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by James Thomas, Sunday, 27 November 2016 | Categories: Asthma

According to Asthma UK, there are 5.4 million people living with asthma in the UK, 1.1 million of whom are children. That adds up to 1 in every 11 children, meaning that on average there are three with asthma in every classroom in the country.

At first glance, asthma might not seem like the worst health condition to live with, but the reality can be scary. For adults and children coping with severe asthma, living a normal life can be a daily struggle.

The good news is that asthma medications and the techniques for managing the condition effectively are constantly improving. Recent research from the American Academy of Pediatrics also looks set to make a significant contribution to the health of asthmatic children and adults.

According to the experts, the indoor environment of asthma sufferers’ homes plays a crucial role in respiratory health. In fact, controlling this environment could be as vital to asthma management as the use of medication. This discovery is particularly important for parents of asthmatic children, because air-borne pollutants can disrupt the development of young airways. Children are also more likely to be exposed to irritants and pollutants than adults because they spend more time on the floor.

Keeping your Home Safe

The new guidance recommends that parents with asthmatic children take the following precautions in their home:

  • Reduce your child’s exposure to cigarette smoke
  • Dust and clean regularly to avoid exposure to dust mites
  • Address any mould or damp issues
  • Address any issues with pests or vermin

Ultimately, the best thing you can do for your child is to keep your home very clean, dust-free and regularly vacuumed – particularly the rooms they spend the most time in.

Pets & Asthma

The report also discussed the role that family pets can play in children’s asthma. Animal dander is a common asthma trigger and it’s not always easy to control – even if you have a so-called "hypoallergenic" pet.

Giving up your dog or cat is not necessarily the only option if your child has asthma. This is because animal dander is only a problem if your child has an allergy to it – not all asthma sufferers are automatically allergic.

You’ll be able to tell if your child is allergic by monitoring their symptoms when they are around your pets. When the allergy is severe, a reaction will be instant, causing coughing, wheezing, shortness of breath and sometimes even a rash. When the allergy is only mild, a reaction may take a few days to develop.

For children with only a mild allergy, it may be possible to keep pets as long as they are not allowed into bedrooms or communal living areas. Keeping your pets well groomed and clean is also important, as is regularly cleaning and vacuuming.

For children with a severe allergy, it’s worth getting a definitive allergy test before you consider giving up your pet. It may be that your child is allergic to something else in your home.

Other Management Techniques

Keeping your home clean and safe is very important when it comes to asthma management, but there are other important techniques to keep in mind.

The first is having a written asthma action plan. This is a document which details all the vital information related to your child’s condition. It will include a list of your child’s triggers, medications, and what to do in the event of an asthma attack. To establish a comprehensive asthma action plan for your child you will need to take some time monitoring their condition, and working out what their asthma triggers are.

It’s also crucial to make sure your child is using the correct asthma medication. If they are only using a blue reliever inhaler (usually Ventolin) but experiencing symptoms more than three times a week, then it is likely that will need a preventer inhaler.

However, frequent flare-ups of symptoms could also be a sign of an unidentified trigger in the home – whether it’s cigarette smoke, animal dander, dust mites, food additives or mould. In this situation, an allergy test is recommended.

You can read more about asthma and the various medications available to treat it at The Online Clinic. Click here to view our inhalers and learn more about asthma management.

by Marijana Domazet, Saturday, 06 September 2014 | Categories: Asthma

The relationship between vitamin D and asthma has been receiving increasing attention in the scientific community. In the past five years, studies have looked at how vitamin D (or lack thereof) affects the development of asthma, the persistence of asthma attacks and the treatment of asthmatic symptoms. Here we consider the most recent study that looked at the use of vitamin D in addition to standard treatments.

The study, which was published in Annals of Allergy, Asthma and Immunology, was a case control study. In total 130 participants of varying ages took part. The study included participants who were classified as having mild to moderate asthma. Whilst one of the groups only received the standard treatment that included an inhaler with dry powder, the other group received the standard treatment and additional doses of vitamin D. The participants in this group received an injection of 100,000 units, followed by instructions to take 50,000 units orally on a weekly basis. The researchers then measured the lung functioning of both groups at different time points throughout the life of the study. The main findings indicated that both groups were performing equally well after eight weeks. However, 20 weeks after the study started there were marked differences between the groups. On average, the participants who had been given vitamin D performed 20 percent better than they had at the start of the study. In contrast to that, participants who had been given the standard treatment performed seven percent better. Based on this, the researchers concluded that larger studies are needed to see whether vitamin D could be used as supplementary treatment in the management of asthma symptoms.

These findings are far from surprising as they are pointing in the same direction as previous research. There are a few points from the current study that are worth considering when interpreting the results or when attempting to replicate its findings. One of the flaws is the reliance on self-report of adherence to treatment. The researchers measured the adherence to the treatment via telephone interviews. However, assuming that the adherence (or lack thereof) is equally distributed between the groups, the findings would still hold. Another flaw is that participants were not tested for vitamin D deficiency prior to taking part in the study. Having said that, it is clear that that the researchers were keen to stress the importance of further research. It is also worth noting that this study is one of the few studies within this line of research that included adults.

It is easy to see the appeal of vitamin D as an additional treatment. It is non-invasive and easy to administer. At the same time it is worth mentioning that experts in this field have stressed that the research is still in its early stages and individuals should not start taking vitamin D as a treatment.

We will keep an eye on developments in this field.

Further information can be found here.

by Marijana Domazet, Wednesday, 07 August 2013 | Categories: Asthma

A key issue with most asthma inhalers is that a large part of the medication stays in a patient’s throat rather than reaching their lungs. However, this may be about to change as a team at Monash University has developed a new method of making ultra-fine particles, which would pass easier to the lungs.

The team, which is currently sponsored by the Australian Research Council, presented its findings in China last year and has attracted significant interest from the pharmaceutical industry. Initially the team had been researching dairy production, with the purpose of attempting to produce lactose crystals using nitrogen laced with ethanol vapour. This led to the development of tiny and uniform lactose particles. Having investigated this unexpected outcome, the researchers concluded that the alcohol absorbed into the initial droplets led to the development of the uniform lactose particles.

It is now hoped that the method described above could be harnessed to develop ultra-fine and uniform particles of the asthma medications so that they would be able to reach the lungs. As a result of this, it is hoped that it could increase the efficacy and accuracy of inhalers. Moreover, it means it would affect the manufacturing process and potentially make the production of inhalers more cost effective.

It is still too early to say whether this method is viable in the manufacturing process of asthma inhalers. However, if this were to produce the expected outcomes then we would be keen to see what clinical implications it would have in terms of prescribed dosages in the inhalers.

You can read more about this discovery at Fierce Drug Delivery.

by Robert MacKay, Tuesday, 07 May 2013 | Categories: Asthma

When it comes to treatment of various illnesses it is not always the case that one size fits all. Instead, it is not uncommon for individual treatment plans to be developed to suit the affected person. A good example of that can be seen in how individuals who have asthma often need to find what is right for them. Yet, despite the many options available, there are still some individuals who do not respond well to traditional treatments for asthma. Although this is a long-standing problem, no large-scale studies have addressed the issue to date. However, this is about to change.

Researchers from University of Adelaide School of Medicine recently announced that they are recruiting participants for a five-year study in Australia. The key purpose of the research is to consider the benefits of macrolide antibiotics in the lungs of asthmatics, who (despite taking medications), are still symptomatic. In addition to that, the same team will conduct clinical trials on an alternative treatment for this population.

According to the researchers the current treatments target so called eosinophil cells (white bloods cells). However, they postulate that targeting neutrophil cells (also white blood cells) may be more suitable for some individuals as many asthma sufferers have normal levels of eosinophil cells. It is their hope that their research and clinical trials will illuminate this relationship for further research to be done and new treatments to be developed.

It is important to point out that the proposed treatment therapy is not only appropriate where there is an infection present. Macrolide antibiotics have anti-inflammatory properties and the use in asthma has been postulated before in a study dating back to 2004.

We are always a bit weary of researchers’ claims before seeing the results of any trial. However, the scope of this project is substantial, not only in terms of length of time but also in terms of funding. As such, it is our hope that the research will at the very least help clarify unanswered questions regarding cell biology in the process of asthma development and treatment. You can read more about this study here.

by Marijana Domazet, Tuesday, 19 March 2013 | Categories: Asthma

In the UK, most individuals with asthma are well aware of the possibility to use an inhaler that contains a combination of corticosteroids and so-called LABA. In fact, in the UK the treatment (which is commonly called SMART) appears to have been widely available for adults for nearly ten years. Yet, two trials that were recently published in The Lancet Respiratory Medicine recently appear to have met some resistance in the US, with some sources claiming that recommending the use of SMART inhalers would go against national and international medical guidelines, that clinicians’ perceptions of the efficacy of SMART are not the same as patients perceptions and that the promotion of SMART inhalers reflects financial interests rather than a concern for patients well-being. In this blog post, we consider whether there is any foundation behind those statements and whether the findings from the two studies warrant a serious consideration of SMART treatments.

The first study, conducted by Patel et al, was a 24 week trial that included a total of 301 patients. The participants, who were between the ages of 16 and 65 were randomly put into groups that either used SMART inhalers or used standard inhalers. The key findings indicate that individuals in the SMART group had fewer severe asthma exacerbations, leading the researchers to conclude that SMART is a particularly suitable treatment for adults that are at risk of having severe asthma exacerbations.

In addition to standardising the treatments so that they were comparable between the groups, the researchers also used an electronic device to ensure that the measurement of actuations was more precise than it had been in past studies. This study also differed from past studies, as the researchers did not use dry powdered inhaler and as it was the first study that had not received funding from a pharmaceutical company.

The second study, conducted by Papi et al, was a double blind trial that was conducted between a total of 14 European countries (183 centres) over the course of 48 weeks. The 1714 participants, who were over the age of 18, were randomly put into groups that either used a combination of corticosteroids and LABA or only relied on LABA. After controlling for factors such as lung function, symptoms scores and asthma exacerbation, the findings suggested that the latter group had severe exacerbations earlier than the former group. Moreover, individuals in the former group also had fewer mild asthma exacerbations. Based on this the researchers concluded that the using a combination of corticosteroids and LABA would be useful for patients with moderate to severe asthma.

Given that this trial controlled for many aspects that previous studies did not address sufficiently, it is unlikely that the findings from this large-scale trial are random. The sheer size of the trial, in combination with the blind design, makes it challenging to question the findings.

It is clear that both of the aforementioned trials are robust and unique in many ways. However, despite the fact that these studies corroborate findings of past trials and testimonies of clinicians, it also appears that patients’ perception of their symptoms improving or being better controlled as a result of using SMART inhalers is not always a given. This of course, should not be taken lightly. However, some likely explanations for this incongruence could be attributed to variations in diagnosis severity, triggers and medication compliance.

To our knowledge there are no studies to address this, but it does seem like a feasible explanation for the incongruence between clinicians and some patients’ perceptions. We believe that rather than considering negative patient testimonies as noise, it would be valuable to understand the difference between patients who find SMART useful and patients who do not. This of course, is less extreme than suggesting that SMART treatments are breaching medical guidelines.

In conclusion, we find it abundantly clear that the two studies are extremely valuable in further supporting the use of SMART inhalers. We see little support for the argument of financial motivation, especially when considering the Patel et al trial and hope that future research efforts are put into optimising the use of SMART inhalers for relevant patient groups.

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