Stress of parents increases Asthma hospitalisation

The moment doctor utters the word Asthma for the cough and wheezing which little ones have been suffering for months the parents go into anxiety mode which is expressed as denial of the label Asthma.
The moment inhalers are prescribed parents anxiously question "Is it Asthma that you prescribe inhaler?"
They begin to say "no its not all that bad , cough is only at night etc etc..."
why inhaler ? My child will get addicted to it etc etc are more expressions of anxiety.
During each follow up they have a standard question "when will you stop inhaler?"
They are happy that child is playful , active , interested in sports , has picked up growth,
sleeps sound but their worry is "so what he is on inhaler,
There is evidence to support it scientifically that parents worry hampers recovery of children.
Parents , leave thy burdens on shoulders of doctors and stop worrying please , for the sake of childrens health!

ASTHMA and GERD

Gastroesophageal re flux should always be investigated and treated as an Asthma trigger
Particularly in children it can result in difficult control of Asthma.
In uncontrolled Asthma very often steroids are given which can cause Acid peptic disease due to prolonged use. Whereas if GERD is considered simple measures can result in Asthma control avoiding the need for oral steroids.and invasive investigations..

 WHEAT ALLERGY a cause of INFERTILITY !
 Pardon my ignorance , but the above finding came to me by chance.
A middle aged ( 34 yrs) lady came to me for treatment of Asthma and nasal allergies.
I studied her history , did a thorough examination and relevant tests and found that she also had Coeliac disease which is a gluten allergy  and is often considered as a disease of whites but we see  many cases in India too presenting mainly with abdominal symptoms , growth retardation , anemia etc.
 She was often depressed due to infertility of 12 years post marriage . She had consulted many gynecologists and had many tests  and treatment. Nothing helped her , she had given up on this but meanwhile developed Asthma. Few months of treatment with us  did control her Asthma and allergies.but avoiding wheat in a wheat growing state of Punjab was almost a shock to the entire family.
Repeated  counseling of family and the patient did convince her to comply  by the gluten free diet.
This helped in better asthma control and reduction of medicines. Every thing was smooth for her until she came too me in utter depression because at this young age now she has missed her periods and the doctors said she has had premature menopause and should go on HRT. I also was sad and sympathetic but out of curiosity I did her pregnancy test which was positive ! I repeated it again by another method , in another lab and then sent her for ultrasound which confirmed pregnancy. Mine and patients joy  knew no bounds. We celebrated in the clinic. Yesterday she came to me for vaccinations of her 2 month old lovely little angel.
The review of literature is full of association of Coeliac disease and infertility. This patient did not have typical abdominal symptoms , thank God she had allergies which made us investigate her in this direction.

Health Line - Asthma - 8 June 2011 - Part 1

Hi Everyone,
I recently was invited by a TV channel to discuss allergies and asthma. Enjoy the video.


Here's the second part


Would love yr comments and circulate widely!

ASTHMA & ALLERGIES in children ( Scientific practices)

Asthma prevalence is increasing world over .The mortality has reduced to some extent though the morbidity has not, in spite of wonderful scientific advances. It is possible to prevent the mortality and keep the disease under control making the lifestyle comfortable provided people follow the treatment and avoid the myths.
There is nothing the Asthmatics can miss out on provided they keep their disease under control by scientific practices.The Asthmatics winning gold even in Olympics is on record .In spite of this several children keep suffering mainly due to myths prevalent even amongst doctor parents.
Many doctor couples bring their little ones to me who are on several antibiotics , cough syrups , antihistaminics and off and on on steroids for the chronic cough of several months duration. Children had several Xrays , CT scans and lab reports of all kinds. some of them are also halfheartedly empirically been treated for TB.
I explain to them that there is an entity called Cough variant Asthma and child needs inhalers to manage that and not antibiotics etc etc..
In spite of being doctors it is difficult to convince them. They are not ready to accept the label ASTHMA "just for chronic cough".They are not ready to accept everyday use of inhalers.They are not willing to accept that cough syrups are not needed and even unnecessary vitamins etc are a burden on the system.
It is not surprising at all that after the cough disappears the parents are each day worried about stopping the inhalers.The fears are two , child will become addicted to inhalers and these are steroids.I pull out scientific literature to show to the parents that inhalers even though they were steroids they were safe even in long term use.They would not retard growth. In fact the disease free state would result in better growth and development and also proper puberty.
They are not ready to give the child cold water ,more fluids and even curd , banana , rice , oranges, lime and , chocolates freely. I have to again convince the parents that there is no doubt that FOOD ALLERGY can be there but there is no general rule to avoid definite food for all asthmatics. If at all there is a doubt tests are possible. They immediately jump to give the blood sample.
It was again difficult to convince them that Allergy tests need not be a battery of standard tests for everyone.Which test to apply and what to test would depend upon detailed history by a qualified doctor.
Their next request is to ask for a certificate so that child could be excused PT and Games as the grounds are dusty.I had to convince them hard that Exercise is to be encouraged . Another couple asked for a certificate so that bus could come to their doorstep so that child did not exert to walk up to the bus stop. Another couple had made the child swallow the entire book of pharmacology.
How difficult it was to convince them that different salts meant for Asthma, treatment are meant for different stages of Asthma and they may do more harm than good.
Some children are forced into advanced breathing exercises in the name of Yoga , which results into exercise induced Asthma attacks. Yoga is undoubtedly beneficial for healthy people and useful in Asthmatics as an adjunct to pharmacotherapy and should be done under supervision.
Asthma can manifest in many ways and even chronic cough can be due to Asthma , at the same time all that wheezes may not be asthma. Therefore expert advise is needed.
Detailed history and clinical examination by expert clinches the diagnosis and not the blood sent to some lab for allergy tests.
Once diagnosed treatment is simple and aims at making patient independent and to have good quality of life.Inhalers are the cornerstone of Asthma management.
They are needed as long term management.
The rescue inhalers are for emergencies only , and can be guided by simple measurement by peakflowmeter.Preventive inhalers are needed even when you feel you are alright. Inhalers are state of art research molecules which do not retard growth even on long term use. Stopping the inhaler at your own will can be harmful.
Pushing oneself into emergency and using nebulisers again and again is really harmfulInhaler is the surest and safest device foe drug delivery into the airway , but salts needed are different for different purposes.
The steroids in inhalers are the state of art molecules of research which give benefits without side effects.Leukotrein inhibitors , antihistamines and mast cell stabilisers are needed only for specific situations. every medicine is needed by every patient.
Allergy tests are needed only for difficult asthmatics , occupational Asthmatics , seasonal Asthmatics where immunotherapy is planned and also for patients in whom food allergy is suspected.
Tests are never useful if done by remote , just by sending blood sample to a particular lab. This causes more confusion and have to be discouraged.
obsession of avoiding dust and white food articles , and many more compulsions result in personality disorders in children besides resulting in nutrition deprivation.Frequent monitoring is needed.
Parents must not be anxious to stop the inhalers. Parents must not focus on stopping food based on myths for growing children.If at all food has to be avoided it must only be after Allergy to food is proven by Double blind placebo controlled food challenge rather than just by blood test.
Its heartening to see children achieve full growth , puberty ,excellence in academics, music and sports if they follow the scientific treatment for Asthma. and keep away from myths.

STRESS of PARENTS increases Asthma severity.

There is increasing evidence of a link between stress and asthma development and symptom control. Studies have shown that in healthy children, parental stress is associated with an increased frequency of childhood illnesses and altered immune function, and in children with asthma, increased parental stress can be associated with altered functional status, hospitalizations for asthma, and poor asthma control. The majority of these studies have focused on maternal or “caregiver” stress (a general term, not specifying whether this is the mother, father, or another person). There is interest in learning whether a father’s stress could also be linked to the development of asthma in his children.

In an upcoming issue of the Journal of Allergy and Clinical Immunology, Lange and colleagues write about their study analyzing the relationship between parental psychosocial stress, individually in mothers and fathers, and asthma complications in their children. Their study included parents of 339 sets of twins from Puerto Rico. The parents were interviewed separately about their own psychosocial stress and about asthma in their children individually at age 1 and again about the children’s asthma at 3 years of age. Fathers were asked about symptoms of post-traumatic stress disorder, depression and anti-social behavior, and mothers were asked about depressive symptoms.

The authors found that indicators of paternal stress and psychiatric disorders were significantly associated with recent asthma symptoms in children at age 1. Maternal depressive symptoms were associated with children’s asthma hospitalizations at age 1, and at age 3, both asthma hospitalizations and asthma diagnosis. Examining asthma complications at 1 year and 3 years of age combined, a father’s stress appeared to be associated with a child’s recurrent oral steroid use, while a mother’s stress was associated with a child’s recurrent hospitalizations for asthma and with asthma diagnosis. Both maternal and paternal depression were associated with children’s recurrent hospitalizations for asthma. The authors suggest that parental stress, particularly depression, is an important modifiable risk for childhood asthma problems, especially in high-risk populations.
Dear Parents ,this information has been given to you in the interest of your children.

Unconscious in bathroom , worth preventing.

Yesterday I went to a post graduate institute for a clinical meeting where they presented patients who went for a bath , & were recovered from the bathroom in unconscious state sometimes even after three hours. They were investigated for neurological & other causes for this .
Even the MRI showed changes. Some including a doctor were also started on anti epileptic medicines thinking it to be a seizure! It was systematic analysis with high index of suspicion which revealed that it was happening due to Gas Geyser in the bathroom. In winters generally the bathroom windows are closed especially while bathing . This results in accumulation of Carbon monoxide(CO) -a gas which has 250 times more affinity for Hemoglobin in blood than oxygen ( O2). Co typically competes with O2 , not only attaches itself to hemoglobin but also displaces it form hemoglobin. This results into severe oxygen deprivation of brain and unconsciousness.
If at all you must install a gas geyser it should be out side the bathroom.Bathroom windows must be open for ventilation. GO FOR SOLAR ENERGY.!