Vol. 17 •Issue 19 • Page 14
Kids and Asthma
RTs Can Put Misconceptions to Rest
Sometimes superstitions, like old wife’s tales, pass from person to person because somewhere in the original advice lay a nugget of wisdom. For example, medical studies have shown chicken soup, the old staple for dealing with the common cold, indeed offers scientific benefits.
Now that’s not to say people should cling to every bit of folksy lore. Many sayings are still baseless bunk, granting no special benefits or protections. After all, not every black cat crossing your path this fall will bring bad luck, and you need not immediately phone your mother’s chiropractor should your foot land on a crevice in the sidewalk.
Similar misplaced conceptions often surround children with asthma. Because of the condition’s volatility, many parents believe they must put curbs on the children’s activities. But too much prevention can be damaging too. In this instance, the ounce of prevention may create the need for a pound of cure. Coddling can lead youngsters to be too inactive, say experts.
The fact remains that physical activities like running and swimming have been shown to decrease the severity of asthma symptoms, according to researchers at the Johns Hopkins Children’s Center in Baltimore. Despite the preponderance of data available promoting exercise for asthmatics, a recent study revealed 20 percent of children with asthma do not get enough exercise.
Published in the journal Pediatrics, the report showed physical inactivity is due partly to parents’ misconceptions that exercise poses a risk to asthmatic children. The findings are based on the results of a telephone survey of the parents of 137 children with asthma and parents of 106 healthy children.
According to the study, almost one-fifth of all parents agreed with a statement that exercise is dangerous for children with asthma. More telling is the finding that one-quarter of parents of asthmatic children said they were afraid their children would get sick if they exercised, and that their children get upset with strenuous activity. Children whose parents held such beliefs were more likely to be inactive.
The study’s authors further indicated that children with moderate or severe asthma—including those who take asthma-controlling medications—were less likely to engage in high levels of physical activity.
“These results are troubling,” said David Lang, MD, MPH, who led the research while a pediatric fellow at the children’s center. “Despite medical advances and a better understanding of asthma, we found that beliefs still exist that exercise is dangerous for asthmatic children and that children with asthma should not exercise. In reality, physical activity has important benefits for all children, including those with asthma.”
Another misconception making the rounds is that flu vaccinations can help control asthma exacerbations. The rumor persists despite the fact recent research has been unable to link influenza vaccinations with asthma, either positively or negatively.
“There have been worries and hopes” on the issue, according to Dr. Frank DeStefano, a researcher with the U.S. Centers for Disease Control and Prevention’s National Immunization Program. On one side, some parents worry a flu shot might trigger an attack. Likewise there are parents who hold hope that the same flu shot might actually prevent an exacerbation.
“I think it’s clear that the flu shot doesn’t have impact,” added DeStafano, “but that’s not the reason to recommend flu shots.”
Herman J. Bueving MD, and his colleagues studied almost 700 children with asthma between the ages of 6 and 18 years, 347 of whom were given the flu vaccine and 349 who were given a placebo. Forty-two pharyngeal swabs from the children were positive for influenza, with 24 in the vaccine group and 18 in the placebo group—a 33 percent difference. Ultimately they found flu shots did not significantly reduce the number, severity or duration of flu-related asthma attacks.
Bueving noted the vaccines used in the flu seasons spread over several years were very effective. “For the two seasons of this study, we had good matches with the type of flu and vaccine, and that is important.” he adds. “Otherwise it can be said, ‘Well, if you don’t have a good match, you were just lucky with your results.’
The authors said the influenza-related asthma exacerbations they detected were all of similar severity. The study’s young participants were recruited through family physicians in the city of Rotterdam, the Netherlands, and its surrounding areas during the flu seasons of 1999-2000 and 2000-2001. This study appears in the American Journal of Respiratory and Critical Care Medicine.
Starting the day after their vaccinations, children were asked to fill in a daily diary. In their booklet, they scored upper and lower respiratory tract symptoms, uses of medication, physician visits and trips to medical facilities.
When the symptom score reached a predefined level, the investigators would take a pharyngeal swab. The primary outcome of the study was the number of asthma exacerbations associated with proven influenza viruses.
Asthma remains one of the most common chronic diseases in children, affecting at least 4.8 million in the United States alone. Physical activity is an essential ingredient for healthy development, even though it can trigger asthma attacks in susceptible children. Researchers caution parents to follow some precautions when encouraging their youngsters to participate in strenuous activities.
Even now, more than three-fourths of children with asthma are unprepared for an exercise-induced bronchospasm (EIB) event or asthma attack, according to a recent study. Inhalers are the best treatment and should be readily available.
In the study, published in a recent issue of Annals of Allergy, Asthma and Immunology, 579 children 12 years old and younger were surveyed on the playing field. Of the 80 who had been diagnosed with asthma, only 22 percent had prescribed inhalers with them.
“Inhaler availability among children with asthma who participate in organized sports is suboptimal,” said Gilbert E. D’Alonzo Jr., DO, FCCP, professor of medicine in the division of pulmonary critical care at Temple University School of Medicine and Temple University Hospital, Philadelphia. He collaborated on the study with colleagues at the University of Colorado in Boulder and at Drexel University of Philadelphia. “Without adequate preparedness and control for possible exercise-induced asthma attacks, children will not be able to play to their potential. Furthermore, uncontrolled attacks could affect their desire to engage in play and organized sports at all.”
Active sports should be monitored, of course. “With the added seasonal risk of increased exposure to triggers, it is critical that asthma patients pay close attention to any warning signs and keep in touch with their physician,” said Anne Dixon, MD, assistant professor of medicine and director of clinical research at the Vermont Lung Center at the University of Vermont, Burlington. “If patients suffer an attack, the best course of action is to get them to take their prescribed medication and get emergency medical help immediately.”
For the one-third of asthmatics whose asthma is not well controlled, regardless of the season, clinical research offers hope. At the Vermont Lung Center and American Lung Association Asthma Clinical Research Center at the University of Vermont, research is under way in several areas.
Current studies include a comparison of three different asthma medications being used to reduce the number and severity of asthma attacks in people with mild to moderately severe asthma; looking at how airway cells in asthmatics influence lung inflammation; and studying the effects of drug presentation and education on the efficacy of montelukast and placebo in asthma.
Regardless of whether any of these efforts ultimately offer novel asthma therapies, parents should rely on caregivers to give them solid, scientifically based information.
In the end, a little extra time spent educating parents and youngsters with asthma can make a big difference. That way, the people who most directly impact the daily lives of asthmatics can make sound decisions without relying on the aid of Ouija boards and crystal balls.
You can reach Shawn Proctor at [email protected].
Patient Protection Tips
Here are some tips and guidelines to help asthma patients keep attacks at bay:
• Develop a plan for battling an asthma attack and see your doctor regularly, because your asthma can change over time.
• Know your triggers—smoke, pollens, pets—and avoid them.
• Maintain your maintenance medication schedule, even if you’re busy or not feeling ill.
• Don’t take cough medicine to treat asthma symptoms. Take only medicines prescribed by your doctor.
• Get educated about asthma, its treatment and important clinical research under way.
• In addition, asthmatics should contact a doctor as soon as possible if they experience any of the following symptoms:
• Difficulty breathing in the middle of the night,
• Wheezing when breathing,
• Difficulty performing regular activities during the day,
• A need to take more medicine than a doctor has prescribed,
• Reduced effectiveness from the medicines a doctor has prescribed.