AAFA Newsletters

Issue In This Issue
May 2008 #1 Are you ruled by Sinusitis? Sinusitis is an infection or inflammation of the empty spaces in our head called sinus cavities. These cavities serve no purpose other than to make our heads lighter and easier to move, yet the lining of these cavities DO serve an important purpose: they protect us from breathing in dust, pollen and other foreign matter and germs. The sinuses are lined with a membrane, a soft, moist tissue covered with mucous and densely covered with tiny hair-like cilia which act like little combs or wands moving all the pollen, germs and other irritants caught in the sinuses, then flushing them into the stomach through the back of the throat, nature's way of filtering bacteria from entering our body when we breathe.

We have 4 pairs of sinus cavities: 2 above the eyes just behind the forehead; 2 to the side of the nose and below the eye just above the upper teeth; 2 between the eyes, and 2 far in the back of the head, far behind the eyes and above the throat, just in front of the brain case. Any complications in those particular sinus cavities are very serious.

At any given time, more than 35 million Americans have sinusitis which is any kind of inflammation or irritation of the sinuses and is usually caused by bacterial infections but can also be triggered by allergies. Symptoms start with a stuffy nose and heavy nasal drainage, but can also begin with nasal blockage instead or draining, and/or a thick yellow/green discharge. Problems occur if sinusitis becomes acute or sudden, with pain in the cheeks, forehead or between the eyes that worsens when coughing, lying down or bending over; with headache or toothache in the upper jaw; with fever or loss of sense of smell. These symptoms usually indicate infection. If you have a sinus infection you not only feel miserable but this infection can weaken the whole body's mechanism for keeping other infections away because the washing action by the cilia is compromised. And the worse your sinuses get, the worse you feel. You can't breathe properly until the sinusitis is treated.

Sinusitis may be caused by either a viral or bacterial infection and, in some patients with immune system disorders, sometimes fungus. Poorly controlled rhinitis or structural problems in the nose caused by tumors, polyps or a deviated septum (the wall that separates the left and right side of your nose) can also trigger sinusitis. Read this complete issue to learn how to prevent and treat sinusitis and the pain of sinus headache.
Apr 2008 #2 "Air it Out" continues our discussions with Dr. William Howland, MD, Board certified in Internal Medicine & Allergy and Immunology, Allergy & Asthma Center of Austin, (512-345-7635) concerning some difficult patient inquiries.

GERD (Gastroesophageal Reflux Disease) is linked to so many respiratory illnesses — asthma, allergies, food allergies, vocal cord dysfunction, chronic cough, COPD, Chronic Bronchitis to name a few. What exactly is GERD?

Dr. Howland explained that GERD (Gastro = stomach, Esophageal = swallowing tube) Reflux Disease is more commonly known as heartburn or indigestion. Reflux, or a back-up of stomach acids, occurs when stomach acid and digestive juices flow back up the swallowing tube (esophagus) and irritates or damages the membrane lining the esophagus. GERD patients may experience a burning or gnawing pain in the upper stomach or lower chest. A weakness of the muscle at the bottom of the esophagus as it passes through the diaphragm (muscle under the lungs which aids in breathing) is the usual cause.

Some people have a "hiatal hernia" which is a small part of the stomach dropped through the diaphragm into the chest cavity. With a hiatal hernia, acid reflux occurs because the diaphragm is no longer helping the esophageal muscle keep stomach contents in the stomach.

We asked "which comes first, the chicken or the egg? In other words, does having GERD provoke respiratory illnesses like asthma or do these respiratory illnesses cause GERD?" Dr. Howland replied that GERD is common in about 60% of asthma patients. It can make asthma worse in a number of ways. When stomach contents back-up into the lower esophagus, a reflex cough and broncho-spasm can occur, leading to asthma symptoms or exacerbation. Cough and heavy breathing associated with asthma can actually increase gastric back-up which can increase asthma and cough which results in a vicious circle of symptoms. GERD is often worse when a person is lying down; stomach contents can more easily back-up into the esophagus, a reason that asthma can flare at night while a patient is in bed. Reflux should be suspected for the asthma patient who wakes suddenly with a choking cough. Sometimes a patient will have spasm of the vocal cords as the body tries to protect the windpipe. The patient may feel tight in the throat or upper chest, feel they can't get a breath, or make wheezy sounds while trying to breathe in. The acute or sudden symptoms may pass in a few minutes but may be followed by asthma problems lasting minutes to hours. Reflux associated asthma and cough symptoms are worse if the underlying asthma is not under good control.

If cough and wheezing are prominent asthma symptoms, GERD may be a reason. To make things even more complicated, many asthma patients with GERD don't have heartburn or indigestion and are unaware that GERD is playing a role in their asthma. Theophylline, a popular pill which was used extensively in the US for asthma control until the 1990s, can actually make reflux worse.

Read the complete issue to learn how GERD is diagnosed and how it can be controlled.
Apr 2008 #1 Frequently, AAFA-TX receives some difficult patient questions. Air It Out asked Dr. William Howland, MD, Board certified in Internal Medicine & Allergy and Immunology, Allergy & Asthma Center of Austin, (512-345-7635) for his insight into these questions. The question today relates to geographical environment and asthma and allergies.

Many ask AAFA-TX the best place to live if they have respiratory illness. How does a humid or dry environment, or a heavily polluted environment or a thin atmosphere due to higher elevations affect those with respiratory diseases? Dr. Howland responded that weather, location and elevations affect the environment which can have secondarily affects on the respiratory tract, affecting asthma and allergies.

Lower elevations in metropolitan areas are associated with higher levels of air pollution and, depending on climate, higher levels of vegetation. Air pollution has a minor or major effect on allergies and asthma depending on the individual patient.

There are different types of air quality (AQ) problems associated with urban areas including gases (sulfur dioxide, ozone, diesel exhaust fumes) and fine particulates (carbon particles, latex particles from tires, etc). In general, these act as respiratory irritants and may also promote inflammation in the respiratory tract. In addition, increased levels of 'greenhouse gases', particularly carbon dioxide, can cause increased growth of plants (plants absorb carbon dioxide as food). Consequently, more pollution causes plants to grow larger and release more pollen resulting in more allergies. And, as our climate grows warmer (global warming) plants are pollinating for longer periods each year resulting in more allergies, too. Air pollution creates a vicious cycle for respiratory problems.

Geographic locations and elevations do affect respiratory illnesses. Locations closer to oceans may be better for allergic people. However, coastal areas are often humid with an increased mold spore count, a problem for those with mold allergy, plus heavier rainfalls encourage plant growth on shore, yet generally, tropical plants aren't pollinated by the wind but by birds and butterflies. Land located near lakes and rivers has an increase in vegetation pollen near the water and is generally associated with higher humidity levels which also encourage mold growth.

Desert or arid (dry) climates are generally better for allergy sufferers due to minimal vegetation and mold spores. Growing seasons in the desert are short except where there is heavy irrigation, too, which mean less pollen

Higher elevations have shorter growing seasons and less pollen too and dust mites can't survive at elevations above 5,000 feet. Many people find lower humidity and 'thinner' air at higher elevations is better for their respiratory symptoms but above 7,000 feet, many people experience shortness of breath associated with less oxygen in the air at elevations over 5000 feet. Most people adapt to this over several months; however, some people develop altitude sickness but it is rarely life threatening, just not pleasant. For more information on this topic, read the whole issue.
Mar 2008 #2 What is Vocal Cord Dysfunction and how does it relate to asthma? Perhaps it's easier to say what VCD isn't: it's not asthma although sometimes it mimics asthma and is mistaken for asthma and treated as asthma. VCD isn't a new condition although few doctors knew much about it until it was studied in depth at the National Jewish Medical & Research Center in 1983.

Symptoms mimic asthma and sometimes VCD is misdiagnosed as Exercise Induced Asthma when the patient doesn't have asthma at all. The Ohio State University Division of Pulmonary and Critical Care Medicine discovered that approximately 20% of their patients referred to them for disability evaluation due to asthma really had Vocal Cord Dysfunction, not asthma. VCD occurs when the vocal cords don't open and shut properly causing symptoms similar to asthma but there is no airway inflammation as there is in asthma. Symptoms of VCD include shortness of breath, intermittent hoarseness and/or wheezing, chronic cough and/or throat clearing, chest and/or throat tightness and difficulty taking in air. Many physicians unfamiliar with VCD treat the disorder as Exercise Induced Asthma, prescribing corticosteroids or bronchodilators but these have no beneficial affects for VCD.

There are differences between EIA and VCD: In Vocal Cord Dysfunction, symptoms occur less than 5 minutes after exercise begins; the patient complains of throat tightness and maybe some upper chest tightness; a high-pitched sound is heard when inhaling; repeated episodes will occur right after re-starting the strenuous exercise; recovery from an episode is usually less than 10 minutes; inhalers or corticosteroids have no affect on symptoms. With Exercise Induced Asthma, symptoms occur more than 5 to 10 minutes after beginning an exercise; there is usually middle or lower chest tightness; coughing or wheezing might occur when breathing out; it's easier to resume exercising because symptoms don't re-occur for several hours and inhalers and/or corticosteroids do usually ease symptoms.

The cause for this condition is unknown; but it does seem to be provoked by conditions such as post nasal drip, GERD (gastroesophageal reflux) or environmental triggers such as using the vocal cords harshly while singing or shouting, by exposure to tobacco smoke or exposure to chemical fumes or strenuous physical activity. A very real condition affecting thousands, it can also be precipitated by psychological stress and sometimes misdiagnosed as panic attacks. The strongest link to any other medical condition is to GERD, although it's not clear if the GERD is caused by VCD or the opposite. Part of a treatment plan for VCD is to treat the GERD, too.

Because it is so easy to confuse Vocal Cord Dysfunction as asthma or anxiety, it is important to have a correct diagnosis. Refer to this issue for more information about the diagnosis and treatment of Vocal Cord Dysfunction.
Mar 2008 #1 The majority of asthmatics (approximately 70%) have asthma that is triggered by allergies and 80-90% of asthmatics will also experience Exercise Induced Asthma while exercising, but some people who don't have asthma can also experience the symptoms of asthma during or immediately after vigorous or prolonged physical activity. How can that be?

During hard and/or prolonged exercise or strenuous activity like hard exercise, dancing, mowing the grass or moving furniture, we tend to breathe through our mouths rather than through our nose and this means the air we're breathing is colder and drier when it reaches our lungs because it misses the first few "stops" on the way to our lungs which cleanse and warm the air. The muscle bands around the airways are sensitive to temperature and humidity changes; they react by contracting or spasming if the incoming air is too cold or dry and this narrows the airways. These contractions result in asthma symptoms such as coughing, tightness in the chest, wheezing, or unusual fatigue while exercising or working strenuously, plus an accelerated heart rate and feeling a shortness of breath. If pollen counts are moderately high or high, or if the air is polluted with ozone, dust, exhaust, or smoke, or the air is cold or too dry, or if you have an upper respiratory infection, then the symptoms of exercise induced asthma could be worse.

If you're affected by EIA (exercise induced asthma), symptoms will usually occur within 5 to 20 minutes after the start of physical activity or 5 to 10 minutes after you've stopped the strenuous activity. Having EIA is not a reason to stop exercising or performing strenuous activity: an active lifestyle is important to both our physical and mental health. EIA can be treated. As always, the first step is to visit your physician for a proper diagnosis and then to develop a personal management plan tailored to your needs and activity preferences. Your physician may prescribe inhaled medications such as short-acting Beta2-Agonist or albuterol 15-20 minutes before you do strenuous exercises.

Select an activity or sport that works for you, one that fits your management plan. Many doctors feel all exercise or sports activities can work for most asthmatics if the proper management plan is followed; however there are some sports or exercises that have a greater tendency to induce EIA symptoms, exercise that forces your lungs to work hard over a long period of time or that expose your lungs to cold, dry air. Read the whole article for suggestions of appropriate sports activities and other tips on how to cope with Exercise Induced Asthma symptoms.
Feb 2008 #2 Stress is harmful, a condition we experience when we feel that the demands made on us exceed our personal ability to cope, in other words, a feeling of being overwhelmed. It can take many forms: internal, from a physical illness; external, caused by pain, extreme heat or cold; psychological, caused by poor working or living conditions, financial strain or by difficult social and personal interactions. Stress is a genetic response which is designed to save us from danger by releasing hormones that provide a burst of energy or adrenaline that protects us from a real danger. But this survival technique also has a negative impact for modern living: if not controlled, stress causes health problems by lowering our resistance and making us prone to diseases and skin eruptions like hives. Stress can also be a major trigger for asthma exacerbations or flare-ups. A chronic illness like asthma creates its own stress because of the constant medical, emotional, physical and financial disease pressures. Stress and strong emotions can worsen asthma symptoms in some people. The hormones released by the body during times of stress cause the muscles around air passages in the lungs to tighten, which narrows the air tubes, making it difficult to breathe. It is important that asthmatic patients learn to recognize stressful situations (an asthma exacerbation is definitely a stressful situation) and know when they need to relax and how to concentrate on slowing down their breathing in order to relax.

Stress also makes many allergy related symptoms appear or worsen. When we are under stress, allergy symptoms tend to pop-up; you can actually acquire more allergies during times of stress as your body's immune system goes into overdrive.

Dealing with stress levels is an important step towards controlling and preventing asthma and allergy symptoms as well as enjoying life a lot more. The key to avoid stress-induced asthma symptoms is to learn basic relaxation breathing techniques and practice them BEFORE an asthma flare-up occurs and to know how to use these same techniques during an exacerbation to help reduce the affects of the symptoms. This issue describes breathing and relaxation techniques to help reduce stress and help reduce the affects of stress related asthma and allergy symptoms.
Feb 2008 #1 Severe food allergy can result in anaphylaxis, a life-threatening response to an allergen. Anaphylaxis can also be provoked by allergy to insect stings or bites, latex and medications. What can a child or adult with these severe allergies do? 1) They should see a physician to identify their allergens and then avoid them completely. 2) For those with severe allergies that could lead to anaphylaxis, day-to-day living is more complicated by the need to avoid their allergens. Be vigilant in avoiding the allergic foods or other allergen. Read labels carefully as products often change their recipes or formulas. Learn the food family your allergen falls into and if instructed to do so by your physician, avoid foods in the whole family. Take care eating outside the home, always asking the chef if there is danger of cross-contamination for your allergen. 3) Persons at risk for anaphylaxis should carry an epinephrine device such as Twinject or Epipen at all times (in an emergency, it serves little purpose at home in the medicine) 4) Wear a medical alert ID bracelet or necklace so others will know the cause of distress in an emergency. Some examples of these are found on American Medical ID's website.

But what if your children don't have serious allergies that can lead to death? 4 of 6 food allergy deaths occur in schools; what can schools do to help prevent a food allergy provoked death on campus? What can you, the parents of children with classmates or friends with severe allergies do to prevent an anaphylactic incidents for those classmates? The answer focuses on compassion. The goal is NOT to ostracize any child or adult with severe allergies which might lead to anaphylaxis but to respond with understanding and compassion. Read the entire issue for suggestions how you can help those with severe allergies prevent a life threatening incident.
Jan 2008 #2 Did you know that asthmatics who breathe air containing coarse particulate matter (road & construction dust, etc) may be exposing themselves to heart problems according to a recent study by the University of N. Carolina Center for Environmental Medicine. For asthmatics, even breathing a small amount of these particles found in poor quality outdoor air can increase their bad cholesterol levels and increase inflammation-linked white blood cells.

Did you know that
Jan 2008 #1 one of three university athletes has exercise-induced asthma, or EIA. A recent study conducted at the Ohio State University Asthma Center said these athletes may have no prior history of asthma. EIA usually occurs 5 to 20 minutes after intense physical exertion with symptoms like shortness of breath, chest pain, wheezing, chest tightness or coughing. Approximately one in ten people with no history of asthma can experience EIA, and neither gender nor sport made any difference in testing positive for EIA. Often EIA in competitive athletes is misdiagnosed because the symptoms vary so widely. Researchers stressed the need to develop routine asthma diagnosis and management standards for competitive athletes.

Did you know the number of medication allergies is rising, and if a patient with a drug allergy is admitted to hospital and is unconscious or otherwise unable to share drug allergy information to the admitting nurse, this omission could be fatal. Even if an allergy is in the patient's personal medical records there is no way (yet) the hospital can tap into those records in an emergency.

Did you know some adults who have chronic bronchitis and are smokers may have or develop COPD or Chronic Obstructive Pulmonary Disease. Chronic bronchitis in a smoker (or past smoker) may be one of the earliest signs of COPD, an irreversible disease where there is inflammation in the small airways with airflow obstruction, shortness of breath, a chronic cough and lots of phlegm.

Did you know the beach phenomenon known as "Red Tide," found seasonally along the Gulf coast of Florida, is actually blooms of an ocean organism that produces potent toxins. A healthy person who inhales these toxins may have eye irritation, rhinitis, wheezing and a non-productive cough which usually disappears an hour after leaving the beach. These toxins affect asthma patients to a greater degree. Asthmatics exposed to the toxins for just an hour experienced respiratory problems and decreased lung function. If you live in Florida or plan a vacation there and are asthmatic, be alert for "Red Tide" invasions and stay off the affected beaches.

Did you know the number of persons experiencing allergic rhinitis worldwide is rising, perhaps due to an increase in poor outdoor air quality due to Global Warming plus an increase of poor indoor air quality due to our use of volatile compounds and chemical irritants in building materials and home furnishings.

Did you know that if you have red or puffy skin on parts of your body, you might have an allergic skin condition called angiodema which is swelling in the deeper layers of the skin and often occurs along with hives. Angiodema usually occurs in the soft tissue of the body — the eyelids, mouth or genital area and can be chronic or acute. Like hives, they are an allergic reaction of histamines but in deep tissue, not surface skin.

To learn more about these topics, including how to control these issues, read the full article.
Dec 2007 #1 WHAT CAUSES ASTHMA?

The number of people afflicted with asthma continues to rise. It is now the third leading cause of hospitalizations in the US. In Texas in 2005, 6.8% of the adult population and 6.2% of children under age 17 had asthma. Between 1999 and 2005, 1,831 Texans died of asthma complications. This isn't a local problem but a worldwide problem with every nation reporting major increases in the incidence of asthma. Why are we seeing this drastic increase in asthma patients? Scientists first have to examine what causes asthma before they can examine why there is such an increase in the number of children and adults presenting with this disease.

There is no single cause of asthma; there is no simple answer. Many physicians now believe asthma is a syndrome, signs and symptoms indicating characteristics of a disease. Many factors determine why one person has asthma and another doesn't. One reason for asthma is genetics; some people have an inherited tendency to allergies and asthma.

.Asthma may be triggered by the "hygiene hypothesis." In order for our immune system to develop properly, it must be exposed to bacteria, viruses or other invaders to build up resistance, yet now we sanitize everything with antibacterial cleaners, we overuse antibiotics when not needed, killing all bacteria, the good and the bad. We don't allow our immune systems to develop and do their job. But the hygiene hypothesis alone doesn't explain the immense growth in the number of asthma cases.

The rise in obesity also affects the increase in the incidence of asthma. There is a connection between these two diseases. Many scientists believe the most likely cause of the rapid asthma growth rate may be due to environmental factors.

What are these contributing environmental factors? 1) Smoking: anyone who smokes and has asthma, or who is around a smoker, will have more severe asthma symptoms and those who don't have asthma are at risk for developing asthma (and cancers) if they smoke or are around smokers. Even your pet dog could develop cancer or respiratory problems from being around a smoker. The message: stop smoking. Yes, it is difficult to stop since nicotine is addictive, so it's best not to start. Whatever means it takes stop smoking. 2) Air pollution: we know dirty air makes asthma symptoms worse but it hasn't been proven that bad air quality will actually cause anyone to develop asthma. 3) Environmental allergens: these are the substances which cause our immune system to react with an allergic reaction. The most common include animal dander, particularly cat dander; dust mites, mold and pollens. Again, scientists don't feel that any of these allergens can cause asthma, but they do cause symptoms in those with asthma.

So, if it's not 100% genetic, not caused by smoking, dirty air or cat dander, what is causing this increase in asthma? The BAD NEWS is, no one knows for certain and until scientists do determine the cause of this disease and how to prevent it, the GOOD NEWS is, asthma can be controlled! YOU have the power to control your asthma. Read this issue and learn tips to empower yourself and control this life-threatening disease.
Nov 2007 #2 ASTHMA IN INFANCY AND RAD.

In this issue, we continued our conversation with Dr. Richard Herrscher, MD, Board Certified in Internal Medicine and Allergy and Immunology. Dr. Herrscher has offices on Communications Parkway in Plano (972-473-7544). We asked him how infant asthma is diagnosed. Dr. Herrscher responded that diagnosing asthma in infancy (children up to 2 years of age) is extremely difficult and is based primarily on visible symptoms including wheezing or chronic cough. The main problem with symptom diagnosis is that many infants will also wheeze when they have a viral respiratory infection. Many times an asthma diagnosis is deferred until after age 5 when the progression to asthma can be more accurate. Currently available diagnostic tests aren't reliable or possible for infants. Typical diagnostic tests such as office based tests of lung function (forced expiration and impulse oscillometry) can sometimes be used reliably down to age 3 but not below that age. Exhaled nitric oxide testing has shown promise in diagnosing asthma, but this test is not widely available and again has limits down to age 3. Invasive procedures such as bronchoscopy or closed loop spirometry can be used in infants but are usually reserved for research situations or in severe cases when a diagnosis or the need to rule out other diseases is critical. High resolution CT scanning has the ability to show changes in the airway in infants indicative of asthma, but this test is still not validated or proven. This brings us back to the point of symptoms for most infant diagnosis.

Current studies and the 2007 asthma guidelines give risk factors that can be used to predict the probability of infant wheezing progressing to asthma. These risk factors include 4 or more wheezing episodes in the last year that lasted more than 1 day and affected sleep AND have EITHER one of the following: parental history of asthma, physician diagnosed eczema, or evidence of IgE sensitization to aeroallergens OR two of the following: IgE sensitization to foods, blood eosinophils more than 4%, or wheezing not related to colds. Infants with these risk factors have a high probability of asthma after age 5.

There are some signs to look for indicating an infant might be having an asthma flare-up or exacerbation. The typical signs are wheezing or audible sounds while the infant is breathing. Pressing one's ear over the infant's chest or back closely mimics what can be heard with a stethoscope and improves the ability to pick up wheezing sounds. Chronic or frequent cough is often the only sign seen in infants, particularly if it worsens at night or after exertion/play. Other more serious signs include rapid breathing or retractions (sinking of the skin inward) of the abdomen/chest/neck, cyanosis or pallor (either a blue or a pale tint to lips, face or hands, feet, nails), and restlessness during sleep or listlessness while awake.

We asked Dr. Herrscher the difference between RAD (Reactive Airways Disease) and asthma, also. Read this article for his response concerning RAD as well as some valuable tips for patients who use albuterol. New inhalers propelled by HFA (hydrofluoroalkanes), an aerosol gas that is environmentally friendly, will be mandatory by December 31, 2008. What differences will patients who use albuterol notice in their new inhalers? This issue helps explain those differences.
Nov 2007 #1 ADULT ONSET ASTHMA; CLASSIFICATIONS OF ASTHMA.

AAFA-TX has a patient & caregiver "helpline" to answer questions on asthma and allergies, provide referrals or sources of assistance for disease-related issues. Some questions are complicated. Air It Out asked Dr. Richard Herrscher, MD, Board Certified in Internal Medicine and Allergy and Immunology, for help. Dr. Herrscher has offices on Communications Parkway in Plano (972-473-7544).

We asked Dr. Herrscher if there was a difference between asthma diagnosed in childhood and Adult Onset Asthma. Dr. Herrscher remarked that while the majority of asthma cases do begin in childhood there are subgroups including early onset (infancy) asthma, with wheezing due to viral respiratory infections that seem to fade away by school age. Children that continue or begin to wheeze after age 5 show more signs of allergic disease and have more persistent asthma into adulthood, though as many as half of these cases will improve in puberty or early adult years. Several studies have shown that the severity of childhood asthma from ages 5-10 tends to predict the severity of asthma that persists into adulthood, with lung function remaining relatively stable over time.

Adult Onset Asthma, another subgroup, shows less chance of improving; it tends to be more severe and more progressive in terms of lung function decline. While Adult Onset Asthma can show the typical allergic characteristics of childhood asthma, many cases are non-allergic and are typified by either 1) an increase in eosinophils (a white blood cell common with allergies), nasal polyps and aspirin sensitivity or 2) wheezing that is made worse by gastroesophageal reflux (GERD). These two subgroups of Adult Onset Asthma are different from the typical allergic childhood form of the disease in both physical and genetic characteristics.

The current feeling is that asthma is a syndrome much like high blood pressure, with multiple genetic causes that interact with an individual's environment to produce different aspects of this disease. These different aspects or clinical variants determine severity, progression and response to treatment. However, we are just beginning to determine precisely these different genetic-based forms of asthma. The current classifications of asthma are based on a model of severity that takes into account the level of symptoms, lung function and risk of exacerbations or flares. This is useful in determining the level of initial treatment necessary for symptom relief, but leaves us short in predicting the natural progression of asthma or the response to treatment, in other words, will the patient improve?

Another problem with the current classification scheme is that it is based on studies performed in older children or adults with results carried over into the younger age groups. Since kids under age 5 have the highest incidence of asthma onset and there seems to be quite a bit of difference compared to adult asthma, one has to ask is this extrapolation rational or even appropriate? The current asthma classification and treatment guidelines are the best evidence-based models we have and while there may be major changes later as more research is done, we have to work with what we know, not with what we don't know.

Dr. Herrscher continues by discussing the current asthma classification scheme divided into four subgroups determined by a patient's symptoms, as well as commenting on endoscopic sinus surgery to improve allergy symptoms.
Oct 2007 #2 ASTHMA DEVICES

Asthma patients can use special devices to help measure lung function or to help take their medications. These devices include peak flow meters, spacers and nebulizers.

A Peak Flow Meter is used by both adults and kids to measure breathing; it can detect breathing difficulties even before other symptoms of an asthma flare occurs. In fact, a first sign of an asthma flare-up is a drop in the peak flow reading, which is why it's so important to have and use a PFM. A peak flow meter will help you to stay compliant with your medication plan — if used correctly.

Devices differ but each has 3 color "zones" indicating how open the airways are: Green = airways are open, the patient feels well and can perform all normal activities; Yellow = airways are blocking, the patient doesn't feel very well, activity is slowed down and it may mean using additional medications; Red = danger! This means the airways are closed; the patient feels very ill, has great difficulty breathing and may even have blue lips or fingertips. Immediate help, more medications and perhaps emergency care is required. Every patient has a "best number" or benchmark - the biggest, fastest breath blown into the meter when the patient feels well and has no asthma symptoms.

Some doctors may recommend using the PFM twice a day for a few weeks, especially when beginning new medications; some recommend using it in the morning before taking medications, or both before and after taking medicine to see how effective the prescribed medications are in controlling the patient's asthma.

Many asthma medications are delivered by inhaler, a hand-held tube used to hold a medicine cartridge. A propellant gas directs a spray of medicine into the lungs. Usually adults or kids over six years of age use inhalers but some younger kids may be able to learn how to use one. Younger children may use syrup, liquid or pill medications instead.

A spacer is a tube device that's attached to an inhaler focusing the medication into the lungs so most or more of the prescribed dose is inhaled. Without a spacer medication often escapes into the air, not into the lungs. To use, gently shake the inhaler, then hook it into the spacer; place the spacer mouthpiece into your mouth, push the inhaler once to put one dose of medicine into the spacer holding chamber, inhale slowly and hold your breathe for 5-10 seconds then slowly exhale..

A nebulizer is a machine driven by compressed air converting medicine into a mist to be breathed through a tube or mask. Kids under age 5 or patients who have problems using a metered dose inhaler or patients with severe asthma will often use nebulizers. These machines ensure the patient gets the right dosage of medication. To learn how to use and maintain these asthma devices, refer to this newsletter issue.
Oct 2007 #1 ASTHMA AND ALLERGY CONTROL THROUGH HEALTHY EATING

There may be an additional step that children and adults with allergies or asthma should follow to help reduce their allergy and asthma symptoms and the number of asthma flare-ups, other than eliminating their allergens and following the right medication plan: they could adopt a healthy diet of the right foods to help reduce exacerbations and symptoms.

According to some physicians, eating a nutritious diet helps alleviate or perhaps even prevents allergy and asthma symptoms for several reasons. Eating certain foods controls the underlying causes for inflammation of the airway passages; eating certain healthy foods can dilate the airway passages; certain healthy foods may thin the mucus in the lungs; a healthy diet consisting of the right foods may prevent food-allergy reactions that can trigger asthma flare-ups; obesity affects asthma and the best way to reduce weight is to eat healthy foods, eat less and exercise more.

Overweight/obese children and adolescents have more severe asthma then asthma patients who have a normal Body Mass Index. Obesity statistics are shocking. In 2002, 10 million or 63% of adult Texans were overweight or obese compared to the national rate of 33%. The Texas Department of Health states 33% of Texas children (6-11) and adolescents (12-19) are overweight or obese compared with the national average of 15.5%. These numbers nationwide have doubled over the past 25 years and they're still growing. A serious side effect of childhood obesity is more serve asthma.

Eating healthy means avoiding empty-calorie foods, fast-foods loaded with bad fats or eating an excess of meat protein. Healthy eating means eating more fruits, veggies, whole grains, fish, dairy, beans, lentils and soy proteins.

What specifically are these good foods? Foods containing the good fat, Omega-3 Essential fatty acids, that are natural anti-inflammatory agents; fruit juices that are loaded with antioxidants and which clear inflammation from the body; high-fiber foods that are good for the gut, boosting our immune system; eating large quantities of "live active culture" yogurt daily to restore the balance between good and bad bacteria in the gut where most of our immune system is located.

Read more about the super foods which should become part of your healthy diet to help control asthma and allergy symptoms.
Sep 2007 #2 WHAT IS ALLERGIC RHINITIS?

Allergic Rhinitis, commonly referred to as runny nose, is an inflammation in the nose caused by exposure to an allergen. There may be other symptoms besides a runny nose such as sneezing, congestion, or an itchy feeling in the nose, throat, or on the roof of the mouth, or even watery or itchy eyes and blurred vision and a general "lousy" feeling, or a combination of these symptoms. The symptoms can vary each day and from person to person, too. Some have what is referred to as seasonal allergic rhinitis, or Hay Fever, which occurs at certain times of the year and is usually triggered by pollens. This seasonal rhinitis may last only a few months until the first frost kills the pollens. But if you have symptoms all year round, then you have perennial allergic rhinitis and this is generally caused by environmental allergens including but not limited to dust mites, mold, animal dander, cockroaches or chemical irritants.

Most rhinitis patients treat the symptoms with over-the-counter medications; some ignore the symptoms hoping they'll go away; others don't even recognize that the symptoms they're experiencing are an allergic response and not a cold. Ignoring rhinitis or under-treating it can lead to other health problems. Our nose, throat and ears are all inter-related, and sometimes chronic rhinitis symptoms lead to other long-term medical problems, some with serious results, especially for young children.

Untreated allergic rhinitis can provoke middle ear infections, post-nasal drip, sinus infections, chronic congestion, headaches and even sleep apnea. Learn the signs and symptoms of rhinitis and how to help avoid these complications.
Sep 2007 #1 SEVERE ASTHMA

Asthma varies from patient to patient. Most (approximately 70%) have asthma symptoms that are triggered by allergies and/or irritants; some have asthma triggered by exercise; some will have asthma symptoms triggered by allergens, irritants and exercise. Some have very mild occasional asthma symptoms; some have more frequent symptoms but still moderate in severity; they might need to use more medications to control their asthma. Yet they can control their asthma. But approximately 10% of all patients have very severe asthma and control is difficult.

There are possible explanations why someone gets to the point where they have severe asthma. One possibility is that the asthma was misdiagnosed, under-diagnosed or un-diagnosed in the beginning when control was more attainable. Or it may not have been treated properly with the right medications. Many times severe asthma is the result of lack of compliance by the patient. The patient may have the right medications but doesn't take them, or doesn't use them as prescribed as often as is necessary.

If the severe asthma patient has been properly diagnosed and is compliant in taking their medications, perhaps the severity is the result of not eliminating the environmental allergens that trigger their asthma. Or, the patient might have a viral infection causing acute and chronic bronchitis or bronchiolitis. Or, the patient may be exposed to air pollution, especially in the form of tobacco smoke. If you have asthma and you smoke or are around smokers, whether cigarettes, pipes or cigars, your asthma will be more serious and you will have more frequent flare-ups. Or, the patient may be overweight or obese, which impacts asthma severity, making it much worse.

Chronic rhinitis, nasal polyps (growths), sinusitis (sinus inflammation that reoccurs frequently) or untreated gastric reflux - GERD (back-up of stomach acids into the esophagus and sometimes into the airways) can also contribute to the severity of asthma. If any of these above conditions are the contributing cause, then once the condition is treated successfully, asthma severity may improve.

Learn about the contra-indications of NSAIDS and beta blockers for those with severe asthma and the ways you can control severe asthma.
Aug 2007 #2 NEWS & VIEWS:

A new study examines the likelihood of developing childhood asthma if multiple dogs live in the household. Is this a deterrent to developing asthma in young children or do other factors play a role, too?

Aspirin is recognized as beneficial to heart health in adults but will taking an aspirin every other day help deter adult onset asthma also?

A British study concludes all pillows, whether foam, feather, or synthetic, are miniature ecosystems and breeding grounds for fungus. Learn what you can do to prevent breathing potentially harmful fungal spores.

Will your son be more likely to acquire asthma rather than your daughter? What impact does sexual gender have on asthma and why?

The best way to control your Hay Fever (or seasonal Rhinitis) is to avoid the allergens that trigger it but in Texas that's very difficult. Trees are the earliest pollen-producers and pollen producing trees remain active into November in Texas. Tree pollen is so light winds can carry these pollens many miles from their source. Of the more than 50,000 types of trees, less than 100 types contribute pollen, and most of them are native to Texas. How can you reduce your exposure to these and other pollens that trigger your Hay Fever?
Aug 2007 #1 THE TRUTH ABOUT HIVES

About 20% of us develop hives at some time in our lives. Hives usually just "appear" without warning and generally, individual hives only last for 24 hrs. and most cases of hives disappear in 2-4 hours; yet for many, a bout of hives can last anywhere from a few hours to six weeks.

Some people, however, have hives constantly or their hives may last for years in the form of chronic urticaria. Though it feels like it to those affected, chronic hives aren't life-threatening yet they can cause disability and lots of distress.

Sudden or acute hives are usually caused by an allergic reaction to a normally non-threatening substance or phenomena. Hives can be caused by foods, medications or insect bites or stings, but no one knows with certainly what causes chronic hives. Many physicians think chronic hives may be a reaction to oneself.

Chronic, or continual hives can be aggravated by heat, stress, fatigue or exertion, alcoholic drinks, fever, hyperthyroidism and even PMS. Some people have what is known as "pressure" hives; they occur on the buttock (from sitting in the same position too long) or around the waist if belts are worn too tight. Chronic hives shouldn't be ignored but examined by a physician to determine the cause. It may be a symptom of some other illness or disease triggering the hive reaction. Your physician will want to rule out other diseases that can have hives as a symptom such as hepatitis, hyperthyroidism, Lupus or even possibly (but rarely) cancer. Learn how to best treat hives in this issue.

In the News: there are two primary steps to keep your asthma in control: identify and eliminate contact with your triggers and then develop a good medication plan that works for you, and, most importantly, follow it. But there's a third step to this equation: the time you take your medications. Learn the role circadian rhythms play in asthma and allergy control.
Jul 2007 #2 TIPS TO PREPARE FOR THE NEW SCHOOL YEAR WHEN YOUR CHILD HAS ASTHMA OR ALLERGIES

New school-year jitters are common for every child no matter the age. It's always a challenge for both parents and kids to face a new school year if your child has asthma and allergies, but it doesn't have to be a fearful or unpleasant experience if you take a few steps to prepare.

The first step is to make a doctor's appointment before school begins to assess your child's asthma control.

Next, fill any new prescriptions. Check to see all inhalers are full; get an extra peak flow meter to keep at school; mark all medications and devices with your child's name using labels. Texas law allows kids with asthma to carry and self-administer prescription asthma medicine on school property or at a school-related event if the student has written permission from the student's parent and physician. Parents and nurses: ask AAFA-TX for a free form.

Next step, make an appointment with your child's new teacher to: clarify what the teacher knows about asthma and allergies; discuss your child's triggers; if you feel your child is too young to handle their own meds at school, ask where medications will be kept — and how the child accesses them; develop an emergency plan: make sure the teacher knows how to use asthma devices; discuss how exercise and emotions effect the disease and perhaps your child's actions.

If the child is at risk for anaphylaxis ask your physician for epinephrine auto-injectors, one to send to school, one to keep at home. Texas law allows a child to carry their own epinephrine devices to school or at school sponsored activities with signed permission. Ask us for a free permission form.

Discuss these allergies with teachers and school staff. Are teachers and staff aware of the symptoms of food allergy? Ask what steps are taken at school to prevent cross-contamination of food allergens. Children, especially little ones, won't or can't verbally express all their symptoms for a severe allergic reaction. Supervising adults have to learn body language and "child-speak" and then act quickly to save a life. If they see any of these signs after a child is exposed to their allergic trigger, teachers must follow emergency procedures. Ask AAFA-TX for a free copy of an anaphylaxis emergency action plan. Empower yourself and your child this school year.
Jul 2007 #1 SLEEPING BETTER WITH ASTHMA OR ALLERGIES

Ninety percent of asthma patients and all of their caregivers sometimes have disturbed sleep because of the disease. Most physicians agree: neither asthma patients nor their caregivers have to suffer from disturbed sleep. The major reason an asthma patient might have a poor night's sleep is uncontrolled or poorly controlled asthma.

Many asthma flare-ups or symptoms occur at night, robbing patients of the rest they need to withstand and recuperate from these same flare-ups. The reasons for these nocturnal flares or symptoms vary. They might be caused by the "morning dip," by other medical issues such as GERD, or even the time medications are taken or daytime stress can affect a patient's ability to sleep well, and sleeping poorly creates a vicious circle of symptomatic daytime asthma as well. Yet there are some simple and easy steps to take that ensure a good night's rest for both patients and caregivers.
Jun 2007 #2 HOW TO SELECT A CHILDCARE FACILITY IF YOUR CHILD HAS ASTHMA OR ALLERGIES

Choosing the right childcare facility is a challenge for all parents. Every parent wants a safe facility with qualified instructors, a school where their child can feel welcome and will thrive. Cost and convenience are also considerations for most parents. If your child has allergies or asthma, there are more factors to consider in choosing the right facility including its location, whether the staff has had disease education, how well the facility controls environmental allergens and whether they have anaphylaxis procedures in place, just to name a few areas of concern.

If possible, parents or caregivers should always visit the facility before a decision is made to enroll a child. Parents should interview the director and ask some very important questions to safeguard their children. AAFA-TX recommends some things you might consider in making your selection if your child has asthma or allergies so that you can be an informed advocate for your child.
Jun 2007 #1 EATING HEALTHY IF YOU HAVE FOOD ALLERGIES

If you have food allergies or food sensitivities, its normal that you might be concerned that eliminating certain foods from your diet because of your allergies might also mean eliminating nutrients like omega-3 fatty acids, proteins or good carbohydrates required for over-all good health. With careful choices and some new products, eating healthy with food allergies or sensitivities is now easier for those with allergies to fish, eggs or wheat (celiac disease).
May 2007 #2 HOUSEHOLD CHEMICALS AND THEIR IMPACT ON ASTHMA & ALLERGIES

We all look for shortcuts to help us with routine chores like cooking, cleaning, gardening, etc. But if you have asthma or allergies, there is something to consider with these shortcuts besides convenience: many of the products we use to speed our housekeeping chores consist of chemicals that irritant asthma or can even cause asthma symptoms. The chemicals most often used in cleaning products, Formaldehyde, Ammonia, Sodium Lauryl Sulphate, D-Limonene and Sodium Hypochlorite, are not true allergens, but they can be irritants and unhealthy for anyone but especially dangerous to those with asthma or allergies. For those with asthma, whose lungs are in an irritated condition under normal circumstances, these strong chemicals found in almost all commercial cleaning products can exacerbate symptoms - even causing a flare-up. Breathing these chemicals can cause symptoms like congestion, rhinitis, red, burning or itchy eyes, wheezing, headaches, coughing or even disorientation. People with eczema might also break out in a rash when coming into contact with these harsh chemicals. As with any irritant, reactions will vary from person to person from mildly annoying to actually debilitating. If you think rushing out to buy "natural," "organic" or "green" cleaning products is the answer to avoiding these chemicals, think again. Many "natural" products contain some of these chemicals because these chemical are found in nature. But there are some non-toxic cleaning substitutes which normally won't cause irritation.
May 2007 #1 ASTHMA AND PREGNANCY

Do asthma and allergies have an effect on pregnancy? Uncontrolled asthma in pregnancy can contribute to complications; controlled asthma during pregnancy poses little problems or risks to either mother or unborn child.
Apr 2007 #2 INDOOR AIR QUALITY AND ASTHMA AND ALLERGIES

Indoor air pollution is one of the top 5 environmental health risks. Is your homes IAQ (Indoor Air Quality) poor? How can you tell? What can you do to improve your IAQ?
Apr 2007 #1 IS IT FOOD ALLERGY OR FOOD INTOLERANCE?

Food allergies vs. food intolerance. Which is it? Medication allergies are very difficult to determine; some drugs have side affects that imitate an allergic reaction making it hard to determine what is happening — allergy or side effect.
Mar 2007 #1 COPING WITH ASTHMA AND ALLERGIES

The rate for childhood asthma has more than doubled since 1980. How can parents better cope with the stress of having a child with severe asthma or allergies? Why is Spirometry an important function in diagnosing asthma?
Feb 2007 #2 PROFESSIONAL AIR DUCT CLEANING; WILL IT HELP YOUR ASTHMA OR ALLERGIES?

It is impossible to advise having your air ducts professionally cleaned just because someone in the household suffers from allergies to dust and mold. No studies have ever determined that duct cleaning has improved anyone's health or that "dusty" ducts circulate the dust back into the home. If you do have your ducts cleaned, become a savvy consumer.
Feb 2007 #1 HYGIENE HYPOTHESIS

In the news: How are asthma, allergies and antibiotics linked? Is the discovery of natural killer T cells a link to an asthma cure? Epinephrine can save your life if you have an anaphylactic response to an allergy.

IMPORTANT: Information contained in these publications should not be used as a substitute for responsible professional care to diagnose and treat specific symptoms and illness. Any reference to products and procedures is not an endorsement. AAFA-TX and all parties associated with the publications presented on this website will not be held responsible for any action taken by readers as a result of the information provided.