Category: Featured Stories and Interviews

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Asthma Symptoms Impairs Sleep

Asthma symptoms impair sleep quality and school performance in children

#ATS2013, PHILADELPHIA ? The negative effects of poorly controlled asthma symptoms on sleep quality and academic performance in urban schoolchildren has been confirmed in a new study.

“While it has been recognized that missed sleep and school absences are important indicators of asthma morbidity in children, our study is the first to explore the associations between asthma, sleep quality, and academic performance in real time, prospectively, using both objective and subjective measures,” said principal investigator Daphne Koinis-Mitchell, PhD, Associate Professor of Psychiatry & Human Behavior (Research) and Associate Professor of Pediatrics (Research) at Brown University’s Alpert Medical School in Providence, Rhode Island. “In our sample of urban schoolchildren (aged 7 to 9), we found that compromised lung function corresponded with both poor sleep efficiency and impaired academic performance.”

The results of the study will be presented at the American Thoracic Society’s 2013 International Conference.

The study included data on 170 parent-child dyads from urban and African-American, Latino, and non-Latino white backgrounds who reside in Greater Providence, RI. These data are part of a larger 5-year study of asthma and allergic rhinitis symptoms, sleep quality and academic performance (which will include 450 urban children with persistent asthma and healthy controls) funded by The Eunice Kennedy Shriver National Institute of Child Health and Human Development. Project NAPS (Nocturnal Asthma and Performance in School) is administered through Rhode Island Hospital at The Bradley Hasbro Research Center.

Asthma symptoms were assessed over three 30-day monitoring periods across the school year by spirometry, which measures the amount and speed of exhaled air, and with diaries maintained by children and their caregivers. Sleep quality was assessed with actigraphy, which measures motor activity that can be used to estimate sleep parameters. Asthma control was assessed with the Asthma Control Test (ACT), a brief questionnaire used to measure asthma control in children. Academic functioning was assessed by teacher report during the same monitoring periods.

Compared with children with well-controlled asthma, those with poorly controlled asthma had lower quality school work and were more careless with their school work, according to teacher reports. Higher self-reported and objectively measured asthma symptom levels were associated with lower quality school work. Poorer sleep quality was also associated with careless school work. Increased sleep onset latency (the amount of time children take to fall asleep) was associated with more difficulty in remaining awake in class.

“Our findings demonstrate the detrimental effects that poorly controlled asthma may have on two crucial behaviors that can enhance overall health and development for elementary school children; sleep and school performance,” said Dr. Koinis-Mitchell. “Urban and ethnic minority children are at an increased risk for high levels of asthma morbidity and frequent health care utilization due to asthma. Given the high level of asthma burden in these groups, and the effects that urban poverty can have on the home environments and the neighborhoods of urban families, it is important to identify modifiable targets for intervention.”

“Family-level interventions aimed at asthma control and improving sleep quality may help to improve academic performance in this vulnerable population,” Dr. Konis-Mitchell continued. “In addition, school-level interventions can involve identifying children with asthma who miss school often, appear sleepy and inattentive during class, or who have difficulty with school work. Working collaboratively with the school system as well as the child and family may ultimately enhance the child’s asthma control.”

* Please note that numbers in this release may differ slightly from those in the abstract. Many of these investigations are ongoing; the release represents the most up-to-date data available at press time.

Abstract 42716

Asthma, Sleep, And School Functioning In Urban Children
Type: Scientific Abstract
Category: 02.03 – Disparities in Lung Disease and Treatment (BSHSR)
Authors: D. Koinis Mitchell; Brown Medical School/Rhode Island Hospital – Providence, RI/US; and the Project NAPS Study Group

Abstract Body

Rationale: Urban children are at an increased risk for asthma morbidity. Poor quality sleep is an indicator that asthma is in poor control. Asthma and poor sleep can affect children’s academic performance. No studies have examined asthma, sleep quality, and academic functioning in urban children with asthma using objective and subjective methods. This study investigates associations among asthma symptoms (FEV1 and symptom reports), asthma control, sleep efficiency (through actigraphy) and academic functioning in a sample of urban children.

Methods: Data are from a larger study of asthma and allergic rhinitis symptoms, sleep quality and academic performance in urban children (aged 7-9).To date, data are collected from 170 parent-child dyads from African-American, Latino, and non-Latino white backgrounds. Asthma symptoms were assessed by FEV1 percent predicted via the AM2 (electronic hand-held spirometer) over three, 30 day monitoring periods across the academic year. Children and caregivers also recorded days when asthma symptoms were present via a standard diary. Sleep quality was assessed through actigraphy for 3, 30 day periods across the academic year. Asthma diagnosis and persistent asthma status were confirmed through clinician assessment using standardized procedures (NHLBI, 2007). Asthma control was assessed using the ACT. Teachers reported on children’s academic functioning during the same time periods when asthma and sleep data were collected.

Results: Results to date show that children with poorly controlled asthma had lower quality school work by teacher report (MN=2.2) relative to their counterparts with well controlled asthma (MN=2.8; F(1,73)=4.9, p=.03). Similarly, on average, children with poor asthma control were reported to be more careless with their school-work (MN=3.1) relative to children with good asthma control (MN=2.5; F(1,73)=4.5, p=.04).

Higher levels of asthma symptoms (by diary report) were related to lower quality of school work (r= – .24, p=.03) by teacher report. Careless and hasty schoolwork was negatively associated with objectively measured asthma symptoms (FEV1), (r= -.25, p=.05).

Careless school work was associated with poorer sleep quality (r= -.25, p=.03). Teacher report of children’s struggle to stay awake in class was negatively associated with sleep onset latency (r=-.29, p=.01), suggesting that children who are more alert in class have less difficulty falling asleep.

Conclusions: Results to date indicate that children’s asthma symptoms correspond with sleep efficiency indicators using objective and subjective methods, and children’s academic performance by teacher report. Results can inform family and school-based interventions designed to improve asthma control, sleep quality and academic performance in urban children.

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New Asthma Trials Shows Promise

New Asthma Trials Shows Promise – Let’s Declare War on Asthma Starts Now!

#ATS2013. The World Asthma Foundation (WAF) is covering the American Thoracic Conference #ATS2013 this week in search of solutions for Asthma suffers everywhere. To that end, press reports published today reflect that a new type of asthma drug meant to attack the underlying causes of the respiratory disease slashed episodes by 87 percent in a mid-stage trial, making it a potential game changer for patients with moderate to severe disease, researchers said on Tuesday.

“Overall, these are the most exciting data we’ve seen in asthma in 20 years,” said Dr. Sally Wenzel, lead investigator for the 104-patient study of dupilumab, an injectable treatment being developed by Regeneron Pharmaceuticals Inc and French drugmaker Sanofi in reports to Reuters.

The drug also met all its secondary goals, such as improving symptoms and lung function and reducing the need for standard drugs called beta agonists.

Although far larger trials will be needed to confirm findings from the “proof of concept” study, researchers expressed optimism. They noted that dupilumab has also shown the ability to tame atopic dermatitis, or severe eczema, an allergic condition that is not well controlled by current treatments.

Results of the 12-week asthma study are being presented on Tuesday at the annual scientific meeting of the American Thoracic Society in Philadelphia.

WAF in our effort to Declare War On Asthma will be following this story very closely. Stay tuned for in depth interviews on this topic.

Read full article at http://www.reuters.com/article/2013/05/21/us-regeneron-sanofi-asthma-idUSBRE94K0I020130521

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Ginger and Asthma

Ginger compounds may be effective in treating asthma symptoms

#ATS2013 PHILADELPHIA ? Gourmands and foodies everywhere have long recognized ginger as a great way to add a little peppery zing to both sweet and savory dishes; now, a study from researchers at Columbia University shows purified components of the spicy root also may have properties that help asthma patients breathe more easily.

The results of the study were presented this week at the ATS 2013 International Conference.

Asthma is characterized by bronchoconstriction, a tightening of the bronchial tubes that carry air into and out of the lungs. Bronchodilating medications called beta-agonists (?-agonists) are among the most common types of asthma medications and work by relaxing the airway smooth muscle (ASM) tissues. This study looked at whether specific components of ginger could help enhance the relaxing effects of bronchodilators.

“Asthma has become more prevalent in recent years, but despite an improved understanding of what causes asthma and how it develops, during the past 40 years few new treatment agents have been approved for targeting asthma symptoms,” said lead author Elizabeth Townsend, PhD, post-doctoral research fellow in the Columbia University Department of Anesthesiology. “In our study, we demonstrated that purified components of ginger can work synergistically with ?-agonists to relax ASM.”

To conduct their study, the researchers took human ASM tissue samples and caused the samples to contract by exposing them to acetylcholine, a neurotransmitting compound that causes bronchoconstriction. Next, the researchers mixed the ?-agonist isoproterenol with three separate components of ginger: 6-gingerol, 8-gingerol or 6-shogaol. Contracted tissue samples were exposed to each of these three mixtures as well as unadulterated isoproterenol and the relaxation responses were recorded and compared.

At the conclusion of their study, the researchers found that tissues treated with the combination of purified ginger components and isoproterenol exhibited significantly greater relaxation than those treated only with isoproterenol; of the three ginger components, 6-shogaol appeared most effective in increasing the relaxing effects of the ?-agonist.

Once they were able to demonstrate that the ginger components enhanced the relaxing effects of the ?-agonist, they turned their attention to learning why. First, the researchers wanted to determine if the ginger components might work by affecting an enzyme called phosphodiesterase4D (PDE4D). Previous studies have shown that PDE4D, which is found in the lungs, inhibits processes that otherwise help relax ASM and lessen inflammation. Using a technique called fluorescent polarization, they found that all three components significantly inhibited PDE4D.

Next, the study looked at F-actin filaments, a protein structure which previous studies have shown plays a role in the constriction of ASM, and found that 6-shogaol was effective in speedily dissolving these filaments.

“Taken together, these data show that ginger constituents 6-gingerol, 8-gingerol and 6-shogaol act synergistically with the ?-agonist in relaxing ASM, indicating that these compounds may provide additional relief of asthma symptoms when used in combination with ?-agonists,” Dr. Townsend noted.”By understanding the mechanisms by which these ginger compounds affect the airway, we can explore the use of these therapeutics in alleviating asthma symptoms.”

Dr. Townsend and her colleague, Dr. Charles Emala, hope future studies will enable them to gain a better understanding of the cellular mechanisms that facilitate ASM relaxation and to determine whether aerosol delivery of these purified constituents of ginger may have therapeutic benefit in asthma and other bronchoconstrictive diseases.

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EPA’s Coordinated Approach on Asthma

The U.S. EPA’s Coordinated Approach on Asthma Interview with Dr. Daniel Costa

The US Environmental Protection Agency (EPA) promotes scientific understanding of environmental asthma triggers and ways to manage asthma in community settings through research, education and outreach. With federal, state and local partners, we are building the nation’s capacity to control asthma and manage exposure to indoor and outdoor pollutants linked to asthma. The purpose is to build knowledge and awareness to improve the quality of life for millions of Americans with asthma.

In the three minute with Daniel L. Costa, Sc.D, DABT, National Program Director for Air, Climate, & Energy Research Office of Research and Development we learn:

• The benefits of the 2013 ATS Conference
• The relationship/links between clean air and Asthma
• Clean air and Asthma studies
• About the EPA and Asthma
• Why the WAF War on Asthma is important

To learn more about the EPA and its efforts to support Asthma education visit http://www.epa.gov/asthma/

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Remote Patient Monitoring with ERT

Remote Patient Monitoring and Telehealth for Asthma Interview with ERT

Respiratory disease affects millions of people across the globe, with chronic lower respiratory diseases having the fourth highest mortality rate in the U.S. alone. Effective drug treatment is in high demand, which stresses the importance of respiratory clinical testing.

In the three minute with Michael Taylor, Senior Director, Healthcare Solutions at ERT we learn:

•How ERT is spearheading remote patient monitoring and telehealth for Asthma and COPD patients that provides a dedicated centralized spirometry for providing the most comprehensive clinical respiratory services and devices to ensure accurate data and efficient trial management.
•Why the WAF War on Asthma is important to him

According to ERT the key is having the right study resources in place and a centralized approach to drive the highest quality data.

Learn more about ERT’s Respiratory solutions at: http://www.ert.com/respiratory

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Proposed ATS Asthma Treatment Guidelines Present Problems for Patients

May Lead to Limited Access to Asthma Therapies and Testing

ATS-2013 – In the three minute with David S. Wilson, M.D, FCCP, with the Lung Institute at Columbus Regional Hospital we learn:

•How the proposed American Thoracic Society (ATS) Asthma Treatment Guidelines Present Problems for Patients that May Lead to Limited Access to Asthma Therapies and Testing
May Lead to Limited Access to Asthma Therapies and Testing
•Why the WAF War on Asthma is important to him

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WAF versus Asthma – It’s War

World Asthma Foundation Declares War on Asthma at ATS 2013

ATS 2013, PHILADELPHIA – The World Asthma Foundation (WAF) is declaring war on Asthma and is calling for support for May 2013, Asthma Awareness Month.

The campaign is in support of 26 million people in the United States living who are battling asthma, a disease affecting the lungs and causing repeated episodes of wheezing, breathlessness, chest tightness, and coughing. Asthma cannot be cured, but it is possible to manage the disease successfully in order to reduce and prevent asthma attacks, also called episodes according to the U.S. Center for Disease Control.

The World Asthma Foundation’s War on Asthma Campaign was announced today the American Thoracic @atsConference taking place in Philadelphia, PA. this week.

The World Health Organization estimates 300 million people worldwide suffer from asthma and 250,000 asthma-related deaths are reported annually.  It is one of the most common and costly diseases in the world and its prevalence has increased significantly in recent decades.

“We are entering a new era of public awareness of people living with chronic lung disease such as Asthma and COPD,” said Sam Louie, MD and professor of medicine and director of the UC Davis Asthma Network (UCAN). Louie is also director of the UC Davis Reversible Obstructive Airway Disease (ROAD) Center and a World Asthma Foundation (WAF) Board Member.

“People with Asthma and COPD deserve better treatment,” Louie said. “It requires that we all take responsibility, patients too, but physicians must take their empathy one step further and realize how reversible Asthma and COPD can be.”

“It really begins with empathy.” Louie said. “Empathy of healthcare providers for how Asthma and COPD patients suffer when they are given prescription drugs without education on an individual level. We have to ignite that empathy by increasing awareness and providing education.”

Let's Declare War On Asthma

The World Asthma Foundation provides educational resources to inform patients, medical professionals and the general public about the latest clinical advances, management and treatment options for asthma disorders.

Asthma affects people of all ages and backgrounds. In most cases, it’s not known what causes asthma and there is no cure. Certain factors may make it more likely for one person to have asthma than another. If one family member has asthma, it’s likely that other family members will also have it. Regular physical exams that include checking lung function and allergies can help healthcare providers make the right diagnoses.

With a healthcare provider’s help, patients can develop their personal asthma management plan so that they know what to do based on their symptoms. It’s recommended that patients use asthma medicines as prescribed and be aware of common triggers in the environment known to bring on asthma symptoms. Triggers are smoke (including second-hand and third-hand cigarette smoke), house pets, dust mites and pollen. They should limit or avoid exposure to these and other triggers whenever possible. The important thing to remember is that individuals can control their asthma.

To learn about how World Asthma Foundation (WAF) supports Asthma education visit: https://worldasthmafoundation.org

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Nutrition and Asthma

The Role of Nutrition and Nutritional Supplements in Asthma

Nutrition and Nutritional Supplements in Asthma Interview with Nicholas Kenyon, M.D. Associate Professor of Medicine Division of Pulmonary and Critical Care Medicine University of California, Davis.

We learn about:

* Increased consumption of vegetables and fruit led to fewer respiratory symptoms and improved lung function
* Is obesity an independent risk factor for asthma in adults?
* Mouse model to adult trials in asthma. These options are cheap, readily available, and there is decent biological rationale to study them in severe asthma
* Effect of oral magnesium supplementation on measures of airway resistance and subjective assessment of asthma control
* Nitric oxide may be protective against the development of allergic airway inflammation and airways hyper-responsiveness
* Fish oils and Asthma
* Essential Vitamins, Elements, and Amino Acids—potential treatments such as
-Magnesium
-Vitamin A
-L-arginine
* EPA-enriched omega3 fatty acids as asthma supplements
* Diet’s impact on the immune system will be focus of increasing research
* Recommendations such as
– Olive oil !!!
– Walnut !!!
– Omega 3 fatty acids !!
– L- arginine !!
– Vitamins A, D !
– DASH diet – Fruit/Veg !!

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Improving Asthma Control in Patients of Hispanic & African Americans

Interview with Grace E. Hardie, PhD, RN, UCSF, SF State Associate Professor San Francisco State University

Our understanding of how ethnicity influences how patients describe their asthma symptoms and how ethnicity impacts airway responsiveness is extremely limited. Ethnic influences on symptom
description and airway responsiveness were the subject of a 2010 study of induced bronchoconstrictor administration in African Americans and Hispanic, Latino & Mexican Americans with mild asthma (Journal of Asthma, 2010; 47:1-9).

If healthcare professionals are better able to understand the ethnic differences in symptom descriptors and airway responsiveness, then treatment decisions that are both culturally and ethnically sensitive may be applied and outcomes may be improved.

Using a standardized methacholine (McH)challenge (bronchoconstrictor) procedure a doubling dose (0.078-10mg/ml) of McH was used that would result in a 30% fall (PC30) in FEV1. Mild asthma was defined as FEV1?70% of predicted. Baseline FEV1 was comparable for both groups. Mean age of African Americans was 30.3 y and mean age of Hispanic/Latino/Mexican Americans was 30.9 y. Ethnic differences in both airway hyperresponsiveness and symptom presentation were documented. The dose of McH at PC30 for African Americans was 2.6 mg/ml; Hispanic, Latino & Mexican Americans was 2.62 mg/ml. The dose of McH at PC30 reflects the significance of the degree of airway hyperresponsiveness experienced by both ethnic groups during episodes of acute asthma. African Americans used only upper airway ethnic word descriptors (EWD) at PC30 including itchy throat, tight throat, voice tight, & itchy neck. Hispanic-Mexican Americans at PC30 used both upper and lower airway EWDs to describe their symptoms:

Upper airway: voice tight, itchy throat, itchy inside throat & chest, & tickle cough: Lower airway EWDs were-sore lung-chest, wheezing, can’t get air in/out. The EWDs reported and their differences across the differing ethnicities reflect the uniquely different perception of acute bronchoconstriction for each ethnic group. For the health professional, the EWDs provide an opportunity to expand our understanding of ethnic differences in symptom presentation and, also, to determine symptom management.

What is not fully understood is the relationship between EWDs, the regulation of beta-adrenergic airway responsiveness and ethnicity. The current word descriptors of wheezing, shortness of breath and chest tightness were derived from studies enrolling primarily Caucasian adults. These EWDs need to be expanded and revised to reflect our more diverse ethnic populations. As health care professionals asking your asthma patients what their primary asthma symptoms are when they seek care for an acute episode is an essential step forward if symptom management for all diverse ethnic groups are to be improved.

J Asthma. 2010 May;47(4):388-96. doi: 10.3109/02770903.2010.481341

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Innovations in Asthma Management

Interview with Michal Konstacky, MD at @Aerocrine

Aerocrine, a medical technology company focused on improving the treatment of patients with inflamed airways by identifying nitric oxide (NO) as a marker of inflammation. Aerocrine has HQ in Sweeden.

The founders of Aerocrine emerged from the highly prestigious Karolinska Institute in Sweden where they were the first to identify nitric oxide (NO) as a marker of inflammation. Aerocrine has taken this significant discovery from laboratory to listed company and is now established in some of the world’s largest markets. The company markets NIOX MINO. A highly reliable and effective tool to assist in the diagnosis and control of airways disease.