Archive for December, 2010

How Does Obesity Affect Asthma?

“While the precise mechanism is not yet known, obesity appears to play a role in airway hyperresponsiveness and asthma severity.”

Obesity, increasingly prevalent in children as well as in adults, is a recognized risk factor for type 2 diabetes mellitus, hypertension, atherosclerosis, and some forms of cancer.  According to PulmonaryReviews.com evidence suggests that obesity may also contribute to or even cause asthma.

  • Asthma prevalence is increased in obese persons.
  • Obese patients with severe asthma account for 75% of emergency department visits for asthma
  • When morbidly obese asthma patients lose weight, there is a decrease in asthma symptoms and severity

The PR article by Gale Jurasek discusses further the how the characteristics REDUCED PULMONARY FUNCTION and INCREASED INFLAMMATION present in the obese patient contribute to onset of asthma.

REDUCED PULMONARY FUNCTION

  • Increased abdominal and chest wall mass in obese people causes lower functional residual capacity
  • Obese persons breathe at higher frequencies—but substantially smaller tidal volumes
  • Weight loss improves lung function, it does not affect airway responsiveness. This is consistent with the hypothesis that obesity plays a role in irreversible airway remodeling.

INCREASED INFLAMMATION

  • Chronic low-level systemic inflammation is present in obese persons
  • Adipose tissue also contains leptin, adiponectin, and plasminogen activator inhibitor-1, all of which contribute to airway hyperresponsiveness
  • Plasma adiponectin levels are decreased in obese individuals but increase with weight loss

“In summary,” the authors concluded, “the incidence of asthma is increased in the obese. The importance of understanding this relationship is underscored by the extremely high prevalence of obesity in inner-city children, who are at the greatest risk of asthma, and by observations indicating that obesity is a strong predictor of the persistence of childhood asthma into adolescence.”

read the entire pulmonaryreview.com article

For more on Childhood Obesity and Asthma read this CDC.com article, Healthy Weight – it’s not a diet, it’s a lifestyle!

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Asthma Symptoms in Children

As I previously discussed Exercised Induced Asthma can be adversely affected by cold weather. Unfortunately, children are not exempt. Asthma is the leading cause of chronic disease in children.  Below is a list of potential signs and symptoms that may alert you to an asthmatic condition in your child.

  • Frequent coughing spells, which may occur during play, at night, or while laughing. It is important to know that cough may be the only symptom present.
  • Less energy during play
  • Rapid breathing
  • Complaint of chest tightness or chest “hurting”
  • Whistling sound (wheezing) when breathing in or out
  • See-saw motions (retractions) in the chest from labored breathing
  • Tightened neck and chest muscles
  • Feelings of weakness or tiredness

Not all children exhibit the same asthma symptoms, and these symptoms may vary by episode. Also, be aware that not all wheezing or coughing is caused by asthma.

If your child has problem breathing, take him/her to the doctor immediately for an evaluation.

For an appointment at one of my 4 convenient NYC offices, contact me at 866-632-5537.

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Winter Sports and Asthma

Unfortunately for people with asthma, winter sports have more than snow and ice in common. Winter sports involve exposure to cold air, which may exacerbate asthmatic conditions.

Prevention, as with most allergy treatments, is the best way to control exercise-induced asthma (EIA). Controlling EIA with a physician prescribed treatment plan may include using an asthma inhaler before exercising.  If you are under the care of a physician for asthma, before making any changes to your treatment plan, be sure to consult your healthcare provider.

In addition to using a prescribed inhaler, take time to warm up before exercise. By warming up your body with light activity, you’ll add natural body-produced chemicals which protect against brochospasm. Both of these steps will lead to better cold weather experiences.

If you exhibit symptoms of coughing, wheezing, and shortness of breath, following physical activity, these may be signs of EIA.  Symptoms may appear 5 to 20 minutes after finishing the activity. Coughing and wheezing after exercise are important signs to consider that an individual has or is developing asthma. People experiencing these symptoms should speak with a medical practitioner.

Again, a checklist for easing and preventing Exercise-Induced Asthma during outdoor winter activities:

  • Wear a mask or scarf to warm cold air before breathing it
  • Take asthma medication 15-30 minutes before skiing, snowboarding, ice skating, etc.
  • Warm up 30 minutes before starting the exercise

Communicating with your doctor is imperative to receive proper care for an asthmatic condition. If you exhibit any of the symptoms; coughing, wheezing, and shortness of breath, contact a healthcare professional.  Live in the NYC area? Feel free to contact me to set up a successful treatment plan to ensure that asthma doesn’t keep you from enjoying winter.

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Help for Nighttime Nasal Sinus Congestion

Studies suggest Mometasone Spray Relieves Allergic Rhinitis Nasal Congestion at Night

As reported by Fran Lowry of Medscape Medical News, Eli O. Meltzer, MD, clinical professor of pediatrics at the University of California, San Diego, presented study results in a poster session at the American College of Allergy, Asthma & Immunology (ACAAI) 2010 Annual Scientific Meeting supporting the use of once-daily mometasone furoate nasal spray to relieve nighttime and early morning nasal congestion in patients with seasonal allergic rhinitis.

“Nasal congestion is clearly the most problematic of all symptoms of seasonal allergic rhinitis. It is also the most common bothersome symptom, and is responsible for increased problems with middle ear disease, increased sinus disease, increased nighttime awakenings, and increased asthma. Therefore, anything we can do to improve nasal congestion will relieve our patients’ morbidity and comorbidities.” Eli Meltzer, MD

The trials comprised a total of 1812 subjects 12 years and older with at least a 2-year history of seasonal allergic rhinitis who received mometasone furoate nasal spray 200 μg or placebo once daily for 15 days.

The analysis showed that treatment with mometasone furoate nasal spray produced significantly greater reductions in mean change from baseline in AM PRIOR nasal congestion scores than placebo, which began as early as day 2 and continued until day 15 (P < .001)

“Sleep disruption is often one of the biggest complaints by people who suffer from allergic rhinitis”, said John J. Oppenheimer, MD, associate clinical professor of medicine at New Jersey Medical School in Newark, and chair of the ACAAI abstract review committee.

“From the standpoint of quality of life, improving nasal obstruction, especially at night, may really help with sleep interference in this population. “Allergic rhinitis is not a life threatening disease, but it is a quality-of-life-threatening disease. As we begin to study the aspects of this illness and its impact on patients, and ameliorate some of their larger complaints, we are really moving forward, so I applaud this study for that reason.”

If nasal congestion is a reoccurring barrier between you and a good night’s sleep, see your healthcare provider.

Live in the NYC area, feel free to contact my office for an appointment to improve sleep and your quality of life.  Reach me at 866-632-5537.

Read the entire article here

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Allergic Occupational Asthma

A discussion of Occupational Asthma has appeared in several periodicals lately. A LA Times article by Janet Stobart summarizes a study published in the medical journal Thorax which shows Occupational Asthma  is causing substantial financial losses to the British government and health agencies.

Neil Churchill, head of Asthma UK, told the Daily Telegraph, “Occupational asthma is the most frequently reported work-related respiratory disease in the UK … Over a quarter of people with asthma have missed days off work as a result of their symptoms and 32% of people with asthma tell us that their employer is not doing enough to protect them from asthma at work.”

From the Asthma and Allergy Foundation of America (aafa.org) Some 200 substances—gases, vapors, and organic and inorganic dusts—found in manufacturing workplaces and among certain occupations have been identified as causes of asthma. It’s estimated that some 11 million US workers are exposed to at least one of these substances.

People who get occupational asthma are those who either:

  • Become sensitized to an allergen in the workplace and on subsequent exposure have an allergic reaction to the allergen or,
  • Are already asthmatic and have very sensitive airways that react to irritants in the workplace.

Occupational asthma also varies considerably among industries. For example, up to 30 percent of bakers exposed to flour dust get asthma. A disproportionate number of people develop asthma who work in the manufacture of detergents, in the logging or furniture industries or in handling animals.

What Are Symptoms of Occupational Asthma?

Physical symptoms include coughing, wheezing, breathing problems and chest tightness. The skin, eyes and nose may become inflamed. Three basic patterns of asthmatic response can be seen:

  • A prompt response of trouble breathing and wheezing within minutes of exposure to the allergen. The condition is worse in 10 to 30 minutes and clears up in 1 to 2 hours. Symptoms often go away soon after the worker leaves the workplace and do not recur on weekends.
  • A delayed or late onset reaction, which often begins 1 to 6 hours after exposure and peaks in 3 to 8 hours. Sometimes it lasts 2 to 36 hours and can recur nightly after a single exposure. It may take days or weeks to resolve.
  • A dual response, both prompt and late onset. Symptoms begin within minutes of exposure and return to normal in 1 to 2 hours. Symptoms flare up again in the evening or after bedtime and continue in some patients for up to 12 hours.
  • Spill of an agent can cause high-level exposure that triggers a reaction quickly.

For more on Allergic/Occupational Asthma continue reading  here

If you are exhibiting symptoms or have questions about the treatment of Allergic/Occupational Asthma,  contact your allergist.

Live in the NYC area? I invite you to call me at 866-632-5537 for an appointment to discuss treatment options to better control an asthmatic condition.

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Cold or Sinuses?

Sinusitis implies inflammation of the sinuses. Whether it’s caused by a cold, an infection or allergies, any swelling of the sinuses can produce symptoms such as:

  • Pressure or pain behind the eyes or cheeks
  • Pain in the top teeth
  • Congestion
  • Green or yellow nasal drainage
  • Headache
  • Post nasal drip

People suffering from inflammation of the sinuses also complain of fatigue, difficulty breathing through the nose, decreased sense of smell, and restless sleep.

If your sinuses are flaring up every month or every other month your illness is most likely not a cold, but rather chronic sinus infection.

There are three types of sinusitis:

  • Acute sinusitis usually lasts less than four weeks.
  • Chronic sinusitis brings on symptoms that last more than 12 weeks.
  • A third type of sinusitis is the recurrent infections of the sinuses, often four or more bouts of acute sinusitis a year, usually from viruses or bacteria.

Treating Sinus Infections

If you suspect you have a sinus infection and it hasn’t resolved after a few days, you should probably head to the doctor for a physical examination.

Live in the NYC area? Feel free to contact me at 866-632-5537 for an appointment.

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