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More reporting on asthma

Asthma and respiratory issues have received a fair amount of attention this month.  In 1980, according to the Centers for Disease Control and Prevention, four percent of children were diagnosed with asthma:  today, we have fifty percent more cases, with six percent of children diagnosed.  Predisposing factors include genetics, allergens, and a dirtier environment.  The article didn't mention it, but we may also be noticing asthma more as we "tighten up" interior environments to be more energy efficient.  We also may be better at diagnosing asthma than we were thirty years ago.  In any event, the potentially life-threatening illness is more common than it was.

First, there was reporting of the controversy over whether medicines such as Advair, Symbicort, Foradil and Serevent [medicines with a long-acting beta agonist] are unsafe, redundant or useful in treating asthma.  There is clearly very little consensus on that issue, with some experts maintaining each position.  A safety official with the FDA recently attributed 14,000 deaths to the use of beta agonists (among some six million people treated with these medications) and suggested that the risk of taking them outweighs the advantage, when compared with simple steroid therapy.

The only consensus seems to be that asthma patients should not use long-acting Serevent without also using a topical steroid.  Since long-term steroid use in children can compromise development, some researchers conclude that children should rely on rescue inhalers and episodic steroids, as needed.   The drug manufacturers dispute this claim and stress the difference between topical (inhaled) steroids and systemic steroids.  No one disputes that these medications are effective and useful in treating COPD and emphysema.

Some doctors maintain that beta agonist medications should not be prescribed for children, in particular.  Others point to declining asthma fatalities, despite the increase in the number of asthma patients, and attribute these numbers to improved pharmacological treatment.  The maker of Advair and Serevent claims that the prevalence of asthma has doubled in twenty years, while fatalities from the disease have decreased by 35 percent.  This controversy won't be resolved in the next decade, probably.

Next were reports indicating that children born in the fall are more susceptible to asthma.  The American Journal of Respiratory Care published data suggesting that fall babies have a 30 percent higher likelihood of diagnosis.  They based this conclusion on a review of the birth and medical records of 95,000 children born in Tennessee. Researchers concluded that at least for some children in some environments, being exposed to the viral flu season too early in the development of the immune system may render a newborn vulnerable to asthma. 

The Journal Thorax concluded that children born by C-section also face a higher risk for developing asthma.  They studied the records of 3,000 children for a diagnosis by age eight.  C-section babies faced an 80 percent greater probability of developing asthma by that age.  The authors wondered whether a vaginal birth, exposing the fetus to bacteria in the birth canal, "primes" the child's immune system. 

Tufts University published an article in the Journal of Asthma that studied black families in Dorcester, Massachusetts.  These authors found that babies born in the U.S. were more likely to have asthma than babies born in a foreign country.  These authors returned to the speculation that "sterile" births may actually be unhealthy--in terms of asthma development.

Apparently, genetically-predisposed families (we know who we are) should time their children's births to avoid the autumn.  Maybe they should also consider renting a flat in the third world where the child can be delivered naturally into a safe, but bacterially-rich environment that is free from environmental allergens or viral exposures..........Oh, never mind.

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