asthma Archives - Medical Association of the State of Alabama

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Critical Errors in Inhaler Technique Common in Children with Asthma

Posted by admin on April 25, 2019

In the first study to evaluate inhaler technique in children hospitalized for asthma – the group at highest risk for complications and death from asthma – researchers found that nearly half of participants demonstrated improper inhaler use, which means they routinely were not taking in the full dose of medication. Adolescents most commonly displayed critical errors in inhaler technique. They also often skipped using a spacer, which is a device that is recommended for use with an inhaler to help the right amount of asthma medication reach the lungs. Findings were published in the Journal of Hospital Medicine.

“We know that asthma can be well managed in the majority of patients and using your inhaler correctly is a key factor in managing asthma,” says lead author Waheeda Samady, M.D., hospitalist at Ann & Robert H. Lurie Children’s Hospital of Chicago, and Assistant Professor of Pediatrics at Northwestern University Feinberg School of Medicine. “Improper inhaler technique can contribute to children having uncontrolled asthma and needing to come to the hospital for their asthma. Our study suggests that as healthcare providers we can do a better job showing patients and families the correct inhaler and spacer technique, and checking it frequently to ensure they master it.”

Out of 113 study participants, 2-16 years of age, 42 percent missed at least one critical step in their inhaler technique. Researchers found that 18 percent did not use a spacer device with their inhaler and that these patients were mostly older.

“We see that our adolescent patients, who are transitioning to independent medication management, still need close monitoring to make sure they use their inhaler and spacer appropriately to achieve optimal asthma control,” says Dr. Samady. “Teens may feel that using a spacer is only for younger children, but using a spacer is recommended for adults as well.”

Previous studies have shown that adding a spacer device to an inhaler increases the amount of asthma medication a person takes in from 34 percent to 83 percent.

“Children with asthma can lead full lives if they receive the right medication at the appropriate dose, which is why correct inhaler technique is so crucial,” says Dr. Samady.

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Research at Ann & Robert H. Lurie Children’s Hospital of Chicago is conducted through the Stanley Manne Children’s Research Institute. The Manne Research Institute is focused on improving child health, transforming pediatric medicine and ensuring healthier futures through the relentless pursuit of knowledge. Lurie Children’s is ranked as one of the nation’s top children’s hospitals by U.S. News & World Report. It is the pediatric training ground for Northwestern University Feinberg School of Medicine. Last year, the hospital served more than 212,000 children from 49 states and 51 countries.

Tags: asthma

Posted in: Education

Largest Pediatric Study Shows Obesity Increases Asthma Risk in Children

Posted by admin on November 29, 2018

ORLANDO – Ten percent of pediatric asthma cases could be avoided if childhood obesity were eliminated, according to research led by Nemours Children’s Health System. The research, published in Pediatrics, the journal of the American Academy of Pediatrics, reported on the analysis of medical records of more than 500,000 children. The study is among the first to use the resources of PEDSnet, a multi-specialty network that conducts observational research and clinical trials across eight of the nation’s largest children’s health systems. PEDSnet is funded by the Patient-Centered Outcomes Research Institute (PCORI), a government-supported nonprofit.

“Pediatric asthma is among the most prevalent childhood conditions and comes at a high cost to patients, families and the greater health system. There are few preventable risk factors to reduce the incidence of asthma, but our data show that reducing the onset of childhood obesity could significantly lower the public health burden of asthma,” said Terri Finkel, M.D., PhD, Chief Scientific Officer at Nemours Children’s Hospital in Orlando and one of three Nemours researchers participating in the study. “Addressing childhood obesity should be a priority to help improve the quality of life of children and help reduce pediatric asthma.”

In this retrospective cohort study design, researchers reviewed de-identified data of patients ages two to 17 without a history of asthma, receiving care from six pediatric academic medical centers between 2009 and 2015. Overweight or obese patients were matched with normal weight patients of the same age, gender, race, ethnicity, insurance type, and location of care. The study included data from 507,496 children and 19,581,972 encounters.

In their analysis, the researchers found that the incidence of an asthma diagnosis among children with obesity was significantly higher than in children in a normal weight range and that 23 to 27 percent of new asthma cases in children with obesity are directly attributable to obesity. Additionally, obesity among children with asthma appears to increase disease severity. Being overweight was identified as a modest risk factor for asthma, and the association was diminished when the most stringent definition of asthma was used. Other significant risk factors of an asthma diagnosis included male sex, age of under 5 years old, African-American race, public insurance.

With 6 to 8 million cases of pediatric asthma previously reported in the United States, the study’s data suggest that 1 million cases of asthma in children might be directly attributable to overweight and obesity and that at least 10 percent of all U.S. cases of pediatric asthma might be avoided in the absence of childhood overweight and obesity.

“This is the first study of its kind, looking at obesity and the risk of developing asthma entirely in a pediatric population, and is made possible through the PEDSnet data collaboration,” said Finkel. “The PEDSnet collaboration brings the power of Big Data to pediatric research and medicine – as well as the expertise to structure the data and understand how to extract the most meaningful points.”

Several limitations of the study are noted, including the retrospective design using electronic health data, which prevent the researchers from drawing absolute conclusions regarding the causal nature of the association between obesity and asthma. Additionally, while the study includes data from a large, geographically diverse population of children, rural children may be underrepresented in the study results.

The research team hopes in the future to use PEDSnet’s capabilities to continue to gain new epidemiologic insights into the relationship between pediatric obesity and asthma, including measures of lung function, comorbidity, and medication data. Each PEDSnet member institution is able to map its own data onto the common data model, creating an enormous resource across the network with the power to produce findings relatively quickly.

Tags: asthma, child, health, obesity

Posted in: Research

Breathing Easier with Amy CaJacob, M.D.

Posted by admin on March 2, 2018

BIRMINGHAM – The most recent Alabama data find one in every 10 Alabama adults, or 306,000, suffer from asthma. The data also show more than 12 percent of Alabama children are living with the chronic respiratory disease at some point in their lives. Unfortunately, these children live sheltered lives trying to avoid the triggers that can induce an asthmatic episode. Summer camp was not an option for these children…that is until Camp WheezeAway opened 27 years ago.

“Camp WheezeAway is one of the longest-running asthma camps in the country. It’s a memorial camp dedicated to Patsy Ruff, who was the world’s first successful double lung transplant in 1987,” explained Dr. Amy CaJacob, a pediatric allergist/immunologist and the camp’s medical director. “Patsy had asthma, COPD and was a smoker for 22 years. One of the things Patsy wanted was a camp for kids because when she was growing up with asthma, she couldn’t go to a summer camp like her friends. She really wanted kids with asthma to have a normal summer camp experience that she never had, and that’s what we try to do at Camp WheezeAway.”

Camp WheezeAway is celebrating its 27th anniversary this year and is free to qualified applicants – youngsters ages 8 to 12 suffering from persistent asthma. Campers are selected in June, and the camp is July 1-6, 2018, at YMCA’s Camp Chandler.

Dr. CaJacob explained the importance of education about asthma and how to handle its limitations is as much a part of the camp as having fun. Asthma affects nearly 25 million people of all ages and races. An estimated 7 million children have asthma, a chronic disease caused by inflammation of the airways in the lungs. During an asthma attack, the muscles around the airway constrict, the lining of the airway passages swell, and the lungs produce excess mucus making breathing difficult, which can lead to coughing, wheezing and shortness of breath.

“Every year at camp on the last night we have a smokeless campfire at night after dinner,” she explained. “We wheel around an oxygen tank and talk to the kids about the dangers of smoking. We tell them the story of Patsy Ruff, her surgery, and how the camp began. All the campers are at that age where they may want to experiment with smoking, and they are going to be making their own decisions about their health or possibly succumb to peer pressure about smoking. They need to understand how their decisions will affect their health.”

If you think asthma education is boring, think again. Dr. CaJacob and the staff of medical volunteers find new ways each year to make it as interactive and fun as possible for the campers…even if it involves grossing out some of the kids.

“We don’t want to bore the kids during the education section. The project I do every year is, well…we make mucus…it’s so messy, but the kids love it! The girls not as much as the boys, though,” she laughed. “We’ve done skits of how to avoid asthma triggers where the kids dress up as ragweed or cigarettes and a rescue inhaler. Sometimes it’s just hands-on training so they can learn how to use their inhalers.”

All in all, the campers get a well-rounded experience. From shaving cream battles, kayaking, and horseback riding, to rock climbing and archery…and anything you can think of doing in the lake…plenty of emphasis is placed on kids with asthma being NORMAL kids.

“We do all the stuff other camps do, but safety always comes first,” Dr. CaJacob said. “Camp has changed dramatically over the years from the kinds of kids who attend because asthma care has come a long way. There used to be much more medically complex kids than we have now. At one time there were kids on ventilators for their asthma. Our inhalers and treatments are so much better now. That’s not to say there might not be a child or two we may have to step up treatment during the week by putting them on a little stronger inhaler or an oral steroid. I’m there the entire week, and we have a number of nursing and respiratory therapists who are there as well.”

In many instances, Camp WheezeAway is a camper’s first sleepover outside the home. Because campers are not allowed cell phones, Dr. CaJacob assures parents they should not worry. A mother herself, there are plenty of times when she shrugs off her physician’s coat for her mom hat.

“For a lot of our campers, it’s their first time away from home, and we get a lot of homesickness that first night. Part of my job is doctoring that week, but a lot of it is just being a mom! That first night the kids can’t sleep or have tummy aches, but when they settle in and start having fun, everything is just fine! The campers aren’t allowed cell phones, but we take plenty of photos of the children and stay in touch with their parents by sending them photos of the activities, and let them know how things are going,” Dr. CaJacob said.

For more information regarding selection or medical qualifications and limitations, contact Brenda Basnight, CRT, at brendabasnight@yahoo.com. Camp WheezeAway is free to qualified applicants — youngsters ages 8 to 12 suffering from moderate to severe asthma, but registration is required. Donations are also appreciated and can be made online.

Tags: asthma, cajacob, camp, chandler, wheezeaway, ymca

Posted in: Physicians Giving Back