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!
Wednesday, July 13, 2011
Wednesday, June 29, 2011
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.
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.
Thursday, January 6, 2011
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.
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.
Thursday, October 14, 2010
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.!
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.!
Friday, September 17, 2010
Quality of life in Asthma and no emergency please.
Emergency room visits can surely be minimized , inspite of increasing incidence of asthma.
The key issues are to accept the diagnosis and follow the methods which can control the disease and improve the quality of life. Often people have the tendency to deny the label of Asthma , they consider inhalers as habit forming , they fear steroids in inhalers and have a myth that this should be the last resort.
Even educated and not so much moneyed have shopping around behavior for the above fears.
They are ready to accept very prolonged and troublesome treatment with hidden salts and unscientific alternate therapies in spite of no definite health benefits , but they fear proven scientific inhalers. The symptom free periods in seasonal asthma are automatic , but they give credit to homeopathy or aurvedic salts.
Health education on continuous basis in friendly way is the only method to keep patients on appropriate scientific treatment.
There is always some amount of ongoing inflammation in the airway even in asymptomatic phase. Doctor , with the help of lung function tests and eosinophil counts etc will decide when to stop and when to restart the inhaler. In seasonal allergies the inhaler may start in preseason even if there are no symptoms.
Patients worry the restart of inhaler as though doctor is useless because she could not stop the inhaler for ever.
The aim of treatment should be good night sleep, being able to do all physical and other activities with pleasure , minimal side effects of medicines , being able to control the attacks oneself with help of rescue inhaler and no emergency room visits. This will improve quality of life and is possible with all the instructions of qualified doctors
The key issues are to accept the diagnosis and follow the methods which can control the disease and improve the quality of life. Often people have the tendency to deny the label of Asthma , they consider inhalers as habit forming , they fear steroids in inhalers and have a myth that this should be the last resort.
Even educated and not so much moneyed have shopping around behavior for the above fears.
They are ready to accept very prolonged and troublesome treatment with hidden salts and unscientific alternate therapies in spite of no definite health benefits , but they fear proven scientific inhalers. The symptom free periods in seasonal asthma are automatic , but they give credit to homeopathy or aurvedic salts.
Health education on continuous basis in friendly way is the only method to keep patients on appropriate scientific treatment.
There is always some amount of ongoing inflammation in the airway even in asymptomatic phase. Doctor , with the help of lung function tests and eosinophil counts etc will decide when to stop and when to restart the inhaler. In seasonal allergies the inhaler may start in preseason even if there are no symptoms.
Patients worry the restart of inhaler as though doctor is useless because she could not stop the inhaler for ever.
The aim of treatment should be good night sleep, being able to do all physical and other activities with pleasure , minimal side effects of medicines , being able to control the attacks oneself with help of rescue inhaler and no emergency room visits. This will improve quality of life and is possible with all the instructions of qualified doctors
Host Factors in pediatric Allergy
Genes no one can change but triggers are very much in ones control.
Right from the newborn age if we modify the host factors Allergy can be prevented.
Mothers milk can help prevent allergies of all kinds and should be continued for longer than a year.
Mothers diet should be healthy but in infant there should be a delay in introduction of salt as well as proteins , these should be postponed till one year of age.
There should be lot of exposure to sunlight throughout life so that vit D is obtained in sufficient amount as vitamin D,s role in Allergy prevention is well established.
Fresh food should be given instead of preserved and processed fancy ready made or precooked packed food. Artificial food colors should be avoided.
Synthetic clothing and toys with cheap paint should be avoided.
Fresh air ,fresh-food, avoidance of smoking in infants room ,avoiding chemical mosquito repellents are some useful host factors.
Right from the newborn age if we modify the host factors Allergy can be prevented.
Mothers milk can help prevent allergies of all kinds and should be continued for longer than a year.
Mothers diet should be healthy but in infant there should be a delay in introduction of salt as well as proteins , these should be postponed till one year of age.
There should be lot of exposure to sunlight throughout life so that vit D is obtained in sufficient amount as vitamin D,s role in Allergy prevention is well established.
Fresh food should be given instead of preserved and processed fancy ready made or precooked packed food. Artificial food colors should be avoided.
Synthetic clothing and toys with cheap paint should be avoided.
Fresh air ,fresh-food, avoidance of smoking in infants room ,avoiding chemical mosquito repellents are some useful host factors.
Friday, July 2, 2010
Do not stop inhaler.
you may be better but do not leave your inhaler.
People often are worried and anxious about using inhaler. They leave it ontheir own , even on feeling slightly better. This results into flaring of inflammation again in the airways and increasing blockage of airways can again triggor asthma attack.
It is safer option to continue inhaler , disease is more harmful than the continued use,
Research has prooved that inhaled steroids are safe in all ages and prolonged use also does not result into growth retardation in children or bone loss in adults.
So why worry and why be anxious to leave them or experiment about leaving.
People often are worried and anxious about using inhaler. They leave it ontheir own , even on feeling slightly better. This results into flaring of inflammation again in the airways and increasing blockage of airways can again triggor asthma attack.
It is safer option to continue inhaler , disease is more harmful than the continued use,
Research has prooved that inhaled steroids are safe in all ages and prolonged use also does not result into growth retardation in children or bone loss in adults.
So why worry and why be anxious to leave them or experiment about leaving.
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