Asthma Studies Today
Asthma rises as children return to school
Last September the number of children aged 16 and under admitted for asthma across England was 58 per cent higher than the average monthly figure over the year as a whole.
The previous September the corresponding figure was 102 per cent, according to the NHS Information Centre.
The spikes were driven by admissions of children aged five and under.
The figures matched the experiences of many parents, according to Asthma UK, a charity.
Erica Evans, head nurse at Asthma UK, said: “There are a number of possible factors involved, including the spreading of colds and viruses, the potential stresses that a new school term can bring and children not taking their regular preventer medicine over the summer holidays.
“We also know that a quarter of children with asthma miss six or more days from school a year as a result of the condition, which can have a significant knock on effect on school work.”
She said parents of children with asthma should make sure they have a “tailored plan” to help themselves and teachers cope with an attack; find out how the school or nursery manages asthma; and ensure their child has a review with a GP or specialist nurse every six or 12 months.
telegraph.co.uk
Prenatal smoke tied to poorer asthma-drug response
(Reuters Health) – Studies have shown that children whose mothers smoked during pregnancy may have an increased risk of developing asthma. Now new research suggests they may also get less benefit from the inhaled steroid medications used to prevent asthma attacks.
In a study of more than 1,000 kids between five and 12 years old with mild-to-moderate asthma, researchers found that those who had been exposed to smoke in the womb had less of a response to the inhaled corticosteroid budesonide (Pulmicort) than children with no prenatal exposure to smoking.
Overall, both groups of children improved with the medication. However, children with prenatal smoke exposure had 26 percent less of an improvement in their “airway responsiveness.”
Airway responsiveness refers to a “twitchiness” in the airways that, in people with asthma, can be triggered by small amounts of a normally benign irritant, like pollen or pet dander.
Inhaled steroids are the mainstay of therapy for persistent asthma, helping to prevent attacks of coughing, wheezing and breathlessness. One of the ways doctors measure whether a patient is responding to inhaled steroids is by testing airway responsiveness.
In this study, children with prenatal exposure to maternal smoking had less of an improvement in airway responsiveness after starting budesonide — and some had no improvement at all, said Dr. Benjamin A. Raby of Brigham and Women’s Hospital in Boston, one of the researchers on the study.
The full implications of the difference are not clear. The researchers did not have information on whether children exposed to prenatal smoking actually had higher rates of asthma attacks or hospital visits than other children, despite treatment with inhaled steroids.
But the findings do raise that possibility, Raby told Reuters Health.
He stressed, however, that no one is suggesting children with prenatal tobacco exposure should forgo inhaled steroids. “Inhaled steroids are the first-line therapy for persistent asthma, regardless of whether children had in-utero exposure to smoking or not,” Raby said.
Instead, he explained, the findings offer a potential explanation for why a child with prenatal exposure to smoking may not be responding as well as hoped to inhaled steroids. These children may need a second type of medication — such as oral drugs known as leukotriene modifiers — added to their treatment in order to control their asthma, Raby said.
The study, which was led by Dr. Robyn T. Cohen of Drexel University in Philadelphia, is published in the Journal of Allergy & Clinical Immunology.
The data come from a clinical trial in which 1,041 children with persistent asthma were randomly assigned to use budesonide, another type of inhaled asthma medication called nedocromil or a placebo over four years.
Of those children, 150 had been exposed to smoking in the womb, and 39 of them were given budesonide.
The study is the first to link prenatal smoke exposure with a reduced response to inhaled steroids, which, along with the small number of children exposed, means that further research is needed to replicate the findings, according to Raby.
It is also impossible to definitively say that prenatal tobacco exposure is the lone culprit, the researcher noted. He and his colleagues did account for children’s current exposure to secondhand smoke at home, but teasing out the impact of prenatal exposure by itself is difficult.
The researchers do think it is biologically plausible that prenatal tobacco exposure could affect children’s later response to asthma medication.
Lab research suggests that prenatal exposure to smoke can influence the development of the lung structure or the smooth muscles of the airways, which could affect the body’s later response to asthma medications.
Child asthma admissions soar in September
The number of children being admitted to hospital for asthma soared by 58% above the average monthly rate in September of last year, according to figures published today by the NHS Information Centre.
The figures show that in September 2009, asthma admissions were 6,900, more than half of which (3,670) were for children aged 16 and under and 30% of which (2,090) were for children aged five and under.
A sharp rise in admissions of children aged five and under caused the September peak in England within the 16 and under age group.
The figures are part of a special topic from Provisional Monthly HES for Admitted Patient Care, which is published monthly to provide up-to-date information and describe recent trends.
Between May 2009 and April 2010, the provisional monthly average for all asthma admissions was just 5,660, while the provisional monthly average for the 16 and under age group was 2,320 (accounting for 41% of all admissions).
This means that hospital admissions for asthma among children aged 16 and under were 58% higher in September 2009 than the monthly average for the year.
The same pattern occurred in September 2008 when there was a 102% increase compared to the monthly average for between May 2008 and April 2009.
Between May 2008 and April 2009 the provisional monthly average for all asthma admissions was 5,920, while the provisional monthly average for the 16 and under age group was 2,380 (accounting for 40% of all admissions).
But in September 2008 there were 8,370 admissions for asthma; of these 4,820 (58%) were for children aged 16 and under and 2,780 (33%) were for children aged five and under.
The September pattern was not repeated in those aged 17 and over, with admissions for older age groups mostly peaking in October or December. Admissions for the condition generally reduce as age increases.
NHS Information Centre chief executive Tim Straughan said: “Although provisional, these figures provide a useful insight at a national level into the admissions passing through our hospital doors in England, and also into possible shifts in trend during the different seasons.
“These figures appear to highlight September as a hotspot for asthma admissions among our very young children, which may prompt possible investigation as to why this may be.”