Genetics has improved asthma wisdom

Physicians first recognized asthma in the 5th century B.C., and here we are, over 2,500 years later, and they are still trying to figure out this disease.  Compare this with a disease like cystic fibrosis, a disease that wasn't discovered until the 1930s, of which scientists quickly learned was caused by mutations in the CFTR gene.

Unlike cystic fibrosis, it appears that asthma is caused by many genes, each playing a unique role in the development and severity of the disease.  Understanding that there are many genes responsible for asthma may explain why some cases of asthma are more severe than others, why there are so many different things that might cause asthma, why some people have more severe asthma than others, and why asthma medicines don't work for about 10% of asthmatics. 

When the first asthma genes were discovered in the late 1990s, or early 2000s, it was thought that medicine could be invented to block their effect, or shut them off completely.  Although, things rarely work out to be as easy as they initially seem.  As it turns out, there are so many genes responsible for asthma that physicians are still busy discovering them, and still learning what they are responsible for.  

Just to give an example, here are some of the asthma genes that have been discovered to this date.  

1. Cause people to develop asthma: 
• Regulate IgE production
• Regulate proliferation and maturation of eosinophils and mast cells, and epithelial function
2. Those that affect a person's response to medicine
• Cause them to develop a tolerance to bronchodilators like albuterol
• Cause them to develop a tolerance to systemic and inhaled corticosteroids

These genes can also be broken down into:

1. Genes that cause asthma by themselves, regardless of exposure to environmental influences:  These might be responsible for early-onset, or childhood onset asthma.  
2. Genes that are influenced by environmental influences: These might explain why there are so many things that might cause one to develop asthma

This would explain why about 75 percent of asthmatics develop allergies, and therefore develop sensitivities to the various allergens, such as dust mites, cockroaches, molds, fungus, pollen, etc. It may also explain why some asthmatics are overly sensitive to viral and bacterial infections, while others are not.  

It might also explain why some people develop asthma as a response to Asprin or Tylenol, and others do not.  Along the same lines, it might explain why Asprin and Tylenol are asthma triggers in some asthmatics, but do not bother others. 

References:

1. Elzouki, et al, "Textbook of clinical pediatrics," 2nd edition, 2012, Springer, New York, London, pages 1373-1375

Asthma/ COPD medications over-prescribed?

According to ranker.com, asthma is the 7th most common diagnosis, with COPD falling to #37.  However, according to the Detroit Free Press, based on the amount of asthma and COPD medicine prescribed, asthma and COPD are the 4th most commonly diagnosed diseases.  

The evidence seems to suggest that there are a lot of people being prescribed asthma and COPD medications -- i.e. albuterol -- who have not been diagnosed with either asthma or COPD. 

Many respiratory therapists observed this as a common truth years ago, as it is quite obvious that many of the people prescribed aerosolized albuterol, Duoneb, and Pulmicort do not need these medicines.  

However, there was a study done a while back that proved the placebo effect of albuterol, whereby 50% of patients who were given albuterol noted that they felt better after the treatment, and 50% of those given the placebo noted that they felt better after the treatment.  

Check out our hall of Bronchodilator Reform

Half of all adults develop allergies, study shows

My wife was sniffling and sneezing the other morning, and she said, "I've never had an allergy in my life, and now I'm 30 and all of a sudden I think I'm having an allergic reaction to something. Is it possible to develop allergies as you age?"

My initial answer was not. From my previous research, I figured that if one was to develop an allergy it would be developed when we are small children, as I wrote about in my post, "The Hygeine Hypothesis."

Yet a new study reported at "The Medical News," showed that IgE levels increase as we age. Researchers at the National Center for Health and Statistics "observed a highly statistically significant increase of IgE, a type of antibody associated with allergic reactions."

By comparing this recent study with a similar one done in 1970, scientists were able to determine that IgE levels basically double by the time we reach the age of 55. In fact, the study showed that over half the population developed one or more allergy by the age of 55.

When someone first develops an allergy as an adult it usually goes unnoticed, and is thought to be a common cold. For this reason, doctors and allergists need to be trained to pick up on new allergies, do proper testing, and help people cope with their new allergy.

Vitamin E shown to reduce risk of COPD

Of all the patients we RTs care for in the hospital setting, a majority are COPD patients. That's not a coincidence, as in the year 2000 it was responsible for the deaths of 2.74 million people, and by the year 2020 the World Health Organization predicts COPD to be the leading cause of death in the World.

While smoking is a leading cause of COPD, many are being diagnosed with this disease, or asthma, due to the high amounts of air pollution, both man made and natural occurring. So while the number of people who smoke is declining, the number of those being diagnosed with some type of COPD is still increasing.

Yet new research shows that "supplementing" your diet with Vitamin E may reduce your risk of developing COPD or of your COPD worsening with time. In fact, a recent randomly controlled study showed this reduction was as much as 10%.

This article from NaturalNews.com, notes that it's not easy to get enough Vitamin E from our normal diet, so taking a Vitamin E supplement is essential. Likewise, the post notes you can get Vitamin E from the following food sources:

• Almonds
• Apples
• Broccoli
• Carrots
• Kiwi
• Peanuts
• Spinach
• Sunflower Seeds
• Vegetable and Seed/Nut Oils (sunflower oil, almond oil, olive oil, palm oil, peanut oil, etc.)

Vitamin E is essential to our bodies because free radicals get into our bodies via cigarette smoke and pollution in the air, such as "burning fuels in smokestacks, car exhaust pipes or house chimneys or from the formation of ground level ozone during hot weather," according to fellow asthma expert. Kathi MacNaughton in her post, "Are We at Risk From Free Radicals in Our Air?"

A free radical is any electron that has a single unpaired electron in its outer shell, and when it gets into our body it does whatever it needs to do to get what it needs. This can often result in disease formation in the human body, such as asthma or COPD.

Kathi notes our bodies don't have a defense mechanism against free radicals. Although antioxidents are known to interact safely with free radicals and "stop their action before vital cells are damaged." And, she notes a major source of antioxidents is vitamin E, C and beta carotene.

So while this new wisdom is still in the study phase, if you have a family history of lung disease, you may want to think about supplementing your diet with vitamin E.

c-sections increase risk of asthma by 80%

You heard right. According to a study referred to here, children born by c-section are 80% more likely to develop asthma.

Scientists are unclear of the reason, but there are theories. First off, one must be aware that asthma is an auto-immune disorder that only those who have the asthma gene will have a chance to acquire. In most cases it is caused in infancy when the immune system is forming.

One great theory is the hygeine theory, in which scientists believe we as humans have worked so hard to clean up the way we live to prevent the spread of disease that we have literally cleaned ourselves into some new diseases, and one of them is asthma.

Your immune system ideally is supposed to attack bad parasites and bacteria. It is believed that the immune system has to constantly be stimulated. Absent bad bacteria and bad parasites, the immune systems of some people get bored and start to attack good things, like harmless dust mites, molds, animal dander, cockroach urine and stuff like that (common allergens).

One such theory, according to MedicineNet.com, has scientists thinking, "babies born via C-section have impaired immune cell function because of suppression of regulatory T cells, which regulate the development and function of the immune system."

Basically, children born by c-sections have immature immune systems. The same thing is believed to be true of babies born pre-maturely.

The study, presented at the American Thoracic Society's 2008 Conference in Toronto, "suggests that the stress and process of labor itself or exposure to specific microbes through the birth canal in vaginal rather than C-section delivery may influence neonatal immune responses."

This study significantly impact the decision by many people to have elective c-sections, especially by parents who have a history of allergies and asthma (and probably have the asthma gene).

Stay tuned, because in a future post here at the RT Cave I will explore other possible causes of asthma, or things that might turn the asthma gene to the on position. Stay tuned.

Asthma Wisdom

Latest News

1. Seven Classic Asthma Medicines To Be Discontinued (7-6-2010)
2. Were you sick with allergies yesterday (11-18-10)

Sources of Asthma Wisdom:

1. List of asthma blogs
2. Related blogs and recommended links
3. My Hardluck Asthma Blog
4. My Hardluck Asthma story
5. Other asthma links
6. Asthma Lexicon
7. Asthma FAQ

Basic Asthma Wisdom:

1. Asthma facts.
2. 20 more facts about asthma
3. Asthma Statistics
4. What is asthma?
5. The signs and symptoms of asthma
6. How to gain control of your asthma
7. How asthma is diagnosed
8. Everything asthmatics need to know about pulmonary function testing (PFTs)
9. Know your asthma triggers and how to avoid them
10. What is an asthma Action Plan and how to create one
11. Exercise Induced Asthma
12. 7 best exercises for asthmatics
13. How to use your peak flow meter
14. Why Your Peak Flow Meter Is An Important Tool
15. How to tell if your asthma is controlled
16. Why asthmatics need to exercise
17. The Hygiene Hypothesis, or what causes one to get asthma
18. How to find the best daycare for your child with asthma
19. 20 reasons not to smoke if you have asthma
20. Asthmatics, YOU are not alone! The new worldwide asthma community!
21. 10 tips to help asthmatics prepare for national disaster
22. Types of airflow obstruction
23. Don't waver! Seek help for bad asthma
24. 9 reasons you must never forget you have asthma
25. 10 things that are essential for all asthmatics
26. Is it cold or allergies triggering your asthma
27. Have baby with asthma? Here's 10 tips to watch out for
28. Is your asthma doctor out of date

Asthma medication:

1. What asthma medicine is best for you
2. Asthma medicines
3. Asthma medicine lexicon (coming soon)
4. The Debate: Albuterol or Lebalbuterol
5. Competition for Advair may soon lower prices
6. You should not be afraid to use Advair and symbicort
7. MDI or Nebulizer: Which one works best for your child
8. Here's what asthma meds cost
9. Are bronchodilators safe? A Q and A about Albuterol
10. Modern Meds may cause fatal asthma (but not the way you might think)
11. Symbicort may offer new option for asthmatics
12. A concern of expectant mothers: are asthma meds safe for baby
13. Theophylline no longer top line asthma medicine
14. Alternative medicines for asthma
15. Does Advair cause weight gain?
16. Antihistamines may cause weight gain

Asthma tips from a fellow asthmatic:

1. Asthma forgetfulness and asthma honesty

Information about exercising with asthma:

1. Alright asthmatics! Here's your incentive to get in shape this year
2. Even we asthmatics can run
3. Exercise Induced Asthma

Interesting Facts About Asthma:

1. Asthma linked to anxiety and depression
2. The link between COPD and asthma
3. Types of airway obstuction (Asthma, bronchitis, Emphysema, or a combination)
4. 10 asthma myths busted
5. 13 Things We Asthmatics Can Be Thankful For
6. Kids with asthma can and should play team sports
7. Seven Ways Asthma Has Benefited My Life
8. Seven Benefits of Being a Dad with Asthma
9. 10 tips to becoming a better asthma dad
10. Asthmatics can lead a normal life
11. What are long-term effects of asthma?
12. c-sections increase risk of asthma by 80%
13. The common sense approach to hard luck asthma
14. 8 factors may increase risk of fatal asthma
15. case study: Does intervention worsen asthma?
16. Is it possible pure asthma is NOT a fatal disease?
17. Bronchospasms don't always wheeze
18. Asthma/COPDers should avoid pop & beer
19. Chronic lungers and fans go hand in hand
20. Lack of interest in asthma means less funding
21. Cardiac asthma should not be treated as asthma
22. Some good asthma/COPD drugs get a bad rap
23. Airway remodeling in asthma patients
24. Asthma Hospitalizations on the Decline
25. Studies Link Alcohol to Worsening Asthma/Allergies
26. Asthma is not all in your head

History and future of Asthma:

1. Check out these 19th century asthma remedies
2. Check out these ancient asthma remedies
3. Neat website I found with old asthma medicines
4. Susphrine: The asthma wonder drug of old
5. It's time to bring back susphrine
6. Asthma cigarettes served a useful purpose
7. I'd like to meet asthmatic Teddy Roosevelt
8. From asthma cigarettes to a normal life
9. Asthma: A cure may be on the horizon
10. Scientists develop new cure for asthma, allergies

Types of Asthmatics and inspiring asthma stories:

1. The 11 types of asthma patients (or click here for the lexicon)
2. Meet Jake Gallant, the perfect asthmatic
3. Meet Joe Goofus: The Asthmatic You Don't Want To Be (But Probably Are)
4. Being the Best Asthma Patient You Can Be
5. Are you a bronchodilatoraholic?
6. Confessions of a recovering bronchodilatoraholic
7. Bronchodilator Anxiety
8. The "Wet Noodle" Technique Works For Keeping Calm During An Asthma Attack
9. The Phlegmatic Asthmatic
10. Some Asthmatics are Good Actors
11. The Doubting Thomas Asthmatics
12. Confessions of an asthmatic in denial
13. Meet Breathin' Stephen, the Hard Luck Asthmatic On His Way to the Boston Marathon
14. Breathin' Stephen, the Hardluck Asthmatic, completes Boston Marathon
15. The Journey of a Hardluck Asthmatic to Gallant Asthmatic, or why it's easier to control asthma in 2010 as compared to the 1970s and 1980s when I grew up
16. Josie Goofus: The Asthmatic you don't want to be
17. I am your respiratory therapist
18. Kid asthmatics love their respiratory therapists
19. Asthmatics can't live in a bubble
20. When it's asthma it's personal for me
21. Asthmatics can still attend hunting camp

Types of Asthma Doctors and wisdom about doctors:

1. The 6 types of asthma doctors
2. The 24 signs of a great asthma doctor
3. You and your doctor must be an asthma control team
4. Is your doctor doing a good job
5. Do You Need An Asthma Specialist?

Additional asthma wisdom:

1. Advice for parents of asthmatics
2. Five things that could get in the way of a healthy you (and how to get around them!).
3. What's it like to be intubated?

Asthma Book Reviews:

1. Start the asthma talk with "Alphie's Attack!"

Fun Asthma Writings:

1. Santa's elves working on new asthma medicine

Morph to Hardluck Asthma where I delve into the past and future of asthma.