Non-Adherence Biggest Issue in Asthma Management Today
                     Adherence to medication is the main method of prevention in chronic asthma cases. Asthma symptoms can be suppressed rather successfully with a consistent approach to medication usage. Neglecting to follow a medication regime is one of leading causes of hospitalization and even death for asthma sufferers. BBC published a recent study showing that almost one third of asthma patients in the U.K miss important hospital check-ups. This prevents doctors and healthcare professionals from being able to monitor their patients. Studies also show that a similar percentage of asthma patients in the U.S do not show up to their medical check-ups.
More than a million people suffering from asthma are missing out on key yearly checks. New analysis by charity Asthma UK found that 31% of asthma patients did not receive an "essential" annual review to check whether they are on the right medicine.
The charity said that its review of GP data for 2012/13 showed that there were 3,359,612 people in England who should have received an asthma review but 1,025,539 patients missed out.
NHS guidance suggests that everyone with asthma should get an annual review, an asthma action plan and their inhaler technique checked.
"With the worrying scale of prescribing errors identified by the National Review of Asthma Deaths, it's vital that doctors and nurses do everything they can to follow up with patients to review their medicines, especially as asthma can vary hugely over the year.
"There is also an unacceptably large variation in the numbers of people attending annual reviews, which ranges from only 52% to 79% across the UK," a spokeswoman said.
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Study: Asthma Inhaler use in Children Stunts Growth
                  The Guardian recently covered two asthma studies regarding inhaler usage and growth in children. The studies were conducted by Francine Ducharme, a pediatrician at the University of Montreal. The first study analyzed published inhaler usage trials of over 8,400 children. Results showed that the growth rate for children under 18 without steroid usage exceeded the growth rate for children using steroids by approximately half a centimeter per year.
The second study followed children who were taking medication doses between 50 to 200 micrograms of inhalable steroids. The children who took higher doses were at an increased risk of stunted growth.
Children who use inhalable steroids for asthma grow slower than their peers in the first year of taking the medication, researchers say.
But doctors said the effect was so small it was easily outweighed by the clear benefits of taking the drugs, which prevent serious asthma attacks and even deaths from the breathing disorder.
Children who used the common corticosteroids to alleviate their asthma symptoms grew on average half a centimetre less over the course of a year, compared with children who did not take the medicine.
The steroids seemed to affect children's growth only in the first year and had even less of an impact on their growth rate when used in low doses of no more than 100 micrograms.
Most people with asthma use inhalers that deliver a puff of salbutamol, a non-steroidal drug that quickly opens constricted airways. But around 80% will at some point take an inhalable steroid too, which works more slowly to reduce inflammation in the airways. Some 5.4 million people in Britain have asthma, with around a million being children.
The latest findings come from two studies by Francine Ducharme, a paediatrician at the University of Montreal, and researchers at the Federal University of Rio Grande in Brazil, for the Cochrane collaboration, an organisation that publishes "gold standard" reviews of health care research.
For the first report, the researchers compiled evidence from 25 published trials of more than 8,400 children up to 18 years old. All had mild to moderate persistent asthma. From 14 trials that reported the figures, the average growth rate for children not taking steroids was six to nine centimetres a year. The range fell by half a centimetre in children who took any of six common corticosteroids used for treating asthma.
The second review looked at 22 studies of children who took low (50 to 100 micrograms) or medium (200 microgram) doses of inhalable steroids. Only three trials followed children for a year or more. They found that those on the higher doses of steroids were most affected, growing around 20mm less in a year than children who took lower doses.
Ducharme said that the small number of studies that followed the effects on children for more than a year was a "major concern", and recommended "that the minimal effective dose be used in children with asthma until further data on doses becomes available".
Samantha Walker at Asthma UK said the use of inhalable of steroids has seen hospitalisations and deaths from asthma plummet, but that three people still died from attacks in Britain every day.
"Half a centimetre in growth is a small price to pay for medicine which may save your child's life," Walker said. "Uncontrolled asthma can substantially increase the likelihood of asthma attacks, hospitalisation and even death and we know that inhaled steroids, taken regularly, significantly reduce the likelihood of these events happening."
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Check out the first and second studies.
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New Inhaled Drug Could Potentially Relieve Asthma and Allergy Symptoms
WebMD reports a new drug called quilizumab has the potential to treat mild asthma and allergy symptoms. The drug, targets blood cells that produce immunoglobulin type E (IgE), a protein that causes allergic reactions. In an initial study, the drug reduced total levels of IgE in patients suffering from mild asthma or allergic reactions. The levels of IgE were kept low for a month on the drug. Results also show that production of IgE was not only reduced but stopped in some cases. In early stages of testing, the drug only seems to be working with mild asthma and not with moderate to severe cases. Quilizumab is aiming to replace its rival, omalizumab, which requires one to three injections every two to four weeks. Quilizumab, on the other hand, only requires one inhalation approximately every three months.
WebMD News from HealthDay
By Dennis Thompson
HealthDay Reporter
WEDNESDAY, July 2, 2014 (HealthDay News) -- A new inhaled medication has the potential to treat mild asthma and allergies by interrupting the production of an immune system protein that triggers allergic reactions, a new study reports.
The drug, quilizumab, targets the blood cells that produce a protein called immunoglobulin type E (IgE), that serves a key role in allergies.
Quilizumab lowered total levels of IgE in the blood of people with allergies and mild asthma, and kept them low for a month, researchers report in the July 2 issue of the journal Science Translational Medicine.
"The subjects who received the drug not only had a reduction in their total IgE level, it also seemed to block production of new IgE in response to the allergen they inhaled," said study co-author Dr. Jeffrey Harris, principal medical director of immunology, tissue growth and repair for the drug manufacturer Genentech, which produces quilizumab and funded the study.
However, one expert noted that the drug has yet to prove itself against moderate to severe asthma.
IgE is present in minute amounts in the body, but plays a major role in allergic diseases.
The protein binds to allergens upon first exposure, and then triggers the release of inflammatory substances when a person is re-exposed to the same allergens, creating an allergic response and, potentially, an asthma attack.
There currently is only one medication that specifically targets IgE, an injectable drug called omalizumab that binds to the protein in the bloodstream and neutralizes it.
Experts say quilizumab has the potential to replace the existing drug because it is more convenient and longer lasting.
Patients on omalizumab must receive one to three injections every two to four weeks, Harris said. If quilizumab proves as effective as it was in this early study, patients may only need to inhale a dose every three months or so.
"This could be very exciting, if it works," said Dr. Bradley Chipps, an allergist in Sacramento, Calif. "It could be even more effective than omalizumab, which binds to IgE after it's produced. This drug tries to keep it from being produced."
Researchers tested the drug in one group of 36 allergy patients and another group of 29 people with mild asthma, randomly giving patients either quilizumab or an inactive placebo. In the study, patients were exposed to allergens and then blood samples were taken to measure levels of IgE in their bloodstream.
Quilizumab reduced overall levels of IgE, and also reduced the amount of IgE that specifically targeted the allergens to which patients were exposed, the study found. Further, the IgE levels remained lower for at least six months following the patients' last dose of the drug.
However, the drug did not have a significant effect on the early and late asthmatic responses in patients after they were exposed to an allergen, compared to placebo, said Dr. Myron Zitt, an allergist and associate professor at State University of New York, Stony Brook.
"It is interesting because it is a new drug that blocks IgE production, but when you look at the figures, it's not so impressive," Zitt said, adding that quilizumab will have to display effectiveness in treating people with moderate to severe asthma if it stands a chance of replacing either omalizumab or standard steroid treatment.
Study author Harris said a follow-up clinical trial involving 560 people with more severe asthma is underway, with results likely available next year.
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     The University of Melbourne recently carried out a study testing the benefits of broccoli as it relates to asthma. Results showed that consuming one to two cups of steamed broccoli prevents asthma symptoms and potentially reverses lung damage. However, the benefits are not only limited to broccoli but are also found in other cruciferous vegetables.
These vegetables alter the airway formation making it easier to breath. This study is among others that aim to discover the benefits of dietary changes for various illnesses and will be presented at the 2014 Undergraduate Research Conference in Shanghai.
Broccoli could help asthma patients to breathe easy, a new study suggests.
According to researchers at the University of Melbourne, eating one to two cups of lightly steamed broccoli could prevent asthma from worsening.
Other vegetables belonging to the cruciferous family such as kale, cabbage, brussel sprouts, cauliflower and bok choy also help reverse lung damage, the study found.
"Laboratory tests have shown that consumption of broccoli changes the formation of the airway and may make clear breathing easier for those who suffer from asthma and allergies," said Nadia Mazarakis, who is an author of the study and an honors student at the University.
"Blockages in the airway were reversed almost entirely," said Mazarakis. "Using broccoli to treat asthma may also help for people who don't respond to traditional treatment."
The study is still in its experimental phase. Researchers said that people suffering from asthma should follow standard medical care.
The study will be presented at the 2014 Undergraduate Research Conference about Food Safety in Shanghai, China.
Cruciferous vegetables are a good source of fiber and are rich in nutrients including several carotenoids (beta-carotene, lutein, zeaxanthin), vitamins C, E, and K, folate and minerals, according to the National Cancer Institute. Other researchers have been trying to understand the effects of compounds present in these veggies on cancer growth and development. Other research have shown that daily consumption of broccoli is associated with lower risk of breast, colon and prostate cancer.
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The Center for Disease Control conducts an annual survey to discover the self-reported U.S asthma rate. Results indicate a significant drop in asthma to a nine year low. 7.4% of the U.S population reported an asthma diagnoses compared to a fairly consistent rate at approximately 8.5% since 2009. The CDC is not completely convinced, having surveyed 47,000 people last year, and they are hesitant to declare its decline. Asthma is a chronic illness affecting around 3 million children and adults in the United States. One of the leading causes of asthma deaths is attributed to a lack of medication adherence.
(Reuters) - Self-reported U.S. asthma rates have fallen significantly for the first time in four years to a nine-year low, according to a survey released on Thursday, but researchers cautioned that the numbers may not mean the disease is dwindling.
About 7.4 percent of the U.S. population reported having asthma in 2013, down from a level that has hovered around 8.5 percent since 2009, the U.S. Centers for Disease Control and Prevention survey found.
That drop represents about 3 million U.S. children and adults, CDC statistician Jeannine Schiller told Reuters.
Fewer episodes of the disease, which can causes wheezing, breathlessness and coughing, were also reported.
Last year, 3.8 percent of the population said they experienced an asthma attack, a rate not seen in over a decade and a half. In 2012, 4.4 percent of those polled reported an attack.
But Schiller said she was not quite ready to declare asthma's decline.
"We've all been kind of scratching our heads" at the finding, she said. "We have no reason not to believe it, but I think it is important to just be cautious about it."
The findings could be a statistical anomaly rather than a sign that the country has made major strides in combating the disease, Schiller said.
CDC's National Health Interview Survey polled about 47,000 people in the United States during 2013 on their experiences with asthma.
Black children saw some of the steepest declines in the disease, falling to a rate of 13.1 percent from 16.4 percent in the previous year, the study found.
Asthma is among the most prevalent long-term diseases among children, according to the CDC, although adults are also affected. While its causes are not yet fully known, environmental factors like tobacco smoke, cockroaches and mold can trigger attacks. (Reporting by Curtis Skinner; Editing by Scott Malone and Susan Heavey)
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Asthma symptoms vary depending on a few major factors, one of them being seasonal change. With spring time approaching and children going outside to play in warmer weather, it is important to review prevention methods. A recent article posted by Dr. Michael Rosenthal on Delaware online provides a good overview. Â Spring brings with it a slew of new triggers that can impact asthma. These include air pollution, pollen and increased exposure to animals. Thus, medication adherence is especially important during this time as it could prevent dangerous symptoms.
âChildhood asthma is the most common chronic disease in children, and can occur year-round. Now that spring has arrived and children are heading outside to play, itâs a good time to consider the impact and dangers of this disease, as well as how to protect against asthma attacks.
Asthma is a chronic lung disease that inflames and narrows the airways, causing wheezing, shortness of breath and coughing. The smaller airways within the lungs have a hard time moving air in and out, making breathing difficult.
Causes of asthma range from genetics to allergens and pollutants. No cure for asthma exists, although some children have fewer symptoms as they get older only to have it recur later in life due to certain triggers.
More than 7 million children nationwide have asthma. The disease accounts for more hospitalizations than any other childhood illness and more than 3,000 childhood deaths each year.
Aside from the health problems, asthma can affect learning and school performance. Among children ages 5 to 17, it is the leading cause of absences from school related to a chronic illness. Children with asthma miss an average of eight days per year, according to the Asthma and Allergy Foundation of America.
Given that asthma is activated by triggers unique to each individual, the way to control it is by keeping those triggers at bay. For example, if your childâs asthma is triggered by indoor air pollution, you should not smoke in the house or anywhere near them (or, better yet, donât smoke at all!) Lingering environmental tobacco smoke will only exacerbate their asthma. Other indoor triggers include pet hair, cockroaches, dust and mold.
Outdoor air pollution also can be a trigger. Pollen that comes from trees and grass and high ozone levels during the summer can exacerbate your childâs asthma. If that is the case, you should limit your childâs outdoor activity on days when the pollen count is high or when ozone levels are up. Easy-to-use air quality âappsâ like the one from the American Lung Association for your smartphone or tablet can be helpful guides.
Medication is another way to control asthma. Anti-inflammatory medications lower mucus production and airway reactivity. These medications should be included as part of the treatment of all children with recurrent and persistent asthma. Bronchodilators also can be used to relax the muscles in the airways, making it easier to breathe. Some of those medications are also defined as ârescue inhalersâ and should be kept within reach for easy access if an attack comes on.
It is important to identify the early signs of worsening asthma to help prevent a severe attack. Those warning signs include wheezing, tightness in the chest and severe coughing (especially at night). Itâs important to pay attention to these warning signs so you can ensure your child takes their medications as soon as possible.
Itâs also important to work with your childâs health-care provider to establish an asthma action plan. The plan will have instructions on what to do if asthma symptoms get worse. The plan also should cover what to do if an attack occurs, such as which medications to use, when to call the doctorâs office, and when a visit to the emergency department is warranted. You also should encourage your child to speak up at school to their teacher or school nurse if they experience the warning signs of an oncoming attack.
Partner with your physician to help you and your child identify the triggers, recognize the warning signs of an oncoming asthma attack and create an asthma action plan. No cure exists for asthma yet, but the proper use of the right medications can greatly diminish the dangers of this disease and lead to a happy, normal childhood.
Dr. Michael Rosenthal is chair of the Department of Family & Community Medicine at Christiana Care Health System.â
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TEDMED, a platform for sharing health related ideas and innovative solutions, recently featured the Geckocap in a blog post. The article focused on companies using data and monitoring techniques to help adolescents suffering from chronic or temporary health issues. The following companies were discussed in the article: Kinsa, an oral thermometer coupled with the technical prowess of a smartphone, Nonoly, a chemical making vaccine refrigeration obsolete allowing medicine to travel easily to rural areas and our very own Gecko Health Innovations.
Medication adherence is such an integral part of healthcare management that it is important to establish such habits at early ages, thus potentially creating a lifetime of medication self-management.
Move over, plastic stethoscopes: A number of innovations from TEDMED Hive 2013 companies aim to help even the littlest patients become engaged in their own real-life care.
Kinsa makes an oral thermometer that leverages the crowdsourcing power of a smart phone. The thermometer plugs into and transmits data to a free smartphone app â iOS now, but Android as well in the future â which also records and tracks symptoms and temps for easy retrieval at a pediatricianâs office. Whatâs more, the next phase of the product will provide crowd sourced data from social networks to allow parents to see whatâs going on in a childâs neighborhood or school. Strep going around? Lice? Better act now.
The company is focusing first on tracking childhood ills, because mothers are the primary users of thermometers, says Kinsa deputy CEO Qian Qian Tang, and because children are prime carriers of highly contagious diseases like flu, whooping cough and measles.
The FDA approved the thermometer in January and a first prototype is in production. Itâs priced at $19.99, a point below many digital thermometers on the market, but to reach the mass market it will need to provide local data.
Kinsa also offers a solution for getting the temp in the first place: The iOS app runs a game to keep Junior amused while youâre trying to take his temp, and send a warning signal when he wriggles and loses contact with the thermometer â a problem he can correct himself.
Asthma is another prevalent childhood disease â some 6.8 million kids in the U.S. suffer from it, according to the CDC â and management can be tricky. GeckoCap is a small low-energy smart button that, when placed over an asthma inhaler, wirelessly sends dosage records when near a smartphone. It also glows to let kids know when itâs time for their next dose, potentially avoiding a serious attack.
The idea is to help young patients learn to manage their condition and to get the knack of using wireless reporting.
âAs a physician, I couldnât educate my adult patients because they donât want to learn anymore, but with children thereâs really a place to make some change,â says Yechiel Engelhard, CEO and founder.
Engelhard says the company aimed to assist asthma patients because of the disease prevalence, and also what he says is a lack of innovation in drug administration for it. GeckoCap is in initial production for product testing, and has also partnered with a number of medical institutions that are eager to conduct studies on dosage administration and response with the first large group of patients to adopt the technology this summer.
Nanoly Bioscience aims to help save lives of children in the developing world. Many lack access to vaccines, in part because vaccines need to be kept within a precise temperature range until administered. Breaking the âcold chainâ contributes to some 25% of wasted vaccines each year, according to the World Health organization, and hampers delivery to remote parts of the world that have no electricity.
Despite the best efforts of many aid organizations, there are still critical gaps in cold chain equipment. âLooking at what exists now, youâll find refrigeration for the cold chain; youâll find camels that carry solar refrigerators,â said Nanxi Liu, Nanolyâs founder. The Gates Foundation has awarded millions in research for solutions, but Liu points out the need is dire enough to accommodate many ideas.
For its part, Nanoly is skirting the equipment issue entirely. The group is developing a non-toxic nanoparticle polymer that will eliminate the need for refrigeration for protein-based vaccines. It can be mixed with the vaccine at any point in its supply or transport chain.
Liu says she and her co-founder saw the unmet need for Nanoly first-hand: âHeâs from India. I grew up in rural China, and I didnât get any of my immunizations until I came to the U.S. Both of us saw an impact in our lives from a lack of vaccines, and we saw the problems of vaccine transportation first-hand,â she says.
Intelâs Top Social Innovation for 2012, Nanolyâs R&D has received funding from Intel, Dell, UC at Berkeley, Cornell and Duke.
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