AsthmaNow

September 2009 Calendar and Updates

2009-09-04T06:13:00.000-07:00

Asthmanow is undergoing a face lift. Look for a new site in the coming months.

CALENDAR AND UPDATES SEPTEMBER 2009

1. Calendar
2. Back to School: Asthma Related Resources
3. Swine Flu Resources
4. Asthma Updates

1. CALENDAR
September 10 Eager Breather’s Fresh Air Day Cruise.

September 18 9:30-11:30 Asthma Health Improvement-Asthma Educator Network Working Group, Catholic Medical Center Pulmonology Department, Notre Dame Pavillion. Contact Malone Cloitre at Southern NH Area Health Education Center, mcloitre@snhahec.org

The First Annual C. Everett Koop, MD Tobacco Treatment Conference, Lake Morey Resort, Fairlee VT. Register ONLINE at http://ccehs.dartmouth-hitchcock.org

September 28 Fairways for Airways Golf Classic™ to be held at the Lake Winnipesaukee Golf Club. Participation in this event directly supports Breathe New Hampshire's lung health programs & initiatives in the state. FMI: 1-800-835-8647 x 120 or http://www.breathenh.org/Page.aspx?pid=554

October 20 NH Public Health Association Fall Forum

October 23 8:000-4:30, Autumn Logic 2009: Using EHR to Enhance the Patient-Centered Medical Home. Contact Traci Holmes at Southern NH Area Health Education Center, tholmes@snhahec.org

November 19 2nd Annual Breathe Fest, featuring the music of Adam Ezra Group, 7-9:30. Proceeds to benefit Breathe New Hampshire. FMI: www.tupelohall.com or 603-437-5100

2. BACK TO SCHOOL: ASTHMA RELATED RESOURCES
Research indicates that less than one-third of parents surveyed make sure their children are under medical supervision or talk to school administrators or school nurses about their child’s asthma. These results may help explain why emergency room and hospitalization rates spike in September. The following resources can help health professionals, parents, students and school personnel insure a safer start to the school year.

• The Centers for Disease Control’s Manage Asthma at School
• AsthmaNow’s School Resources
• AsthmaNow’s Parent’s Resources
• AsthmaNow’s Children & Teens Resources
• Health Professionals
• Asthma Tool Box

3. SWINE FLU (H1N1) RESOURCES
A flu vaccine for H1N1 is expected to be available in mid October. First in line for the vaccine include: pregnant women; infants’ caregivers and contacts; children ages 6 months through 24 years old; People up to 65 years old with medical conditions (asthma would be considered a qualifying condition); health care workers and emergency medical services workers. One of the best ways to prevent the flu is to wash your hands with soap and water, or with hand sanitizer, frequently. Avoid touching eyes, nose or mouth.

• Centers for Disease Control’s website Novel H1N1 (Swine Flu)

• New Hampshire’s Department of Health and Human Services website on H1N1 (Swine Flu)

• Swine Flu Primer by Betsy McKay of the Wall Street Journal:

• Centers for Disease Control’s H1N1 Flu (Swine Flu): Resources for Child Care Centers, Schools, Colleges and Universities http://www.cdc.gov/h1n1flu/schools/

• Cover and Wash Swine Flu Posters from Chronic Conditions Information Center of VT/NH

4. UPDATES
INSURANCE, MEDICAL PROVIDER DO NOT ASSURE ASTHMA CONTROL: A study of for 155 students with asthma in 19 elementary and middle schools in the Denver Public School system, where 90 percent had health insurance and 92 percent had a physician caring for their asthma, found that asthma control among the students was generally poor, but similar among students with and without health insurance. Thirty percent of those with insurance had persistent daytime symptoms, while 25 percent of those without insurance did. Fifty-seven percent of those with insurance had sought emergency care for their asthma, while 63 percent without insurance had sought emergency care. Only 30 percent of those with insurance used controller medications. There was no difference in asthma control between those who had private insurance and public insurance, such as Medicaid. Those with doctors more frequently reported persistent daytime symptoms and emergency care. Only 25 percent of those with doctors were on regular controller therapy compared to 20 percent of those with out a physician. Journal of Allergy and Clinical Immunology 8/09

INTERACTIVE ASTHMA EDUCATION PROGRAM REDUCES NEED FOR EMERGENCY CARE AND STEROID USE IN CHILDREN: Education on asthma management in children delivered in small, interactive groups improved asthma outcomes and the overall care of children with asthma, concludes a randomized study of 398 children, aged 3 to 16. Children who participated in the interactive education program were 38% less likely to require emergency care and required fewer courses of oral corticosteroids compared with the children who did not participate in the program. The intervention group participated in a 4-week asthma care program developed by the Children's Asthma Education Centre as well as their usual medical care. The materials included specific educational materials, personalized mailings to reinforce the program's key points and age-appropriate pamphlets. A key component was small-group interaction for children and their families to discuss successes and failures in managing their child's asthma. While the number of visits to the emergency department decreased in both groups in the year after the study, children in the intervention group made significantly fewer visits (.45 visits per child) compared with the control group (.75 visits). The likelihood of children in the intervention group requiring oral corticosteroids was reduced by 36%. As well, primary caregivers in this group missed significantly less work than the control group, suggesting the asthma was under better control. Canadian Medical Association Journal 8/09

STILL SEARCHING FOR PREDICTORS OF ASTHMA ATTACKS: A 46-week study, including 546 adolescents and young adults (ages 12 to 20 years old) in 10 cities across the United States, finds that an extensive set of clinical tests cannot successfully predict the future risk of asthma attacks in participants who both receive care based on current guidelines and adhere to treatment recommendations. This finding differs from previous reports suggesting that certain clinical findings and laboratory tests could help predict future asthma attacks. These earlier conclusions, however, were based on observations of patients with poorly controlled asthma who had not received care based on current guidelines. The Journal of Allergy and Clinical Immunology 8/09

STRESSFUL EVENTS MAY WORSEN KIDS’ ASTHMA: When asthma and symptoms of depression coexist in kids, asthma may become worse, study findings suggest. Researchers studied the breathing patterns of 90 7- to 17-year-old boys and girls with asthma before and after they watched scenes from the movie ET: The Extraterrestrial. Half of the kids had symptoms of depression, in addition to asthma, while the other half did not. The children with both asthma and symptoms of depression were more likely to show greater airway resistance after watching troubling scenes from the movie. Those with depression consistently showed breathing patterns indicative of worsening asthma after watching distressing scenes in the movie. Distressed breathing was most pronounced during scenes of family distress, loss, and death. Parents of children with asthma should be aware of the possibility that stressful or emotionally troubling events may lead to worsening asthma episodes. Journal of Allergy and Clinical Immunology, July 2009

PREVALENCE OF NON ADHERENCE IN DIFFICULT ASTHMA: General Practitioner prescription refill records for the previous 6 months for inhaled combination therapy and short acting beta-agonists were compared to prescribed and expressed for 182 patients. Patient demographics, hospital admissions, lung function, oral prednisolone courses and quality of life data were analyzed to identify variables associated with reduced medication adherence. A significant proportion of patients with difficult to control asthma, remain non-adherent to corticosteroid therapy with only 35% filling inhaled medication prescriptions; and 88% admitting poor adherence with inhaled therapy after initial denial. Am J Respir Crit Care Med. 7/30/09

CAN MONTELUKAST SHORTEN PREDNIOLONE THERAPY IN CHILDREN WITH MILD TO MODERATE ACUTE ASTHMA? A randomized double blind study of 130 children (2 to 17 years of age), with mild to moderate acute asthma, were studied to determine whether outpatient post stabilization therapy with montelukast produces more treatment failures than prednisolone. The rates of treatment failure were 7.9% in the prednisolone group and 22.4% in the montelukast group. Montelukast does not represent an adequate alternative to corticosteroids after outpatient stabilization in mild to moderate acute asthma. This population should receive oral corticosteroids after discharge. Journal Pediatrics 8/3/09

EFFICACY AND TOLERABILITY OF ONCE-DAILY BUDESONIDE/FORMOTEROL: A double-blind study of 619 patients, 12 years and older with mild to moderate asthma, concludes that pulmonary function and asthma control were more effectively maintained with all budesonide/formoterol regimens vs once-daily budesonide and with twice-daily budesonide/formoterol at twice the daily formoterol dose vs both once-daily budesonide/formoterol doses. Ann Allergy Asthma Immunol. 2009 Jul;103(1):62-72

NH Declares Air Quality Days 8/17/09

2009-08-17T10:44:00.000-07:00

State Declares Air Quality Action Days

Unhealthy Air Pollution Levels Predicted for Today and Tomorrow

Concord, NH – The New Hampshire Department of Environmental Services (DES) is expecting air pollution concentrations to reach unhealthy levels for sensitive individuals in Rockingham County, especially in coastal areas, on Monday, August 17 and Tuesday, August 18. DES officials are calling for Air Quality Action Days and advise sensitive individuals in these areas to take precautions to protect their health by limiting prolonged or heavy exertion. Sensitive individuals include children and older adults, anyone with heart or lung disease such as asthma, emphysema, and bronchitis, and people who are active outdoors. Even healthy individuals may experience mild health effects and should consider limiting strenuous or prolonged activities.

DES forecasts unhealthy concentrations of ground-level ozone (the main component of smog) for sensitive individuals in Rockingham County. In addition, concentrations of fine particle pollution are forecasted to approach unhealthy levels for sensitive individuals in southern and western areas of the state. The combination of the two pollutants may intensify health effects.

The expected unhealthy air quality is due to the persistence of high temperatures under sunny skies and light winds transporting pollution into New Hampshire from surrounding areas. Conditions are expected to improve on Wednesday as cooler, cleaner air moves into the region.

Symptoms of ozone exposure include coughing, wheezing, chest tightness or pain when inhaling deeply, and shortness of breath. Symptoms of particle pollution exposure for people with heart disease may include chest pain, palpitations, shortness of breath, and fatigue. People with existing lung diseases may not be able to breathe as deeply or vigorously as normal and may experience symptoms such as coughing and shortness of breath. The severity of the health effects increases as ozone and fine particle concentrations increase. In addition to harmful health effects, fine particle pollution may create hazy conditions that reduce visibility.

For further information, contact DES at (603) 271-1370. For air quality forecasts and current air pollution levels in New Hampshire, call 1-800-935-SMOG or visit the DES website at www.airquality.nh.gov.

CALENDAR AUGUST 2009

2009-08-04T12:33:00.000-07:00

If you have an asthma related event coming up, and you would like it posted on this calendar, please send the date, place, time and contact information to margoc@tds.net Meetings listed below are open to all interested in attending.

August 3 10-12 noon, Air Quality and Schools Legislative Commission, Legislative Office Building, Concord NH, http://www.gencourt.state.nh.us/misc/directions/

August 3-5 26th Annual School Nurse Institute, St. Anselm College. This year’s institute features a hald day program on asthma: Aug 3, 1-4:30 om, Asthma for School Nurses. FMI: go to St. Anselm’s website for program and registration information: http://www.anselm.edu/academics/depts/nursingconted

August 9 Annual Mud Hog Race, Gunstock Mountain Resort, Gilford, NH Fundraiser for Breathe New Hampshire. FMI

September 10 Eager Breather’s Fresh Air Day Cruise.

September 18 9:30-11:30 Asthma Health Improvement-Asthma Educator Network Working Group, Catholic Medical Center Pulmonology Department, Notre Dame Pavillion. Contact Malone Cloitre at Southern NH Area Health Education Center, mcloitre@snhahec.org

The First Annual C. Everett Koop, MD Tobacco Treatment Conference, Lake Morey Resort, Fairlee VT. Register ONLINE

September 28 Fairways for Airways Golf Classic™ to be held at the Lake Winnipesaukee Golf Club. Participation in this event directly supports Breathe New Hampshire's lung health programs & initiatives in the state. FMI: 1-800-835-8647 x 120 or http://www.breathenh.org/Page.aspx?pid=554

October 20 NH Public Health Association Fall Forum

October 23 8:000-4:30, Autumn Logic 2009: Using EHR to Enhance the Patient-Centered Medical Home. Contact Traci Holmes at Southern NH Area Health Education Center, tholmes@snhahec.org

November 19 2nd Annual Breathe Fest, featuring the music of Adam Ezra Group, 7-9:30. Proceeds to benefit Breathe New Hampshire. FMI: www.tupelohall.com or 603-437-5100

Pediatric Asthma Management and Control 7/09

2009-08-04T11:09:00.000-07:00

The NH Asthma Control program has recently posted a new report Asthma in New Hampshire: Pediatric Asthma Management and Control, July 2009.

7/17/09 FDA Looking at Xolar

2009-07-18T01:51:00.000-07:00

FDA Reviewing Preliminary Safety Information on Asthma Drug Xolar

Asthma Calendar and Updates 7/09

2009-07-01T12:13:00.000-07:00

CALENDAR AND UPDATES JULY 2009

1. Calendar
2. Asthma Updates

1. CALENDAR
If you have an asthma related event coming up, and you would like it posted on this calendar, please send the date, place, time and contact information to margoc@tds.net Meetings listed below are open to all interested in attending.

July 15 1-3 pm, Healthy Schools Program Meeting, Local Government Center, Concord NH, http://www.nhlgc.org/LGCWebsite/index.asp

• 2 pm, Webinar on Maine Healthy Homes Strategic Planning Process. Contact Eileen Gunn at the New England Asthma Regional Council, egunn@hria.org

July 25 4-6 pm, Advocacy Round-up and Planning for 2009-2010, Breathe New Hampshire, Bedford NH, http://www.breathenh.org/Page.aspx?pid=193

August 3 10-12 noon, Air Quality and Schools Legislative Commission, Legislative Office Building, Concord NH, http://www.gencourt.state.nh.us/misc/directions/

August 3-5 26th Annual School Nurse Institute, St. Anselm College. This year’s institute features a hald day program on asthma: Aug 3, 1-4:30 om, Asthma for School Nurses. FMI: go to St. Anselm’s website for program and registration information: http://www.anselm.edu/academics/depts/nursingconted

September 10 Eager Breather’s Fresh Air Day Cruise. http://www.breathenh.org/Page.aspx?pid=383

September 18 9:30-11:30 Asthma Health Improvement-Asthma Educator Network Working Group, Catholic Medical Center Pulmonology Department, Notre Dame Pavillion. Contact Malone Cloitre at Southern NH Area Health Education Center, mcloitre@snhahec.org

September 28 Fairways for Airways Golf Classic™ to be held at the Lake Winnipesaukee Golf Club. Participation in this event directly supports Breathe New Hampshire's lung health programs & initiatives in the state. FMI: 1-800-835-8647 x 120 or http://www.breathenh.org/Page.aspx?pid=554

October 20 NH Public Health Association Fall Forum, , http://www.nhpha.org/

October 23 8:000-4:30, Autumn Logic 2009: Using HER to Enhance the Patient-Centered Medical Home. Contact Traci Holmes at Southern NH Area Health Education Center, tholmes@snhahec.org

2. ASTHMA UPDATES
FDA FLAGS PSYCHIATRIC RISKS OF ASTHMA DRUGS: New labels on popular asthma drugs like Merck's Singulair must highlight language about suicidal behavior, depression and anxiety seen in a small number of patients,. After 15 months of investigation, the Food and Drug Administration said Merck & Co. Inc., AstraZeneca and Cornerstone Therapeutics will have to raise label warnings about psychiatric problems reported by a handful of patients taking their drugs. "Patients and healthcare professionals should be aware of the potential for neuropsychiatric events with these medications," the FDA said in a posting to its Web site. A spokeswoman for Merck said the language already appears in Singulair's label, but will be raised to the "precautions" section. It's now listed in a section about various side effects reported by patients. http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm048223.htm

ADULTS WITH ASTHMA NOT GETTING FLU SHOTS: According to The Behavioral Risk Factor Surveillance System (BRFSS) survey vaccination estimates for the 2006-2007 influenza season ranged from 26.9% in California to 53.3% in Tennessee with a median across all states of 43.1%. Influenza vaccination coverage was 33.9% for adults with asthma aged 18–49 years compared to 54.7% for adults with asthma aged 50–64 years. Among people aged 18–64 years without asthma, vaccination coverage was 28.8%. In addition, despite adjustments for a set of socio-demographic and access to-care variables, researchers found a gap of 8 to 10 percentage points between levels among non-Hispanic whites compared to levels among Hispanics and non-Hispanic blacks. American Journal of Preventive Medicine, Volume 37, Issue 2 (August 2009) http://www.ajpm-online.net/

OBESITY DOES NOT WORSEN ASTHMA BUT MAY REDUCE RESPONSE TO MEDICATIONS: Being overweight or obese does not make asthma worse in patients with mild and moderate forms of the disease, according to a study by National Jewish Health researchers, although it may reduce the response to medications. "By studying a well characterized group of patients with asthma, [1,256 patients ] we were able to determine that increased weight is not associated with more severe asthma. Although benefits can be obtained with weight loss in other diseases, these findings suggest that an improvement in asthma may not necessarily result from weight loss. "The findings also suggest that patients and physicians should be aware that obese asthma patients may not respond well to corticosteroids, the most successful controller medication for asthma, which can affect dosing decisions and choices of possible alternatives to steroids." Journal of Allergy and Clinical Immunology 6/09 www.jacionline.org/

WAYS TO PREDICT EXERCISE INDUCED ASTHMA AND ITS SEVERITY WITHOUT AN EXERCISE CHALLENGE: Two Indiana University studies have explored the potential use of two simple tests for not only predicting whether someone has exercise-induced asthma (EIA) but also its severity, without subjecting the patient to an exercise challenge. One test involves measuring exhaled breath levels of nitric oxide. The other involved measuring the pH level of exhaled breath. Researchers found that both tests could be effective at predicting EIA and its severity. Both tests can be performed in a doctor's office while the patient is at rest.. American College of Sports Medicine annual meeting http://www.sciencedaily.com_ /releases/2009/05/090530172218.htm

June Calendar and Updates

2009-05-27T02:14:00.000-07:00

CALENDAR AND UPDATES JUNE 2009

1. Calendar
2. International Conference of the American Thoracic Society
3. Asthma Updates

1. CALENDAR
If you have an asthma related event coming up, and you would like it posted on this calendar, please send the date, place, time and contact information to margoc@tds.net

June 4-5 EPA National Asthma Forum, Washington DC. www.epaasthmaforum.com.

June 10 NH Asthma Steering Committee Spring/Summer Meeting, 9-11:30 am, Society for the Protection of NH Forests. FMI: ldearborn@dhhs.state.nh.us or 603-271-0855

June 17 Healthy Homes Specialist Refresher Course, 8-4:30, NH Housing (32 Constitution Drive, Bedford NH). Fee is $30. To register, go to www.snhahec.org. Option to take the Healthy Homes Specialist Credentialing Exam. Contact Tracie Holmes (603-895-1514 ext.4, for information on registration and scholarships for credentialing.

June 25-26 Asthma Educator Institute. Sponsored by the American Lung Association, Southern NH Area Health Education Center and the NH Asthma Control Program. For individuals interested in developing skills as an asthma educator and/or to prepare for the national asthma educator certification exam. Holiday Inn, Nashua, 8-4:30 each day. Cost: $250 with a limited number of scholarships available for individuals from NH. Register at www.snhahec.org. Contact Tracie Holmes (603-895-1514 ext.4 for more information.

August 3-5 26th Annual School Nurse Institute, St. Anselm College. This year’s institute features a hald day program on asthma: Aug 3, 1-4:30 om, Asthma for School Nurses. FMI: go to St. Anselm’s website for program and registration information:

September 10 Eager Breather’s Fresh Air Day Cruise.

September 28 Fairways for Airways Golf Classic™ to be held at the Lake Winnipesaukee Golf Club. Participation in this event directly supports Breathe New Hampshire's lung health programs & initiatives in the state. FMI: 1-800-835-8647 x 120 or http://www.breathenh.org/Page.aspx?pid=554

2. INTERNATION CONFERENCE OF THE AMERICAN THORAIC SOCIETY
Abstracts for the Conference are available at http://www.thoracic.org/sections/publications/abstracts-
online.html

DEVICE EASES SEVERE ASTHMA WITHOUT DRUGS: The Alair Bronchial Thermoplasty System
device, made by privately held Asthmatx Inc., cut the rates of extreme asthma
attacks by 32 percent and reduced trips to the emergency room by 84 percent in 297 patients with
severe asthma in six countries. Patients missed fewer days of work or school because of asthma
symptoms and had more symptom-free days compared with people who received a placebo, according
to results of the late-stage clinical trial. The Alair device uses a thin tube to gently heat the walls of the
lung's air passages, killing off some of the muscle tissue to reduce narrowing of the airways.

FLU VACCINE DOES NOT PREVENT FLU RELATED HOSPITALIZATIONS IN CHILDREN
WITH ASTHMA: The inactivated influenza vaccine does not appear to be effective in preventing
influenza-related hospitalizations in children, especially those with asthma. In fact, children who get the
influenza vaccine are more at risk for hospitalization than their peers who do not get the vaccine. To
determine whether the vaccine was effective in reducing the number of hospitalizations that all children, and
especially those with asthma faced over 8 consecutive influenza seasons, the researchers conducted a
cohort study of 263 children, aged 6 months to 18 years, who were evaluated at the Mayo Clinic in
Minnesota between 1996 to 2006. Thos children who had received the vaccine had 3 times the risk of hospitalization, as compared to children who had not received the vaccine. No other measured factors, such as insurance plans or severity of asthma, appeared to affect risk of hospitalization.

VITAMIN D MAY HALT LUNG FUNCTION DECLINE IN ASTHMA: Vitamin D may slow the progressive decline in the ability to breathe that can occur in people with asthma as a result of human airway smooth muscle (HASM). Researchers found that calcitriol, a form of vitamin D synthesized within the body, reduced growth-factor-induced HASM proliferation in cells isolated from both persons with asthma and from persons without the disease. The proliferation is a part of process called airway remodeling, which occurs in many people with asthma, and leads to reduced lung function over time. The experiments were conducted with cells from 12 subjects, and the researchers compared calcitriol with dexmethasone, a corticosteroid prescribed widely for the treatment of asthma. Although, dexmethasone is also a powerful anti-inflammatory agent, the researchers found that it had little effect on HASM growth.

OVERWEIGHT MOMS MORE LIKELY TO HAVE KIDS WITH ASTHMA: A mother's weight may have lasting effects not just on her own health but on the respiratory health of her children. The risk of asthma is 65 percent higher among the offspring of overweight mothers if one or both of the child's parents have a history of the disease. The study included nearly 4,000 children, who were followed from birth to 8 years of age.

3. ASTHMA UPDATES
ASTHMA SELF MANAGEMENT PROGRAMS IMPROVE ADHERENCE: A s t h m a p a t i e n t s w h o s p e n d a s l i t t l e a s 3 0 m i n u t e s w i t h a h e a l t h c a r e p r o f e s s i o n a l, t o d e v e l o p a p e r s o n a l i z e d s e l f - m a n a g e m e n t p l a n, s h o w i m p r o v e d a d h e r e n c e t o m e d i c a t i o n s a n d b e t t e r d i s e a s e c o n t r o l , a c c o r d i n g t o a n e w s t u d y of 8 4 a d u l t s w i t h a s t h m a. Subjects s e l f - m o n i t o r e d t h e i r s y m p t o m s a n d k e p t a d a i l y l o g o f t h e i r p e a k e x p i r a t o r y a i r f l o w . O f t h a t g r o u p , 4 5 p a t i e n t s w e r e r a n d o m l y s e l e c t e d t o a l s o r e c e i v e a p e r s o n a l 3 0 - m i n u t e s e s s i o n t h a t i n c l u d e d a s t h m a i n f o r m a t i o n , p e r s o n a l l y r e l e v a n t a l l e r g e n e x p o s u r e r e d u c t i o n , a p e r s o n a l a c t i o n p l a n , a n d i n s t r u c t i o n i n t h e c o r r e c t u s e o f t h e i r i n h a l e r s . P a r t i c i p a n t s i n t h e i n t e r v e n t i o n g r o u p e x p e r i e n c e d f e w e r n i g h t t i m e a w a k e n i n g s , a m a r k e r o f a s t h m a c o n t r o l . I n t e r v e n t i o n p a r t i c i p a n t s a l s o u s e d r e s c u e i n h a l e r s l e s s f r e q u e n t l y , e x p e r i e n c e d a n i n c r e a s e d s e n s e o f c o n t r o l o v e r t h e i r a s t h m a , a n d h a d a s i g n i f i c a n t d e c r e a s e i n t h e i r l e v e l s o f t r y p t a s e , w h i c h i s r e l e a s e d f r o m c e l l s i n t h e p r e s e n c e o f a l l e r g e n s . T h e J o u r n a l o f A l l e r g y a n d C l i n i c a l I m m u n o l o g y 5/09

INTEGRATED PEST MANAGEMENT REDUCES COACKROACHES AND ALLERGENS IN SCHOOLS: F o r y e a r s , s c i e n t i s t s h a v e a s s o c i a t e d g r o w i n g a s t h m a r a t e s a m o n g c h i l d r e n w i t h e x p o s u r e t o c o c k r o a c h a l l e r g e n s , e s p e c i a l l y a m o n g i n n e r - c i t y c h i l d r e n . A n e w s t u d y s h o w s t h a t u s i n g i n t e g r a t e d p e s t m a n a g e m e n t ( I P M ) t o c o n t r o l c o c k r o a c h e s i s m o r e e f f e c t i v e a t r e d u c i n g c o c k r o a c h e s a n d t h e i r a l l e r g e n s t h a n c o n v e n t i o n a l m e t h o d s w h i c h d o n o t u s e I P M . U n l i k e c o n v e n t i o n a l p e s t - c o n t r o l m e t h o d s , w h i c h o f t e n i n v o l v e p e r i o d i c s p r a y i n g o f i n s e c t i c i d e s o n a p r e d e t e r m i n e d s c h e d u l e , I P M i n v o l v e s c l o s e m o n i t o r i n g f o r s i g n s o f s p e c i f i c p e s t s , c o m b i n e d w i t h b a i t s a n d t r a p s t o c o n t r o l t h e m . T h e a u t h o r s o f t h i s s t u d y c o m p a r e d t w o s c h o o l d i s t r i c t s u s i n g t h e c o n v e n t i o n a l m e t h o d w i t h o n e s c h o o l d i s t r i c t u s i n g I P M , a n d f o u n d t h a t t h e o n e u s i n g I P M h a d m u c h l o w e r c o n c e n t r a t i o n s o f c o c k r o a c h a l l e r g e n s a n d z e r o c o c k r o a c h e s c a u g h t i n p r e - s e t t r a p s . J o u r n a l o f M e d i c a l E n t o m o l o g y , 2 0 0 9 ; 4 6 ( 3 ) : 4 2 0

Asthma Educator Institute

2009-05-15T13:50:00.000-07:00

Asthma Educator Institute
June 25 and 26, 2009
8:00 a.m. – 4:30 p.m.
Holiday Inn, Nashua, NH (exit 4 off of 93)

The Asthma Educator Institute will again be sponsored by the American Lung Association
in New Hampshire in partnership with the Southern New Hampshire Area Health Education
Center and the New Hampshire Department of Health and Human Service’s Asthma
Control Program.

The Asthma Educator Institute (AEI) is a two day course designed for health care
professionals with an interest in learning more about asthma, asthma management and
asthma education. For those asthma educators interested in seeking national certification
the curriculum reflects the detailed content outlined in the NAECB Certified Asthma
Educator candidate book (see www.naecb.org) for details). The AEI includes hands-on
skills, demonstrations, and practice to increase individuals’ knowledge and skills.

Who Should Attend

Individuals with a keen interest in developing skills as an asthma educator and/or would
like to prepare for the NAECB. To take the exam you must be a licensed or credentialed
healthcare professional or individual with 1,000 hours of experience in asthma education,
counseling or coordination services.

Course Objectives

At the end of the program, participants will be able to:
• Analyze the components of asthma education: lung pathophysiology, assessment of
physical status, environmental factors, learning styles, and factors relating to
culture, language, socioeconomic status, ethnicity, education level and
pharmacological interventions.
• Design asthma management and education plans for individuals from a variety of
situations.
• Teach individuals how to manage their asthma using appropriate devices and
techniques.
• Pursue national certification through NAECB if desired.

Continuing Education Accreditation

Application has been made to the American Association for Respiratory Care (AARC) for continuing education
contact hours for respiratory therapists.

Nurses:
The Southern New Hampshire Area Health Education Center is an approved provider of continuing nursing
education by the New Hampshire Nurses’ Association Commission on Continuing Education (NHNACCE), an
accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation.

This continuing education activity has been approved for 13.25 contact hours
Activity Number: 0965

Registration

Cost: $250. Limited Scholarships are available Registration deadline: June 12, 2009

Registration fee includes resource materials, continental breakfast and lunch both days. Upon completion, participant will
receive a continuing education certificate or a certificate of attendance.
Cancellation policy: any cancellation after June 8, 2009 will be assessed a $25 processing fee.
No refunds after June 8, 2009.
Three Easy Ways to Register

1. Register online at www.snhahec.org
2. Complete registration form below (please print) and mail to: Southern NH AHEC,
128 Route 27, Raymond, NH 03077 Attn: Tracie Holmes
3. Complete registration form below and fax to: (603) 895-1312
4. For questions please contact Tracie Holmes (603) 895-1514 ext. 4 or
tholmes@snhahec.org

Name: ______________________________ Credentials: ______________________

Mailing Address:
Street: _____________________________________

City/Town: __________________________________

State: ____________ Zip code: __________________

Place of Employment: _________________________________________________

Work phone: ___________________________

Home phone: ___________________________

Email: _________________________________

Payment Method

Registration fee: $250 (An email confirmation will follow you registration.)

____Check or Money Order enclosed (payable to the American Lung Association)

____Purchase Order requested from my organization made payable to the American
Lung Association.

*if you are interested in scholarship information please contact Tracie Holmes
at thomles@snhahec.org or 603-895-1514 ext. 4 Scholarships are limited.

For hotel reservations please contact the Holiday Inn in Nashua at
www.holidayinn.com/nashuanh or call 603-888-1551. To secure the group over night
rate of $84 please use AEI as your code.

May 2009 Asthma Calendar and Updates

2009-05-01T03:09:00.000-07:00

CALENDAR AND UPDATES MAY 2009

1. Calendar
2. Free Asthma Screenings in May
3. Swine Flu Resources
4. Asthma Updates

1. CALENDAR
If you have an asthma related event coming up, and you would like it posted on this calendar, please send the date, place, time and contact information to margoc@tds.net

May Asthma Awareness Month. Go to the EPA website for a planning kit http://www.epa.gov/asthma01/awm/index.html

May 14-15 Basic Motivational Interviewing. FMI: lstockwell@breathenh.org.

May 16 NH School Nurses Association Spring Conference, Wayfarer Inn, Bedford,
www.nhschoolnurses.org/.

May 28 Advanced Motivational Interviewing. FMI: lstockwell@breathenh.org.

May 28 NH Bureau of Elderly and Adult Services 2009 Conference on Aging, Radisson Hotel, Manchester, www.dhhs.nh.gov/DHHS/BEAS/2008coa.htm.

June 4-5 EPA National Asthma Forum, Washington DC. www.epaasthmaforum.com.

June 6-7 Asthma Family Weekend, YMCA Camp North Woods and Pleasant Valley,
Tuftonboro, NH The inaugural Breathe New Hampshire Family Weekend is
designed to help parents and children improve their understanding of asthma and
to enhance the lives of children who are coping with asthma. The weekend is a
time for families to interact and to participate in hiking, canoeing, arts and crafts,
and more, plus learn about asthma management and control. FMI: Lisa
Stockwell at (800) 835-8647 or lstockwell@breathenh.org.

June 10 NH Asthma Steering Committee Spring/Summer Meeting, 9-11:30 am, Society for the Protection of NH Forests. FMI: ldearborn@dhhs.state.nh.us or 603-271-0855

2. FREE ASTHMA SCREENINGS IN MAY
Free asthma screenings will be offered at more than 200 sites across the United States in May, which is
National Asthma and Allergy Awareness Month. Adults and children with symptoms such as wheezing,
coughing and shortness of breath are encouraged to take advantage of the screenings that will be
conducted by allergists. During a screening, adults and older children complete a 20-question test, while
children under age 15 complete a special test that allows them to answer questions about any breathing
problems. There's another test available for parents of children up to 8 years of age. Screening
participants also take a lung function test and then meet with an allergist to determine if they require a
thorough examination and diagnosis. To find the closest free asthma screening, go to
http://www.acaai.org/public/lifeQuality/nasp/locations.htm

3. SWINE FLU RESOURCES
• Posters for swine flu prevention are now on-line at www.cc-info.net

• The NH public inquiry line is now staffed from 8:00 am to 8:00 pm seven days a week to answer questions from the public about swine flu. The toll-free number is 888-330-6764.

4. ASTHMA UPDATES
EFFECT OF ESOMEPRAZOLE FOR TREATMENT OF POORLY CONTROLLED ASTHMA: In a parallel-group, double-blind trial, 412 participants with inadequately controlled asthma, despite treatment with inhaled corticosteroids, and with minimal or no symptoms of gastroesophageal reflux, were assigned to receive either 40 mg of esomeprazole twice a day or matching placebo. The study found that despite a high prevalence of asymptomatic gastroesophageal reflux among patients with poorly controlled asthma, treatment with proton-pump inhibitors does not improve asthma control. Asymptomatic gastroesophageal reflux is not a likely cause of poorly controlled asthma. N Engl J Med. 2009 Apr 9;360(15):1551-3.

COMBO INHALER MIGHT SIMPLIFY TREATMENT FOR ASTHMA: A systematic review compared the effectiveness of the new inhaler to the current “best practice” of separate inhalers for different phases of asthma treatment. The Cochrane reviewers found no significant reduction in the number of asthma exacerbations that required hospitalization among the patients who used single inhaler therapy. However, the reviewers did find that fewer adults on single inhaler therapy had exacerbations needing a course of oral corticosteroids. Compared with 18 people of 100 in the control inhaled corticosteroid group who had an exacerbation treated with oral steroids over 11 months, there were 11 of 100 for the single inhaler therapy group. “One attraction of the combined inhalers is that the inhaled corticosteroid is automatically taken with the beta-agonist, which does relieve symptoms. Single-inhaler therapy takes this one stage further, as the inhaled corticosteroid is automatically increased, with the beta-agonist, if the asthma symptoms worsen. This approach shows clear advantages in comparison to taking inhaled corticosteroids alone, but is less convincing when compared to current best practice.” The reviewers wrote that five large studies currently awaiting publication that compare single-inhaler therapy with the current separate inhaler therapy should provide further information about this approach to asthma management. Cochrane Database of Systematic Reviews, 2009; DOI: 10.1002/14651858.CD007313.pub2

LOW VITAMIN A, C INTAKE TIED TO ASTHMA RISK: A meta analysis of 40 studies conducted between 1980 and 2007 showed that people with asthma had a significantly lower dietary intake of vitamin A than those without the disease. The average intake among those with asthma was 182 micrograms a day, which is between a quarter and a third of recommended daily intake. The review authors also found that people with severe asthma had a significantly lower intake of vitamin C (about half the recommended daily intake) than those with mild asthma. In addition, low circulating levels of vitamin C in the blood and lower dietary intake of foods containing vitamin C were associated with a 12 percent increased risk of asthma. There was no association between vitamin E intake and asthma risk, but blood levels of vitamin E were much lower among people with severe asthma than in those with mild asthma. Those with severe asthma had an average vitamin E intake of 2 milligrams/day, which is 20 percent lower than the daily recommended amount, the review authors said. These findings don't prove cause and effect, but they do challenge a study published last year that found no association between antioxidants and asthma risk. Thorax 4/09

LOW VITAMIN D DEFICIENCY MAY MAKE ASTHMA WORSE: Researchers examined the association between vitamin D levels and markers of asthma severity and allergy in 616 asthmatic children from Costa Rica. Twenty-one children, or 3.4 percent, had blood levels of the vitamin D metabolite 25-hydroxyvitamin D considered to be "deficient" and an additional 152, or 24.6 percent, had vitamin D levels considered "insufficient." The investigators found that lower levels of vitamin D were associated with increased odds of being hospitalized for asthma, increased airway "twitchiness," and more severe allergies. American Journal of Respiratory and Critical Care Medicine 5/1/09

FOLIC ACID MAY LESSEN ASTHMA SYMPTOMS: Folic acid, or vitamin B9, may suppress allergic reactions and lessen the severity of allergy and asthma symptoms, according to a review of medical records of more than 8,000 people ages 2 to 85. People with higher blood levels of folate had fewer IgE antibodies, fewer reported allergies, less wheezing and lower likelihood of asthma Journal of Allergy & Clinical Immunology on-line 5/09

ASTHMA PLUS TRAFFIC EQUALS POOR LUNG FUNCTION: The results of a new study appear to expand the link between traffic exposure and poor lung function among people with asthma. In a study of 176 adults with asthma or rhinitis, found "the closer adults with asthma live to roadways with heavy traffic...the lower their lung function." Journal of Allergy and Clinical Immunology 4/09

ASTHMATIC KIDS BREATHE EASIER WITH SMOKE FREE AIR: For children with asthma, reducing exposure to environmental tobacco smoke greatly decreases their chances of an asthma flare-up, hospital admission or emergency room visit, a new study of 290 children with asthma shows. "We found this to be true when the child's exposure (to second-hand smoke) decreased, even if the decrease did not mean completely eliminating their exposure.” Chest, April 2009

PREGNANCY MANAGEMENT OPTIMIZES HEALTH OF MOTHERS WITH ASTHMA: Pregnant women with asthma, should actively manage their asthma in order to optimize the health of mother and the baby, according to new management recommendations published in the current issue of the New England Journal of Medicine . The recommendations are based to a large degree on a 12-year Kaiser Permanente study of 1,900 pregnant women, and a Maternal Fetal Medicine Units network study of 2,620 women from 16 university hospital centers around the country. Both studies concluded that women with actively managed asthma are just as likely to have healthy pregnancies and babies as women who don't have asthma.

FAMILY HISTORY OF ASTHMA BOOSTS ODDS ALMOST SIX TIMES: Adults with a family history of asthma are up to six times more likely to develop the disease than an average person, concludes a CDC study of 1,500 adults, aged 20 and older,. The researchers found that 85 percent of people were at average risk, 13 percent at moderate risk, and 2 percent at high risk. Asthma prevalence was 9.4 percent among those at average risk, 20.4 percent for those at moderate risk, and 37.6 for those at high risk. Asthma risk was 2.4 times higher for those at moderate risk and 4.8 times higher for those at high risk, compared to those at average risk. After they adjusted for other factors, the researchers found that asthma risk was 2.4 times higher in the moderate-risk group and 4.8 times higher in the high-risk group. Other asthma risk factors included being black, obesity, low income, smoking or living with a smoker, and physical inactivity. Average onset of asthma was 22 years in the average-risk group, 19 years in the moderate-risk group, and 17 years in the high-risk group. Genetics in Medicine 5/09

STATE OF THE AIR: The American Lung Association has issued State of the Air 2009. The highest grade received by a county (Belknap, Cheshire, Grafton, and Merrimack) in NH was a C. Coos, Hillsborough and Rockingham received Fs. For more information about NH go to http://www.stateoftheair.org/2009/states/new-hampshire/

COLLEGIATE ATHLETES WITH ASTHMA NEED MORE HEALTH: Very few athletic trainers associated with National Collegiate Athletic Association (NCAA) programs said that they were following best practice standards for managing asthma among their athletes, according to a new study. Medicine & Science in Sports & Exercise 5/09

MAYO CLINIC BACKS NEW PERSONAL HEALTH RECORD SITE: The Mayo Clinic has combined its medical expertise with Microsoft Corp.'s technology in a free Web site that will let people store personal health and medical information. The Mayo Clinic Health Manager is meant to give people an easy way to organize medical information and transfer it to a new clinic, hospital or specialist. But those providers aren't necessarily ready for such an electronic revolution, which for now means it takes some work on the patient's part to set up and maintain the records. The Mayo Clinic Health Manager uses Microsoft's HealthVault system to store medical histories, test results, immunization files and other records from doctors' offices and hospital visits, along with data from home devices like heart rate monitors. Anyone can sign up for an account, not just Mayo Clinic patients. Users can give access to different slices of their health information to doctors and family members as the need arises. Privacy advocates urge people who want to set up a personal health record online to read the fine print. Deven McGraw, director of the health privacy project at the Washington-based Center for Democracy and Technology, said sites like the Mayo Clinic Health Manager aren't currently covered by national laws that specify cases in which health care systems can access and share information without patients' consent. http://www.mayoclinic.com

AsthmNow Calendar and Updates 4/09

2009-04-06T01:40:00.000-07:00

CALENDAR AND UPDATES APRIL 2009

1. Calendar
2. American Academy of Allergy, Asthma & Immunology (AAAAI) Annual Meeting
3. Asthma Updates

1. CALENDAR
If you have an asthma related event coming up, and you would like it posted on this calendar, please send the date, place, time and contact information to margoc@tds.net

April 2 New England Asthma Regional Council Member Meeting. Panels on regional data analysis of asthma control indicators from the Behavioral Risk Factor Surveillance Survey and successful Healthy Homes programs; breakout sessions asthma health outcomes and best practices, asthma surveillance, indoor and ambient air quality, and healthy homes. Contact: mbrett@tmfnet.org 617-279-2289.

April 8 NH Public Health Association Annual Meeting, 4 pm Milyard Museum, Manchester. FMI: www.nhpha.org

April 16-17 Basic Motivational Interviewing. FMI: lstockwell@breathenh.org.

April 29 Update on Treatment and Nicotine Dependency, St. Anselm College Continuing Nursing Education, 5.5 contact hours. FMI: www.anselm.edu/cne, 603-641-7086.

April 30-May 1 2009 Asthma Educator Institute, Southern Maine Community College, South Portland ME. FMI: Lee G. Scott at lscott@lungme.org or call 1-207-624-0309
May Asthma Awareness Month. Go to the EPA website for a planning kit http://www.epa.gov/asthma01/awm/index.html

May 14-15 Basic Motivational Interviewing. FMI: lstockwell@breathenh.org.

May 16 NH School Nurses Association Spring Conference, Wayfarer Inn, Bedford,
www.nhschoolnurses.org/.

May 28 Advanced Motivational Interviewing. FMI: lstockwell@breathenh.org.

May 28 NH Bureau of Elderly and Adult Services 2009 Conference on Aging, Radisson Hotel, Manchester, www.dhhs.nh.gov/DHHS/BEAS/2008coa.htm.

June 4-5 EPA National Asthma Forum, Washington DC. www.epaasthmaforum.com.

June 6-7 Asthma Family Weekend, YMCA Camp North Woods and Pleasant Valley,
Tuftonboro, NH The inaugural Breathe New Hampshire Family Weekend is
designed to help parents and children improve their understanding of asthma and
to enhance the lives of children who are coping with asthma. The weekend is a
time for families to interact and to participate in hiking, canoeing, arts and crafts,
and more, plus learn about asthma management and control. FMI: Lisa
Stockwell at (800) 835-8647 or lstockwell@breathenh.org.

June 10 NH Asthma Steering Committee Spring/Summer Meeting, 9-11:30 am, Society for the Protection of NH Forests. FMI: ldearborn@dhhs.state.nh.us or 603-271-0855

2. AAAAI ANNUAL MEETING
The AAAAI meeting was held March 13-17 in Washington DC. For copies of abstracts go to http://www.aaaai.org/members/annual_meeting/am2009/ Late breaking abstracts are available in PDF at http://www.aaaai.org/members/annual_meeting/am2009/late_breaking_abstracts.pdf

• Long-Acting Beta Agonist Plus Inhaled Corticosteroid Beneficial in Children With Asthma Abstract 290

• Budesonide/Formoterol Combination Improves Small-Airway Obstruction in Moderate to Severe Persistent Asthma Over 1 Year: Abstract 291

• Bronchial Thermoplasty for Severe Asthma Opens Airways and Improves Quality of Life. Abstract 7

• Using More Than 6 Canisters of Short-Acting Beta2-Agonists Indicates High Risk for Asthma Exacerbations in Children Abstract 603

• Poorly-controlled asthma has detrimental effects on quality of life in patients with moderate to severe asthma. Abstract 436

• Mometasone Furoate/Formoterol Shows Similar Efficacy to Fluticasone Propionate/Salmeterol in Severe Asthma Abstract 606

3. ASTHMA UPDATES
CITY KIDS BREATH EASIER ELSEWHERE After a week away from urban air pollution, children with mild persistent asthma begin to show dramatic changes in their respiratory health. The researchers took 37 children who lived in an urban area in Italy and brought them to a rural hotel for a week of camp. All of the children had allergies and mild persistent asthma, though none were being treated at the time of the study. After a week in the rural environment, there was a fourfold decrease in nasal eosinophil levels and an increase in lung function, as measured by peak expiratory flow (the strength at which you can breathe out). Pediatrics 3/09

ANTIBIOTICS IN FIRST YEAR OF LIFE ASSOCIATED WITH SMALL INCREASE IN ASTHMA: A Canadian study has found that antibiotic use in the first year of life was associated with a small increase in the risk of developing asthma later in life and that the risk increases with each course of antibiotics that is prescribed. Pediatrics 3/09

NO LINK BETWEEN ASTHMA AND ROUTINE VACCINATION: A Swiss study found no link between the development of asthma and routine vaccination against whopping cough (pertussis). Pediatrics 3/09

ASTHMA COACHES KEEP KIDS OUT OF HOSPITAL: Community health workers acting as asthma coaches are able to reduce the need for rehospitalization for asthma episodes among children in low-income families. A population-based study of 191 African American children between 2 and 8 years of age covered by Medicaid who were hospitalized for asthma was were randomly assigned to usual care or to work for 2 years with an asthma coach. Coaches reinforced basic asthma education and positive behaviors to manage the disease on home visits and by phone calls. Teaching was tailored to the parents' "readiness to adopt management practices." Coaches used a "nondirective supportive style." "The coach doesn't need expertise, just basic familiarity with the terms of an action plan and the time and good communication skills to work effectively with the parent." There was an average of 21.1 contacts per parent over the 24 months of the intervention. During the first 3 months, 89.6 percent of parents had at least one contact with the coach. Thirty-five of 96 children (36.5 percent) assigned an asthma coach were rehospitalized with asthma compared with 55 of 93 children (59.1 percent) who received usual care. "The 52 percent reduction in hospitalization (average admissions per child, 0.73 in the coached and 1.52 in usual care group) is comparable with the effect of interventions implemented by professionals," the investigators report. While there was no reduction in visits to the emergency department (ED) in this study, there was a reduction in the need for hospitalization following an ED visit in the coached group, suggesting "acuity at arrival for emergency care may be reduced by having learned to initiate treatment before emergency care or to seek emergency care earlier." Archives of Pediatrics and Adolescent Medicine, March 2009

USING MUSIC & SPORTS TO IMPROVE KIDS’ ASTHMA: The singular appeal of music and sports can be successfully harnessed to deliver health information to young children and teens coping with asthma, while also encouraging them to stick more closely to the treatments prescribed for their condition, a pair of new studies suggests. One study explored giving teens regular access to popular music, via digital music players, and mixing in audio messages about asthma authored by the teens themselves. The result: Kids exposed to the music-message combo were much more likely to take their medications. A second study found that the amount of time young children ended up seeking asthma treatment from either a doctor or a hospital emergency room dropped in the months after they participated in a day-long asthma education camp that had been coupled with basketball lessons. "We improved asthma controller adherence to above the clinically important 70 percent mark, up from 39 percent before we began. And we maintained it above 70 percent for the entire study.” So this is very exciting." AAAAI Meeting

NEW TREATMENTS IMPROVE CONTROL FOR SEVERE ASTHMA: Over just one decade, new medications and tools have significantly improved the management of asthma. When compared to children treated in the mid-'90s, children with severe asthma during 2004 to 2007 were less likely to need oral steroids and rescue inhalers, and their lung function scores were improved, according to a study from National Jewish Health in Denver. "The current cohort was less likely to require chronic oral glucocorticoids, have better asthma control and have fewer glucocorticoid-induced adverse effects compared to a cohort of severe asthmatic children studied a decade ago.” AAAAI Annual Meeting

SUSPENDING ASTHMA TREATMENT CAN INCREASE RISKS OF PREMATURE BIRTH AND HYPERTENSION: Pregnant women with asthma run a greater risk of giving birth prematurely if they suspend their asthma treatments. In addition, the probability of suffering from hypertension during pregnancy also increases for women who interrupt their asthma treatment.” Contrary to what some researchers have said, there is no difference between male and female hormones and how they impact bronchial sensitivity, which would in turn accentuate asthma symptoms when a woman carries a girl.” The study used data collected by the Régie de l'assurance maladie, the Ministère de la santé et des services sociaux and the Institut de la statistique du Québec, on 13,000 pregnant women who consulted a physician for asthma between 1990 and 2002. Respiratory Medicine 3/09

EXPERIMENTAL DRUG MAY DAMPEN SEVERE ASTHMA: A new type of asthma therapy might be especially helpful for people with severe asthma who often have to take oral steroids to control their symptoms. The drug is called mepolizumab, and two small studies in the March 5 issue of the New England Journal of Medicine have found that, when taken regularly, it can reduce asthma exacerbations. Additionally, people taking the drug had lower levels of eosinophils, a type of white blood cell that has been implicated as a potential cause of asthma. "This is a new treatment which substantially reduces the risk of asthma attacks in a severe asthma population," said the senior author of one of the studies. Both studies were funded by GlaxcoSmithKline, the pharmaceutical company that is developing the drug. New England Journal of Medicine 3/5/09

BROCCOLI SPROUTS MAY SOOTHE AIRWAY INFLAMMATION: In a study of 65 healthy volunteers, researchers found that an oral preparation made from broccoli sprouts trigger an increase in inflammation-fighting enzymes in the upper airways. The credit appears to go to a compound called sulforaphane, which is found naturally in broccoli and other cruciferous vegetables like Brussels sprouts, cauliflower and cabbage. "Further studies will be needed to investigate the clinical significance, and so it's too early to give advice on a beneficial 'dose' of cruciferous vegetables." Broccoli sprouts contain 20 to 50 times the concentration of sulforaphane that mature broccoli does. So a person would have to eat large amounts of broccoli to get the sulforaphane dose that young broccoli sprouts provide. Clinical Immunology 3/09

AsthmaNow Updates and Calendar March 2009

2009-03-02T08:19:00.000-08:00

CALENDAR AND UPDATES MARCH 2009

1. Calendar
2. Asthma Updates

1. CALENDAR
If you have an asthma related event coming up, and you would like it posted on this calendar, please send the date, place, time and contact information to margoc@tds.net

March 3-6 19th Annual Dartmouth Pediatric Conference, Stratton Mountain Resort. FMI: Karen.lee@hitchcock.org

March 5 Breathe Easy at Home Program: Linking Asthma Clinicians to Housing, Code Enforcement EPA Asthma Program Webisnar 2-3 pm. Register.

March 18 Successful Chronic Disease Management: One Patient at a Time, Grappone Center, Concord NH Conference objectives: define risk factors common to chronic diseases and identify innovative strategies to reduce them; integrate strategies to reduce the impact of chronic disease morbidity and promote optimal health; and enhance professional networks to better prevent and manage chronic diseases. FMI mcloitre@snhahec.org or 603-895-1514 ext. 3

March 21 Queen City Climb to benefit the NH Lung Association. Hampshire Plaza, 1000 Elm Street, Manchester, NH. Fundraising minimum of $65 must be turned in day of climb. FMI:

April 2 New England Asthma Regional Council Member Meeting. Panels on regional data analysis of asthma control indicators from the Behavioral Risk Factor Surveillance Survey and successful Healthy Homes programs; breakout sessions asthma health outcomes and best practices, asthma surveillance, indoor and ambient air quality, and healthy homes. Contact: mbrett@tmfnet.org 617-279-2289.

April 8 NH Public Health Association Annual Meeting, 4 pm Milyard Museum, Manchester. FMI: www.nhpha.org

April 16-17 Basic Motivational Interviewing. FMI: lstockwell@breathenh.org.

April 29 Update on Treatment and Nicotine Dependency, St. Anselm College Continuing Nursing Education, 5.5 contact hours. FMI: www.anselm.edu/cne, 603-641-7086.

April 30-May 1 2009 Asthma Educator Institute, Southern Maine Community College, South Portland ME. FMI: Lee G. Scott at lscott@lungme.org or call 1-207-624-0309

May Asthma Awareness Month. Go to the EPA website for a planning kit http://www.epa.gov/asthma01/awm/index.html

May 14-15 Basic Motivational Interviewing. FMI: lstockwell@breathenh.org.

May 16 NH School Nurses Association Spring Conference, Wayfarer Inn, Bedford,
www.nhschoolnurses.org/.

May 28 Advanced Motivational Interviewing. FMI: lstockwell@breathenh.org.

May 28 NH Bureau of Elderly and Adult Services 2009 Conference on Aging, Radisson Hotel, Manchester, www.dhhs.nh.gov/DHHS/BEAS/2008coa.htm.

June 4-5 EPA National Asthma Forum, Washington DC. www.epaasthmaforum.com.

June 6-7 Asthma Family Weekend, YMCA Camp North Woods and Pleasant Valley,
Tuftonboro, NH The inaugural Breathe New Hampshire Family Weekend is
designed to help parents and children improve their understanding of asthma and
to enhance the lives of children who are coping with asthma. The weekend is a
time for families to interact and to participate in hiking, canoeing, arts and crafts,
and more, plus learn about asthma management and control. FMI: Lisa
Stockwell at (800) 835-8647 or lstockwell@breathenh.org.

June 10 NH Asthma Steering Committee Spring/Summer Meeting, 9-11:30 am, Society for the Protection of NH Forests. FMI: ldearborn@dhhs.state.nh.us or 603-271-0855

2. ASTHMA UPDATES
ASTHMA DRUGS NEED TO BE MAINTAINED FOR CONTINUED BENEFIT “CAMP” STUDY FINDINGS: Children whose asthma improved while taking steroid drugs for several years did not see those improvements continue after stopping the drugs, The results come from the Childhood Asthma Management Program (CAMP) clinical trial, in which more than 1,000 children age 5-12 were treated for mild to moderate asthma over more than four years at eight centers, including Washington University School of Medicine in St. Louis. The children in the randomized trial were divided into three groups: one received twice-daily budesonide, an inhaled corticosteroid medication; one received nedocromil, an inhaled non-steroid medication; and one group received a placebo. All children received albuterol, a bronchodilator, and oral corticosteroids as needed for asthma symptoms. The study followed up with the children nearly five years after the end of the trial. Researchers found that the children, now in their late teens, who took the medications during the trial showed no difference in their asthma control compared with the children who received the placebo. "The interesting thing is that as kids with asthma get older, they actually do better, we used to say they were outgrowing their asthma. What we know now is that as they go from being young children to age 20, their airways get bigger. They still have asthma but don't have as much trouble from it." Although the patients had fewer symptoms five years after stopping the daily medication, Strunk cautions that doesn't mean that they can stop using asthma medications altogether or that their asthma is cured. "While the kids did get better with age and didn't seem to need the medicine as much, laboratory measurements indicated that they were still having symptoms, and therefore were primed to an attack if they got a bad cold or were exposed to a significant weather change." The researchers determined that continued benefit of these medications likely requires continued use.

In another part of the follow-up study, researchers looked at long-term side effects of the steroid medications on growth, bone density and fracture rate. The only side effect of budesonide was a 0.4-inch decrease in height among female patients compared to the patients who took a placebo during the trial. However, one-fourth of the girls and more than half of the boys in the trial had not reached final adult height at the end of the post-trial period, researchers said. There were no effects of the nedocromil treatment on growth. The Journal of Pediatrics, 2009; DOI: 10.1016/

NEW ASTHMA RESEARCH QUESTIONS CURRENT DRUG TREATMENT: Just when the Food and Drug Administration is reconsidering the use of stimulants to treat asthma, a new research study offers further evidence to support a University of Houston professor's theory that an opposite approach to asthma treatment may be in order. Richard A. Bond has been investigating whether beta blockers ultimately might be a safer, more effective strategy for long-term asthma management than the currently used beta-2 adrenoreceptor agonists (or stimulants). A recent study shows the absence of asthma-like symptoms in a mouse model that lacks the key gene that produces the receptor. This lends further evidence to Bond's theory that questions whether the pharmaceutical industry should be working to block or inhibit the receptor instead of the current approach of chronically stimulating it to reduce asthma symptoms. Bond and his colleagues propose an alternative to stimulants, using antagonists (or beta blockers) instead. This approach, termed paradoxical pharmacology, suggests patients may be treated with medication that initially worsens their symptoms before eventually improving their overall health. Proceedings of the National Academy of Sciences 2/09

SCHOOL SUPERVISED ASTHMA THERAPY IMPROVES CONTROL: New research suggests that adherence with daily asthma "controller" medications among children with asthma can be enhanced with school-based supervised asthma therapy. Researchers assessed asthma control in 290 children from 36 schools who were randomized to receive school-based, supervised therapy or usual care. No change in asthma control was seen in children in the control group during the 15-month follow-up period. For the group privy to supervised asthma therapy at school, however, the likelihood of poor asthma control was 57 percent higher during the period before the study than during the follow-up period, indicating that supervised asthma therapy had a marked impact on their asthma symptoms. "Once-daily supervised asthma therapy is a simple intervention that improves asthma control." Doctors who have children with poorly controlled asthma possibly due to non-adherence to controller medication "should consider coordinating supervised therapy with the parent and the child's school." Pediatrics, February 2009

KIDS WHOSE ASTHMA IS UNDER CONTROL MAY NOT MISS MORE SCHOOL: Although it is commonly thought that children who suffer from asthma miss more school than their peers, a new study suggests this is not the case. A study, of 19 inner-city Dallas schools, found that fourth-, fifth- and sixth-graders with asthma had no more absences than their classmates without the lung disease. "This study shows that school-aged children with asthma may not suffer unduly from absences, if their asthma is well-controlled." "In 2009, parents should expect that their children with asthma should be able to compete on the same playing field as their non-asthmatic peers, participating in the same activities and achieving the same degree of success, with current asthma medications available." Students in Dallas schools have benefited from proactive measures to help control the problem. Nearly all schools have a full-time registered nurse who develops an asthma management plan for each student with the lung condition. Nurses also complete continuing education on proper asthma management and can refer students who are not on the appropriate medication to neighborhood clinics for follow-up. In this study, students whose asthma had been identified by a school nurse had no more school absences than their peers whose asthma was spotted during a screening program conducted at the schools. Chest, February 2009

INDOOR AIR POLLUTION INCREASES ASTHMA SYMPTOMS AMONG CHILDREN: A new study has found an association between increasing levels of indoor particulate matter pollution and the severity of asthma symptoms among children. The study, which followed a group of 150 children with asthma, ages 2 to 6, in Baltimore, Md., is among the first to examine the effects of indoor particulate matter pollution. Ninety-one percent of the children who participated in the study were African-American, from lower socioeconomic backgrounds, and spent most of their time indoors.
“We found that substantial increases in asthma symptoms were associated both with higher indoor concentrations of fine particles and with higher indoor concentrations of coarse particles.” For every 10 micrograms per cubic meter of air (ug/m3) increase in indoor coarse particle concentration, there was a 6 percent increase in the number of days of cough, wheeze, or chest tightness, after adjusting for a number of factors. For every 10 ug/m3 increase in fine particles measured indoors, there was a 7 percent increase in days of wheezing severe enough to limit speech and after adjusting for various factors, a 4 percent increase in days on which rescue medication was needed. In many cases, the level of indoor fine particle pollution measured was twice as high as the accepted standard for outdoor pollution established by the EPA. “Improving indoor air quality and lowering indoor particulate matter concentrations may provide additional means of improving asthma health, especially for children living in inner cities.” Environmental Health Perspectives, 2008; DOI: 10.1289/ehp.11770

BABIES BORN IN POLLEN AND MOLD SEASONS HAVE GREATER ODDS OF DEVELOPING ASTHMA SYMPTOMS: A study of 514 children born in 1999 and 2000 in California's Salinas Valley, a region with mild, rainy winters and dry summers, were studied for any link between mold and asthma. Researchers identified 27 spore and 48 pollen groups in the study, recording the average daily concentrations for the groups that accounted for more than 3 percent of the total during the first three months of life for each child in the study. The peak of the pollen and spore seasons did not always occur in the same months of each study year, but for this region, ambient mold levels begin to increase in November and December, and pollen peaks in the early spring months of March and April, the researchers said. After adjusting for such factors as family history of asthma, air pollution, secondhand smoke and signs of cockroaches, rodents or mold in the home, the researchers found that babies born in the fall and winter have triple the odds of developing early wheezing, often a precursor to asthma, by 24 months of age. Thorax on-line 2/24/09

PRENATAL EXPOSURE TO POLLUTION MAY LEAD TO ASTHMA: Traffic pollution may cause genetic changes in the womb that increase a child's risk of developing asthma, concludes a study of umbilical cord blood from New York City children. Evidence was found of a possible new biomarker -- an epigenetic alteration in the gene ACSL3 -- associated with prenatal exposure to polycyclic aromatic hydrocarbons (PAHs), which are created as byproducts of incomplete combustion of carbon-containing fuels such as gasoline. PAH levels are high in heavy-traffic areas, and exposure to PAHs has been linked to such diseases as cancer and childhood asthma. PLoS One 2/16/09

C-SECTION MAY RAISE ASTHMA RISK 2917 children were studied for asthma and allergy risks up to 8 years of age. Children delivered by c-section were 79 percent more likely to develop asthma than children born vaginally. The association between c-section and asthma was even stronger for children born to one or two allergic parents than for children born to parents without allergies. Thorax, February 2009

FAST FOOD DIET CANCELS OUT BENEFITS OF BREASTFEEDING IN PREVENTING ASTHMA: Many studies have shown that breastfeeding appears to reduce the chance of children developing asthma. But a newly published study has found that eating fast food more than once or twice a week negated the beneficial effects that breastfeeding has in protecting children from the respiratory disease. More than half the children studied ate fast food more than twice a week. The researchers suggested the prevalence of fast food in today's society may explain why asthma rates keep rising even though more mothers are breastfeeding. The group did not look at why fast food might cause asthma, but the authors suggest the high fat content, and high salt levels (which can increase twitchy airways and wheezing) may be to blame. Clinical and Experimental Allergy 1/09

CLEANING HOME MAY WORSEN ASTHMA: Scrubbing the kitchen floor or doing other cleaning chores around the home may trigger a spike in breathing problems in women with asthma. In a 12-week study, the health effects of household cleaning among 25 asthmatic and 19 non-asthmatic women who reported that they are the primary cleaners in their homes were studied. After cleaning, the researchers observed a statistically significant increase in the number of respiratory symptoms in asthmatic women compared with non-asthmatic women, "which indicates that these cleaning activities were aggravating their symptoms." In fact, according to the researchers, all of the women in the study - both asthmatic and non-asthmatic women - exhibited respiratory symptoms in response to exposure to cleaning agents rated as mild in toxicity. This finding, they say, points to a subtle but potentially important adverse health effect of long-term low-level exposure to these chemicals. Annals of Allergy, Asthma and Immunology, January 2009

IMPACT OF TV AND COMPUTERS ON URBAN CHILDREN WITH ASTHMA: In the first study to examine screen time among children with asthma, 74 percent of the 226 children whose parents were surveyed exceeded more than two hours of screen time per day. On average, children with asthma watched 3.4 hours daily. "Even though these findings are preliminary, a message for parents would be to remain aware of the amount of time your child is spending in front of screens and try to encourage your child to participate in a range of activities," Though the American Academy of Pediatrics recommends that no child have a television in their bedroom, 77 percent of the children had a TV in their room and nearly half the children owned a hand-held video game system. Even though the goals of asthma therapy are to quell asthmatic symptoms and prevent limitations with activities, about 63 percent of children used screen time when their asthma symptoms physically limited their activities. Researchers suspect that some parents could have underestimated their child's screen time, which would demonstrate an even larger problem of excessive screen time and lack of other physical and mental activities than the study found. Academic Pediatrics 1/09

February 2009 Calendar and Updates

2009-01-31T01:07:00.000-08:00

CALENDAR AND UPDATES FEBRUARY 2009

1. Calendar
2. Asthma Updates

1. CALENDAR
If you have an asthma related event coming up, and you would like it posted on this calendar, please send the date, place, time and contact information to margoc@tds.net

February 6 NH Public Health Association Open House, 4 pm at 4 Park Street, 3rd floor, Concord, NH

February 17 NH Asthma Steering Committee Winter Meeting, 9-11:30 am, Society for the Protection of NH Forests. FMI: ldearborn@dhhs.state.nh.us or 603-271-0855

February 25-26 Northern New England Facilities Masters Conference: Career development and professional training event exclusively for School Operations Professionals in New Hampshire, Maine and Vermont. Best Practices in Facilities Planning and Management, Energy Management, Environmental Issues and Risk Management SchoolDude Services and Product Training. FMI: Nan Comai, NNE Facility Masters Conference, amencomai@comcast.net 1-603-315-8534

March 3-6 19th Annual Dartmouth Pediatric Conference, Stratton Mountain Resort. FMI: Karen.lee@hitchcock.org

March 18 Successful Chronic Disease Management: One Patient at a Time, Grappone Center, Concord NH Conference objectives: define risk factors common to chronic diseases and identify innovative strategies to reduce them; integrate strategies to reduce the impact of chronic disease morbidity and promote optimal health; and enhance professional networks to better prevent and manage chronic diseases. FMI mcloitre@snhahec.org or 603-895-1514 ext. 3

March 21 Queen City Climb to benefit the NH Lung Association. Hampshire Plaza, 1000 Elm Street, Manchester, NH. Fundraising minimum of $65 must be turned in day of climb. FMI: http://www.mrsnv.com/evt/home.jsp;jsessionid=723062e89da41f657d38?id=2247

April 2 New England Asthma Regional Council Member Meeting. Panels on regional data analysis of asthma control indicators from the Behavioral Risk Factor Surveillance Survey and successful Healthy Homes programs; breakout sessions asthma health outcomes and best practices, asthma surveillance, indoor and ambient air quality, and healthy homes. Contact: mbrett@tmfnet.org 617-279-2289.

April 8 NH Public Health Association Annual Meeting, 4 pm Milyard Museum, Manchester. FMI: www.nhpha.org

April 16-17 Basic Motivational Interviewing. FMI: lstockwell@breathenh.org.

April 29 Update on Treatment and Nicotine Dependency, St. Anselm College Continuing Nursing Education, 5.5 contact hours. FMI: www.anselm.edu/cne, 603-641-7086.

April 30-May 1 2009 Asthma Educator Institute, Southern Maine Community College, South Portland ME. FMI: Lee G. Scott at lscott@lungme.org or call 1-207-624-0309

May Asthma Awareness Month. Go to the EPA website for a planning kit http://www.epa.gov/asthma01/awm/index.html

May 14-15 Basic Motivational Interviewing. FMI: lstockwell@breathenh.org.

May 28 Advanced Motivational Interviewing. FMI: lstockwell@breathenh.org.

June 6-7 Asthma Family Weekend, YMCA Camp North Woods and Pleasant Valley, Tuftonboro, NH The inaugural Breathe New Hampshire Family Weekend is designed to help parents and children improve their understanding of asthma and to enhance the lives of children who are coping with asthma. The weekend is a time for families to interact and to participate in hiking, canoeing, arts and crafts, and more, plus learn about asthma management and control. FMI: Lisa Stockwell at (800) 835-8647 or lstockwell@breathenh.org.

June 10 NH Asthma Steering Committee Spring/Summer Meeting, 9-11:30 am, Society for the Protection of NH Forests. FMI: ldearborn@dhhs.state.nh.us or 603-271-0855

2. ASTHMA UPDATES
US FLUNKS ON TOBACCO CONTROL REPORT CARD: According to the American Lung Association's State of Tobacco Control 2008, the federal government as well as most states failed to enact critical policy measures, such as higher taxes on cigarettes and to adequately regulate tobacco products. Tobacco-related diseases kill more than 392,000 Americans each year, and another 50,000 die from exposure to secondhand smoke. The report card faulted the federal government for not doing more to increase access to smoking-cessation programs, "While the Medicare drug program covers smoking-cessation drugs, the federal government does not require state Medicaid programs to cover cessation treatments and services for Medicaid recipients. This, despite the fact that people receiving Medicaid smoke at almost a 60 percent higher rate than the national average.” On the state level, no state earned a straight A. Hawaii, Maine, Massachusetts and Rhode Island received the best grades. The states with the worst grades -- all Fs -- were Alabama, Kentucky, Missouri, North Carolina, South Carolina, Virginia and West Virginia, according to the report. In 2008, only Massachusetts, New Hampshire, New York and the District of Columbia raised cigarette taxes. The average state tax is $1.19 per pack, Billings said. New York State has the highest tax at $2.75 a pack; South Carolina has the lowest at 7 cents a pack. American Lung Association http://www.lungusa.org/site/c.dvLUK9O0E/b.22937/k.A576/Tobacco_Control.htm

CLEANING PRODUCTS UP NURSES’ ASTHMA RISK: Frequent exposure to hospital cleaning products and disinfectants greatly increases nurses' risk of asthma, according to a U.S. study that included 3,650 Texan health care professionals, including 941 nurses. The researchers found that nurses regularly exposed to cleaning products and disinfectants were 72 percent more likely than other health care colleagues to report being diagnosed with asthma since starting their job, and 57 percent more likely to report symptoms similar to asthma. Nurses who regularly cleaned medical instruments were 67 percent more likely to have newly diagnosed asthma, and those working with solvents and glues used in-patient care were 51 percent more likely to report symptoms similar to asthma. Nurses who used powdered latex gloves before the year 2000 were 6 percent more likely to have newly diagnosed asthma. The researchers noted that products used by nurses in the study included a number known to be potentially strong respiratory irritants or sensitizers. These include: topical cleansers and antiseptics used for cleaning patients' skin; glutaraldehyde for cold sterilization of medical instruments; and all-purpose general cleaning products, such as bleach. Occupational and Environmental Medicine 1/09 http://oem.bmj.com/

FDA SAYS SINGULAIR DATA DO NOT SUGGEST SUICIDE LINK: The FDA says their review of clinical trials does not suggest Merck & Co's Singulair asthma drug or similar medicines cause suicide or suicidal thought, although the data were inadequate to draw a firm conclusion. However, the FDA said it was continuing to review the data to determine if the class of drugs causes other psychiatric problems, including mood and behavioral changes. The agency noted it may take months to conclude that analysis and report its findings. The FDA last March said it would conduct a 9-month review of safety data that raised concerns that Singulair (montelukast) might be linked to suicidal thought, suicide and behavioral and mood side effects. The agency also studied trials involving two other medicines that work by blocking inflammation-causing proteins called leukotrienes, AstraZeneca Pls's Accolate (zafirlukast) and Zyflo (zileuton) sold by Cornerstone Therapeutics Inc. "Although these data do not suggest that montelukast, zafirlukast or zileuton are associated with suicide or suicidal behavior, these clinical trials were not designed specifically to examine neuropsychiatric events," the FDA said. "As a result, some events may not have been reported." The FDA said it had reviewed results of 41 placebo-controlled trials involving Singulair conducted among patients 6 years of age and older. "One adult patient out of 9929 patients treated with (Singulair) had suicidal ideation and there were no completed suicides," the agency said. It said no patients taking placebos in the Singulair trials had suicidal thoughts or committed suicide. No patients taking Accolate in 45 trials had suicidal thoughts or completed suicide, while one patient taking a placebo in the trials tried suicide and another had suicidal thoughts, the FDA said. No patients in 11 Zyflo trials, either those taking the drug or a placebo, had suicidal thoughts or completed suicide, the FDA said.1/14/09 http://www.medscape.com/viewarticle/586789

NITRIC OXIDE MONITORING DOES NOT HELP MOST CHILDREN WITH ASTHMA: Calibrating medications based on daily monitoring of the fractional exhaled nitric oxide (FENO) and symptoms in asthmatic children showed no significant improvement over medicating based on daily symptom monitoring alone. The study randomized 151 children from 15 academic centers and hospitals with mild to moderate asthma to a 30-week monitoring course. Families were called every 3 weeks and reported on the daily symptoms in the prior 3 weeks. The child's medication was adjusted accordingly. The researchers compared the rates of exacerbation, symptoms, use of medications, and other endpoints between the last 12 weeks in the 2 groups. There were no significant differences whether or not FENO had been part of the daily monitoring. However, both groups enjoyed an impressive overall improvement in symptoms, despite a reduction of about 50% in inhaled steroid dose, suggesting considerable benefit of frequent monitoring. The FENO group did, however, have nearly twice as many dosage changes as the symptom-only group, which supports the idea that the lack of difference may be a reflection on the limits of compliance, rather than an inherent limitation in the technique. Still, the added cost and apparent lack of benefit of daily FENO monitoring found in this study suggests that applying the technique in this way is not of benefit to the asthmatic population at large, when compared to daily symptom monitoring. American Journal of Respiratory and Critical Care Medicine 1/09 ajrccm.atsjournals.org/

STEROIDS DO NOT HELP WHEEZING KIDS: Steroid drugs, a common treatment for young children prone to wheezing and colds, do not help and may even be harmful, according to new research. Preschoolers in Britain who were hospitalized with a wheezing attack and treated with the steroid prednisolone stayed just as long as other children who were given placebos. In another study, Canadian children who had previous wheezing trouble and who took the steroid fluticasone as a preventive measure showed modest improvement, but the side effect of possible stunted growth outweighed the benefit, researchers said. New England Journal of Medicine 1/22/09 content.nejm.org/

STRESSED KIDS AT RISK OF ASTHMA IN ADULTHOOD: Children who suffer physical abuse, death of a parent or other childhood adversity and are anxious or depressed are at increased risk of developing asthma in adulthood, a study suggests. The findings stem from information gathered from more than 18,000 adults in the Americas, Europe and Asia who were interviewed between 2001 and 2004 as part of the World Mental Health surveys. Childhood adversity predicted adult-onset asthma, with increasing risk correlating with a greater number of adversities suffered in childhood. These adversities included physical or sexual abuse, neglect, parental death, parent divorce, other parental loss, parental mental disorder, parental substance use, parental criminal behavior, family violence, and family economic adversity. Anxiety and depressive disorders in childhood also strongly predicted the development of asthma later in life. The presence of both childhood adversity and childhood anxiety or depression also increased the risk of a child suffering from asthma as an adult. The ties between childhood adversity and anxiety and depression held up in analyses that factored in the impact of smoking on the risk of asthma. This suggests that the relationship between mental disorders and subsequent asthma onset is independent of smoking. It's unclear if childhood adversity and anxiety and depression actually cause adult asthma, although there are some plausible biological mechanisms to support a causal link. Psychosomatic Medicine November/December 2008 www.psychosomaticmedicine.org/

PARENT HEALTH SWAYS VIEWS OF CHILDREN WITH ASTHMA’S HEALTH: A study of more than 500 children, aged 5 to 17, with asthma, found that those whose parents had a chronic health problem tended to miss more school days. Their parents were also less likely than other parents to rate their child's health as "very good." On average, children whose parents had a chronic disease missed one to two more days of school per year. The findings suggest that parents with chronic health conditions of their own may have "altered perceptions" of their children's health. These parents may, for example, be more likely to see their children as vulnerable, keeping them home from school more often or keeping them out of certain activities. Pediatrics 1/09 pediatrics.aappublications.org/

AsthmaNow Calendar and Updates 1/09

2009-01-22T06:55:00.000-08:00

CALENDAR AND UPDATES JANUARY 2009

1. Calendar
2. Asthma Updates

1. CALENDAR
If you have an asthma related event coming up, and you would like it posted on this calendar, please send the date, place, time and contact information to margoc@tds.net

January 29 Asthma & COPD: Everything you need to know to tell the difference. 6 pm. Location TBA. Dinner and presentation for asthma educators. Presenter: Dr. Albee Budnitz, Downtown Medical Associates, Nashua. Sponsors: Breathe NH and NH Asthma Control Program. Register online: www.breathenh.org

March 3-6 19th Annual Dartmouth Pediatric Conference, Stratton Mountain Resort. FMI: Karen.lee@hitchcock.org

March 18 Successful Chronic Disease Management: One Patient at a Time, Grappone Center, Concord NH This conference will focus on prevention, risk factors, co-morbidities & impact. The objectives of the conference are to: define risk factors common to chronic diseases and identify innovative strategies to reduce them; ntegrate strategies to reduce the impact of chronic disease morbidity and promote optimal health; and enhance professional networks to better prevent and manage chronic diseases. FMI msteele@snhahec.org or 603-895-1514 ext. 3

March 21 Queen City Climb to benefit the NH Lung Association. Hampshire Plaza, 1000 Elm Street, Manchester, NH. Fundraising minimum of $65 must be turned in day of climb. FMI: http://www.mrsnv.com/evt/home.jsp;jsessionid=723062e89da41f657d38?id=2247

April 2 New England Asthma Regional Council Member Meeting. Agenda and location TBA

April 8 NH Public Health Association Annual Meeting, 4 pm Milyard Museum, Manchester. FMI: www.nhpha.org

April 16-17 Basic Motivational Interviewing. FMI: lstockwell@breathenh.org.
May Asthma Awareness Month. Go to the EPA website for a planning kit http://www.epa.gov/asthma01/awm/index.html

May 14-15 Basic Motivational Interviewing. FMI: lstockwell@breathenh.org.

June 6-7 Asthma Family Weekend, YMCA Camp North Woods and Pleasant Valley,
Tuftonboro, NH The inaugural Breathe New Hampshire Family Weekend is
designed to help parents and children improve their understanding of asthma and
to enhance the lives of children who are coping with asthma. The weekend is a
time for families to interact and to participate in hiking, canoeing, arts and crafts,
and more, plus learn about asthma management and control. FMI: Lisa
Stockwell at (800) 835-8647 or lstockwell@breathenh.org.

2. ASTHMA UPDATES
ROUGH TRANSITION TO A NEW ASTHMA INHALER http://www.breathenh.org/NETCOMMUNITY/Page.aspx?pid=441&srcid=441] Beginning January 1, all albuterol inhalers must be powered by the more eco-friendly chemical HFA, or hydrofluoroalkane.. This change is required by the 2005 federal mandate to comply with the 1987 treaty to protect the earth’s ozone layer by banning most uses of CFCs (chlorofluorocarbon). The new inhalers will be three times the cost of the old ones $30-$60 versus $5-$10- and there are differences in feel, force, taste, and how they are primed and cleaned. There are a number of concerns about whether the medical community, patients and their families, are prepared for this change.

RISKS OF NEW ASTHMA DRUGS VARY, FDA: Advair does not appear to have an increased risk of serious respiratory complications seen with similar new medicines, according to the FDA. But a less widely used medication, Serevent, had a significantly higher rate of complications when compared to older treatments, The FDA is concerned about asthma drugs known as LABAs, which already carry warnings. The long-acting medications relax tight muscles around stressed airways and free patients from the need to take a puff from their inhaler every few hours. For many asthma sufferers, that means they can sleep through the night. But LABAs, for reasons that are still being debated, can increase risks of death and respiratory complications in some patients. The risk may be lower when a LABA is used together with a steroid to treat underlying inflammation deep inside the airways. Current medical guidelines suggest using both kinds of drugs together for patients with chronic asthma who are not responding well to other treatments. A review team from the FDA's safety office unanimously recommended that Serevent and Foradil, the two LABA-only drugs, no longer be approved for treating asthma. Safety reviewers also recommended that none of the drugs be used to treat children, because clinical data indicates they are at greater risk of developing respiratory complications with LABAs. Associated Press 12/5/08 http://www.npr.org/templates/story/story.php?storyId=98116239

TOO MANY KIDS WITH ASTHMA BREATHING SMOKE: A "distressingly high" proportion of inner-city children with asthma are exposed to cigarette smoke at levels that could be harming their health, a study conducted in Chicago demonstrates. More than two-thirds of the 8- to 14-year-olds in the study had levels of the nicotine byproduct cotinine in their saliva demonstrating that they were breathing enough second-hand smoke to affect their asthma. Researchers surveyed caregivers of 482 8- to 14-year-old children with asthma about tobacco use, and also tested the children's saliva for cotinine, an indicator of tobacco smoke exposure. Nearly half of the caregivers said that there were smokers living in the household, while 31 percent admitted to smoking themselves. But the saliva tests revealed that roughly 68 percent of the children were exposed to tobacco smoke. Among the children with caregivers who reported smoking, cotinine levels were nearly double those of the children whose caregivers didn't smoke. Having a smoker in the household also increased cotinine levels, but to a lesser degree. Journal of Allergy and Clinical Immunology, October 2008 http://www.jacionline.org/

ALMOST HALF OF KIDS STILL EXPOSED TO SECOND HAND SMOKE: Despite progress in establishing clean indoor air policies, 42 percent of U.S. children are still exposed to secondhand smoke each week, according to a new survey. Among the other major findings from the Social Climate Survey of Tobacco [Make live link to http://www.socialclimate.org/reports.html]

* Seventy-five percent of American households forbid smoking in the home and car, but children in one-quarter of U.S. families aren't protected from secondhand smoke.
* Among parents who smoke, only 53.5 percent prohibit smoking in the home and only 22.5 percent forbid smoking in the family vehicle.
* More nonsmokers than smokers prohibit smoking in their home.
* More than 25 percent of smokers report that children have been exposed to smoke in their home.
* About 8.1 percent of U.S. parents report that their child has been exposed to secondhand smoke in an indoor public place in the past seven days.

The survey was released by the American Legacy Foundation, the American Academy of Pediatrics (AAP), and researchers from Mississippi State University.

SECONDHAND SMOKE INCREASES BEHAVIORAL PROBLEMS IN BOYS WITH ASTHMA A study 220 boys and girls ages 6 to 12, with asthma found that for each doubling of secondhand smoke exposure, boys showed a twofold increase in behavioral problems such as hyperactivity, aggression, and depression. secondhand smoke had no impact on girls, even though they were on average exposed to higher levels of tobacco smoke than boys. Additional research is needed to explain this gender difference, the researchers said. Journal of Developmental & Behavioral Pediatrics12/08 www.jrnldbp.com/

ASTHMA LINK TO C-SECTION BABIES: Babies born by Caesarean section are more likely to develop asthma than children delivered naturally, Swiss researchers conclude from a study of 3,000 children whose respiratory health was tracked until they were 8 years of age. At that time, 12% had asthma About 9 percent of the children were born by C-section but these babies were nearly 80 percent more likely to develop asthma compared to those born vaginally. Babies born by C-section are not exposed to their mother's bacteria when they pass through the birth canal -- something that helps prime the immune system and could explain the increased risk, the researchers said. The findings also underscore the potential risks of elective C-sections as more women in Western countries choose to avoid a natural birth. Thorax 12/08 thorax.bmj.com/

PLACE OF BIRTH CONTRIBUTES TO ASTHMA DISPARITY: Place of birth plays a role in the occurrence of asthma in a United States black population. The researchers found that within one inner-city population, blacks born in the United States were more likely to have asthma than blacks born outside of the United States. "Within Asian and Hispanic populations, there is research that indicates that asthma varies between those who are born in the U.S. and those who are foreign-born. "This study cannot be generalized to the U.S. population because we focused on a specific neighborhood in Boston. "If future research confirms that the U.S.-born black population has a higher prevalence of asthma than the foreign-born black population, resources such as asthma screening and detection can be directed to populations or communities most in need." Journal of Asthma, 2008; 45 (9): 785 http://www.informaworld.com/smpp/title~content=t713597262~db=all

ASTHMA INCREASE IN INFANTS OF MOM’S TAKING FOLATE: Folate is recommended to reduce the risk of birth defects, and many countries fortify their flour with folic acid. Data on more than 32,000 children born between 2000 and 2005 who were part of the Norwegian Mother and Child Cohort Study found that infants whose mothers took folate supplements in the first three months of pregnancy were slightly more likely than other infants to have wheezing and/or respiratory infections up to the age of 18 months. These children were also 24 percent more likely to be admitted to hospital for treatment of their respiratory infection. Archives of Disease in Childhood 12/08 adc.bmj.com/

KIDS TAKE RESPONSIBILITY FOR ASTHMA MEDS EARLY: In surveys of 351 parents of asthmatic children and teenagers, the researchers found that by the age of 7, children were giving themselves their daily controller medication nearly 20 percent of the time. By age 11, they were responsible for taking their medication about half of the time. The findings suggest that even young children should be included when doctors and parents discuss asthma management, researchers report in the journal Pediatrics. There are no general guidelines as to what age children should be given this task. Instead the decision depends on an individual child's readiness. Pediatrics, December 2008 pediatrics.aappublications.org/

SCHOOL PROGRAM HELPS CUT ASTHMA RISK: A school-based asthma management program can help children and teens reduce their symptoms and the number of missed school days, a study conducted in a California school district shows. Researchers analyzed the effectiveness of a program called Kickin' Asthma, a four-session curriculum developed by American Lung Association staff and nurses and peer educators from the Oakland Unified School District. The program provides students with information and tools to better manage their asthma, such as teaching them about triggers and telling them when and how to take their medication. Program participation was voluntary, but students who completed the program during the first two years of the study were given a small incentive. About 990 students in grades 7 to 10 from 15 middle schools and three high schools took part in the program. The program achieved measurable improvements in asthma symptoms and correct medication use and a reduction in the rate of asthma occurrence during the first three years. Days for which participants had activity limited or missed school were reduced by a half-day for every four weeks of the program. During the first two years of the program, there was a significant decline in the number of students who reported outpatient emergency care or hospitalization for asthma. Frequency of daytime symptoms also declined during the program's first three years. Journal of School Health 12/08 http://www3.interscience.wiley.com/journal/117974040/home

BREATHING EXERCISES CAN HELP EASE ASTHMA: While asthma breathing exercises can improve a patient's quality of life, they don't reduce the need for inhalers, according to a study by Scottish researchers. The University of Aberdeen study included nearly 200 adults being treated for mild to moderately severe asthma. About half (94) of the patients did three sessions of breathing exercise training provided by a physiotherapist, while the rest received information and advice about their disease. After one month, both groups showed improvements in quality of life. But after six months, the patients in the breathing exercises group were significantly less anxious and depressed, and tended to control their asthma better than those in the information/advice group. Thorax.12/08 thorax.bmj.com/

POOR MENTAL HEALTH MAY BOOST ASTHMA RISK: People who rated their mental health as poor were more likely to have asthma than those who described their mental health as good, Brown University researchers report. Data on 318,151 people, who took part in the Behavioral Risk Factor Surveillance System, found that “any number of days of poor mental health was associated with currently having asthma." "Even low levels of poor mental health were associated with an increased risk of currently having asthma." People who said their mental health was poor or fair were at 1.31 times greater risk of asthma, compared with those who rated their mental health as good, very good or excellent. Chest 12/08 www.chestjournal.org/

OBESITY, LACK OF EXERCISE REPORTED IN PEOPLE WITH ASTHMA: Study findings suggest less than one quarter of adults with asthma meet national exercise guidelines and, among this group, obesity may be a greater exercise deterrent than asthma symptoms. People with asthma may get caught in a vicious cycle,. "Obesity leads to worse asthma, which can be associated with less exercise, which predisposes to obesity and long-term (worsening) asthma." Exercise habits were assessed in 258 patients (75 percent women) who were 42 years old. The patients had mild-to-moderate asthma for 21 years on average and, in 37 percent, asthma was well controlled. Overall, 40 percent of the patients were obese, 29 percent were overweight, and 31 percent were of normal weight, the researchers report. Annals of Allergy, Asthma and Immunology 11/08 www.annallergy.org

INCREASED RISK OF PNEUMOCOCCAL DISEASE IN ASTHMA PATIENTS: Mayo Clinic research shows adults with asthma are at increased risk of serious pneumococcal disease caused by Streptococcus pneumoniae, the most common bacteria causing middle ear infections and community acquired pneumonia. It also causes blood stream infections and brain infections. The researchers recommend including asthma as an indication for pneumococcal vaccination in adults. "We found that adults with invasive pneumococcal disease, a serious, potentially fatal disease, are seven times more likely to be asthmatics. Our study also showed that 17 percent of the burden of invasive pneumococcal disease can be attributable to asthma at a population level. This is quite a significant impact on the burden of invasive pneumococcal disease," says Young Juhn, M.D., a pediatric and adolescent medicine physician-scientist at Mayo Clinic and lead author of the study. "Invasive pneumococcal disease is a vaccine-preventable disease. The implication is that we have the ability to significantly reduce instances of this potentially fatal disease by expanding the indication for the pneumococcal vaccine to include adults with asthma." Researchers used a population-based, retrospective case-control study of 3,941 records from the Rochester, Minn. population to see if there was a higher incidence of pneumococcal disease among people with asthma. Adults diagnosed with asthma were almost seven times more likely to develop invasive pneumococcal diseases than adults who were not diagnosed with asthma. In children the sample size for was not large enough to draw a definitive conclusion. Journal of Allergy and Clinical Immunology 10/08 http://www.jacionline.org/

Calendar and Updates 12/08

2009-01-08T02:24:00.000-08:00

CALENDAR AND UPDATES DECEMBER 2008

1. Calendar
2. Flu Resource
3. Resources
4. European Respiratory Society 18th Annual Congress
5. Asthma Updates

1. CALENDAR
If you have an asthma related event coming up, and you would like it posted on this calendar, please send the date, place, time and contact information to margoc@tds.net

Want information on smoking? Check out a new website from the NH Tobacco Prevention and Cessation Program, www.trytostopnh.org

December 8 NH Advocacy Network Summit, 8:30-3:30, Holiday Inn, Concord. FMI: 603-225-2264 or info@childrennh.org

January 29 Asthma & COPD: Everything you need to know to tell the difference. 6 pm. Location TBA. Dinner and presentation for asthma educators. Presenter: Dr. Albee Budnitz, Downtown Medical Associates,
Nashua. Sponsors: Breathe NH and NH Asthma Control Program.

March 18 Successful Chronic Disease Management: One Patient at a Time, Grappone Center, Concord NH This conference will focus on prevention, risk factors, co-morbidities & impact. The objectives of the conference are: define risk factors common to chronic diseases and identify innovative strategies to reduce them. Integrate strategies to reduce the impact of chronic disease morbidity and promote optimal health; and enhance professional networks to better prevent and manage chronic diseases. FMI msteele@snhahec.org or 603-895-1514 ext. 3

March 21 Queen City Climb to benefit the NH Lung Association. Hampshire Plaza, 1000 Elm Street, Manchester, NH. Fundraising minimum of $65 must be turned in day of climb. FMI: http://www.mrsnv.com/evt/home.jsp;jsessionid=723062e89da41f657d38?id=2247

2. FLU RESOURCES
• NH Find a Flu Clinic http://www.dhhs.state.nh.us/DHHS/CDCS/fluclinics.htm

• NH Department of Health and Human Services Flu Website http://www.dhhs.state.nh.us/DHHS/CDCS/flu.htm

• Centers for Disease Control and Prevention’s Website http://www.cdc.gov/flu/

• Send an e-card to friends, family, co-workers reminding them to get a flu shot http://www2a.cdc.gov/ecards/browse.asp?act=brs&chkcategory=Flu&submit1=GO

3. RESOURCE INFORMATION
NEW BRFSS DATA AVAILABLE: County-level reports using the 2007 NH Behavioral Risk Factor Surveillance System (BRFSS) are now available online. They include the most commonly requested health risk factors from the BRFSS, including smoking status, diabetes prevalence, alcohol consumption, obesity, and physical activity. Two sets of reports are now available at the state & county level. http://www.dhhs.state.nh.us/DHHS/HSDM/behavioral-risk.htm

4. EUROPEAN RESPIRATORY SOCIETY 18TH ANNUAL CONGRESS
Abstracts from the conference are available on-line at http://www.ersnet.org/learning_resources_player/abstract_print_08/main_frameset.htm

OMALIZUMAB REDUCES EXACERBATIONS OF MODERATE TO SEVERE PERSISTENT ALLERGIC ASTHMA INDEPENDENT OF FORMER SMOKING STATUS: Omalizumab, a recombinant humanised monoclonal antibody, significantly reduces rates of clinically significant asthma exacerbations in ex-smokers with moderate to severe allergic asthma compared with placebo, according to an analysis of 5 multicentre, randomized, double-blind, placebo-controlled, parallel-group, phase 3 studies.

THEOPHYLINE PLUS INHALED BECLOMETHASONE BETTER THAN BECLOMETHSONE ALONE IN SMOKERS WITH ASTHMA: The combination of low-dose theophylline and inhaled beclomethasone promotes improvements over inhaled beclomethasone alone for lung function, asthma symptoms, and sputum differential count for smokers with stable mild to moderate asthma, according to a randomized, double-blind, active-comparator, parallel-group trial.

BUDESONIDE/FORMOTEROL MAINTENANCE AND RELIEVER THERAPY RESULT IN SIMILAR OR BETTER ASTHMA CONTROL: The combination of budesonide and formoterol for maintenance and reliever therapy for patients with asthma provides similar or better asthma control compared with conventional best standard treatment, with significantly reduced inhaled corticosteroid (ICS), according to a multicenter, randomized, open-label, parallel-group study.

BREAST FEEDING REDUCES RISK OF CHILDHOOD ASTHMA: A study of 7,000 children, aged 6-15 years of age found that children who had been breast fed for six months or more had a significantly reduced risk of asthma – particularly among young boys. Children breast fed from 4-9 months had a significantly lower risk of asthma. Those breastfed up to 7-9 months had lower instances of persistence wheezing and coughing. In the second part of the study, both boys and girls in the highest BMI (body mass index) percentile, had higher prevalence rates of asthma and respiratory symptoms (wheeze, cough, breathlessness and exercise-induced wheezing) than non-obese children. In boys, the risk of overweight is associated with exercise-induced wheezing, lifetime asthma, and current wheeze; in girls it is mainly associated with exercise-induced wheezing.

5. ASTHMA UPDATES
WHEEZING AND ASTHMA IN YOUNG CHILDREN: A comprehensive review of clinical practice and peer reviewed studies show that the difficulty of accurate diagnosis is often underestimated by pediatricians who may link wheezing to a passing cold or other non-serious condition rather than relating it to asthma. In early childhood, asthma is often under recognized and under-diagnosed because the symptoms can vary widely and are similar to other common childhood illnesses, including non-specific cough, flu and bronchitis. Establishing a diagnosis of asthma in young wheezing children also can be challenging for the physician because the type, severity and frequency of asthma symptoms vary widely among children and, sometimes even with an individual child. Symptoms consistent with asthma in young children include:
* Recurrent wheeze associated with such triggers as viral infection or exercise
* Cough
* Chronic bronchitis
* Recurrent Pneumonia
* Increased bronchial hyper-reactivity, such as cough or wheeze with mild exercise
Clinical Pediatrics 10/08 cpj.sagepub.com/

ASTHMA OFTEN POORLY CONTROLLED: A significant number of asthma patients visiting their primary care doctor for other reasons have inadequately controlled asthma. A total of 2,150 patients ages 18 or older with a self-reported diagnosis of asthma completed a survey just prior to seeing their primary care physician. Forty percent of patients were seeing their physicians for a breathing-related problem and 60 percent were seeing them for other reasons. Nearly 48 percent of patients seeing their doctor for other reasons had asthma that was not well controlled. Asthma that was not well controlled was more common among African Americans than Caucasians or Hispanics. Roughly one third of patients with inadequately controlled asthma had disease flare-ups in the previous 12 months compared with one quarter of those with well-controlled asthma. American College of Allergy, Asthma and Immunology Meeting http://www.nlm.nih.gov/medlineplus/news/fullstory_71492.html

PARENTS IMPACT ASTHMA CONTROL: Asthma control in over one in three children with asthma is not as good as it could be, and in many cases the suboptimal control relates to potentially modifiable beliefs of the parents, new research suggests. In a study of 754 children between 2 and 12 years old with persistent asthma, 280, or 27 percent, had "suboptimal control" of their asthma. Nearly half of the children with suboptimal control underused controller medication. Children were more likely to have troublesome asthma symptoms if their parents had low expectations for how well their asthma could be controlled; there was no set time or routine for taking asthma medication. Pediatrics October 2008 pediatrics.aappublications.org

HARMLESS VIRUS MAY CAUSE ASTHMA: A usually harmless childhood virus may hide in the lungs and come back to cause wheezing and other symptoms of asthma. Research is showing that respiratory syncytial virus or RSV stayed in the lungs of mice and caused the overactive airway symptoms that characterize asthma. "This research suggests that there's a potential new mechanism for asthma related to viral infections in children that could be associated with RSV, and could aid in the development of preventive and therapeutic interventions for children with recurrent wheezing due to a virus such as RSV." Journal of Infectious Diseases 10/08 http://www.idsociety.org/Content.aspx?id=9460

KIDS WHO WHEEZE WITH RHINOVIRUS AT GREATER ASTHMA RISK: Researchers followed a group of nearly 300 newborns with one or both parents who have allergies or asthma, making the newborns at increased risk for asthma. The children were followed until they were 6 years old, while the researchers evaluated them for the presence of respiratory viruses and the development of asthma. The children who wheezed with rhinovirus during the first year of life were nearly three times as likely to have asthma when they were 6 years old, compared with children who wheezed with respiratory syncytial virus (RSV, another common respiratory ailment) who did not have increased asthma risk. The older the children were when the rhinovirus-associated wheezing occurred, the greater the effect, the study found. Children who wheezed with rhinovirus in their second year of life were more than six times as likely to have asthma, and rhinovirus-associated wheezing at age 3 was associated with a more than 30-fold increased risk. American Journal of Respiratory and Critical Care Medicine 10/08 http://ajrccm.atsjournals.org/

GENE VARIATIONS & SECONDHAND SMOKE LINKED TO EARLY ASTHMA: Certain genetic variations previously identified as putting people at higher risk for asthma apparently only increase the risk of early-onset asthma, which is disease that appears at 4 years of age or younger. The risk is further increased by exposure to secondhand smoke, again early in life. "This helps support the theory that asthma is not a uniform disease. It's probably several problems that end up with the same type of symptoms.” "It also supports the fact that it's not just genes that cause asthma, and it's not just the environment, but the interaction between the two." New England Journal of Medicine 10/16/08 content.nejm.org/
GENES MAY EXPLAIN RACIAL DISPARITIES IN ASTHMA: Asthma patients who are black tend to have more severe disease than asthma patients who are white, leading to more asthma control problems, higher rates of emergency department visits, and overall worse quality of life. Using data from The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens (TENOR) study, which included 1,885 white patients and 243 black patients who were treated by more than 400 specialists in lung diseases and allergies at 283 study sites across the United States, blacks were more likely to have asthma that was classified as severe by their physicians and to be treated with three or more long-term controller drugs. No differences were found in access to treatment between the two racial groups and no evidence of differences in asthma-related knowledge or behavior in the patients. The researchers conclude that the TENOR study data support the idea of a genetic component that causes a poor response to asthma treatment in blacks. Annals of Allergy, Asthma and Immunology 9/08 www.annallergy.org/

GAS STOVE EMISSIONS WORSEN ASTHMA: Johns Hopkins scientists report that high levels of a noxious gas from stoves can be added to the list of indoor pollutants that aggravate asthma symptoms of inner-city children, especially preschoolers. Nitrogen dioxide (NO2), an irritating and toxic form of nitrogen oxide gas, is most prevalent in industrial zones but also found at higher levels in homes with unvented gas stoves. Each 20-point increase in nitrogen dioxide levels led to 10 percent more days of cough and 15 percent more days with limited speech due to wheezing. Use of gas stoves, space heaters or home heating with a stove or an oven, practices prevalent in low-income households, each drove up nitrogen dioxide concentrations. Environmental Health Perspectives, October 2008 www.ehponline.org/

KID’S FLU SHOT INEFFECTIVE LAST TWO YEARS. Over the past two flu seasons, vaccinating children five and younger did not reduce the number of child hospitalizations or doctor's visits linked to influenza. Given the poor match between the flu vaccine and circulating strains during the last two years, "this finding is not surprising." "We know that the inactivated vaccine -- the flu shot -- doesn't work real well in children, particularly when the virus has evolved and drifted away from the type that is put in the vaccine," he said. In contrast, the live attenuated vaccine given as a nasal spray is far more effective. Archives of Pediatrics & Adolescent Medicine 10/08 archpedi.ama-assn.org/

FORMOTEROL, ASTHMA, SERIOUS ADVERSE EFFECTS: People with asthma, who regularly take the beta2-agonist formoterol, are more likely to suffer non-fatal serious adverse events than those given placebos, concludes a meta analysis report by the Cochrane Group. Findings showed a significant increased risk for people who took the drug once or twice daily for at least 12 weeks. Cochrane Collaboration http://www.cochrane.org/

CHILDREN INCREASINGLY MEDICATED: More and more U.S. children are being given drugs to fight chronic conditions such as asthma and hyperactivity. From 2002 to 2005 prescriptions for asthma medications rose by more than 46 percent. The researchers suggest that such increases could mean that chronic conditions are on the rise. But they said the trend could also reflect other factors such as changes in the way doctors prescribe drugs and better screening that identifies more chronic conditions. Pediatrics 11/08 pediatrics.aappublications.org/

INHALED STEROIDS MAY HAVE BENEFITS BEYOND THE LUNG: In a study, older asthmatic women using inhaled steroids were significantly less likely to die from any cause over 5 years compared to comparable women not using inhaled steroids. The findings "support and extend" the results of two recent studies from Canada, which suggested that inhaled steroid therapy may have benefits outside the lungs. Findings stem from 2,671 women with persistent asthma participating in the Nurses' Health Study who responded to a 1998 supplementary asthma questionnaire. Chest 9/08 www.chestjournal.org/

MEDITERRANEAN DIET MAY PROTECT KIDS FROM ASTHMA: Researchers examined the association between both children's diet and their mother's diet during pregnancy, and the development of asthma and allergic rhinitis in a random sample of 1,476 children aged 6 to 7 years old. Among children, greater adherence in the previous year to a Mediterranean diet -- that it, one high in vegetables, fruits and nuts, legumes, fish and cereals, and low in dairy products, meat, junk food and fat -- was associated with less asthma, wheezing, allergic rhinitis, sneezing and itchy-watery eyes. The researchers did not find an association between consumption of a Mediterranean diet during pregnancy and reduced risk of asthma or allergic rhinitis in children. Allergy 9/08 http://www.blackwellpublishing.com/journal.asp?ref=0105-4538

OBESITY LINKED TO POORER ASTHMA TREATMENT RESPONSE: Lab experiments indicate that people with asthma who are overweight or obese have a reduced response to steroid treatment, compared with their leaner counterparts. The study involved 45 non-smoking adults, including 33 with asthma and 12 without. American Journal of Respiratory and Critical Care Medicine, October 2008. ajrccm.atsjournals.org/

GLUCOCORTICOIDS NOT AS EFFECTIVE IN OBESE PATIENTS WITH ASTHMA: Glucocorticoids are 40% less effective in overweight and obese patients with asthma than in those of normal weight. The study also identified a potential mechanism involved in the resistance, which suggests therapeutic targets for future medications. Dexamethasone increased the levels of MAP kinase phosphatase-1 (MKP-1) by 5.27 times in cultured blood cells from lean asthma patients, whereas MKP-1 levels in overweight and obese asthmatics increased by only 3.11 times, a 41% smaller response. The heavier a person was the less their cells were likely to respond to dexamethasone. This negative relationship between weight and response to steroids did not occur in participants who did not have asthma. American Journal of Respiratory and Critical Care Medicine 10/08 http://ajrccm.atsjournals.org

EXPOSURE TO MICE INCREASE RISK OF WHEEZE IN KIDS: A study of 498 children, whose parents have asthma or allergies were followed from birth to 7 years of age. An association was observed between parents' reports of mouse exposure and transient wheeze, but not with persistent wheeze and late-onset wheeze. The research eam notes that early life mouse exposure was not predictive of asthma, eczema, or hayfever at 7 years of age. However, infants who lived in homes with detectable levels of mouse allergen at age 2 to 3 months had a twofold increased risk of having an allergy at school age. Allergy 11/08 http://www.nlm.nih.gov/medlineplus/news/fullstory_71209.html
ANTIBODIES TO COCKROACH MOUSE PROTEINS ASSOCIATED WITH ASTHMA: Developing antibodies to cockroach and mouse proteins is associated with a greater risk for wheeze, hay fever, and eczema in urban preschool children aged as young as 3 years, This study is part of a broader multi-year research project launched in 1998 by Columbia Center for Children's Environmental Health (CCCEH) that examines the health effects of exposure of pregnant women and babies to indoor and outdoor air pollutants, pesticides, and allergens. Journal of Allergy and Clinical Immunology 11/08 www.jacionline.org/

OUTDOOR POOLS BOOST CHILD’S ASTHMA RISK: Swimming in outdoor chlorinated pools appears to increase the odds a child will develop asthma. New findings cast doubt on the idea outdoor pools are safer than indoor ones where chlorine vapors remains trapped inside an enclosed space. Belgian researchers tested 847 students around the age of 15 for allergies and asthma and asked their parents about exposure to asthma risks such as tobacco smoke, pets and pollution, and how much time the children had spent in chlorinated pools. The risk for the 50 percent of children predisposed to allergies and asthma was directly related to the amount of time spent in a pool. Children with the highest pool attendance -- one hour per week for 10 years -- were five times more likely to be asthmatic than young people who had never swum in a pool. European Respiratory Journal 10/08 erj.ersjournals.com/

AUTUMN BABIES AT GREATER RISK FOR ASTHMA: Babies born four months before the peak cold and flu season have a 30 percent higher risk of developing asthma, suggesting that these common infections may trigger asthma. Medical records of 95,000 infants and their mothers in the state of Tennessee were studied. All babies in the study were at increased risk if they had bronchiolitis. While genetic risk factors predispose a child to develop asthma, environmental exposure such as winter viral infection, and particularly RSV infection, may activate those genes. American Journal of Respiratory and Critical Care Medicine 11/08 http://ajrccm.atsjournals.org