Overweight children displayed poorer asthma control than lean children

Lang JE. J Allergy Clin Immunol. 2014;doi:10.1016/j.jaci.2014.08.029.

Overweight and obese children with early-onset asthma had distinct symptoms and experienced poorer asthma control compared with lean children, according to recent study results.

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Researchers conducted a cross-sectional study of 21 lean children (20% to 65% BMI; mean age, 12.8 years; 67% boys) and 35 overweight and obese children (≥85% BMI; mean age, 12.5 years; 57% boys) with persistent, early-onset asthma. Patient history, qualitative and quantitative asthma symptom characterization and lung function were determined during two to three visits. Multivariable linear and logistic regression were used to determine the association between weight status and symptoms.

Similar lung function was displayed by both cohorts. The overweight and obese children reported more than three times frequent rescue treatments compared with lean children (3.7 vs. 1.1 treatments/week; P=.0002), while experiencing lower fraction of exhaled nitric acid (30 vs. 62.6 ppb; P=.037) and reduced methacholine responsiveness (PC20FEV1 1.87 vs. 0.45 mg/mL; P<.012).

“Weight status affected the child’s primary symptom reported with loss of asthma control (Fisher exact test; P=.003),” the researchers wrote.

Shortness of breath was more often reported by the overweight/obese cohort (OR=11.8; 95% CI, 1.41-98.7), while cough was reported less often by those children (OR=0.26; 95% CI, 0.08-0.82). Overweight and obese children had higher gastroesophageal reflux disease scores compared with thin children (9.6 vs. 23.2; P=.003), which appeared to affect asthma symptoms.

“Greater shortness of breath and beta-agonist use appears to be partially mediated via esophageal reflux symptoms,” the researchers concluded. “Overweight children with asthma may falsely attribute exertional dyspnea and esophageal reflux to asthma, leading to excess rescue medication use.

“Until systematic weight loss interventions become more feasible, respiratory physicians may serve their patients better by considering and discussing alternative causes of dyspnea in self-management plans and discussing when [short-acting beta-agonist] use is warranted for obese patients with asthma.”

healio.com

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150 MILLION EUROPEANS ARE ‘TRAPPED’ BY ALLERGY

Raising awareness about allergic diseases: Asthma

Allergy is a public health problem of pandemic proportions that affects more than 150 million people in Europe.

According to experts, 1 out of every 3 children have an allergy and they expect the disease to affect more than 50% of all Europeans in 10 years’ time.

Allergic diseases can limit activities and lower the quality of life, particularly when they coexist in the same individual. Apart from individual suffering allergic diseases present a very high socioeconomic burden to patients and families.

"The European Academy of Allergy and Clinical Immunology (EAACI) has launched an awareness campaign to help the society to better understand how allergy sufferers feel, how profound allergy impacts quality of life, how severe and costly the diseases can become and how important is to diagnose early and better manage this disease." 
- Nikos Papadopoulos, EAACI President 

Allergy and asthma are closely linked

• asthma and other allergic diseases run in families
• many patients are aware of allergic triggers for their asthma (house dust mites, animal dander, molds)
• atopic eczema is often the first sign that the child has an atopic phenotype and may develop rhinitis and asthma when they grow up
• childhood wheeze often persists into asthma if an allergic background is present
• 75% of adults with asthma have allergic rhinitis
• 50% of people with allergic rhinitis have asthma
• treating rhinitis may improve asthma symptoms, especially cough

      A child using an asthma inhaler

Word from EAACI's Asthma Section The reasons behind asthma are not well understood, however people with allergic rhinitis, atopic eczema, food allergy and those who have asthma running in the family are at risk of developing asthma. You may have asthma if you experience recurrent episodes of coughing, wheezing, breathlessness and chest tightness. The complaints may be triggered by colds, exposure to cigarette smoke, air pollution and / or allergens such as house dust mites, grass pollens, cats, etc. The symptoms increase, decrease or disappear from time to time.

Allergic asthma is considered a special phenotype and composes about 80% of cases in children and 40% in adults. Children with allergic asthma may have more severe and persistent disease and both adults and children with allergic asthma may benefit from a specific form of treatment called allergy vaccines. The majority of people with asthma can be controlled by environmental measures and asthma medications. A small percentage, around 5 % of all cases especially in adults, may have severe asthma and can be difficult to control with the traditional approach.

In recent years, there have been important advances in this field and there are now specific medications for people who do not respond to the regular treatment. These treatments are generally aimed at blocking certain substances that may specifically be responsible for severe asthma in selected patients. For the patient this means that asthma can now be controlled even in more severe forms of the disease.

Asthma is a chronic but controllable disease and persons with asthma can have a normal, active life with no restrictions. The important thing is to recognize and treat the disease.

About EAACI
The European Academy of Allergy and Clinical Immunology, EAACI, is a non-profit organisation active in the field of allergic and immunologic diseases such as asthma, rhinitis, eczema, occupational allergy, food and drug allergy and anaphylaxis. EAACI was founded in 1956 in Florence and has become the largest medical association in Europe in the field of allergy and clinical immunology. It includes over 8,000 members from 121 countries, as well as 47 National Allergy Societies.

http://www.bewareofallergy.com/

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Energy drinks could cause public health problems, says WHO study

Researchers argue for cap on caffeine levels, citing health risks, particularly when the drinks are consumed with alcohol

• Haroon Siddique
• The Guardian, Tuesday 14 October 2014 21.00 BST
• 

A European study found that over 70% of 18- 29-year olds drink energy drinks like Red Bull with alcohol. Photograph: David Sillitoe for the Guardian

Energy drinks will become a significant public health problem if their use among young people is not addressed through a cap on caffeine levels and restrictions on their sale and marketing, United Nations researchers have warned.

The World Health Organisation (WHO) study said the primary risk was from high caffeine levels, which can cause problems such as palpitations, hypertension, vomiting, convulsions and in extreme cases heart failure leading to death. The paper, published in Frontiers in Public Health on Tuesday, will add to concerns about the harmful effects of excessive energy-drink consumption.

João Breda, from WHO’s Regional Office for Europe, and colleaguesThe researchers wrote that caffeine has a proven negative effect on children.

They said: “The full impact of the rise in popularity of energy drinks has not yet been quantified, but the aggressive marketing of energy drinks targeted at young people, combined with limited and varied regulation have created an environment where energy drinks could pose a significant threat to public health.”

Global sales of energy drinks surged from £2.4bn in 1999 to £17.3bn in 2013, according to Euromonitor. Red Bull is the UK’s third bestselling soft drink. Although some coffees have comparable levels of caffeine, energy drinks can be drunk cold and therefore more quickly.

The WHO study, a review of the literature, said there was also a proliferation of new products containing “extreme” caffeine levels, far higher than mainstream brands. Energy drinks also include other ingredients such as guarana, taurine and B vitamins, which the WHO researchers say require further investigation, including into their interaction with caffeine.

The paper, which does not represent WHO policy, said there was growing evidence of harm due to consumption of energy drinks with alcohol. A European Food Safety Authority study found that over 70% of 18- to 29-year olds who drink energy drinks mix them with alcohol.

The study authors said research has shown this is more risky than drinking alcohol alone, possibly because energy drinks make it harder for people to notice when they are getting drunk even though there is no reduction in intoxication.

They said energy drinks had also been linked to dangers when combined with physical activity – despite often being marketed as boosting sports performance – and to obesity and dental cavities.

The authors did not quantify what cap should be imposed on caffeine levels but stated that it should be evidence based. Other recommendations included making health practitioners aware of the potential dangers of excess caffeine consumption, screening patients with a history of diet problems and substance abuse for heavy consumption of energy drinks, educating the public about the risks of mixing them with alcohol and better labelling.

In the UK, the Food Standards Agency requires high-caffeine energy drinks to be labelled as such and from December they must contain a warning stating: “Not recommended for children or pregnant or breastfeeding women.” A spokesman said: “The FSA advises that people who are sensitive to caffeine should only consume high caffeine drinks ... in moderation.” It is not planning further legislation at present.

Gavin Partington, director general of the British Soft Drinks Association(BSDA), said the review had failed to take into account the conclusions of other scientific articles, adding: “Several of the policy recommendations it makes are already well established through the BSDA’s voluntary code and EU regulation.” An industry code of practice restricts marketing energy drinks to children.

In May, Lithuania become the first EU state to pass legislation banning the sale of such drinks to minors.

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