Pediatric Wheezers not such Wizards with Puffers

Regular readers of SRxA’s  Word on Health already know that asthma is the most common chronic childhood disease in the U.S. Direct asthma-related healthcare costs are upwards of $ 6 billion a year and lost productivity costs associated with working parents caring for children who miss school, costs a further billion. Given this huge financial burden we were shocked to learn that fewer than one in 10 children with asthma use their inhalers correctly.

While children have more success with newer inhaler designs, at best, only one child in four gets it completely right, according to the findings published in the journal Pediatrics.

Researchers from the University of North Carolina at Chapel Hill, Eshelman School of Pharmacy studied 296 patients aged 8 to 16 years old who used four different devices to manage their asthma.

The devices were:

  • metered-dose inhaler (commonly called a puffer)
  • diskus, (a dry-powder inhaler delivering Advair)
  • turbuhaler (a dry-powder inhaler delivering Pulmicort or Symbicort)
  • peak-flow meter, which does not deliver a drug but is used to measure lung function to determine if medicine is needed

Only 8% of children in the study performed all of the metered-dose inhaler steps correctly. Older children were more likely than younger children to get more of the metered-dose inhaler steps correct. With a diskus, 22% of children performed all steps correctly, and 15.6% performed all of the turbuhaler steps correctly. Children using a peak-flow meter did so correctly 24% of the time.

The researchers also found that the majority of health-care providers who participated in the study did not demonstrate or assess children’s use of the four devices during pediatric asthma visits.

It is crucial that health-care providers not only show a child how to use an inhaler correctly but also have the child demonstrate the device in front of a physician or pharmacist,” said lead investigator Betsy Sleath Ph.D. “Pediatric practices are extremely busy places so we need innovative ways to demonstrate and assess device technique among asthmatic children.”

Improper use of inhalers and other asthma medication devices can lead to poor control of the condition, more hospitalizations and increased health-care costs.

SRxA’s team of leading asthma experts can help design programs to teach healthcare professionals how to teach patients about their asthma therapy.  These validated programs have been shown to dramatically increase compliance and adherence.  Contact us today to learn more.

Experts not so Ecstatic about new data on drugs-related E.R. visits

According to the Substance Abuse and Mental Health Services Administration (SAMHSA) emergency department visits related to “Ecstasy” use increased nearly 75% from 2004 -2008.

A new national study indicates that the number of hospital emergency room visits involving the illicit drug Ecstasy increased from 10,220 in 2004 to 17,865 in 2008.  70% of these Ecstasy-related visits involved patients aged 18 to 29, but more alarmingly 17.9% involved adolescents aged 12 to 17.

Ecstasy is the colloquial term for MDMA (3,4-Methylenedioxymethamphetamine) –often abbreviated “E” or “X”.  It is an entactogenic drug of the phenethylamine and amphetamine class of drugs

Leah Betts, before her death from Ecstasy. Her parents released the photograph in the hope of deterring other young people from taking drugs.

Ecstasy use can produce psychedelic and stimulant side effects such as anxiety attacks, tachycardia, hypertension and hyperthermia. The variety and severity of adverse reactions associated with Ecstasy use can increase when the drug is used in combination with other substances of abuse.  Most Ecstasy-related deaths occur as a result of the drug users’ failure to recognize their body is abnormally hot.

In the current study almost 80% of emergency department visits involving Ecstasy use also involve the use of at least one or more other substances of abuse.  Half had used Ecstasy with three or more other substances.

The resurgence of Ecstasy use is cause for alarm that demands immediate attention and action,” said SAMHSA Administrator Pamela S. Hyde, J.D. “The aggressive prevention efforts being put into place by SAMHSA will help reduce use in states and communities, resulting in less costly emergency department visits related to drug use.”

SRxA’s Word on Health and its Behavioral Health Advisors are deeply concerned by this trend and applaud SAMHSA on its preventative educational efforts.

Time to hang-up before you trip up!

Men who routinely wear their cell phone on their belt on the right side have reduced bone mineral content (BMC) and bone mineral density (BMD) in the right hip, according to a study in the March Journal of Craniofacial Surgery.

Lead investigator Dr. Fernando D. Sravi of National University of Cuyo, Mendoza, Argentina writes, “The different patterns of right-left asymmetry in femoral bone mineral found in mobile cell phone users and nonusers are consistent with a non-thermal effect of electromagnetic radiofrequency waves not previously described.”

Dr. Sravi measured BMC and BMD, both standard markers of bone strength, at the left and right hip in two groups of healthy men: 24 men who did not use cell phones and 24 men who carried their cell phone in a belt pouch, on the right side, for at least one year.

Average hip BMC and BMD measurements were not significantly different between groups. However, men who did not use cell phones had higher BMC in the right femoral neck (near the top of the thigh bone): a normal left-right difference that was absent in cell phone users.

The cell phone users also had reduced BMD and BMC at the right trochanter – an area at the outside top of the thigh bone, close to where the phone would be worn on the belt. The difference between the left and right trochanters was significantly related to the estimated total hours spent carrying a cell phone.

There have been previous concerns about the potential harmful effects of cell phones. However, few studies have looked at whether electromagnetic fields emitted by cell phones could affect bone mineralization. With the rapid growth in cell phone use, any significant effect on BMD could have a substantial effect on the osteoporosis rate in the population.

Although small, the new study raises the possibility that long-term exposure to electromagnetic radiation from cell phones could adversely affect bone mineralization.  Larger follow-up studies will be needed to confirm or disprove this hypothesis, especially women, who have higher rates of osteoporosis; and children, who would have longer expected lifetime exposure to cell phones.

In the meantime, SRxA’s Word on Health suggests men might want to rethink where they carry their cell phones.

Survey Reveals Unmet Needs Among Patients with Allergic Rhinitis

SRxA’s Word on Health team spent the last week attending the American Academy of Allergy Asthma & Immunology Annual Meeting in San Francisco. In addition to spending quality time with many of our KOL Allergy Advisors and pharmaceutical clients, we were able to catch up with some of the latest research on allergic rhinitis (AR).

Allergic rhinitis is an allergic reaction that happens when the immune system overreacts to inhaled, such as pollen. This causes release of a type of antibody, known as IgE, into the nasal passages, along with inflammatory chemicals such as histamines. The two types of allergic rhinitis are seasonal allergic rhinitis (hay fever) and perennial allergic rhinitis, which occurs year-round. Hay fever is caused by outdoor allergens. Perennial allergic rhinitis is caused by indoor allergens such as dust mites, pet dander, and mold.

Results from a recent pivotal AR satisfaction survey assessing patient and healthcare provider perspectives on AR reveal that symptoms like nasal congestion and post-nasal drip continue to impact patients’ daily activities.

Findings from the Nasal Allergy Survey Assessing Limitations (NASL) 2010, highlight the continued unmet need for more effective treatment options to help reduce symptoms and overall disease burden of AR.

The prevalence of AR in the U.S. has increased during the past three decades.  It is now estimated that 20% of the general adult population and almost 40% of children have the condition.  Of the estimated 60 million Americans affected with AR, approximately 20% have seasonal allergic rhinitis (SAR), 40% have perennial allergic rhinitis (PAR), and 40% have a combination of the two (i.e., PAR with seasonal exacerbations) depending on the allergen sensitivity.

In other words, one in 5 adults and almost half of children suffer from symptoms including:

  • Stuffy, runny nose
  • Sneezing
  • Post-nasal drip
  • Red, itchy, and watery eyes
  • Swollen eyelids
  • Itchy mouth, throat, ears, and face
  • Sore throat
  • Dry cough
  • Headaches, facial pain or pressure
  • Partial loss of hearing, smell, and taste
  • Fatigue
  • Dark circles under the eyes

According to NASL 2010, nasal congestion, post-nasal drip and repeated sneezing continue to be the most frequently reported nasal allergy symptoms among patients. Beyond physical symptoms, AR patients experience emotional burdens, like feeling tired and miserable. When assessing the impact nasal allergies have on productivity, the survey revealed that patients are less productive when their nasal allergies are at their worst, limiting them from doing well at work.

It’s clear from the NASL 2010 findings that the estimated 60 million people living with allergic rhinitis in the U.S. are still significantly affected, both physically and emotionally, by symptoms,” said Gary Gross, M.D. FAAAAI, Dallas Allergy & Asthma Center, Dallas, Texas. “This is a continuing trend we’re seeing in patients having allergic rhinitis as these findings are similar to those released in a past survey evaluating disease burden on patients. The NASL survey results further support the need for more effective treatment options that address these specific issues for patients living with allergic rhinitis.”

Nasal allergies can make it difficult for people to take part in both indoor and outdoor activities if their symptoms are not well controlled. According to NASL 2010, less than 20% of surveyed patients felt their nasal allergies were completely controlled over a one week time period. The vast majority of allergists, otolaryngologists and primary care providers interviewed in the survey stated intranasal corticosteroid sprays as their preferred treatment of choice for adults with moderate to severe persistent nasal allergies.

Because of its prevalence and health effects, AR is associated with considerable direct and indirect costs.  Latest estimates suggest that AR alone results in a staggering  $11.2 billion in healthcare costs, 12 million physician office visits, 2 million days of school absences and 3.5 million lost work days per year. In addition, the presence of co-morbidities such as asthma and sinusitis further increase AR-related treatment costs.

Word on Health will be bringing you more from AAAAI in the coming days, including some exciting new treatment options being developed for allergic rhinitis.

Truth Test for Knees?

Orthopedic surgeons have identified a molecular biomarker that could potentially help people with knee injuries save time, and money and the risks of surgery.

According to a study just published in The Journal of Bone and Joint Surgery researchers from California, Florida, Pennsylvania and New York have identified a biomarker found exclusively in patients with  torn cartilage.  Potentially, this simple test could help patients avoid the time and cost of undergoing an MRI and identify those who are candidates for surgery rather than those who have less operable conditions.

By analyzing the synovial fluid surrounding the knee joints of 30 patients with meniscal tears, researchers found a protein complex called fibronectin-aggrecan that wasn’t present in 10 volunteers with normal, pain-free knees.  To date, fibronectin-aggrecan has not been found in patients with osteoarthritis.

An estimated 700,000 arthroscopic knee operations are performed each year in the U.S. based on the results of MRI scans, which can cost in the region of $2,500.

While surgeons can use MRIs to try to discern the root of a patient’s knee pain, MRIs often cannot differentiate between inflammations from natural degeneration and a full-fledged tear.

Traumatic and degenerative injuries look the same on MRI,” said Gaetano Scuderi, Professor of  orthopaedic surgery at Stanford School of Medicine. “In a 50-year-old, we can’t tell the difference.”

However, correctly identifying a cartilage tear is only one obstacle. Sometimes, patients sustain pain  after corrective surgery because the tear is not actually the root of pain.

Sometimes you would think you did a great job but the patient still had pain,” Scuderi said. “Why did this  person not get better when another person did?”

Previous studies have shown that surgery is only effective for a torn meniscus or cartilage. Knee pain caused by age-related osteoarthritis or injured hip ligaments can resemble a torn meniscus but isn’t helped by surgery. This distinction isn’t always clear on MRI scans.

In a clinical setting, this new biomarker could effectively differentiate knees with pain-inducing cartilage tears that are responsive to surgery from knees with only natural cartilage degradation.

This would be especially beneficial to older patient populations in whom MRIs always show degeneration. The biomarker test offers a cheaper and more specific identification of pathology. Better still, the researchers are hoping to image the molecule non-invasively as opposed to aspirating it for assay.

Now Wash Your Hands Please

Word on Health was horrified to learn that when you meet someone and shake their hand, there’s a one in five chance that they didn’t wash their hands after going to the toilet.

A recent study of 2,000 adults found that more than half did not clean up before eating and even more worryingly, 3:1 men and almost 1:5 women said they also often failed to wash their hands after going to the toilet.

Of those, almost a quarter said they were not worried about hygiene after using their toilet at home because they would only be picking up germs from other members of their family, while one in five said their hands already looked clean without the need to wash them under a tap.

Although 88% of those questioned could correctly name at least one food bacterium such as salmonella, E. coli or campylobacter, many did not realize how easy they were to pick up.

According to the Centers for Disease Control and Prevention (CDC) and leading public health officials, hand washing is the single most important method of preventing the spread of infection.

Perhaps it’s because hand washing is so basic that it’s often taken for granted. Yet the quantity and variety of germs that we carry on our hands everyday is astounding. Each square inch of our skin contains about 5,000 different bacteria.  When we forget to wash our hands, or don’t wash our hands correctly, we can spread these germs to other people.

The importance of hand washing cannot be overstressed. It is so simple and yet forgetting to do it can have such serious consequences.” says Sir John Krebs, chairman of the UK’s Food Standards Agency.

And it’s not just children or the general public that forget to wash their hands, seems health workers are just as guilty.  In the US it is estimated that hand washing alone could prevent 20,000 patient deaths per year. Despite this, studies have shown that hand washing compliance among health-care workers is poor.

Things, it seems, are so bad that  Loyola University Health System has just hosted a forum led by hand-hygiene authority Professor Didier Pittet, MD, MS, and President of The Joint Commission Mark R. Chassin, MD, FACP MPP, MPH.

This forum was designed to educate healthcare leaders about proper hand washing techniques as well as provide strategies to overcome challenges to achieving a highly effective hand-hygiene program.

For those of you who missed the forum, SRxA’s word on Health is pleased to bring you some simple hand hygiene tips:

Always wash your hands before:

  • Preparing food
  • Eating
  • Treating wounds or giving medicine
  • Touching a sick or injured person
  • Inserting or removing contact lenses

Always wash your hands after:

  • Preparing food, especially raw meat or poultry
  • Using the toilet
  • Changing a diaper
  • Touching an animal or animal toys, leashes or waste
  • Blowing your nose, coughing or sneezing into your hands
  • Treating wounds
  • Touching a sick or injured person
  • Handling garbage or something that could be contaminated, such as a cleaning cloth or soiled shoes

Of course, it’s also important to wash your hands whenever they look dirty…or before you come to shake one of ours!

For more on hand hygiene we suggest you check out the CDC’s Clean hands save lives site.

New pee-pee for Pepe

Imagine what it would be like if you were a young boy and your urethra – the pipe that’s supposed to carry urine from your bladder to your penis – was irreparably damaged or traumatically destroyed.

You’d be facing a probable lifetime of incontinence, infection, pain, bleeding and difficulty urinating.

Although small defects in the tube can be repaired, larger defects are treated with a tissue graft, usually taken from skin or the lining of the cheek.  But these grafts fail in half of the cases.

Now imagine if scientists could grow you a new urethra.

Because that’s exactly what researchers from the Institute for Regenerative Medicine at Wake Forest University Baptist Medical Center in North Carolina, have done.

Watching human organs take shape in a lab dish is no longer, it seems, only the realm of science fiction.

The research team, led by Dr. Anthony Atala used patients’ own cells to grow urethras in the lab and have successfully used them to replace damaged tissue in five young Mexican boys.

Six years after surgery, urine flow tests and tube diameter measurements show the tissue-engineered urethras are still working.

The study, published in the  Lancet, represents a first in the growing field of regenerative medicine, which doctors hope will eventually lead to ways to repair injuries and eventually replace whole organs.

When an organ or tissue is irreparably damaged or traumatically destroyed, no amount of drugs or mechanical devices will restore the patient back to normal. Totally grown in the laboratory, these urethras highlight the power of cell-based therapies said Chris Mason, a regenerative medicine expert at University College London, who was not involved in the research.

So how did they do it?

Basically they took a very small piece of tissue, about half the size of a postage stamp. To that, they added a soup of growth factors that nourished the cells and encouraged them to multiply into large quantities. The team made two cell types: muscle cells for the tube’s outer layer and endothelial cells — cells that line blood vessels and other tubular structures — for the inner layer.

Once they had grown enough cells, they applied them onto a biodegradable mesh that was shaped into a tube and sized to be a perfect fit for the patient. Then they heated them in an incubator to allow the cells to start to form sheets.

After a week of incubation to allow the cells to take to the mesh, the lab-grown grafts were surgically transplanted into the patients.

Once implanted, the sheets of cells started forming new tissue, and after about four weeks, they were able to remove the urinary catheter and the boys were able to urinate through the new urethras. Biopsies showed the engineered urethras had normal layers of epithelial and smooth muscle within three months.

Six years in the grafts are doing well, looking and functioning exactly like a normal urethra in the five boys who are now entering their teens.

Although larger studies will be needed before the treatment can be widely used, this data shows the potential power of cell-based therapies.

Eventually, it is hoped that regenerative medicine will be able to cure the large unmet medical needs of our generation including: blindness, diabetes, heart failure, Parkinson’s disease and stroke.

As always, SRxA’s Word on Health will be watching and will bring you new developments as they’re announced.

World Exclusive – Preview of NARAC Knows

Last month, SRxA’s Word on Health bloggers attended the inaugural North American Rhinology and Allergy Conference (NARAC) in Puerto Rico.

NARAC was designed to bring together practicing allergists and otolaryngologists (ENT’s), to share the most up-to-date information regarding diseases of the nose and airways.  And it succeeded.

The Scientific Committee brought together an outstanding faculty representing the Who’s Who of allergy and ENT.  Over 160 delegates from three countries and 37 US states attended and enjoyed a mix of plenary sessions, Problem Based Learning breakouts and industry-sponsored symposia.  The interactive, multi-specialty format provided attendees with both state-of-the-art science and the opportunity to translate it into best clinical practice for their patient s through peer-to-peer discussion.

The scientific proceedings of this meeting will be published in the American Journal of Rhinology and Allergy later this year.  In the meantime however, the conference organizers recognized the need for a Rapid Response e-Newsletter to be disseminated to both attendees and those allergists and otolaryngologists not fortunate enough to have been there.

Based upon recommendations from our independent clinical advisors, the NARAC Course Directors asked SRxA to develop the e-Newsletter on their behalf. The brief was to provide an entertaining and engaging mix of:

  • Meeting Highlights
  • Session Reviews
  • Key Takeaway Messages
  • Pro-Con Discussions
  • Attendee Surveys
  • News from the Exhibit Hall

In the three weeks since the conference, together with our talented team of designers and NARAC’s own editorial review committee, we have done just that.

And now….with much fanfare and drum rolls… we are proud to bring you, our Word on Health readers, the exclusive first edition of NARAC Knows.

In the coming days the e-Newsletter will be distributed to 20,000 clinicians across the US.

NARAC Knows was supported by unrestricted grants from Dey Pharma L.P., Sunovion, and ViroPharma Inc.

If you are planning a medical meeting or conference and would like to have the same type of coverage for your event we’d love to hear from you.

Green Eggs & Ham? No – Green Tea & Fava Beans!

Mothers around the world can collectively breathe a big, “I told you so.”

Vegetables are good for you…and that’s a fact!

A research review just published in the journal Clinical Epigenetics shows that vegetables, particularly broccoli and cabbage, are filled with compounds that can help prevent or reverse cancers and other aging-related diseases.

Your mother always told you to eat your vegetables, and she was right,” says co-author Trygve Tollefsbol, Ph.D., D.O., a biology professor at the University of Alabama at Birmingham. “But now we understand why she was right. Compounds in many of these foods suppress gene aberrations that over time cause fatal diseases.”

Epigenetics is the study of the changes in human gene expressions with time. Changes that can cause both cancer and Alzheimer’s. In recent years, research has identified specific food compounds that inhibit negative epigenetic effects.

Those foods include soybeans, cauliflower, broccoli, cabbage, green tea, fava beans, kale, grapes and turmeric.

The epigenetics diet can be adopted easily because the concentrations of the compounds needed for a positive effect are readily achievable,” says lead author Syed Meeran, Ph.D.

Simply sipping three cups of green tea has been shown to reverse breast cancer in laboratory mice by suppressing the gene that triggers the disease. Similarly, a daily cup of broccoli sprouts, has been shown to reduce the risk of developing many cancers.

Our review article has drawn everything together from global studies, and the common theme is that compounds in the epigenetics diet foods can, at the very least, help us lead healthier lives and help our bodies prevent potentially debilitating diseases like breast cancer and Alzheimer’s,” says Tollefsbol.

Your Word on Health bloggers are now leaving for lunch.  On the menu – berries for our breathing and beans for our brains!

Having the heart for sport?

One moment: a perfect shot to end a perfect season. The star player, just 16, lifted off the floor in celebration.  Teenagers triumphant, crowds cheering, the playoffs ahead and his future wide open. The next: Wes Leonard was on the gym floor, his enlarged heart failing and his life fading as paramedics struggled in vain to revive him.

Then there was Matthew Hammerdorfer, 17 and captain of his high school rugby team. During a match Saturday, he took a hit to the chest, collapsed and died.

Sudden death in an athlete inevitably stirs public concern as well as front-page headlines.   As healthcare professionals, we question what more could have been done? Parents wonder if this could happen to their child. Some may even ask whether the benefits of sport are worth the risk.

While Leonard and Hammerdorfer’s friends, family, team-mates and coaches struggle to come to terms with their untimely passing, doctors at the University of Michigan Cardiovascular Center are helping to explain what happened. Non-traumatic sudden death in young athletes is always disturbing. Fortunately, it is also extremely rare.  It most commonly occurs in males, who have estimated death rates nearly 5-fold greater than female athletes.

According to the National Center for Catastrophic Sports Injury Research, the incidence of non-traumatic sudden seath in athletes is as follows: 

Population group                                                            Age                                                              Incidence

High school/college athletes                                           13-23                                                    7:1,000,000 per year (male)

U.S. Air Force recruits                                                       17 -28 years                                       1:735,000 per year

Rhode Island joggers                                                          <30 years                                            1:280,000 per year

Rhode Island joggers                                                            30 -65 years                                      1:7,620 per year

Marathon runners                                                                Mean 37 years                                   1:50,000 race finishers

Congenital cardiovascular disease is the leading cause of non-traumatic athletic death, with hypertrophic cardiomyopathy being the most common cause. Hypertrophic cardiomyopathy is a genetic disease which results in thickening of the heart muscle. It is the leading cause of sudden death in children and adults and accounts for 40% of all athletics-related deaths. While it is estimated to affect 1:500 Americans, the onset and severity varies. Although some people experience  signs and symptoms, such as shortness of breath, chest pain, dizziness, lightheadedness, fainting or palpitations, in others, such as Leonard, the first symptom may be cardiac arrest or sudden cardiac death.

In Hammerdorfer’s case, the cause of death has been attributed to a complex congenital heart defect known as Tetralogy of Fallot.

Other causes of sudden cardiac death in athletes include:

Even though  deaths in young athletes are rare, each one is one too many.  So what can be done?  Doctors are now suggesting that schools improve their pre-participation sports screening forms and refer selected children for electrocardiograms (ECG’s) and additional screening.

In the meantime SRxA’s Word on Health sends our condolences to the families of all those who have lost loved ones from sudden cardiac death.