COPD & asthma linked to poor anaphylaxis outcomes

patient with maskResearchers have found that patients with chronic lung diseases, including asthma and chronic obstructive pulmonary disease (COPD), are significantly more likely to have poor outcomes when hospitalized for anaphylaxis and other allergic conditions compared with other patients.

Zuber Mulla, MSPH, PhD, Associate Professor and Director of Epidemiologic Research at the University of Texas School of Public Health and Estelle Simons, MD, FRCP from the University of Manitoba, Winnipeg, Canada identified 30,390 patients who were hospitalized in Texas for allergic conditions between 2004 and 2007. Of these, 2,410 had a primary or secondary diagnosis of anaphylaxis at discharge.

The 2,772 (9.1%) patients in the overall cohort who had asthma were 67% more likely to receive mechanical ventilation than patients without asthma, while the 1,818 (6.0%) patients with COPD were 35% more likely to be admitted to the intensive care unit (ICU), 41% more likely to experience a prolonged stay in hospital (over 3 days), and 98% more likely to receive mechanical ventilation than those without the condition.

Patient on ventilatorIn the sub-cohort of patients with anaphylaxis, patients with asthma (n=334; 13.9%) did not have an increased risk for mortality compared with other patients, but they were over two-times more likely to be mechanically ventilated than patients without asthma).

Meanwhile, COPD patients with anaphylaxis (n=149; 6.2%) were 86% more likely to experience a prolonged hospital stay and 61% more likely to receive mechanical ventilation than patients without COPD.

Other lung conditions associated with poor outcomes included pulmonary eosinophilia, which increased the odds for ICU admission in patients with allergic conditions, while chronic bronchitis, emphysema, and interstitial lung diseases were linked to an increased risk for hospital mortality.

In particular, in the sub-cohort of patients with anaphylaxis, interstitial lung disease was linked to an 8.71-fold increased odds for mortality and a 5.16-fold increased odds for mechanical ventilation.

Writing in BMJ Open, Mulla and Simons say that their “unique exploratory analysis of a large database offers new insight into the effects of chronic pulmonary disease on anaphylaxis, an area for which there has previously been a dearth of information.”

SRxA-logo for web

Chicken Soup For the Airways?

As we approach Fall, our thoughts turn to pumpkins, cold mornings, dark nights and welcoming bowls of soup.  Soup is also on the minds of a group of researchers in Scotland. A new study will be conducted by Baxter Food Group, together with researchers from the University of Aberdeen plan to study whether soups enhanced with vitamin E may help reduce the chance of childhood asthma.

Together, they have developed 3 soups containing ingredients with high levels of vitamin E. By judicious tweaking of ingredients, for example, substituting normal tomatoes found in cream of tomato soup with their sun-dried counterparts, they were able to develop three new varieties of “super-soups”.  The soups also contain other ingredients rich vitamin E, including beans, lentils, wheat-germ, sunflower oil and sun-dried tomatoes.  They’ve also created “placebo soups” which have been made to look and taste similar to the real ones, but do not contain intensified levels of vitamin E.

Their intent is to increase the daily intake of vitamin E among pregnant women from current levels which are on average of 8mg per day to approximately 15mg per day.  The 50 women involved in the study will begin consuming 3 servings of soup per week when they are 12 weeks pregnant, and do the same until they deliver their babies.

They will examine whether the new dietary intervention is well tolerated by the women and if it has the desired effect on vitamin intake. And, during the first week of the babies’ lives their lung function will be examined.

The researchers hope that fortifying soup with vitamin E could help prevent childhood asthma.  Prior studies have shown that low vitamin E diets for pregnant women tend to result in babies being born with a higher chance of asthma by the time they reach 5 years old.   But this will be the first asthma study to use dietary supplementation of vitamin E rather than tablet supplements.

Graham Devereux, Professor of Respiratory Medicine at the University of Aberdeen and Honorary Consultant Physician at Aberdeen Royal Infirmary, commented: “Although far more difficult, it seems more natural to give vitamin E in a natural food form rather than a vitamin E pill because the vitamin E containing foods comprise a complex mix of nutrients that might be critically important. When one considers the foods containing vitamin E, soup seems an obvious intervention”.

The overall approach has support from both nutritionists and asthma experts.

If we’re really lucky we might show that the children [born to women] receiving vitamin E enhancement may actually have better lung function,” Prof Deveraux says. “The ultimate aim of this research is to reduce the prevalence of asthma by an effective, inexpensive, acceptable and safe public health dietary intervention. If successful, the proposed intervention could form the basis of public health dietary advice to pregnant women that could reduce the prevalence of childhood asthma by 15-20% within five years.”

Depending on the outcome of the current study, Deveraux and his team plan to launch a much bigger study.

So will these super soups work?  Stay tuned and we’ll ladle out the news as it breaks!

Peanuts and Pregnancy

As we’ve discussed before, peanut allergies are on the rise. One study showed that the incidence of peanut allergy in children doubled between 1997 and 2002. Now, it seems researchers have discovered one of the reasons why.

A study of almost 62,000 mothers showed that the children of those who ate peanuts and tree nuts while pregnant were less likely to develop asthma or allergies than the kids whose mothers shunned nuts.

The results support the recent withdrawal of recommendations in both the US and the UK that pregnant women should avoid nuts because they might raise a child’s risk for allergies to the nuts.

There is little research on peanut eating during pregnancy and the subsequent risk for peanut allergy in her children yet the fear continues to lead many expectant mothers to steer clear of nuts.

So, researchers at the Centre for Fetal Programming at Statens Serum Institut in Copenhagen, wanted to take a more extensive look at nut exposure and the possible health outcomes in kids.

The mothers provided information about how often they ate peanuts and tree nuts, such as almonds and walnuts, during pregnancy.

At age 18 months, the researchers found, the kids whose mothers ate peanuts were less likely to have asthma.

Fifteen percent of kids whose moms ate peanuts more than once a week, had asthma compared to more than 17 percent of kids whose moms never ate peanuts.

When other asthma risk factors were taken into account, the researchers concluded that kids whose mothers ate peanuts regularly were 21% less likely to develop asthma.

At seven years old, this same group of kids was 34% less likely to have a diagnosis of asthma than kids whose moms had abstained from peanuts.

Similarly, mothers who ate tree nuts more than once a week had 18-month-olds who were 25% less likely to have asthma than the moms who avoided the nuts, although this difference appeared to fade as the kids reached seven years old.

Peanuts appeared to have no effect on whether kids developed nasal allergies, and the children of moms who frequently ate tree nuts were 20% less likely to have allergies.

Lead author, Ekaterina Maslova said the findings are further reassurance that moms-to-be don’t need to avoid peanuts and tree nuts, although the study doesn’t prove that nuts are actually protective against asthma and allergies.

Mahr, who is also chair of the section on allergy and immunology at the American Academy of Pediatrics, noted that interviewing people about what they eat can introduce some accuracy issues, but the findings are still interesting.

SRxA Advisor Todd Mahr, a pediatric allergist at Gundersen Lutheran Medical Center in La Crosse, Wisconsin, who was not involved in the study said “A take home from this would be if there’s no food allergy in your family, but there’s an asthma history in your family, maybe you might not want to avoid peanuts specifically.”

All of which is good news for moms with peanut butter cravings.

i-Nhaler i-Mprovement?

Asthma is one of the world’s most common chronic diseases, affecting some 300 million people and almost 5 percent of the world’s population. It’s also the 5th most costly condition in the US  – an estimated at $56 billion annually. But as we’ve reported here previously, a significant number of people with asthma either don’t use their asthma medications or use them incorrectly.

Improving asthma control is known to reduce the cost of treating asthma by eliminating unnecessary hospitalizations, ED visits, and office visits. The additional cost of an uncontrolled asthma patient compared to a controlled asthma patient is estimated at $3,000-$4,000  per patient annually.

So, we were interested to learn last week that the FDA approved a sensorized asthma inhaler that can track usage and transmit the data to a smartphone and the web. The manufacturer – Asthmapolis will begin to market the asthma sensor and both English and Spanish language versions of the companion software in the US very soon.

Our mission is to make it easier for patients and their physicians to do a better job of managing asthma with less effort than traditionally required.” said David Van Sickle, co-founder and CEO of Asthmapolis.

The small and lightweight device attaches to the end of most inhalers, and the app tracks the time and location of each medication discharge and reminds patients to use it if they forget.

In clinical studies of the Asthmapolis system, uncontrolled asthma declined by 50%, and more than 70% of patients improved their level of control.  In addition it can identify trends in a patients asthma triggers and symptoms over time and provide patients with personalized education on how to improve their asthma.

Not only will the device talk directly to the patients, physicians and other health care providers will be able to identify, in near-real-time, patients with uncontrolled disease and attend to them before they suffer a severe exacerbation.

Despite all we know about asthma and how to treat it, the majority of patients still do not have the disease under control, and traditional approaches to self-management have been time-consuming and complicated,” said Inger Couture, chief regulatory officer of Asthmapolis. “The Asthmapolis technology makes it much easier to track symptoms and use of metered dose inhalers, allowing patients, their families and their doctors to gain a valuable new perspective on the disease.”

And that can only be a good thing.

Bring on the Bugs?

Think that keeping your children’s hands and mouths clean is helping them stay healthy?  Think again!  New research from Johns Hopkins Children’s Center reveals that exposure to common antibacterials found in soap, toothpaste, mouthwash and other personal-care products may make children more prone to a wide range of food and environmental allergies.

Using existing data from a national health survey of 860 children aged 6-18, the researchers examined the relationship between the children’s urinary levels of antibacterials and preservatives found in many personal-hygiene products and the presence of IgE antibodies in the child’s blood. IgE are markedly elevated in people with allergies.

We saw a link between level of exposure, measured by the amount of antimicrobial agents in the urine, and allergy risk, indicated by circulating antibodies to specific allergens,” said lead investigator Jessica Savage, M.D., M.H.S., an allergy and immunology fellow at Hopkins.

While antibacterials and preservatives themselves don’t cause allergies, that these agents appear to play a role in immune system development.

The link between allergy risk and antimicrobial exposure suggests that these agents may disrupt the delicate balance between beneficial and bad bacteria in the body and lead to immune system dysregulation, which in turn raises the risk of allergies,” Savage added.

In the study, those with the highest urine levels of triclosan – an antibacterial agent used in soaps, mouthwash and toothpaste – had the highest levels of IgE antibodies and their risk for food allergy risk was twice that of children with the lowest triclosan levels. Similarly, children with the highest urinary levels of parabens – preservatives with antimicrobial properties used in cosmetics, food and medications – were more likely to have detectable levels of IgE antibodies and twice the risk of environmental allergens such as pollen and pet dander.

These findings are consistent with the so-called hygiene hypothesis, which has recently gained traction as one possible explanation behind the growing rates of food and environmental allergies in the developed world. The hypothesis suggests that early childhood exposure to common pathogens is essential in building healthy immune responses. Lack of such exposure, can lead to an overactive immune system that misfires against harmless substances such as food proteins, pollen or pet dander.

Just  this week, other new research from the University of California, San Francisco has provided some answers to why children who grow up in homes with pets are less likely to develop allergies.

All of which suggests that parents should put away the hand sanitizer and let their kids play in the dirt with a dog!

What Not to Do With Your Asthma Inhaler

As most people know, inhalers are an important part of most successful asthma management programs. Considering how many people use them and how critical they are to managing asthma and preventing asthma attacks, the number of patients who make mistakes with their inhalers is shocking.

In a recent survey of 1,000 people with asthma, about half of the respondents weren’t even using controller medications, such as asthma inhalers. And, among the half who did use inhalers, an overwhelming amount – 86%, had trouble controlling their asthma symptoms.  This seems to suggest that most asthmatics simply aren’t using their inhalers correctly.

Though alarming, the statistics aren’t necessarily surprising. According to Summit Shah MD, an allergist at Nationwide Children’s Hospital in Columbus, Ohio, “It is actually very difficult to use an inhaler properly.”

As we’ve blogged about before, improper technique tops the list.

Overuse of inhalers is a close second.  When using a rescue inhaler, one to four puffs should be sufficient. More than that and the patient should consult his health care provider, who may need to adjust the medication or treatment plan.

Similarly, the frequency of rescue inhaler use should be monitored. Rescue inhalers are intended for occasional use to stave off acute asthma attacks. Using a rescue inhaler more than two days a week suggests that the patient also needs to be on a prophylactic (maintenance or controller) inhaler.

Although all patients are encouraged to talk to their own provider, SRxA’s Word on Health is  pleased to provide a number of simple asthma inhaler tips to help people use them correctly:

  • Sit upright
  • Shake the inhaler
  • Exhale completely
  • Use an inhaler with a spacer [device]
  • If you’re using a spacer device, spray the medicine into the spacer and then take in a slow, deep breath through the spacer while creating a tight seal around the mouth of the spacer with your lips
  • After breathing in the medication, hold your breath for 10 seconds
  • Repeat after one minute

Other asthma inhaler tips really come down to common sense, such as keeping inhalers in a safe place away from pets and children and where it won’t get damaged.

Here’s to better puffing!

Wheezing: Whining or Winning?

Many people with asthma avoid exercise because they’re afraid it could trigger symptoms such as shortness of breath, wheezing or a full-blown asthma attack.

However, a new report from The Cochrane Library turns these fears on their head. The authors conclude that not only is it safe for people with asthma to exercise, but it could also reduce their risk of asthma symptoms or attacks!

Study author, Kristin Carson, from The Queen Elizabeth Hospital, Clinical Practice Unit, Adelaide, Australia explains that over time patients with asthma who avoid exercise can become out of shape, losing muscle mass and cardiovascular fitness. That makes any future attempts at physical activity significantly harder, increasing the chances that patients will become fatigued and breathless and further discouraging physical activity. “This results in a spiraling cycle,” she says, in which patients are even more likely to avoid exercise.

To determine whether exercise was a danger to asthmatics, Carson and her colleagues reviewed previous studies that looked at the effects of physical training on people with asthma comparing patients who received no or minimal physical activity to those who exercised for at least 20 minutes, twice a week, over the course of four weeks.

The researchers found that the patients who had exercised, using physical training such as running outdoors or on a treadmill, cycling, swimming or circuit training were no more likely to have a serious asthma-related problem than those who weren’t exercising or who did light exercising such as yoga.

The patients who exercised also improved their cardiovascular fitness, which in turn can reduce asthma symptoms over time. There was also some evidence to suggest that exercise improved patients’ quality of life.

We found no reason for people with stable asthma to refrain from regular exercise,” Carson said. “Physicians should encourage their patents with stable asthma to engage in physical training programs.”

Even though this research suggests that exercise is safe for asthmatics, we suspect that many people will still think they can use their asthma as a reason to avoid physical activity.

Well now there is no excuse, and just in case you’re in any doubt consider the following list of people who never let asthma stop them:

Do you have any asthma and exercise stories to share?