Sunday, June 27, 2004

The culture of daycare -- my newest scapegoat!

Just a thought -- I was going to dig a little into RSV as a possible cause of the Asthma outbreak. I mean, what the hell is RSV, anyway? Where was it when WE were kids? Was it just called "pneumonia" or "bronchitis" or "chest cold" then? Is it a new virus, or just a newly analyzed-and-renamed virus?

...but then it occurs to me that its this new culture of sticking your kids in daycare at 6 weeks of age that's probably to blame. (Yes, I know about the Australian study that showed lower incidence of asthma in daycare kids. But, hello, that's the other side of the freaking planet from here!)

Seriously, babies are meant to be with their mothers (or fathers)for the first few years. I'm a total feminist, but I absolutely believe that's true. They should be home -- not in virtual petrie dishes brimming with bacteria from other kids' snot. That's probably why so many kids are getting RSV (which, most of the time, presents like a cold) and why so many are, consequently, developing asthma.

Think about it -- most of us parents didn't leave home without our folks until age 3 or 4 for nursery school. How many of us have asthma? I knew one kid. That's it. Heck, I hadn't even heard of a nebulizer until my son got RSV.

Okay -- so that's it. I'm crucifying American culture now. It's not the daycare centers. It's US for creating the demand for them.

How does this explain the epidemic? (Today's Asthma News)

Asthma Emerging as Genetic Disorder

I'll skip the first few paragraphs, which outline the general background info -- asthma responsible for 14 million missed school days, growing epidemic, yada, yada, yada.

Here's the meat-and-potatoes (or TVP and cous-cous, in my case!):

Dr. Deborah Gentile, an asthma specialist at Allegheny General Hospital, in Pittsburgh, said immunologists are increasingly coming to understand asthma as a genetic disorder -- at least, in its beginnings. "We're thinking that there are different types of asthma driven by different genes."

A child with one parent who has asthma has a 30 percent chance of developing the airway condition herself. If both parents have it, her odds of getting it approach 70 percent -- not a given but a stacked deck.

Gentile said there are three factors that contribute to a person's risk of asthma. The first is the genetic legacy from parents; the second is exposure to infections and irritants that "program" the immune system and make it sensitive. The third is timing: It seems that the immune system is particularly sensitive during the first two years of life, Gentile said, so children with the right combination of genes and the right mix of exposures early in life are at the greatest risk of developing asthma.

skipping irrelevant stuff...."It's important to distinguish exposures that cause asthma versus those that exacerbate existing asthma," Camargo said. "Although these are, at times, the same, there are also factors that worsen existing asthma but are unlikely to cause disease," such as strong odors like perfumes, he said.

And you can find the whole article here:

My thoughts: If I'm understanding the research correctly, this reinforces the theory that the bronchiolitis and RSV Bryn had suffered by 18 months probably DID cause his asthma -- in conjunction with his dad's history of severe allergies.

What it doesn't explain in the least is why asthma is reaching epidemic proportions...

Thursday, June 24, 2004

This one's for Allison --

Oh, Al, PLEASE post a comment after reading this. It's going to piss you off so profoundly, you'll be shooting steam out of your ears for DAYS!!

A thought on pediatricians --

Anyone who knows me personally has heard me say this:

There have been days when I've taken Bryn to his regular pediatrician, she's listened to his chest and back and told me he sounds fine.

The same afternoon, I'll take the boy to his pulmonologist, she'll listen to him, and she'll tell me that he's *not* moving air well, and put him on either Duoneb or Orapred.

She tells me that there are subtleties to pediatric asthma that you have to really be trained to here. I've heard this from respiratory therapists in the Peds ER, too.

So, while I love, love, love our pediatrician, when it comes to Bryn's breathing, I always call the pulmonologist first.

After reading the "Camp Super Lungs" article, I wonder how many people just trust their pediatricians and *never* see a pulmonologist. Case in point: the kids photographed for the article, a brother and sister, are, well, pretty darned overweight. While I know this can happen when you spend a lot of time on steroids, obesity is probably a little bit of a hindrance when you're already having a hard time breathing. I imagine there are plenty of parents out there who are scared to let their kids run around if they're asthmatic -- but you should probably find out if that's one of your kid's triggers before condemning them to life as a couch potato. (I'm NOT saying that's the case with the kids in the photo.)

Another example -- we have friends whose pediatrician put their kid on Flovent, but only when he's having an attack. Now, I could be wrong, but I'm pretty sure inhaled corticosteroids are intended for LONG term use. I mean, do they even work in the short term? Our doc recently said something along the lines of, "a year of Flovent is like 5 days of Orapred." So I can't see that short-term use of Flovent does much good.

...So my thought to all the pediatricians out there: If you think a young patient of yours has asthma, PLEASE -- send them to a pulmonologist! I'm sure most insurance companies would cover a few visits.

Camp Super Lungs

Here's the headline: "Asthma camp teaches kids to manage illness." And it's called Camp Super Lungs. I'm kind of torn between wanting to send Bryn and being moderately disgusted by the whole idea of it.

The camp is sponsored by Summit Health, and it's intended to teach kids about their asthma. But I mean, if you have serious enough asthma to actually go to camp for it, shouldn't you also have a doctor who educates and supports you and your family?

Wednesday, June 23, 2004

Actually, it appears I *will* be ranting after all...

Check this out: Asthma drug may boost risk of deadly asthma attacks

That's the headline for another one of today's stories. "One of the most commonly prescribed medicines to treat America's 16 million asthmatics may actually make asthma worse and contribute to heart problems, two studies find."

When I first read this, I was (as you can imagine) a little upset. But then I read on: "Salpeter and her team reviewed studies conducted from 1966 to 2003 of asthmatics taking beta-agonists. They found that patients who took the drug daily developed a tolerance and had more inflammation in their lungs than those not taking the drug at all, making them more susceptible to a potentially deadly attack."

...which led me to ask, why would any asthmatic take Albuterol every day? Isn't it just for treatment during an attack? That's how it's been prescribed to us.

And then I remembered: Advair. The wonder drug that toddlers cannot take because it doesn't work with a spacer. Advair is a combination of Serevent (fast-acting bronchiodialator) and Flovent (corticosteroid).

So if you're taking Advair every day -- and you would do -- I'm guessing that you may be doing more harm than good? I haven't found any articles specifically implicating Advair, but, hey, this is just today's news.

That might be fodder for tomorrow's post.

Here's news I can't even rant about...

...except to say that I probably *shouldn't* live in suburban New Jersey with an asthmatic toddler. But, you know, I just moved, so packing up and heading to Arizona just doesn't seem appealing right now.

But what a drag: my first blog post, and I can't even drag my soap box out for a good lengthy rant.

Nevermind. I'm sure you'll hear plenty from me in the near future.

Here's the story -- and I might add that our pulmonologist could have told us all this:

TUESDAY, June 22 (HealthDayNews) -- Changes in weather may influence rates of asthma and eczema in children, says a study in the journal Occupational and Environmental Medicine.

The study of nearly 670,000 children concluded that season-to-season variations in temperature, humidity, altitude, and latitude all affected asthma and eczema rates.

Researchers at the University of Ulm, Germany, analyzed data collected between 1992 and 1996 from children ages 6-7 and ages 12-13 in more than 50 countries. The study found that, in Western Europe, every 10 percent increase in indoor humidity was associated with a 2.7 percent increase in asthma rates for both age groups.

House dust mites, a major allergen for asthmatics, thrive in moist air. Humidity also encourages the growth of mold, a possible respiratory irritant.

Lower rates of asthma were identified in areas where the average outdoor humidity drops below 50 percent for at least one month a year. Lower rates of asthma were also associated with higher altitude and greater seasonal temperature variations.

Higher rates of eczema were associated with increasing latitude, while lower eczema rates were associated with higher outdoor temperatures.

This link between climate and asthma and eczema suggests that climate change caused by global warming may influence rates of these diseases in the future, the study authors wrote.