By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at www.dcp.ca
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
Last time we discussed the timeing and the causes of the September Asthma Epidemic. Two bright researchers from Hamilton, Ontario, Malcom Sears and Neil Johston described how in many countries around the world, including Canada had an increase in the number of children hospitalized with asthma problems 2-3 weeks after the beginning of the new school year. We talked about how it was probably due to rhinoviruses and return to school stress. Rhinovirus infections increase in September. Suddenly cramming kids onto school buses and classrooms is a great way to spread these infections. But if it was just rhinovirus the timing of the hospitalization shouldn’t be as consistent as it has been from 1990 through 2004. So the researchers think that back to school stress may add to the problem. The last piece of the puzzle might be asthma medication usage.
When the researchers look in the Ottawa area, there were fewer fills of children’s asthma medications during the summer months. So the use of asthma controller medication may be at its lowest point just before school starts. Why does this matter? Let’s look at the two broad types of asthma medications.
Asthma medications are broadly classified as relievers or controllers. Relievers are medications like ventolin or salbutamol. These medications rapidly open airways when a patient has asthma symptoms. They work well during an asthma attack, but they don’t reduce inflammation in the lungs, so they don’t prevent future attacks. Controller medications have names like flovent, singulair, and pulmicort. These medications don’t work quickly enough to help someone if they are having an attack now. However, if controller medications are taken every day (even if the asthmatic is feeling well), they reduce inflammation in the lungs and prevent future attacks. So, if patients aren’t taking their controller medications over the summer, their lungs are going to be inflammed. So they will be primed and ready to have a full fledge, hospital-requiring asthma problem in September when they encounter the rhinoviruses and school stress.
So can we prevent the September Asthma Epidemic? Let’s look at the proposed causes: rhinovirus, school stress, and lack of controller medication at the beginning of school. Can we reduce rhinovirus exposure? There is no practical way to put all the kids in bubbles or filter the air on school buses. There might be a rhinovirus vaccine some time in the future. However, short of developing a vaccine, we can’t control rhinovirus. Can we get rid of school stress? Maybe brighter people than I can figure out how to teach children to handle the stress better, but I see no practical way. Also, as much as my daughter Emily might like it, we can’t banish school all together. Can we convince asthmatics to take their medications regularily? Asthmatic patient should keep taking controller medications in August to keep the inflammation down in September. The problem is that we have been telling patient that forever, and obviously in the years 1990 through 2004 (the years the researcher looked at in Canada), patient’s weren’t listening. So the researchers looked at another option. What if everyone took singulair for 6 weeks starting at the beginning of September?
The researchers ran an experiment. From September 1 to October 15, 2005 194 children aged 2 to 14 years took part in a randomized, placebo controlled trial with singulair (aka montelukast). They took the singulair in addition to whatever asthma medication they were regularily on. Guess what? The children who took the singulair had fewer days with worse asthma symptoms and fewer unscheduled doctor visits than those on the sugar pill! It didn’t matter if the children were regularily on other controller medications or not. It didn’t matter if the children had colds during the test period or not. Singulair seemed to help everyone in the first six weeks of school.
So should every school-aged asthmatic child go on Singulair from September 1st to October 15th every year? I’m not quite ready to say that yet. However, it is an intriguing option for my parents to consider. Do you buy less asthma medication over the summer? Does you child go on a drug-holiday in August? Have you every taken your asthmatic child to the emergency room in the third week of school? If you answered yes, ask you pharmacist which is your child’s controller medication. Talk to your doctor or pharmacist about having you child use his/her controller medication regularily in the summer. Ask your doctor if your child is a good candidate for being on Singulair for the first six week of school.
As always if you have any questions or concerns about these products, ask your pharmacist.
Friday, September 26, 2008
Friday, September 19, 2008
The September Asthma Epidemic? Part 1 of 2
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at http://www.dcp.ca/
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
Every few years someone tells us pharmacists that a drug is so good, it should go into the water supply. When I graduated from pharmacy school, it was prozac. We were told that prozac was such a good antidepressant that if it was put in the water supply, not only would we cure depressed patients, the rest of us would be happier too. It was true that prozac was a lot better (and safer) than the existing antidepressants on the market at the time. However, it wasn’t for everyone, and like all medications it did have side effects in some people. The next miracle drug was a type of blood pressure pill called ACE inhibitors. I remember being at a talk by a kidney specialist when he said that ACE inhibitors were so good they should be in the drinking water. Now don’t get me wrong, ACE inhibitors are very good. Aside from treating blood pressure, they help some aspects of diabetes, some types of heart problems and some kidney conditions. But, as good as ACE inhibitors are, they aren’t perfect either. So you can understand why I was skeptical when I heard a drug rep suggesting that all asthmatic children go on singulair. It turns out he wasn’t talking about all asthmatic children going on singulair (montelukast) all the time. He was talking about a study that showed maybe they should be on it during the first 6 weeks of school. The study said it would help treat the “September Asthma Epidemic”.
So what is this “September Asthma Epidemic”? I was given a couple of medical articles when I asked. It seems that two bright researchers from Hamilton, Ontario, Malcom Sears and Neil Johston wrote “Understanding the September asthma epidemic” in the Journal of Allergy and Clinical Immunology in August 2007 and Neil Johnston and his team wrote “Attenuatin of the September Epidemic of Asthma Exacerbations in Children: A Randomized, Controlled Trial of Montelukact Added to Usual Therapy” in Pediatrics in September 2007. Long titles, but interesting reading. Don’t tell my six year old daughter, but the gist is that school makes kids sick.
The researchers first looked at health data from across Canada, and from around the world. They were specially looking at the number and timing of asthma related hospitalizations. The most childhood asthma hospitalizations happen in September every year. This happens in many Northern Hemisphere countries including the United States, Mexico, Israel, Finland, Trinidad, the United Kingdom and Canada. In Canada 20 to 25% of all childhood asthma hospitalizations happen in September.
It gets more interesting when you break down the numbers into age groups and apply it to a family, say mine. We’ll call me the adult (my wife would probably disagree), my daughter Emily is school aged (she’d six), and my son Eric is pre-school (he is three). Now give all of us asthma. Emily should be in the hospital first and have the worst asthma symptoms. Emily would go to the hospital September 19th. Eric (the pre-schooler) would have a less serious attack but would still end up in hospital September 21st. I would have an attack that wasn’t as serious as the kids but I should be admitted September 25th. It seems whatever causes this epidemic hits the school aged kids hardest and first. Then the school aged kids spread it to the pre-schoolers and the adults. (Again, don’t tell Emily she could literately be the cause of all my problems).
So what causes this increase in asthma in September? Well, it probably isn’t allergens or pollution in the air, or least not by themselves. Although amount of allergens in the air like pollens, does increase in the late summer/early fall, they should hit all asthmatics at the same time. School aged children shouldn’t have problems at a different time than adults. Viruses could be another possible culprit. Going back to school is a great time to get a virus. During the summer kids probably play with 3-4 other children at a time. Suddenly, they are in classrooms, school buses, etc with 30 or more other children. It doesn’t take long for that one sick kid to share his or her viruses. There is one virus that interested the researchers in particular. Rhinovirus infections have been associated with up to 80% of asthma attacks in school aged children. School aged children pass rhinovirus infections to their families 3 times more often than working adults do. Finally, rhinovirus infections do go up around September. When the researchers looked, they did seem to find more rhinovirus in the kids with asthma attacks in September. So rhinovirus is the culprit, right? Maybe the timing is too perfect.
The timing of the increase in hospital visits due to asthma is always 2 to 3 weeks after the start of school. The researchers looked at every September in Canada from 1990 to 2004. The peak number of hospitalizations was always at the same time. Rhinovirus infections go up in September, but the timing can easily change by a few weeks either way. There is another piece to the puzzle. That puzzle piece is school. As a bit of proof, the researchers checked other countries. In Canada and England most children go back to school the first week of September. In Scotland and Sweden, they go back in the third week of August. Large peaks in asthma hospitalization occur 2 to 3 weeks after the return to school in all four countries despite their different school start dates.
Next week we will look at why school is the missing link and what can be done about it.
As always if you have any questions or concerns about these products, ask your pharmacist.
We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at http://www.dcp.ca/
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
Every few years someone tells us pharmacists that a drug is so good, it should go into the water supply. When I graduated from pharmacy school, it was prozac. We were told that prozac was such a good antidepressant that if it was put in the water supply, not only would we cure depressed patients, the rest of us would be happier too. It was true that prozac was a lot better (and safer) than the existing antidepressants on the market at the time. However, it wasn’t for everyone, and like all medications it did have side effects in some people. The next miracle drug was a type of blood pressure pill called ACE inhibitors. I remember being at a talk by a kidney specialist when he said that ACE inhibitors were so good they should be in the drinking water. Now don’t get me wrong, ACE inhibitors are very good. Aside from treating blood pressure, they help some aspects of diabetes, some types of heart problems and some kidney conditions. But, as good as ACE inhibitors are, they aren’t perfect either. So you can understand why I was skeptical when I heard a drug rep suggesting that all asthmatic children go on singulair. It turns out he wasn’t talking about all asthmatic children going on singulair (montelukast) all the time. He was talking about a study that showed maybe they should be on it during the first 6 weeks of school. The study said it would help treat the “September Asthma Epidemic”.
So what is this “September Asthma Epidemic”? I was given a couple of medical articles when I asked. It seems that two bright researchers from Hamilton, Ontario, Malcom Sears and Neil Johston wrote “Understanding the September asthma epidemic” in the Journal of Allergy and Clinical Immunology in August 2007 and Neil Johnston and his team wrote “Attenuatin of the September Epidemic of Asthma Exacerbations in Children: A Randomized, Controlled Trial of Montelukact Added to Usual Therapy” in Pediatrics in September 2007. Long titles, but interesting reading. Don’t tell my six year old daughter, but the gist is that school makes kids sick.
The researchers first looked at health data from across Canada, and from around the world. They were specially looking at the number and timing of asthma related hospitalizations. The most childhood asthma hospitalizations happen in September every year. This happens in many Northern Hemisphere countries including the United States, Mexico, Israel, Finland, Trinidad, the United Kingdom and Canada. In Canada 20 to 25% of all childhood asthma hospitalizations happen in September.
It gets more interesting when you break down the numbers into age groups and apply it to a family, say mine. We’ll call me the adult (my wife would probably disagree), my daughter Emily is school aged (she’d six), and my son Eric is pre-school (he is three). Now give all of us asthma. Emily should be in the hospital first and have the worst asthma symptoms. Emily would go to the hospital September 19th. Eric (the pre-schooler) would have a less serious attack but would still end up in hospital September 21st. I would have an attack that wasn’t as serious as the kids but I should be admitted September 25th. It seems whatever causes this epidemic hits the school aged kids hardest and first. Then the school aged kids spread it to the pre-schoolers and the adults. (Again, don’t tell Emily she could literately be the cause of all my problems).
So what causes this increase in asthma in September? Well, it probably isn’t allergens or pollution in the air, or least not by themselves. Although amount of allergens in the air like pollens, does increase in the late summer/early fall, they should hit all asthmatics at the same time. School aged children shouldn’t have problems at a different time than adults. Viruses could be another possible culprit. Going back to school is a great time to get a virus. During the summer kids probably play with 3-4 other children at a time. Suddenly, they are in classrooms, school buses, etc with 30 or more other children. It doesn’t take long for that one sick kid to share his or her viruses. There is one virus that interested the researchers in particular. Rhinovirus infections have been associated with up to 80% of asthma attacks in school aged children. School aged children pass rhinovirus infections to their families 3 times more often than working adults do. Finally, rhinovirus infections do go up around September. When the researchers looked, they did seem to find more rhinovirus in the kids with asthma attacks in September. So rhinovirus is the culprit, right? Maybe the timing is too perfect.
The timing of the increase in hospital visits due to asthma is always 2 to 3 weeks after the start of school. The researchers looked at every September in Canada from 1990 to 2004. The peak number of hospitalizations was always at the same time. Rhinovirus infections go up in September, but the timing can easily change by a few weeks either way. There is another piece to the puzzle. That puzzle piece is school. As a bit of proof, the researchers checked other countries. In Canada and England most children go back to school the first week of September. In Scotland and Sweden, they go back in the third week of August. Large peaks in asthma hospitalization occur 2 to 3 weeks after the return to school in all four countries despite their different school start dates.
Next week we will look at why school is the missing link and what can be done about it.
As always if you have any questions or concerns about these products, ask your pharmacist.
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