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Saturday, December 25, 2010

The Latest Asthma Breakthroughs Can Help Your Child

Victoria Clayton, Special to Lifescript
Published December 25, 2010

Breakthrough: Tylenol (acetaminophen) use linked to asthma.

The research low-down: A large study published this year in the American Journal of Respiratory and Critical Care Medicine found a link between asthma symptoms and acetaminophen use. 

The more acetaminophen children took, the more asthma episodes they experienced, according to the International Study of Asthma and Allergies in Childhood (ISAAC), which looked at 322,959 adolescents in 50 countries.
“In the mid-1970s, we found the link between Reye’s syndrome and aspirin use in children,” says Bradley E. Chipps, M.D., an American Academy of Pediatrics spokesman.“Then we all jumped to Tylenol because we were afraid of aspirin. Now it’s time to rethink Tylenol.” 

What to do: Chipps, an allergy and asthma specialist in Sacramento, Calif., now recommends ibuprofen instead of acetaminophen for his young patients.

“While there’s risk associated with taking any kind of medication [even over-the-counter painkillers], ibuprofen sensitivity in adolescents and children is less than 1%,” he says. “I feel better recommending it.”

But talk to your pediatrician, before avoiding acetaminophen products for your children.

Breakthrough: Elevated triglycerides are an early sign of asthma, even in normal-weight kids. 

The research low-down: Previously, researchers found a solid link between childhood obesity, elevated triglyceride levels and asthma. Now, research has found links between asthma and elevated triglyceride levels even in normal-weight and underweight kids.

“The children who are asthmatic had higher triglyceride levels than nonasthmatic kids do,” says lead researcher Lesley Cottrell, Ph.D., associate professor of pediatrics at West Virginia University. She presented her findings at the 2009 International Conference of the American Thoracic Society. 

The next phase of Cottrell’s research is to tease out the “chicken or egg” question: Is asthma contributing to elevated triglyceride levels? Or is lifestyle – high-fat diets and lack of exercise, for example – causing high triglycerides and thus triggering asthma even without obesity?
What to do: Take a look at your child's neck. Seriously. 

In Cottrell’s studies, something called acanthosis nigricans, a slight darkening of the skin, usually around the collar area on the back of the neck, was linked with raised triglycerides and, ultimately, asthma. 

“If your child has this marking, take him in for a triglyceride check,” Cottrell advises. If his triglycerides are high, you may also be clued in early to asthma.

Breakthrough: Vitamin D supplements may help control asthma.

The research low-down: Vitamin D, known as the sunshine vitamin because our bodies produce it in response to ultraviolet (UV) exposure, is in the health limelight already. Inadequate levels have been linked to cancer, diabetes and now asthma. 

Last year, a study published in the British Journal of Pharmacology found that vitamin D inhibited the growth of airway smooth muscle cells, which, in excess, are associated with asthma. This means vitamin D could eventually be prescribed as a well-tolerated, low-risk adjunct to other asthma medications. 

“We’ve begun routinely monitoring and measuring vitamin D levels in severe asthmatics, and as many as 75% are profoundly deficient,” says Reynold A. Panettieri, Jr., M.D., one of the study’s authors and director of the comprehensive asthma program at the University of Pennsylvania. “We believe they could benefit from supplements.” 

What to do: Ask a doctor to check your child’s vitamin D levels and discuss whether he would benefit from supplements, especially if you live in a colder climate, or if your child is obese or has dark skin – factors that influence D levels.
Good vitamin D sources are salmon, mackerel and fortified milk, but diet and even sunshine are usually not enough when you’re deficient, Panettieri says. 

“Our studies found that those who are deficient actually have to take much, much larger doses of supplements than the current recommendations to reap benefits,” he says. 

The American Academy of Pediatrics currently suggests that infants and children have a minimum daily intake of at least 400 international units (IUs). Research has suggested that doses that are double that or higher are relatively safe. 

The Food and Drug Administration (FDA) is expected to release updated and possibly increased D recommendations later this year. 

Breakthrough: Genetics raise a child’s risk of asthma. 

The research low-down: Using data from 33 studies, Harvard researchers found that children with asthmatic mothers were three times more likely to develop asthma than those whose moms were non-asthmatic. Children with asthmatic fathers were slightly less (2.44) times more likely to develop the disease. 

The gender discrepancy in asthma is intriguing too.

“Before puberty, more boys than girls have asthma, but after puberty, more girls have it,” Panettieri says. “That brings us back to genetics.” 

Is something going on with the X chromosome? “We don’t know yet, but it’s certainly interesting,” he says.
What to do: Know your family’s health history, since this research shows that asthma runs in families, whether it comes from Mom or Dad. 

Breakthrough: The amount of nitric oxide in exhaled breath is an early indicator of childhood asthma.

The research low-down: A 3-year University of Southern California study of 2,206 children found that those with high levels of nitric oxide (FeNO) in their exhaled air were twice as likely to develop asthma than children with the lowest FeNO levels. 

What to do: “Ask your pediatrician about the test,” Panettieri advises. “Say, ‘I’ve heard about this test. Do you plan to do it?’ ” 

Although traditional lung-function tests are impossible for very young children, the FeNO test is easy to administer and has no side effects. 

With the increase in childhood asthma, it won’t be surprising if pediatricians routinely offer it in the future.

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