Chicken Soup For the Airways?

As we approach Fall, our thoughts turn to pumpkins, cold mornings, dark nights and welcoming bowls of soup.  Soup is also on the minds of a group of researchers in Scotland. A new study will be conducted by Baxter Food Group, together with researchers from the University of Aberdeen plan to study whether soups enhanced with vitamin E may help reduce the chance of childhood asthma.

Together, they have developed 3 soups containing ingredients with high levels of vitamin E. By judicious tweaking of ingredients, for example, substituting normal tomatoes found in cream of tomato soup with their sun-dried counterparts, they were able to develop three new varieties of “super-soups”.  The soups also contain other ingredients rich vitamin E, including beans, lentils, wheat-germ, sunflower oil and sun-dried tomatoes.  They’ve also created “placebo soups” which have been made to look and taste similar to the real ones, but do not contain intensified levels of vitamin E.

Their intent is to increase the daily intake of vitamin E among pregnant women from current levels which are on average of 8mg per day to approximately 15mg per day.  The 50 women involved in the study will begin consuming 3 servings of soup per week when they are 12 weeks pregnant, and do the same until they deliver their babies.

They will examine whether the new dietary intervention is well tolerated by the women and if it has the desired effect on vitamin intake. And, during the first week of the babies’ lives their lung function will be examined.

The researchers hope that fortifying soup with vitamin E could help prevent childhood asthma.  Prior studies have shown that low vitamin E diets for pregnant women tend to result in babies being born with a higher chance of asthma by the time they reach 5 years old.   But this will be the first asthma study to use dietary supplementation of vitamin E rather than tablet supplements.

Graham Devereux, Professor of Respiratory Medicine at the University of Aberdeen and Honorary Consultant Physician at Aberdeen Royal Infirmary, commented: “Although far more difficult, it seems more natural to give vitamin E in a natural food form rather than a vitamin E pill because the vitamin E containing foods comprise a complex mix of nutrients that might be critically important. When one considers the foods containing vitamin E, soup seems an obvious intervention”.

The overall approach has support from both nutritionists and asthma experts.

If we’re really lucky we might show that the children [born to women] receiving vitamin E enhancement may actually have better lung function,” Prof Deveraux says. “The ultimate aim of this research is to reduce the prevalence of asthma by an effective, inexpensive, acceptable and safe public health dietary intervention. If successful, the proposed intervention could form the basis of public health dietary advice to pregnant women that could reduce the prevalence of childhood asthma by 15-20% within five years.”

Depending on the outcome of the current study, Deveraux and his team plan to launch a much bigger study.

So will these super soups work?  Stay tuned and we’ll ladle out the news as it breaks!

What Not to Do With Your Asthma Inhaler

As most people know, inhalers are an important part of most successful asthma management programs. Considering how many people use them and how critical they are to managing asthma and preventing asthma attacks, the number of patients who make mistakes with their inhalers is shocking.

In a recent survey of 1,000 people with asthma, about half of the respondents weren’t even using controller medications, such as asthma inhalers. And, among the half who did use inhalers, an overwhelming amount – 86%, had trouble controlling their asthma symptoms.  This seems to suggest that most asthmatics simply aren’t using their inhalers correctly.

Though alarming, the statistics aren’t necessarily surprising. According to Summit Shah MD, an allergist at Nationwide Children’s Hospital in Columbus, Ohio, “It is actually very difficult to use an inhaler properly.”

As we’ve blogged about before, improper technique tops the list.

Overuse of inhalers is a close second.  When using a rescue inhaler, one to four puffs should be sufficient. More than that and the patient should consult his health care provider, who may need to adjust the medication or treatment plan.

Similarly, the frequency of rescue inhaler use should be monitored. Rescue inhalers are intended for occasional use to stave off acute asthma attacks. Using a rescue inhaler more than two days a week suggests that the patient also needs to be on a prophylactic (maintenance or controller) inhaler.

Although all patients are encouraged to talk to their own provider, SRxA’s Word on Health is  pleased to provide a number of simple asthma inhaler tips to help people use them correctly:

  • Sit upright
  • Shake the inhaler
  • Exhale completely
  • Use an inhaler with a spacer [device]
  • If you’re using a spacer device, spray the medicine into the spacer and then take in a slow, deep breath through the spacer while creating a tight seal around the mouth of the spacer with your lips
  • After breathing in the medication, hold your breath for 10 seconds
  • Repeat after one minute

Other asthma inhaler tips really come down to common sense, such as keeping inhalers in a safe place away from pets and children and where it won’t get damaged.

Here’s to better puffing!

Wheezing: Whining or Winning?

Many people with asthma avoid exercise because they’re afraid it could trigger symptoms such as shortness of breath, wheezing or a full-blown asthma attack.

However, a new report from The Cochrane Library turns these fears on their head. The authors conclude that not only is it safe for people with asthma to exercise, but it could also reduce their risk of asthma symptoms or attacks!

Study author, Kristin Carson, from The Queen Elizabeth Hospital, Clinical Practice Unit, Adelaide, Australia explains that over time patients with asthma who avoid exercise can become out of shape, losing muscle mass and cardiovascular fitness. That makes any future attempts at physical activity significantly harder, increasing the chances that patients will become fatigued and breathless and further discouraging physical activity. “This results in a spiraling cycle,” she says, in which patients are even more likely to avoid exercise.

To determine whether exercise was a danger to asthmatics, Carson and her colleagues reviewed previous studies that looked at the effects of physical training on people with asthma comparing patients who received no or minimal physical activity to those who exercised for at least 20 minutes, twice a week, over the course of four weeks.

The researchers found that the patients who had exercised, using physical training such as running outdoors or on a treadmill, cycling, swimming or circuit training were no more likely to have a serious asthma-related problem than those who weren’t exercising or who did light exercising such as yoga.

The patients who exercised also improved their cardiovascular fitness, which in turn can reduce asthma symptoms over time. There was also some evidence to suggest that exercise improved patients’ quality of life.

We found no reason for people with stable asthma to refrain from regular exercise,” Carson said. “Physicians should encourage their patents with stable asthma to engage in physical training programs.”

Even though this research suggests that exercise is safe for asthmatics, we suspect that many people will still think they can use their asthma as a reason to avoid physical activity.

Well now there is no excuse, and just in case you’re in any doubt consider the following list of people who never let asthma stop them:

Do you have any asthma and exercise stories to share?

Improving Inhaler Instruction

Many of us have never been properly trained on how to do or use certain things we really should be good at. Putting on condoms and wearing seat belts are just two that come to mind.  And when we get them wrong, the health consequences can be serious.

The same goes for asthma inhaler use.  Do you shake the device first? Did you breathe in with sufficient force? Did you press the canister at the right time?

Improper use of inhalers is a serious and expensive problem. In the US, 3 patients are admitted to the emergency room with asthma every minute, that’s >5,000 people a day!  Worse still, according to the Asthma and Allergy Foundation of America, 11 people die from asthma every day.

One study estimated up to 94% of patients use their inhalers incorrectly.  The most common mistakes include failure to exhale before actuation, failure to breath-hold after inhalation, incorrect positioning of the inhaler, incorrect rotation sequence, and failure to execute a forceful and deep inhalation. Those of us in healthcare have even seen patients who fail to take the cap off the inhaler before use, and others who use it nasally rather than orally.

This is hardly surprising given that many patients never receive instructions on how to use their inhalers and even those that do, are not routinely followed.  And let’s face it, some of these devices could use training wheels.

Enter the T-Haler, a digital asthma inhaler training device  developed by researchers at Cambridge Consultants.

Patients with asthma can use the inhaler and, via interactive software linked to the wireless device, get real-time visual feedback on the areas that need improving.

Specifically, whether patients have shaken the device before breathing in; whether they use sufficient force when breathing in; and whether they press down the canister that releases the drug at the optimal time. Click here to see a video of the T-haler in action.

Although still a conceptual product, the company says it has been designed as a training device to be available at pharmacies, schools, and clinics for children and adults alike.

They performed a study on 50 people aged 18 – 60 who had no prior experience with either asthma or inhalers and were given no instruction on how to use an inhaler. When tested, about 80% of the participants used an inhaler incorrectly.

They were then given the T-Haler with no further instruction and told to begin. A three-minute on-screen tutorial guided them through the proper use of an inhaler, and the success rate tripled to more than 60%.

Without any human direction beyond the word ‘go’, participants went from around a 20% success rate without training to a success rate of more than 60% after only three minutes with the T-Haler device,” said Kate Farrell, a senior design engineer, in a news release. “This is more than twice the compliance rate we have seen in other studies with trained participants. Interestingly, a week later, 55 percent were still correctly using the device-showing that they retained what they learned.”

Whether the T-Haler itself will ever make it to market remains to be seen, but the concept of a 3-minute training device seems a no-brainer when it comes to properly using a device that may very well save the lives of the estimated 235 million asthma sufferers worldwide.

Oh S**t! – Don’t Try This At Home

In the mood for a little DIY this weekend?  Paint the bathroom…put up a few shelves…perform a poop transplant???

Regular Word on Health readers will recall that last year we brought you news of a successful, yet controversial, new treatment for inflammatory bowel disease – fecal microbiota transplantation. While we remembered to warn you of the “yuck factor” associated with this post, we never thought to add the caution “don’t try this at home.”

Seems we should have.

Lately, stories about the success of at-home fecal transplants have been spreading virally, or should we say bacterially, across the internet!  Stranger still, some respected science writers  and researchers have expressed support for the procedure. People are literally buzzing about the possibilities.

Dr. Lawrence Brandt, head of gastroenterology at Montefiore Medical Center in the Bronx, says that he receives several emails a week from people begging for fecal transplants. While they used to come only from people suffering from bowel disease, now he’s getting requests from people who are hoping to beat diabetes, autism, asthma, MS and obesity too.

As it’s not clear whether gut bacteria can help with any of these complaints, many doctors are unwilling or unable to help.

And that’s why, it seems, patients are now doing it themselves.

Chris Gorski is one such person prepared to take this drastic step. Last year, his daughter developed a gut infection that caused severe and chronic diarrhea. Despite antibiotics, she still has symptoms and now Gorski worries that the infection will destroy the lining of her intestines and affect her for the rest of her life.  Armed with what he’s read on the internet, and a burning desire to help his daughter, he’s decided to collect some of his own stool, strain it, and then squirt it into her body using colonoscopy instruments.

He hopes that his “good bacteria” will become established in the girl’s body and repair her gastrointestinal tract.

Gorski’s plan may sound gross, but he argues that what he’s doing is revolutionary. In an age when probiotics, are being extolled for their beneficial qualities, he says his solution is just an extension of living medicine.

Do you think this is a good idea, or how shall we say it, just a crappy one?!?  Let us know what you think.

Daily Asthma Treatment No Different from Intermittent Treatment in Toddlers

As most parents of toddlers with asthma know, a daily dose of an inhaled steroid is usually prescribed to keep the frequent bouts of wheezing at bay. But, the results of a recent study published in The New England Journal of Medicine could likely change all that.

A group of pediatric asthma researchers nationwide, found that daily inhaled steroid treatment was no better at preventing wheezing episodes than treating the child with higher doses of the drug at the first signs of a respiratory tract infection.

They also found that daily treatment was comparable to use of the inhaled steroid intermittently at decreasing the severity of respiratory-tract illnesses, reducing the number of episode-free days or school absences, lowering the need for a “rescue” inhaler for acute asthma symptoms, improving quality of life or reducing visits to urgent care or the emergency room.

The researchers, from the National Institutes of Health (NIH)-funded Childhood Asthma Research and Education (CARE) Network, studied nearly 300 preschool-age children with frequent wheezing in a trial called MIST (Maintenance and Intermittent Inhaled Corticosteroids in Wheezing Toddlers).

We wanted to understand how to best treat young children who have repeated episodes of wheezing, most of whom appear symptomatic just when they have colds,” says Leonard B. Bacharier, MD, a Washington University pediatric asthma and allergy specialist at St. Louis Children’s Hospital. “Our goal was to start therapy at the first signs of a viral respiratory tract infection or cold to interrupt or slow the progression of symptoms. This trial was aimed to try to prevent wheezing severe enough that requires oral steroids and really gets in the way of children’s lives.”

Children in the yearlong MIST trial were between 12 and 53 months old, had recurrent wheezing and were at high risk for a worsening of asthma-like symptoms that could require treatment with oral steroids and/or a visit to urgent care or emergency room. During the trial, the children received either a dose of budesonide once a day through a nebulizer or a placebo.

At the first signs of a respiratory tract illness, those children who received the inactive placebo received a higher dose of budesonide twice a day, while those who received daily budesonide received a placebo twice daily and kept taking their regular budesonide. Neither the patients nor the physicians knew who received the active drug until the trial was over.

During the study, parents were asked to keep a daily diary of symptoms, such as coughing, wheezing, difficulty breathing or other symptoms that interfered with normal activities, as well as a list of medications, visits to a health-care provider or absences from daycare or school.

Because previous studies had shown that daily inhaled corticosteroid therapy was more effective than placebo, the researchers expected to see the same in the MIST trial. But that’s not what they found.

The two groups were comparable in terms of episodes requiring oral steroids, symptom days, albuterol use and the time before oral steroids were needed,” Bacharier says. “All of the relevant indicators of disease activity were comparable.”

These results indicate that there are a variety of treatments physicians can consider for children with frequent wheezing, who are not compliant with daily therapy.

Asthma Drug Spending Soars in U.S.

According to new government figures U.S. spending on asthma drugs more than quadrupled in the 10 years from 1998 to 2008.  During that time, annual costs rose from $527 million to $2.5 billion.

Many of the reasons are clear.  Firstly, the the number of people diagnosed with asthma grew by 4.3 million between 2001 to 2009. Asthma rates rose 50% among black children during that time.  And the problem is still growing. The U.S. Centers for Disease Control and Prevention (CDC) estimates that 7 million kids and nearly 17.5 million adults suffer from asthma.

Secondly, the proportion of children who used a prescribed drug to treat their asthma doubled from 29% between 1997-1998 to 58% between 2007-2008.  Overall, spending on drugs to control asthma grew from $280 million in the late 1990s to $2.1 billion by 2008. In that same period, spending on drugs to relieve immediate symptoms grew from $222 million to $352 million.

Thirdly, annual spending on older, less expensive drugs such as oral corticosteroids has fallen, while newer more expensive medications have taken their place.  Examples of more expensive medications include,  inhaled corticosteroids which prevent inflammation and control asthma; reliever drugs such as short-acting beta-2 agonists (SABA’s) that make breathing easier and leukotriene receptor antagonists which help prevent asthma symptoms from occurring in the first place.

Over the past decade there has been a 25% rise in the number of patients using inhaled corticosteroids, a 10% rise in the use of beta agonists and a 31% rise in leukotriene receptor agonists such as Montelukast (sold as Singulair®) and Zafirlukast (sold as Accolate®).

Do these spiraling costs take your breath away or suggest that asthma is being better controlled?  Let us know your thoughts.

Joint Treatment for Asthma?

Once again, Word on Health brings you news of a potential breakthrough in the treatment of asthma.  Researchers in Australia believe that a drug used to treat rheumatoid arthritis could also help patients with asthma. According to a paper published in the Lancet the scientists from Down Under have identified two mutant genes that may predispose a person to asthma. After comparing 58,000 DNA samples of people living in Australia, Europe and the United States they found two regions of the DNA that are consistently different between asthmatics and non-asthmatics.”  One of the genes is also linked to rheumatoid arthritis (RA) and the researchers suggested that the drug tocilizumab, which is used to treat RA, may also work for asthma. Tocilizumab, marketed under the brand Actemra by Genentech, targets a certain molecule in the body called “interleukin-6 receptor” and reduces inflammation in RA patients. “Targeting interleukin-6 receptor may be a good strategy to reduce or prevent inflammation (in asthma) in the same way that it is used to prevent or reduce inflammation in rheumatoid arthritis,” suggests lead author Manuel Ferreira at the Queensland Institute of Medical Research. Word on Health awaits further research to confirm if and how the drug may help asthma patients. We’ll bring you further news as we hear it.

Uncontrolled asthma leads to out of control costs

SRxA’s Word on Health has often reported on the price of non-adherence to treatment . So, although we were shocked, we weren’t surprised to learn that poorly controlled asthma doubles costs and affects children’s performance in school.

According to a study just published in the Annals of Allergy, Asthma and Immunology  children with very poorly controlled asthma miss an average of 18 days from the classroom; whereas kids whose disease is better controlled, are absent for two days or less.

The investigators from National Jewish Hospital studied 628 children aged 6-12 with severe asthma. They looked at direct medical costs such as medications, unscheduled doctor visits, emergency department visits and hospital admissions as well as the indirect costs such as school days lost.

Patients were divided into three groups: very poorly controlled, not well controlled and well controlled. Costs were evaluated at the start of the study and then one and two years later.

The group, led by Stanley Szefler MD found that the costs for very poorly controlled patients were twice as high as those of the other groups at baseline. Very poorly controlled patients cost $7,846, compared with $3,526 for not-well controlled and $3,766 for well-controlled.

Two years later the costs for the very poorly controlled group had risen to $8,880 while costs for those with well-controlled asthma dropped to $1,861.  Indirect costs accounted for approximately half the total asthma costs for very poorly controlled asthma patients at each time point.

The authors concluded that very poorly controlled asthma is a major economic burden and improvement in asthma control and is associated with reducing cost.

SRxA together with our expert Allergy and Pulmonary Advisors  can help pharmaceutical companies promote better management strategies that may significantly reduce this burden of illness. For more information, contact us today.

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.