Even Healthy Children Experience Asthma-Like Symptoms with Heavy Exercise
A study finds that children who undergo brief periods of intense exercise may exhibit lung dysfunction or other symptoms similar to those experienced by asthma patients, even when no history of asthma exists. The findings were presented at the American Thoracic Society 2010 International Conference in New Orleans.
While studies have shown that adults who undergo vigorous exercise can experience wheezing and a decrease in pulmonary function testing (PFT), even when there is no prior history of asthma, the extent of exercise-associated PFT abnormality in healthy children had received relatively less attention, according to Alladdin Abosaida, MD, the study’s lead author.
Researchers examined the effects of exercise in 56 healthy children with no clinical history of asthma or allergy, measuring lung function following each exercise test.
“We evaluated two exercise protocols in each child—a constant work rate exercise test commonly used for evaluation of exercise-induced asthma, and a progressive exercise test typically used to determine an individual’s aerobic capacity,” said Abosaida.
Nearly half of the children tested had at least one abnormal result when pulmonary function was measured following exercise. Researchers said the results were surprising.
“We did not expect to see pulmonary function abnormalities after short periods of heavy exercise in such a large number of healthy children in our subject population,” said Abosaida. “We speculate that either the inflammatory response to exercise or cellular changes that may occur as the result of dehydration of the airway surface, or both, led to mild airway obstruction.”
Additional research will be needed to understand the pathogenesis and management plan of exercise-induced bronchoconstriction in healthy children, added Abosaida.
Preventive Approach to Post-Op Pneumonia Proves Successful
A pilot prevention program that included educating physicians and ward staff about pneumonia prevention, along with a standardized postoperative electronic order set, was very successful in diminishing postoperative pneumonia on the surgical ward, according to research presented at the Association of VA Surgeons 33rd Annual Meeting in Boston and appearing in the Journal of the American College of Surgeons. The post-op electronic order set in the physician order entry system included incentive spirometry, chlorhexidine oral hygiene, ambulation, and head-of-bed elevation.
In the postintervention study period, only three of 1,651 inpatient admissions with pneumonia were diagnosed on the ward, representing an 81% decrease in postoperative pneumonia as compared to the preintervention time period.
Other components of the program included twice daily oral hygiene with chlorhexidine swabs, ambulation with good pain control, and pneumonia bundle documentation in the nursing documentation.
“Postoperative pneumonia is a problem facilities face continually, but our research shows that simple steps in prevention can have such a substantial effect,” wrote Sherry Wren, MD, FACS, chief of general surgery, Veterans Affairs Palo Alto Health Care System, and professor of surgery, Stanford University School of Medicine, and lead author of the study. “This program … could help improve patient care and lower morbidity, mortality, and overall health care costs.”
Tobacco-Free Cigarettes as Hazardous as Regular Tobacco Cigarettes
Researchers have found that tobacco-free cigarettes may be more carcinogenic by actually inducing more extensive DNA damage than tobacco products. The findings were published in the journal Cell Cycle.
Using laser scanning cytometry (LSC) technology to measure DNA damage response to the smoke, the researchers found that exposure of cells to smoke from tobacco- and nicotine-free cigarettes leads to formation of double-strand DNA breaks (DSBs). Since DSBs are potentially carcinogenic, the data indicate that smoking tobacco- and nicotine-free cigarettes is at least as hazardous as those containing tobacco and nicotine.
The technique the researchers used to measure the harmful effects of tobacco- and nicotine-free cigarettes is the same technique they developed to document the harmful effects of tobacco products.
Survival of Older Cystic Fibrosis Patients May Guide Future Treatment
Researchers have found that an emerging population of middle-aged cystic fibrosis (CF) patients contains significantly more females and includes a large proportion of patients who lived for decades without a diagnosis or specialized care. The findings published in the American Journal of Respiratory and Critical Care Medicine may help guide future treatment of CF as survival past 40 becomes increasingly common.
In 1962, the median predicted survival for children with CF was 10 years. Today, it is 37, and children diagnosed today can expect to live into their 50s. In addition, many more patients with nontraditional symptoms are being diagnosed for the first time as adults.
The researchers analyzed epidemiological and health data on 156 CF patients over 40 years of age who receive care at National Jewish Health. In addition, data were analyzed on nearly 3,000 patients from around the country who were included in the Cystic Fibrosis Foundation Patient Registry from 1992 to 2007.
The researchers found that fewer females diagnosed as children survived to age 40. However, among those diagnosed as adults, females represented a significant majority, accounting for 54% nationally. Among the adult diagnosed patients, females survived on average 9 to 14 years longer than males.
The findings also indicate that patients diagnosed as adults do not really have milder diseases—as is commonly believed—just delayed onset of an equally severe form of the disease. Although patients diagnosed as adults live longer than those diagnosed as children, the adult-diagnosed patients lose lung function as rapidly as those diagnosed in childhood, and approximately 85% die of respiratory failure or post-transplant complications.
Researchers believe CF remains undiagnosed in a significant number of adults. The findings indicate that once those patients are accurately diagnosed, proper care at a CF center can significantly improve their health, including reversing progressive lung function decline and improving their lung function for at least 4 years.
Older patients commonly do not get specialized CF care. Less than half of long-term CF survivors continue to be seen at CF centers as they pass 40 years, with the fewest among the adult-diagnosed patients.
“In the coming years, more and more cystic fibrosis patients will be living into their 40s, 50s, and beyond,” said Jerry Nick, MD, a pulmonologist at National Jewish Health and lead author of the study. “Our findings concerning the role of gender in survival, progressing of disease, and type of care in current long-term survivors provide important insights that will help us prepare for better treatment of the steadily aging CF population.”
Gulf Oil Spill, Cleanup May Pose Health Risk for People with Respiratory Problems
Oil washing ashore and the chemicals used in the cleanup of the oil spill in the Gulf of Mexico may pose a health risk for those who have respiratory diseases, according to the American College of Allergy, Asthma and Immunology (ACAAI).
While most people will not be affected by the spill and cleanup, those with asthma or chronic obstructive pulmonary disease (COPD) could be at risk, particularly from the oil-dispersing chemicals.
“Since the spill is now coming ashore, adults and children with respiratory diseases need to keep a close eye on their breathing, stay inside, and call their allergist if they feel ill,” says Jonathan Bernstein, MD, allergist and spokesperson for the ACAAI. “The oil-dispersing chemicals could also be harmful since we don’t know what they are or if they have a strong odor that may trigger symptoms.”
Pediatric Hospitalizations for H1N1 Flu More Prevalent in Older Children
Children hospitalized with pandemic H1N1 influenza in 2009 were older and more likely to have underlying medical conditions, according to research presented at the Pediatric Academic Societies (PAS) annual meeting in Vancouver, British Columbia.
Researchers discovered that the median age of children hospitalized with H1N1 influenza was 5 years, compared to 1 year for those hospitalized with seasonal flu in 2003 through 2009. Children with asthma, hemoglobinopathies such as sickle-cell disease, and a history of prematurity made up a larger proportion of all children hospitalized with H1N1 influenza than with seasonal flu, although one third of children hospitalized with H1N1 influenza were previously healthy.
“Our findings underscore the importance of influenza immunization in children of all ages and particularly in children with underlying medical conditions,” said lead author Fatimah S. Dawood, MD, epidemic intelligence service officer, Influenza Division, Centers for Disease Control and Prevention (CDC). “Ensuring immunization of children at risk for hospitalization with influenza will remain critical during the upcoming 2010 to 2011 influenza season when the 2009 pandemic H1N1 virus may continue to circulate and other seasonal influenza viruses may circulate as well.”