Asthma: percentage of members 5 to 50 years of age during the measurement year who were identified as having persistent asthma and who were appropriately prescribed medication during the measurement year.

TITLE
Asthma: percentage of members 5 to 50 years of age during the measurement year who were identified as having persistent asthma and who were appropriately prescribed medication during the measurement year.

SOURCE(S)
National Committee for Quality Assurance (NCQA). HEDIS® 2010: Healthcare Effectiveness Data & Information Set. Vol. 2, Technical Specifications. Washington (DC): National Committee for Quality Assurance (NCQA); 2009 Jul. 417 p.

open here to see the full-text:
Asthma: percentage of members 5 to 50 years of age during the measurement year who were identified as having persistent asthma and who were appropriately prescribed medication during the measurement year.

Nitric Oxide may help pregnant women manage asthma

Asthma is among the most prevalent chronic conditions that afflict pregnant women.  Fear about the effects of asthma medicine on the unborn babies makes treating asthma in pregnancy a major challenge.  Yet a recent study shows nitric oxide might help doctors manage asthma in pregnant women.

According to medindia.net about eight percent of women experience asthma during pregnancy.  Studies show that during the first six months of gestation asthma symptoms increase, and symptoms decrease during the final months of pregnancy.

Studies also show hospitalizations due to asthma increase during pregnancy, and other studies show a link between worsening asthma and decreased fetal growth.  Studies also link asthma in pregnancy with high blood pressure, preterm delivery, and all sorts of other complications.

These studies shed light on the need of finding a method to help these women better manage their asthma. Asthma experts in Australia believe they’ve found the solution.

Asianscientist.com reports on a program being trialed in Australia to help control and prevent asthma among pregnant women that has been rather successful.  The program is based on an algorithm that helps asthma doctors titrate asthma medicine to manage inflammation in the air passages.

The program was sparked by a study published in the Lancet that showed that asthma exacerbations in pregnant women could be “halved” if inflammation was “closely monitored.”  Yet due to fears of women and doctors about the effects of asthma medicine on the unborn baby, many cases of asthma among pregnant women go untreated.

However, as I wrote in this post, most asthma experts believe that it’s important to control asthma in pregnant women, and the advantages of taking asthma medicine should be based on weighing the advantages against the disadvantages.

Inhaled steroids are a proven and effective way of treating the chronic inflammation in asthmatic lungs.  When it comes to pregnant women, you want to have the least amount of the medicine needed to control inflammation.  Yet you don’t want too little inhaled steroid in your system because then the medicine won’t be doing the job.

So Australian experts came up with a Managing Asthma in Pregnancy (MAP) study whereby they monitor inflammation in the lungs by measuring the Fraction of Exhaled Nitric Oxide (FENO).  This is a test that is growing in acceptance because it directly measures how much inflammation is in the lungs.

Based on the FENO results, an algorithm is used to help doctors determine the best dose of inhaled steroid to use.

The study consisted of 220 pregnant women, half had their inhaled steroid adjusted using the algorithm and clinical symptoms, and the other half had their inhaled steroids adjusted using clinical symptoms alone.  The results concluded that those who used the both the algorithm and clinical symptoms to titrate their inhaled steroid were 50 percent less likely to have an asthma flare up.

Researchers surmised the women who used the algorithm to control their asthma used their inhaled steroid more often, although at a lower dose.  This group was also introduced to long-acting asthma preventative medicine sooner than the other group.  Their inflammation was therefore better controlled.

American Cancer Society

Today the Recommended by DeBarra Mayo Award goes to the American Cancer Society.

This organization does wonderful work. The American Cancer Society (ACS) is a nationwide, community-based voluntary health organization.

Congratulations American Cancer Society!

You can visit their website at: http://www.cancer.org/docroot/home/index.asp

Tantas alergias e intolerancias en la polbación tienen que tener un foco. "Annals of Allergy, Asthma & Immunology" puede tener la respuesta: El agua del grifo.". Los pesticidas del agua del grifo pueden tener parte de culpa en el aumento de las alergias a los alimentos, según un nuevo estudio publicado en la revista "Annals of Allergy, Asthma & Immunology". Los investigadores detectaron que los altos niveles de diclorofenoles, un químico usado en pesticidas y para clorar el agua, cuando se encuentran en el cuerpo humano, están asociados con alergias alimentarias. "Nuestra investigación muestra que los niveles elevados de diclorofenol que contienen los pesticidas posiblemente pueden debilitar la tolerancia alimentaria en algunas personas, causando alergia a los alimentos", dijo la especialista en alergias Elina Jerschow, miembro del Colegio Americano de Alergia, Asma e Inmunología (ACAAI, en sus siglas en inglés) y autora principal de la investigación. Diclorofenol es una sustancia química que se encuentra comúnmente en los pesticidas utilizados por los agricultores y los consumidores de insectos y productos de control de malezas, así como en el agua del grifo, según explica Jerschow. Entre los 10.348 participantes en la Encuesta Nacional sobre Salud y Nutrición de Estados Unidos de 2005-2006, 2.548 tenían diclorofenoles medidos en la orina, de los cuales, 2.211 se incluyeron en este estudio. En 411 de estos participantes se encontró que tenían alergia alimentaria, mientras que 1.016 tenían una alergia ambiental. "Los resultados de nuestro estudio sugieren que estas dos tendencias podrían estar vinculadas y que el uso creciente de pesticidas y otros productos químicos se asocia con una mayor prevalencia de alergias a los alimentos", añade la investigadora principal. Aunque pudiera parecer que optar por agua embotellada en lugar de agua del grifo podría ser una manera de reducir el riesgo de desarrollar una alergia, existen otras fuentes de diclorofenol, como plaguicidas para frutas y verduras, que, según los científicos, "pueden jugar un papel más importante en la causa de alergia a los alimentos". Según los Centros para el Control y Prevención de Enfermedades de Estados Unidos, se observó un aumento de alergia a los alimentos de un 18 por ciento entre 1997 y 2007, siendo los alérgenos alimentarios más comunes la leche, los cacahuetes, los huevos, el trigo, las nueces, la soja, el pescado y los mariscos. Los síntomas de alergia a alimentos pueden variar desde una erupción leve hasta una reacción potencialmente mortal llamada anafilaxia, por lo que la ACAAI aconseja a todos aquellos que padezcan alguna alergia de comida que lleven siempre dos dosis de epinefrina recetada por el alergólogo, ya que un retraso en su administración es común en las muertes por reacciones alérgicas alimentarias severas.( fuente del texto/ EP)

Tantas alergias e intolerancias en la polbación tienen que tener un foco. “Annals of Allergy, Asthma & Immunology” puede tener la respuesta: El agua del grifo.’.

Los pesticidas del agua del grifo pueden tener parte de culpa en el aumento de las alergias a los alimentos, según un nuevo estudio publicado en la revista ‘Annals of Allergy, Asthma & Immunology’. Los investigadores detectaron que los altos niveles de diclorofenoles, un químico usado en pesticidas y para clorar el agua, cuando se encuentran en el cuerpo humano, están asociados con alergias alimentarias.

“Nuestra investigación muestra que los niveles elevados de diclorofenol que contienen los pesticidas posiblemente pueden debilitar la tolerancia alimentaria en algunas personas, causando alergia a los alimentos”, dijo la especialista en alergias Elina Jerschow, miembro del Colegio Americano de Alergia, Asma e Inmunología (ACAAI, en sus siglas en inglés) y autora principal de la investigación.

Diclorofenol es una sustancia química que se encuentra comúnmente en los pesticidas utilizados por los agricultores y los consumidores de insectos y productos de control de malezas, así como en el agua del grifo, según explica Jerschow.

Entre los 10.348 participantes en la Encuesta Nacional sobre Salud y Nutrición de Estados Unidos de 2005-2006, 2.548 tenían diclorofenoles medidos en la orina, de los cuales, 2.211 se incluyeron en este estudio. En 411 de estos participantes se encontró que tenían alergia alimentaria, mientras que 1.016 tenían una alergia ambiental.

“Los resultados de nuestro estudio sugieren que estas dos tendencias podrían estar vinculadas y que el uso creciente de pesticidas y otros productos químicos se asocia con una mayor prevalencia de alergias a los alimentos”, añade la investigadora principal.

Aunque pudiera parecer que optar por agua embotellada en lugar de agua del grifo podría ser una manera de reducir el riesgo de desarrollar una alergia, existen otras fuentes de diclorofenol, como plaguicidas para frutas y verduras, que, según los científicos, “pueden jugar un papel más importante en la causa de alergia a los alimentos”.

Según los Centros para el Control y Prevención de Enfermedades de Estados Unidos, se observó un aumento de alergia a los alimentos de un 18 por ciento entre 1997 y 2007, siendo los alérgenos alimentarios más comunes la leche, los cacahuetes, los huevos, el trigo, las nueces, la soja, el pescado y los mariscos.

Los síntomas de alergia a alimentos pueden variar desde una erupción leve hasta una reacción potencialmente mortal llamada anafilaxia, por lo que la ACAAI aconseja a todos aquellos que padezcan alguna alergia de comida que lleven siempre dos dosis de epinefrina recetada por el alergólogo, ya que un retraso en su administración es común en las muertes por reacciones alérgicas alimentarias severas.( fuente del texto/ EP)

What is the microflora hypothesis of asthma?

The following post is from healthcentral/asthma.

“The microflora hypothesis of asthma and allergies.”  (Originally published

It’s a proven fact asthma rates are on the rise in Western nations like the U.S. and U.K.  In the past pollution was blamed.  Yet with pollution on the decline and asthma rates still rising, many experts are looking at other theories.

Two theories gaining acceptance are the hygiene hypothesis and the microflora hypothesis.

The hygiene hypothesis pretty much proposes allergies and allergic are caused because we’re too clean.  In the absence of bacteria our immune system gets bored and attacks things we consider normal — like allergens.

I simplified the hygiene hypothesis in a previous post.  If you’re not familiar with it I recommend you click here.  In this post I’d like to introduce you to the microflora hypothesis.

First a few definitions:

Normal Flora:  According to the Online Textbook of Bacteriology these are tiny little microbes that cover the surface areas of your body, including your skin and mucus membranes.  This consists of some fungi, but mostly bacteria.  Their main job is to prevent the growth of bad bacteria.

Microflora:  According to thefreedictionary.com these are normal flora of a specific location, such as the intestines.

Probiotics:  This is simply a synonym for normal flora.

So what is the microflora hypothesis?

It’s actually similar to the hygiene hypothesis only it goes a step further.  It states microbes in your intestinal tract (microflora) work together with your immune system to keep your immune system working right.

An imbalance of these microbes any time in your life can cause your immune system to develop an inappropriate response.  This may best explain why asthma can be developed at any time in your life.

So what causes microflora to become imbalanced?

Two things in our modern, industrialized way of life are suspected to cause such an imbalance:

• 1. Antibiotics


• 2. Dietary changes

So, how might antibiotics cause an imbalance of microflora?

Antibiotics:  These were considered to be a godsend to the medical field when they hit the market in 1944, as they allowed doctors to treat and prevent infection. While these are good, there are consequences to antibiotic abuse:

• 
  Some bacteria are smart: They catch on and develop resistance to antibiotics and this forces us to invent more powerful antibiotics.


• 
  Some antibiotics kill too much: Instead of killing just the infecting bacteria we were also killing the good bacteria we need to maintain balance


• 
  Antibiotics only kill bacteria: Actually we knew this all along, but I just thought I’d add it here to make a point.

While antibiotics are only able to treat bacterial infections, they were — and often still are – prescribed to treat any infection, even viral.  Often they are ordered just so you think the doctor is doing something.  You have asthma symptoms; you have a cold, so you expect antibiotics.

In fact, this study shows that way too many asthmatic kids are being prescribed antibiotics to treat asthma even though doctors know they aren’t recommended in the treatment of asthma.  It’s expected many doctors order them just to “cover their bases.”

Yet it’s a common fact the most common asthma triggers are viral infections.  So treating your sickness with an antibiotic is useless unless you really have a bacterial infection.

The most common antibiotic prescribed would be broad spectrum antibiotics.  These kill more than one type of bacteria, yet the hope is they’d kill the culprit.  The problem with these is they kill the good along with the bad.

Narrow spectrum antibiotics can also be prescribed.  These are antibiotics that only kill the desired bacteria.  Yet to prescribe them in the office without further testing would be a crap shoot.  To pick the right one you’re sputum must be tested to identify the bacteria.  If no bacteria are identified, antibiotics will be useless.

If bacteria are identified further testing can be done to see what antibiotic kills it.  In this case, a broad spectrum antibiotic can be selected.  The problem with all this is it takes time and money.

So most often your doctor will skip all this testing and just give you the antibiotics you want.  You’re happy, he’s covered all his bases, and you eventually get better.

The solution to this problem might be simple:

• Avoid antibiotics use.


• If antibiotics are needed,narrow spectrum antibiotics should be used.

Modern diet:  According to The Probiotic Revolution, “people in industrialized countries eat significantly more fast food and refined foods, and much less fiber.  They’re also less likely than people in the developing world to rely on fermentation to preserve goods — thus depriving themselves of a ready source of probiotics.”

The solution to this problem might also be simple.  Eat more of the following:

• Whole grains


• Nuts


• Fruits


• Vegetables


• Probiotic supplementation

Probiotic supplementation:  As far as a cure for asthma and allergies, some studies have been ongoing to determine certain therapies can be done to restore the imbalance of probiotics in the gut. Studies are ongoing to see if this prevents or treats allergies.

Since 75 percent of asthmatics also have allergies, the hope is probiotic supplementation will also prevent and treat asthma as well.  Studies are ongoing, and we’ll have to wait and see how they turn out.

So there you have it:  the microflora hypothesis.  It’s one of several theories of what might cause one to develop asthma.  What do you think?

Click here for a more in depth discussion of this hypothesis. 

The modest asthmatic

Yesterday we discussed rare and irresponsible Actor Asthmatic. Today I would like to bring light to the Doubting Thomas Asthmatic.

Most RTs and RNs can recognize them as soon as they walk into the door. Usually they are men who come to the ER with their wives because, “she made me come in. I didn’t even want to be here. I’m fine.”

Then you listen to them and they have all the tel-tale signs of asthma. We really shouldn’t limit Doubting Thomas’s to just asthma either, as we know there are a ton more COPD and chest pain patients who are simply too modest to come into the ER.

There’s a saying we like to use in the ER where I work, “The modest patient stayed home with chest pain and died.”

Over on my asthma blog I wrote about the modest patient, of which we aptly titled the Doubting Thomas. For more information about the Doubting Thomas click here and I will morph you over to my other blog.

The Doubting Thomas Asthmatics
by Rick Frea Wednesday, November 19, 2008
See the accompanying comic!

Thomas was the apostle who did not believe Jesus had been resurrected. According to the Bible, (John 20:24-29) he was not convinced until he actually saw and felt the scars of Jesus.

Since then, anyone who refuses to believe something without direct physical proof is called a Doubting Thomas. And, therefore, an asthmatic that refuses to believe he has asthma is rightfully dubbed a Doubting Thomas.

Believe it or not, I’ve seen my fair share of these folks in my 11 years as an RT. It’s neat, because they will come into the ER for an unrelated reason, the doctor will listen to them and order a breathing treatment, and then I enter the patient’s room thinking I’m going to do another breathing treatment just because the doctor didn’t know what else to do.

Just recently I had a pudgy, balding male named Carl, mid 30s, lying supine on the ER bed. He appeared to be breathing normally. I gave him my usual line, “Hi. I’m Rick from Respiratory Therapy. Are you having trouble breathing?”

“No,” he said, “I feel fine.”

“Okay, so why am I giving you a breathing treatment,” I think to myself. Then I say, “How come you came to the ER tonight?”

“Um… because I was just not feeling right. I also have a little chest pain.”

I pulled my stethoscope from my lab coat and pressed the bell on the patient’s anterior chest. I hear wheezes. “Can you please sit up so I can listen to your back?” I listen to his back. “You definitely have wheezes in there. Do you have asthma?”

“Not that I know.”

I hand the patient a nebulizer that I had already filled with one amp of albuterol.

“What’s this for?” The patient looked at me awkwardly.

“This is for people with breathing trouble,” I said, “The doctor thinks it might help you breathe better.”

“Well, I’ll take it, but I’m not having trouble breathing.”

I plug the nebulizer tubing to the flowmeter and the neb sputters to life, releasing its cool white mist into the room, and hand it to the patient who spends several minutes inhaling the mist.

I stand coolly by until the nebulizer sputters, a tell-tale sign that it’s finished. I turn off the flowmeter, and pluck the nebulizer from the patient’s mouth. “So, how do you feel now?”

“You know what?” he said, taking in a deep breath and smiling, “I think I feel great. Wow! I don’t think I’ve ever felt this good in my life.”

Ah, and that last sentence — “I have never felt this good in my life”– following a bronchodilator breathing treatment — is a tell-tale sign of a Doubting Thomas asthmatic.

“I bet you’ve been short-of-breath for days and you didn’t even know it.” If you ever hear an RT or doctor ask this question, you know he is thinking Doubting Thomas.

“Actually,” the patient said, “I’ve had this regular cough for years, especially after exercising. It got so bad I had to quit exercising a few months ago. I just thought being a little short-of-breath was a normal part of aging.”

Bingo! That last sentence confirmed it for me: This man is definitely a Doubting Thomas.

“You should never have trouble breathing,” I said. “If you do you should always see your doctor, because there’s no reason anyone should ever have to suffer this day and age.”

“What will my doctor do?” Carl asked.

“First of all, the ER doctor is going to prescribe a rescue inhaler that works just as well as the breathing treatment you just had. You can use it up to every 4-6 hours for asthma symptoms.

“Then he’s going to recommend you see your family physician so to get you on an asthma management plan that’s right for you. This plan may include prescribing long term relief medications that actually work to prevent asthma.”

The New York Times wrote a story, “Asthma Medications: Not a Clear Advantage,” about former Olympian gold medal swimmer Dara Tores. She had all the classic signs of asthma, even a family history, and yet she chose to ignore the signs.

One day a friend told her she had all the classic signs of asthma, and she went to the doctor. Once on all the right asthma medicines and her asthma was controlled, the article states, she realized “how much, and how needlessly, she had been suffering.”

Carl was lucky his asthma was discovered before he had a life threatening attack. If you think you are a Doubting Thomas like Carl, don’t wait until something really bad happens before getting help.

The first key to getting help is admitting you have a problem. The second key is to see a qualified asthma physician and getting yourself on a program to manage your asthma.

According to the Gospel of John, after Thomas touched the scars of Jesus, he professed his love of Jesus and was later known as Thomas the believer.

Similarly, any Doubting Thomas who faces his illness, seeks to learn the truth, and is treated accordingly, will no longer “needlessly” suffer.

SAMTER"S TRIAD - INFORMATION TO KNOW

The disorder is caused by an anomaly in the arachidonic acid cascade, which causes undue production of leukotrienes, a series of chemicals involved in the body’s inflammatory response. When prostaglandin production is blocked by NSAIDS like aspirin, the cascade shunts entirely to leukotrienes, causing overproduction of LT-4 and producing the severe allergy-like effects.
There may be a relationship between aspirin-induced asthma and TBX21, PTGER2, and LTC4S.^[3]
In addition to aspirin, other vaso-dilators may induce the same reaction, such as alcohol.

Medication
The preferred treatment now is desensitization to aspirin, undertaken at a clinic specializing in such treatment. Patients who are desensitized then take a maintenance dose of aspirin daily; they have reduced need for supporting medications and fewer asthma and sinusitis symptoms than previously; many have an improved sense of smell.
Treatment formerly focused on relieving the symptoms. Even desensitized people may continue to use nasal steroids, inhaled steroids, and leukotriene antagonists.
Leukotriene antagonists and inhibitors (montelukast, zafirlukast, and zileuton) are helpful in treating Samter’s.
Some patients require oral steroids to alleviate asthma and congestion, and most patients will have recurring or chronic sinusitis due to the nasal inflammation. Desensitization reduces the chance of recurrence.

[edit] Surgery

Occasionally surgery may be required to remove polyps,^[4] although they typically recur, particularly if desensitization is not undertaken.

[edit] Diet

A diet low in omega-6 oils (precursors of arachidonic acid), and high in omega-3 oils, may also help.^{[citation needed]}
Some people find relief of symptoms by following a low-salicylate diet such as the Feingold diet. They may need to eliminate the other salicylate-containing foods identified by Swain in 1985 as well.^[5] For those who need them, these salicylates are listed in charts in the Feingold Handbook based on level of salicylate measured in the item. Unfortunately, any such list is only a rough guideline since amounts will vary depending on fruit/vegetable variety and where grown; in fact, organic foods have been shown to contain more salicylate than conventional produce because the plant is more likely to be under attack from pests, and salicylate is produced by the plant as protection