasonal patterns. Until our paper, there were very little data about exposure to allergens in the air, which we know can trigger symptoms for those who already have asthma. This is the first study to look at the potential role of early life exposure to multiple outdoor fungal and pollen groups in the development of asthma.”

The study results were based on data from 514 children born in Salinas Valley, California, a region with mild, rainy winters and dry summers. In this area, mold spore levels peak in November and December, whereas pollen levels peak in the early spring months of March and April.

When comparing babies born in the autumn and winter months compared to those born at other times of the year, the researchers found these babies have 3 times the likelihood of wheezing 24 months after birth.

But it is not only the mildew at home that is releasing spores to cause wheezing. The mushrooms are part of it, too. The researchers found 2 types of fungal spores which are especially bothersome at this time of the year – basidiospores and ascospores – which are released by mushrooms, molds, and rusts on plants.

However, the researchers are quick to say that there are other factors involved, including genetics in the development of wheezing, which is a precursor to asthma.

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How asthma protects (yes!) you from cancer

My family has a history of asthma. One of my sons is suffering from wheezing and eczema. How can I say that these are good things to have, that they are actually blessings in disguise.

But that is actually what this recent study by French Canadian researchers tells me. Their findings show that men who suffer from eczema had a lower risk for developing lung cancer. And those who suffer from asthma have a lower risk for developing stomach cancer.

But how can one health condition provide protection against another more serious condition? Study author Professor Marie-Claude Rousseau of the INRS–Institut Armand-Frappier explains:

“Asthma and eczema are allergies brought about by a hyper-reactive immune system – a state which might have enabled abnormal cells to have been eliminated more efficiently, thereby reducing the risk of cancer.”

The researchers actually looked at exposures to occupation hazards and the risk for getting cancer. They checked 3000 male participants who have been diagnosed with cancer and compared to 512 people who did not have cancer. They specifically looked at the link between allergies and the incidence of the 8 of the most common types of cancer.

It is ironic to think that a bothersome condition such as allergy can have some benefits. Especially as both cancer rates and allergy rates are on the rise.

A recent estimate gives us the following figures: Allergy rates in the Western world in 1980 were 10%. Today it is 80%. Should this give us hope that our body is fighting back against cancer? It is really too soon to tell.

The study authors wrote:

These findings contribute important knowledge to population health and provide new research leads. Although the study did not allow to identify which specific factors related to asthma and eczema were responsible for reducing the risk of cancer, it offers new angles for research into the molecular and immunological mechanisms that are involved in immunostimulation, a potentially promising strategy for cancer prevention.

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The tiniest are the nastiest: ultrafine particles and asthma

We cannot see, taste or smell ultrafine nanoparticles but their presence play a big role in our health, especially for those who suffer from asthma. This is according to a recent report from researchers at the University of California at Los Angeles (UCLA).

Asthma is a chronic inflammatory disease of the small airways in the lung. Asthma episodes are characterized by tightening of the airways that results in difficulty of breathing and wheezing. In the US alone, about million people are suffering from asthma and a large fraction of these are children.

Previous studies have shown that bigger particles can trigger asthma attacks but less is known about the effect of smaller traffic-generated particles. This is the first study to investigate fine particles.

So far, the smallest air pollutants measured have the diameter of 180 nanometers – about one-thousandth the size of a human hair. Thee minute particles are generated by traffic emissions with the highest concentrations measured along freeways and motorways.

Using a real-time testing method, the researchers tested the effect of these particles on the immune response in the lungs of lab animals. Their results indicate that nanoparticle exposure even for just a short while plays a major role in asthma flare-ups.

“The immune processes involved in asthma, and current treatments, are traditionally thought to be dominated by a specific initial immune response, but our study shows that ultrafine pollution particles may play an important role in triggering additional pathways of inflammation that heighten the disease.”

In fact, ultrafine particles may actually be more damaging than bigger particles. So what makes these minute particles so harmful?

“Pollution particles emitted by vehicles and other combustion sources are coated with a layer of organic chemicals that can be released into the lungs. These chemicals generate free oxygen radicals, which excite the immune system in the lung through a cell- and tissue-damaging process known as oxidation. Oxidation contributes to allergic inflammation in the lungs of people with asthma… Because of their size and large surface area, ultrafine particles have the capacity to carry and deposit a rich load of active organic chemicals deep in the lung. The chemicals coming off the particles in the small airways in the lung promote oxidative stress at those sites.”

The study results highlight the adverse effects of traffic pollution, especially on residents of urban areas and in the vicinity of freeways.

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CT scan as a monitoring tool for asthma

When we talk about computer tomography (CT), we usually think about cancer and detecting tumors. However, this imaging technique which consists of a series of X-rays, can potentially be used to monitor the progression of asthma.

Currently, there are no visual biomarkers sensitive enough to follow how asthma progresses or responds to treatment. Conventional X-rays images cannot detect small structural changes in the respiratory tract of patients with severe asthma. However, scientists at the University of Leicester (UK) may have found something promising using CT scanning technology.

According to study leader Professor Brightling, a Wellcome Trust Senior Clinical Fellow and Honorary Consultant at the Institute for Lung Health

“Currently, there is paucity of markers that can be used to monitor asthma progression, response to treatment and to identify patients who will have recurrent asthma attacks and develop persistent airflow obstruction, features particularly relevant to severe asthma.”

The researchers report that CT scanning may be able to detect structural changes in the airways and lungs of asthma patients. These changes include reduction in the wall thickness of the airways indicative of worsening of lung functions and airway inflammation. The changes in the thickness of the walls may be a potential asthma biomarker and measuring this thickness a useful tool in monitoring the disease as it worsens or responds to treatment

This CT-based monitoring tool has the advantage of being non-invasive and objective. Professor Brightling adds:

“Ability to objectively quantify different structural changes in asthma using CT may assist in differentiating various disease sub-types and help deliver personalised healthcare.”

Asthma is on the rise. According to another researcher Dr Sumit Gupta

“Asthma is a major health problem affecting 300 million people worldwide. Approximately half a million people in UK suffer from severe asthma and are, as a consequence, at increased risk of asthma attacks, hospitalisation and death and often have severely impaired quality of life. Structural changes that occur in airways of asthmatic individuals remain difficult to quantify and monitor. Computed tomography (CT) scans have now emerged as a non-invasive research tool to assess these airway structural changes.”

However, before CT scans should be routinely used for asthma monitoring, the health risks of radiation exposure should be taken into consideration. It is hoped that newer models of CT scanners which work faster and uses less radiation will be able to benefit asthma patients as a monitoring tool.

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What’s the state of the air in your city?

The Americans are concerned about the oil in the Gulf of Mexico. The Europeans are worrying about the volcanic clouds coming from Iceland. But what about what is going on in your immediate environment? What is the air like in your part of the world? The American Lung Association (ALA) recently released their 2009 State of the Air report. And one of the key findings is: 28.9 million Americans live in counties where the outdoor air failed all three tests covered in the State of the Air report.

Are you one of them? Have you checked out what’s blowing in the wind in your city?

The report ranks US cities according to two of the most widespread air pollution: ozone and particulate matter levels.

And the top 10 most polluted cities according to ozone levels are:

• Los Angeles-Long Beach-Riverside, CA
• Bakersfield, CA
• Visalia-Porterville, CA
• Fresno-Madera, CA
• Sacramento-Arden-Arcade-Yuba City, CA-NV
• Hanford-Corcoran, CA
• Houston-Baytown-Huntsville, TX
• San Diego-Carlsbad-San Marcos, CA
• Charlotte-Gastonia-Salisbury, NC-SC

The top 10 most polluted cities in terms of short-term particle pollution are:

• Bakersfield, CA
• Fresno-Madera, CA
• Pittsburgh-New Castle, PA
• Los Angeles-Long Beach-Riverside, CA
• Birmingham-Hoover-Cullman, AL
• Sacramento-Arden-Arcade-Yuba City, CA-NV
• Salt Lake City-Ogden-Clearfield, UT
• Visalia-Porterville, CA
• Modesto, CA
• Hanford-Corcoran, CA
• Merced, CA
• The top 10 most polluted cities in terms of year-round particle levels are:
• Phoenix-Mesa-Scottsdale, AZ
• Bakersfield, CA
• Los Angeles-Long Beach-Riverside, CA
• Visalia-Porterville, CA
• Pittsburgh-New Castle, PA
• Fresno-Madera, CA
• Birmingham-Hoover-Cullman, AL
• Hanford-Corcoran, CA
• St. Louis-St. Charles-Farmington, MO-IL

 So what is wrong with California?

But of course, it’s not all bad news. The report also gives a list of the cleanest cities based on the same criteria as above.

And the cleanest 12 cities according to ozone levels are:

• Bismarck, ND
• Brownsville-Harlingen-Raymondville, TX
• Coeur d’Alene, ID
• Duluth, MN-WI
• Fargo-Wahpeton, ND-MN
• Fayetteville-Springdale-Rogers, AR-MO
• Honolulu, HI
• Laredo, TX
• Lincoln, NE
• Port St. Lucie-Sebastian-Vero Beach, FL
• Rochester, MN
• Sioux Falls, SD

And the cleanest 10 for all year particle pollution are:

• Cheyenne, WY
• Santa Fe-Espanola, NM
• Honolulu, HI
• Anchorage, AK
• Great Falls, MT
• Tucson, AZ
• Amarillo, TX
• Albuquerque, NM
• Flagstaff, AZ
• Bismarck, ND

And the cleanest 10 for short-term particle pollution are:

• Alexandria, LA
• Amarillo, TX
• Athens-Clarke County, GA
• Austin-Round Rock, TX
• Bangor, ME
• Billings, MT
• Bloomington-Normal, IL
• Brownsville-Harlingen-Raymondville, TX
• Cape Coral-Fort Myers, FL
• Champaign-Urbana, IL

So what does the dirty mean for many golden state residents and others who live in polluted areas?

Air pollution has been linked to respiratory problems, asthma, allergy and cardiovascular disorders (see our feature in Battling Asthma). Infants and children are especially susceptible.

Check out the ALA site for the following audio resources:

• What is air pollution?
• The health effects of pollution
• How to protect yourself from air pollution

Photo credit: stock.xchng

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Help! Fresh Air Needed for Children

A plant needs water, sunlight, and fresh air in order to grow. So does a child. However, children who live in big cities seldom have the space, much less the fresh air they need.

The latest State of the Air report by the National Lung Association shows that the air in major cities in the US are so dirty they can “harm your body and risk your life.”

It takes a lot of foresight to foresee what quality of life and air  will be in a hundred years but this was what some visionaries did more than 130 years ago when The Fresh Air Fund was founded, a unique non-profit organization. Unique in a sense that unlike most charity organizations, it does not give the recipients – children – material things or services. What it gives is – fresh air and clean fun!

Look at the activities listed below:

• Playing in the backyard
• Picking wild flowers
• Laughing in the sunshine
• Catching fireflies
• Riding bicycles
• Learning to swim
• Running barefoot through the grass
• Gazing at the stars on moonlit nights
• Building sandcastles
• Making new friends

These are simple things that children in rural areas (including my kids) may take for granted, but many children in big cities will grow up without experiencing all these things.

The Fresh Air Fund is based on the simple mission that city children should get the chance to breathe fresh air and commune with nature. It was initially set up to help children affected the tuberculosis epidemic in the New York City tenements way back in the 1800s. And if one cannot change the city and its air, the next feasible thing is take the child somewhere where it is green and clean. However, all children – not only those with respiratory illness – deserve a respite from the pollutions of the city and to have clean air in their lungs. Since it started in 1877, the Fund has given the gift of fresh air to more than 1.7 million NYC kids.

The Fresh Air Fund gives hundreds of inner city children every summer vacation the chance to enjoy nature and breathe fresh air out in the country side. The children are especially from the New York area aged 6 to 18 years old, whose family cannot afford paying for a vacation The organization hosts these kids in five Fresh Air camps. The camps are located in upstate New York and are also open the whole year round for off season camping and educational field trips.

However, building and maintaining the summer vacation camps is not an easy thing. The Fresh Air Fund needs all the help it can get to continue its work. Here are ways we can help.

Host a child. In order to accommodate more children than what the camps can hold, Fresh Air Fund has solicited the help of rural and suburban families to host city children. The Friendly Town Program has host families in 13 American states and in Canada. Your family could be one of them. Check out the hosting area map.

Volunteer. You can donate your services to the organization in many ways, as camp counselors and helpers as well as volunteers in running the organization. Since a couple of years, optometrists work pro bono to provide eye tests for the summer camp children.

Donate. If you neither have the time to volunteer or the space to host a child, but have the financial means, donating is the best way of supporting the fund. Recently, a very generous donor has offered to match all donations given to the Fresh Air Fund before June 30. This means that any donations they get will be doubled!

This is your chance to give the gift of fresh air!

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Chorioamnionitis, preterm birth, and asthma

Is asthma predetermined in the womb? The results of a recent study point to this. Chorioamnionitis is an infection of the uterine cavity caused by bacteria. When chorioamnionitis occurs together with premature delivery, which is very likely, the risk for asthma in the infant increases dramatically. And the risk increases even more among in children of certain ethnic groups. African American babies for example, have double the risk than other ethnicities, according to a report in the LA Times.

Let us take a look at some statistics from the report:

• About 8% of pregnancies are affected by chorioamnionitis.
• About 14% of American children are afflicted with asthma.
• About 50% of asthma cases are hereditary.
• African Americans have 25% higher incidence of asthma compared to other ethnic groups.

The study used data from the Kaiser Permanente Southern California (KPSC) Matched Perinatal records of 510,216 singleton infants born between 1991 and 2007. The aim of the study was to examine the association between chorioamnionitis and childhood asthma based on gestational age at birth and race/ethnicity.

The results indicate that the combination of premature birth and chorioamnionitis greatly determines asthma development as children grow older. African American children have 98% higher risk of developing asthma before age 8 years. In Latin American children, the risk is 70% higher, and it is 66% higher among whites. No increased risk was found in Asian or Pacific Islander children. No increased risk was also found among kids who were born at full term.

About chorioamnionitis:

Maternal chorioamnionitis or simply chorioamnionitis is characterized by inflammation of the chorion and the amnion, the membranes that surround the fetus. Chorioamnionitis usually is associated with a bacterial infection. This may be due to bacteria ascending from the mother’s genital tract into the uterus to infect the membranes and the amniotic fluid (source Medicine.net).

There is indication that a large proportion of preterm births is directly or indirectly linked to some form of infection, including chorioamnionitis. Signs of placental inflammation have been observed in 42% of infants with extremely low birth weight infants.

The incidence of chorioamnionitis is difficult to determine but it is known to be higher in underdeveloped countries than in developed countries. Its occurrence declines as pregnancy advances toward term gestation. It is also estimated that 40 to 60% of all preterm births are associated with some kind of infection, including chorioamnionitis. The risk of chorioamnionitis depends on health conditions and behaviours but also on gestational age and socioeconomic factors such as economic status, and ethnicity.

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Traffic pollution and wheezing

Wheezing in children is becoming more common. One of my sons suffers from wheezing since he was a baby. Although not considered to be serious, it is nevertheless not a nice sound to hear. Butwhat is wheezing?

Mayo Clinic experts define wheezing as “a high-pitched, whistling noise that usually occurs with exhaling.”

Other signs of wheezing are:

• Breathing that is louder than normal or faster than normal. Newborns typically take 30 to 60 breaths a minute. Toddlers typically take 20 to 40 breaths a minute.
• Frequent coughing or coughing that worsens after active play.
• Coughing, clear mucus and a runny nose caused by hay fever.

Wheezing is a symptom of asthma but it is not always due to asthma. However, it can be the start of asthma. Studies have shown that babies younger than 1 year who suffer continuously from wheezing for two years have significantly increased risk for asthma, say by age 3. But what causes wheezing?

According to University of Cincinnati College of Medicine, wheezing can be triggered by

• Toxic fumes generated by traffic
• Exposure to allergens indoors

Levels of traffic-related fumes were measured based on the locations of homes and day care and their proximity and exposure to vehicular traffic. Indoor levels of endotoxin in these locations were measured from collected dust samples. Aside from household dust, endotoxins can also come from dog dander and exposure to other pets.

The researcher also found that the combination of the outdoor and indoor types of triggers seems to worsen the wheezing. Called coexposure, traffic fumes and indoor endotoxics seem to have a synergistic effect on persistent wheezing in small children.

According to Dr. Patrick Ryan who led the study:

“The prevalence of wheezing increased to more than a third – 36 percent of those children.”

So when does wheezing becomes full-blown asthma? Unfortunately, diagnosis of asthma in children under 5 is somewhat difficult. However, the following can be good indications of asthma according to Mayo Clinic experts:

• Wheezing that won’t go away or keeps coming back
• Having a parent with asthma, allergies or eczema
• Having an allergy, such as a food allergy or hay fever

According to the latest statistics from the Centers for Disease Control and Prevention (CDC):

• 16.4 million non-institutionalized American adults (7.3%) had asthma in 2008.
• 7.0 million American children (9.4%) had asthma.
• 3,613 people died of asthma in 2006, an equivalent of 1.2 deaths per 100,000 population.
• 10.6 million visits to doctors in 2006 were due to asthma. Of these 444,000 resulted in hospitalization with asthmas first-listed diagnosis. The average duration of hospital stay was 3.2 days.

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