childhood asthma in india need for modifying GINA guidelines for INDIA

http://drpeds.blogspot.com/ http://funnytrivias.blogspot.com/ Dr Kondekar Santosh venketraman is a MD pediatrician at seth GS medical college and KEM HOSPITAL MUMBAI INDIA

Breast-Feeding Lowers Risk for Asthma in Childhood

From Medscape Education Clinical Briefs

News Author: Nancy A. Melville
CME Author: Penny Murata, MD

07/26/2011

Clinical Context

Breast-feeding appears to be linked with a decreased risk for childhood asthma-related symptoms, according to Fredriksson and colleagues in the November 28, 2007, issue of BMC Pediatrics. However, the influence of a family history of asthma or allergy is not clear. The link between breast-feeding and the risk for asthma might be mediated by atopy or infection.
The current study by Sonnenschein-van der Voort and colleagues, embedded in the population-based prospective cohort Generation R study, described by Jaddoe and colleagues in the November 2010 issue of the European Journal of Epidemiology, assesses the association of duration and exclusiveness of breast-feeding with the risk for asthma-related symptoms in the first 4 years of life and whether the association is mediated by atopic or infectious conditions.

Study Synopsis and Perspective

Preschool children who were not breast-fed or not exclusively breast-fed for 6 months show increased rates of asthma-related symptoms, such as wheezing, shortness of breath, and dry cough, according to a study published online July 20 in the European Respiratory Journal.
Asthma symptoms in children, known to be a leading cause of morbidity, have been linked in previous studies with lower rates of breast-feeding, but the study from researchers in the Netherlands is said to be the first to demonstrate an association between the length of time a child was breast-fed and the number of wheezing episodes the child experiences.
For the study, the researchers evaluated data on 5368 children that was part of the Generation R study, a population-based prospective cohort study of pregnant women and their children from fetal life on in Rotterdam, the Netherlands.
They gathered information on breast-feeding duration, exclusiveness, and asthma-related symptoms, including wheezing, shortness of breath, dry cough, and persistent phlegm.
The results showed that, compared with children who were breast-fed for at least 6 months, those who were never breast-fed were 1.4 and 1.5 times more likely to develop symptoms of wheezing and persistent phlegm, respectively.
In addition, children who were not exclusively breast-fed during the first 4 months of life and were also fed milk or solids during that period also were at higher risks of wheezing, shortness of breath, dry cough, and persistent phlegm in their first 4 years vs those who were exclusively breast-fed in their first 4 months.
Further adjusted analyses indicated that the associations of breast-feeding with asthma-related symptoms were not explained by eczema but, instead, were partly related to lower respiratory tract infections.

Breast-feeding is widely believed to help reduce the risk for asthma in younger children through a mediating effect on atopy and/or infections, the study authors believe.
“Underlying mechanisms might include IgA [immunoglobulin A], cytokines, especially TGF [transforming growth factor]-beta1, and long-chain fatty acids in breast milk that stimulate the infant’s immune system,” they explained.
“Also, glycans help the innate immune system to inhibit pathogen binding to the host cell target ligand, and changes in the delicate balance between pro- and anti-inflammatory compounds.”

The protective effect of breast-feeding, in particular, appears to be related to gut microflora that is changed with breast-feeding, they added.
“The gut microflora is suggested to be different between breastfed and formula fed infants. Compared to breastfed infants, those who receive formula feeding have a more complex microflora with more facultative anaerobes, bacteroides and clostridia at higher levels and frequencies,” the study authors write.
“We speculate that this might decrease with increasing exclusivity of breastfeeding, leading to lower infection risk and less wheezing by influencing the development of the immune system. Due to this putative effect on the development of the immune system, infections and asthma-related symptoms might occur less frequent even years after stopping breastfeeding.”

The results are in line with previous research showing up to a 2.22-fold increased risk of recurrent wheezing or asthma at the ages of 2 to 6 years among children who were not breast-fed or not exclusively breast-fed until age 4 months.
These new findings add to the previous research by showing a dose-response relationship between breast-feeding and the number of wheezing episodes, said lead author Agnes Sonnenschein-van der Voort, MSc, in a press release.
“The link of duration and exclusiveness of breastfeeding with asthma-related symptoms during the first four years was independent of infectious and atopic diseases,” said Dr. Sonnenschein-van der Voort, a researcher with the Erasmus Medical Center in the Netherlands.
“These results support current health policy strategies that promote exclusive breastfeeding for 6 months in industrialized countries. Further studies are needed to explore the protective effect of breastfeeding on the various types of asthma in later life.”
Eur Respir J. Published online July 20, 2011.

Burgers vs Childhood Asthma

I read in Reader’s Digest that kids who eat three or more burgers per week are 40 percent more likely to be diagnosed with asthma than kids who never or rarely eat burgers.  That study covered 50,000 children in 20 countries, so I label the findings very reliable.  So, I dug further to find the source. The study appears in the latest issue of the journal Thorax.  Look at this information in reverse, the researchers found that eating a diet high in fruits, vegetables, and fish was associated with a lower chance of developing asthma and wheezing.  That’s because fruits and veggies are good sources of antioxidant vitamins, and fish is a good source of omega-3 fatty acids. Antioxidants and omega-3 both have anti-inflammatory properties. Inflammation in the airways triggers asthma-related breathing problems as well as wheezing and coughing. The saturated fat in burgers promotes asthma by causing inflammation, to say nothing of how the fat clogs young arteries and contributes to childhood obesity. 

Diesel Trucks, Oil-Heated Homes and Childhood Asthma

 Domestic airborne black carbon and exhaled nitric oxide in children in NYC (Abstract, Alexandra G Cornell, Steven N Chillrud, Robert B Mellins, Luis M Acosta, Rachel L Miller, James W Quinn, Beizhan Yan, Adnan Divjan, Omar E Olmedo, Sara Lopez-Pintado, Patrick L Kinney, Frederica P Perera, Judith S Jacobson, Inge F Goldstein, Andrew G Rundle, Matthew S Perzanowski, Journal of Exposure Science and Environmental Epidemiology, Feb. 29, 2012)

Also discussed here:
Air Pollution from Trucks and Low-Quality Heating Oil May Explain Childhood Asthma Hot Spots (Science News, Mar. 27, 2012)

Today’s review deals with the health of children in New York City who live near diesel truck traffic. Results show up to three times greater risk for asthma and the need for further reductions in emissions from buildings burning low grade heating oil and from diesel trucks whose routes take them near homes.

Key Quotes:

 “Neighborhood built-environment characteristics were assessed for the 500 m surrounding participants’ homes. Airborne BC concentrations in homes correlated with neighborhood asthma prevalence.. and neighborhood densities of truck routes ..and buildings burning residual oil”

“In New York City… asthma among school-age children ranges from a low of 3% to a high of 19% depending on the neighborhood, and even children growing up within walking distance of each other can have 2- to 3-fold differences in risk for asthma”

“levels of airborne black carbon, which mostly comes from incomplete combustion sources like diesel trucks and oil furnaces, were high in homes of children with asthma”

“Because of its history as a shipping and oil refining center, New York City burns more dirty oil for residential and commercial heating than any other city in the country,”

“Children in this study with higher black carbon in the air of their homes had higher exhaled nitric oxide, suggesting that they were at greater risk for asthma exacerbations”

Childhood Asthma Rates Higher In City Than National Average, Low ...

An inhaler or puffer is a medical device used for delivering medication into the body via the lungs. It is mainly used in the treatment of asthma and Chronic Obstructive Pulmonary Disease (COPD). (Photo by Universal Images Group via Getty Images)

NEW YORK (CBSNewYork/AP) ? A new report shows that one in eight New York City children have been diagnosed with asthma, making childhood asthma rates in the city higher than the national average.

According to the Center for Disease Control and Prevention, about 7 million children across the country suffer from asthma, averaging about one in ten.

The New York City Health Department says poor New York City children are especially vulnerable.

In East Harlem, children are 13 times more likely to go to the emergency room because of asthma than those on the Upper East Side.

The report found that 177,000 children 12 years and younger were diagnosed with asthma at some point in their lives.

The Wall Street Journal reported Wednesday that the numbers are based on a 2009 survey. It says it?s the first time the agency has estimated the number of children suffering from the respiratory disease.

(TM and Copyright 2012 CBS Radio Inc. and its relevant subsidiaries. CBS RADIO and EYE Logo TM and Copyright 2012 CBS Broadcasting Inc. Used under license. All Rights Reserved. This material may not be published, broadcast, rewritten, or redistributed. The Associated Press contributed to this report.)

Source: http://newyork.cbslocal.com/2012/07/18/report-1-in-8-nyc-kids-have-asthma/

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