TREE NUTS, EGGS AND ASTHMA- STRONG LINK ? # 22

   A recent study conducted in Massachusetts reported that almost half the children in the study with food allergies also had asthma. When various foods were tested, children allergic to tree nuts ( including almonds, cashew, hazelnut, pecan, pistachio and walnuts) and eggs showed a more significant degree of asthma than those allergic to other foods like dairy, peanuts, sesame seeds and seafood.  Though allergies to peanut and daily were commonly reported, their link to asthma was not as significant than tree nuts and eggs.

   The link between food allergies and asthma has long been known. This study looked at specific foods and showed that some foods have a higher likelihood to cause asthma than others. The study also reported that children usually show allergies to milk, eggs, wheat and peanuts while adults show primarily peanuts, tree nuts and seafood.

   The authors state that these findings, though warranting more extensive study, suggest that physicians should suspect asthma in children allergic to tree nuts and eggs.


Gaffin JM, et al. Tree Nut Allergy, Egg Allergy and Asthma in Children
Clin Pediatr 2011 50:133-139

              INDOOR POLLUTANTS AND WINTER #21

   Now that the Holidays and Winter are upon us people in the northern regions spend more time indoors. In North America, it has been estimated that adults spend 87% of their time in buildings, 6% in vehicles and 7% outdoors (1). Indoor time naturally goes up during the Winter and asthmatics who are sensitive to indoor irritants are therefore at a higher risk for attacks. The normal indoor trigger of animal dander, tobacco smoke, dust mites,etc are still with us in the Winter. We also have a few additional "triggers" that we use less in the warmer months. These include gas stoves, wood burning stoves and fireplaces and in some cases coal burning stoves. Though these seem like logical triggers, there is little by way of good statistical research data especially in adult asthmatics (2). Small population studies do exist but  the data is conflicting. So what does this mean to you as an asthmatic? Each is an individual and will react or not react to various triggers. You are probably safest when avoiding or at least limiting your exposure if you can. 
Wishing you and yours a Healthy and Prosperous New Year.

(1)Klepeis NE, Nelson WC, Ott WR, et al. The National Human Activity Pattern Survey (NHAPS): a resource for assessing exposure to environmental pollutants. J Expo Anal Environ Epidemiol 2001; 11:231-52

(2)Eisner MD, Yelin EH, Katz PP, et al. Exposure to indoor combustion and adult asthma outcomes: environmental tobacco smoke, gas stoves and woodsmoke. Thorax 2002 57: 973-978

ARE YOU USING YOUR INHALERS CORRECTLY? #20

   The total direct cost of asthma in the US is estimated to be up to $1.48 billion ANNUALLY!!!!  Asthmatics usually fall into two categories: controlled and uncontrolled. The controlled group has few (if any) attacks while the uncontrolled have frequent, often severe attacks requiring ER visits and/or hospitalization.

   Numerous studies have shown that errors or poor technique in handling an inhaler was present in between 14% and 90% of the asthmatics studied. Other studies have shown that proper inhaler education was associated with improved lung function, decreased school absenteeism and fewer ER visits. The fault of poor inhaler technique does not always fall on the patient but can be traced back to inadequate or poor educational attempts.

   The patient’s own beliefs are sometimes a factor to be dealt with. Denial or lack of faith in the medication are areas of contention. Individual preference for one type of inhaler over others is another issue. When the HFA inhalers were introduced, many asthmatics were convinced that they did not work well since the force of the propelled drug, taste, “coldness” were absent. With proper education beforehand, these problems may have been averted. 

   Another issue healthcare providers must remember that the education process is not a one time thing. The asthmatic should repeat their inhaler process and regular intervals to be sure they are using their inhaler properly. Cleaning of the device, which is often overlook by the professional, is paramount in a proper working inhaler.

   In conclusion, if you have questions about your devices whether they are MDI’s, dry powder (DPI) or single or multiple use devices- ASK, ASK, ASK !!!!! Don’t let your healthcare provider think you know how to use your inhaler when you don’t. They won’t think you are being a problem.

1. Price D, et al., Inhaler competence in asthma: Common errors, barriers to use and  recommended solutions, Respiratory Medicine (2012),       http://dx.doi.org/101016/j.rmed.2012.09.017

SECOND-HAND SMOKE AND CHILDHOOD ASTHMA #19

We all know that smoking and asthma do not go together well. We see commercials on TV showing children (assumed asthmatics) breathing in second-hand smoke and not being able to go to school that day. According to a study reported in Pediatric Academic Societies, 53% of the asthmatic children in a survey conducted between 2003 and 2010 were exposed to second-hand smoke. The study also analyzed laboratory data which measured exposure to second-hand smoke in 972 children ages 6-19. Their findings were as follows:

v     Smoke exposure was associated with a 40% increase in the risk of having limitations on activity,. And there was a 40% increase in the risk of having one or more nights a week of disturbed sleep (compared with none) owing to wheezing.

v     Exposure was associated with a 20% increase in the risk of having one or two visits to the doctor’s office or emergency room because of wheezing in the past 12 months.

v     Smoke exposure was associated with a 40% increase in have one or more nights a week of disturbed sleep due to wheezing.

Akinbami LJ, et al "Impact of tobacco smoke exposure on children ages 6-19 years with asthma in the US, 2003-2010" PAS 2012; Abstract 4340.2.

Trends in Asthma Medication Usage #17

A recent study investigated the use of controller medications in asthmatic children and adolescents and compared their use in 3 time periods: 1988-94, 1999-2002 and 2005-2008. The agents studied included inhaler corticosteroids, leukotriene receptor antagonists, long-acting beta agonists, mast-cell stabilizers and methylxanthines.
   The study showed an increase in controller use in children with current asthma but a lower use in non-Hispanic black and Mexican American white children. It also showed a lower use in the 12-to 19 year old group compared to the 1 to 5 years old. As expected, non-insured children also showed a lower use as well.
   The study also showed a number of other interesting statistics:

• in 2009 the prevalence of children and adolescents with "current asthma" was 9.6% nationally
• between 2005-2009 children and adolescents with asthma had 640,000 emergency department visits and 10.5 million missed school days
• compared to white children, American Indian, Alaska Natives and black children have a significantly higher asthma rate
• The adolescent age group (12-19 years) is associated with a decrease in adherence to medications despite the fact that they are still in need of controller therapy

   The study also showed the following breakdown by time periods in boys and girls 1-19 years of age:

• 1988-1994   17.8% used controllers
• 1999-2002   21.1% used controllers
• 2005-2008   34.9% used controllers

   As expected the largest increase in controller medication was in inhaled corticosteroids while methylxanthines (theophylline) and mast-cell stabilizers showed the largest decline.


   The findings of this study are not unusual or in conflict with many asthma studies taht showed a definite decrease in morbiity in children/adolescent using controller medicaiton to treat their asthma.

Cold Air Induced Asthma #16

   As we enter Winter and limit our outdoor activities, there are many of us who participate in skiing, ice skating, sleighing or just being out in the snow and cold. Many of us also have to dig our cars out of snow mounds and get to school or work.
   For those with asthma, these cold air activities can be very problematic. As we know most asthmatics have triggers like smoke (don't forget those fireplaces), animal dander, dust and many others. This doesn't mean asthmatics cannot enjoy the great outdoors. They just have to take a few precautions if they are sensitive to cold air. Here are a few tips:

• KEEP YOUR RESCUE INHALER WITH YOU AT ALL TIMES!!!!
• Stay warm while your outside. Make sure to have a scarf handy to cover your mouth and nose. This can warm the air you inhale and allow you to breathe a little easier.
• Even though outdoor allergens are usually low in the Winter, log fires, burning leaves and chimney smoke can be an issue.
• Do not keep your rescue inhaler outside in your car ,etc. Proper storage (room temperature) allows the device to work properly. If you do go out in the cold, keep the inhaler in an inside pocket close to your body to keep it warm.
• Air pollution can be high in the Winter. Heating fuel, wood fire smoke, car exhausts,etc can trigger attacks. Be prepared.
• If you are going skiing, skating or some other exercise, remember to warm up before and cool down afterwards- especially if you have exercise induced asthma.

Along with your individual asthma action plan, these tips and some common sense, you can have a great Winter.

I wish you and yours a Healthy and Prosperous New Year

FLU VACCINATION AND ASTHMA #15

   This week- December 4-10 has been designated "National Influenza Vaccination Week". This is a very opportune time to remind everyone about "flu shots" and to educate about some of the myths linked to these shots.
   The biggest myth is that flu shots can give you the flu. Injected flu vaccines are made from a virus that cannot cause infection. Often an individual can coincidentally catch the flu between the time of  vaccination and the two weeks it usually takes for the vaccine to provide immunity. Some individuals feel tired which they mistake for "getting sick". This is often a sign of the immune system responding to the vaccine. Finally people who get a cold mistake it for the flu.
   People on immunosuppresive therapy CAN be vaccinated but NOT with the nasal formulation which does not contain dead virus.
   As far as asthmatics are concerned, there are no studies that show a definite reduction in asthma exacerbations in those who are vaccinated. There is however, a positive side in that asthmatics who are vaccinated may avoid the flu and therefore  just have a healthier season.