LifeCare Chiropractic

The Best Chiropractic Care in Mesa, Arizona

Asthma

Anti-leukotrienes as add-on therapy to inhaled glucocorticoids in asthma – (07-08-02)

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Anti-leukotrienes as add-on therapy to inhaled glucocorticoids in asthma

Can’t help but see those smiling adds for Singulair on TV, can you? Geez, with all that money going into advertising, this drug must surely have been proven in clinical trials, right? The correct answer would be NO. I don’t remember seeing that mentioned in the commercials, though. This meta analysis shows a lack of efficacy in this treatment. Funny how strong the double standard is in medicine…

bmj.com Abstracts: Ducharme 324 (7353): 1545

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No Association between Antibiotics in 1st Year of Life – (08-22-02)

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No Association between Antibiotics in 1st Year of Life and Asthma, Allergic Rhinitis, or Eczema at Age 5 Years

I have included this report just to show how fair and unbiased I am in my research. Okay, so I’m actually just including it to better set up the next article…

AJRCCM — Abstracts: Celedón et al. 166 (1): 72

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Adrenocortical Suppression in Asthmatic Children on Inhaled Steroid – (11-01-01)

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Adrenocortical Suppression in Asthmatic Children on Inhaled Steroid

This study used serum DHEA-S levels as a marker to determine that the adrenal glands are suppressed by inhaled steroid use. First of all, I prefer to use salivary levels–much easier to obtain and it measures the physiologically active form of the hormones. Next, this article should raise some major alarms in anyone concerned about what we’re doing to out children. Adrenal suppression in children can have major deleterious effects as that child develops. And remember–these were with INHALED steroids…

JCEM — Abstracts: Kannisto et al. 86 (10): 4908

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7 Ways Drops for Allergies Shine Again: Asthma

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This is not the first time I’ve written about the wonders of drops for allergies for different conditions. But drops for asthma…this is new…

A large chunk of the population deals with the discomfort and limitations of allergies and asthma here in the US.  This allergy season seems to have hit patients particularly hard.  Worse, rarely do I see that commonly used medications like Advair, Allegra and Zyrtec do more than make life a little easier.  Resolution or complete control is not the norm.

While the medications to treat allergies and asthma may be slightly different, I have always lumped them together because the immune system imbalance is the same (Th2 dominance, in case you’re curious).  This also means that the early-life risk factors are similar, such as:

  • Antibiotic use
  • C-section birth
  • Formula feeding instead of breastfeeding
  • Immunizations

When asked what organ plays a critical role in allergies and asthma, few would answer that it is the gut that drives these types of problems.

Why the gut?  Because 2/3 of the immune system is centered around the gut; so designed because the vast majority of foreign material that you are exposed to comes from the stuff you shove in your mouth.

So what if the stuff you were putting into your mouth was very carefully crafted to trick the immune system around your gut into behaving the way it is supposed to?  Sounds pretty cool, right? That is the goal of sublingual immunotherapy, otherwise known as drops for allergies.

This approach to allergies here in the United States, however, lags far behind Europe.  Here in the states, these drops are off-label use because the FDA has not approved its use.  But certainly not for lack of research, as we can see from this particular review.

Researchers looked at the data on drops for allergies and asthma across 63 studies with over 5100 participants total.  What did they find?

  1. Strong evidence supports that sublingual immunotherapy improves asthma symptoms, with 8/13 studies showing 40% improvement.
  2. Moderate evidence supports that drops for allergies decrease rhinitis or rhinoconjunctivitis symptoms, with 9/36 studies showing greater than 40% improvement.
  3. Medication use for asthma and allergies decreased by more than 40% in 16/41 studies.
  4. Moderate evidence found the drops improve conjunctivitis symptoms (13 studies).
  5. Evidence found that drops improved the combined symptom and medication scores (20 studies).
  6. Evidence found that disease-specific quality of life was improved (8 studies).
  7. Local reactions were frequent, but severe allergic reactions were not reported.

Overall, I would have to say that the FDA is WAY behind Europe on this one. Sadly, many allergists dismiss drops for allergies as not having any research to support its use.  You have to be avoiding an awful lot of medical literature to not notice 63 studies IN YOUR FIELD that deal with this approach.

Maybe it’s time to find a new allergist (luckily for those of you in our clinic’s area, we offer drops for allergies).

Glaxo Stops Study of Asthma Drug – (02-03-03)

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Glaxo Stops Study of Asthma Drug

A few important things here. First, this drug was already approved–meaning it was already on the market and this was just a larger follow up study. This study was stopped because it may be associated with an increased risk of life-threatening asthma episodes or asthma-related deaths. HUH?? An asthma drug study is stopped because of side effects of worsening asthma?? Does the word “guinea pig” ring a bell here?

Read entire article here

Jan. 24, 2003 — The U.S. Food and Drug Administration (FDA) yesterday announced that an interim analysis of a large safety study of the approved asthma drug salmeterol xinafoate (Serevent Inhalation Aerosol) suggests that the drug may be associated with an increased risk of life-threatening asthma episodes or asthma-related deaths, particularly in some patients. At the same time, the drug’s manufacturer, GlaxoSmithKline, notified investigators that it is stopping this study, mostly due to difficulties in enrollment and the likelihood the study would not give a clear result, even if fully enrolled.The interim analysis did not show a statistically significant result for the primary endpoint — a combination of respiratory-related deaths or intubations (or ventilatory failure). There was a trend, however, toward increases in asthma deaths and serious asthma episodes when all patients in the study were considered, though again this did not reach statistical significance. A further analysis of the data from the study suggested that the risk might be greater in African-American patients, who made up 17% of the study population. Further analyses showed that patients not taking inhaled corticosteroids at study entry appeared to have greater risk for serious outcomes than those who were taking inhaled corticosteroids.”We don’t know why there was this pattern, and would like to do further studies,” Laura Bradbard, a spokesperson for the FDA, told Medscape. “Is it a socioeconomic reason? Is there a problem getting to the doctor often enough? Is the doctor following the guidelines? Or is there a physiological reason why African-Americans have more asthma? It does seem that population suffers from more asthma, and it tends to be more severe. Is it because it’s not being treated, or because it’s being treated too late? There are too many questions. That’s why we need more studies.”The halted study was designed to further investigate the safety of Serevent, particularly whether it might rarely cause serious asthma-related adverse events. It was begun in 1996, after the FDA received postmarketing reports of several asthma deaths associated with the use of salmeterol and after publication of studies raising concern about the regular use of short-acting and long-acting beta agonists, including salmeterol. Because asthma patients can sometimes suffer sudden, serious life-threatening episodes of bronchospasm as a consequence of their disease, the deaths and serious adverse events reported for salmeterol could neither be clearly attributed to use of this product, nor could it be excluded as a cause. This study was undertaken to try to help provide better information on the safety of this product. The Glaxo Data Safety Monitoring Board overseeing this trial conducted the interim data analyses that led to today’s action. Approximately 26,000 subjects, representing more than 4.3 million patient-days of exposure to the drug, had participated in the study. The study was intended to enroll 60,000 patients.The FDA approved Serevent Inhalation Aerosol in 1994 to treat asthma, and later this approval was extended to use for treatment of chronic obstructive pulmonary disease (COPD). The FDA plans to meet with Glaxo soon to obtain more details about the data from the interim analyses of the study and to determine what steps are warranted to address this information, according to a talk paper posted on the FDA’s Web site. The FDA is particularly interested in further evaluating the question of whether certain patients may be at a greater risk for rare, but potentially serious adverse events due to Serevent use and use of other related drugs.Despite the study stoppage, the FDA emphasizes in the talk paper that based on available data, the benefits of salmeterol for the asthma population continue to outweigh the risks and that the serious adverse events reported in the trial were rare. Patients are strongly advised that they should not stop taking salmeterol, or any other medication, for asthma or COPD, without first talking to their physicians, because abruptly stopping drugs for the treatment of asthma and COPD can result in serious exacerbations of these diseases that could be life-threatening.

 

Rapid Allergy Shots in One Office Visit May Be Safe for Children – (12-05-02)

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Rapid Allergy Shots in One Office Visit May Be Safe for Children

Have we lost all sense of reason and common sense???? This report from the American College of Allergy, Asthma and Immunology suggests that it is safe to give multiple doses of certain allergy shots in one day to obtain the desired immunological response. As if this alone shouldn’t raise an eyebrow (I’m sure every 5 year old would jump at the chance for two sets of shots in one day) the authors suggest pre-treatment for two days with prednisolone and antihistamines. Huh? At one point do we take a step back and decide that we are over-medicating our children?

60th Annual Meeting of the American College of Allergy, Asthma and Immunology.

Accelerated schedules of allergy shots may present little risk of systemic reactions, suggest findings presented here Tuesday at the meeting of the American College of Allergy, Asthma & Immunology.Immunization levels that usually require 6 months to achieve can be obtained through rapid immunization within a single 2.5-hour visit, said investigator Dr. William Smits. Rapid immunization is also “more user-friendly for the office-based practice.””We have to show our non-allergist colleagues that this works,” Dr. Smits said.Others have reported more adverse events with accelerated schedules of allergy shots, he added. But Dr. Smits and colleagues’ retrospective analysis of 37 children treated for allergic rhinitis at their private clinic, in Fort Wayne, Indiana, yielded no instances of systemic reaction.Children between 3 and 15 years were included. Two thirds had asthma, and those with an FEV1 of less than 70% were not considered eligible. There was no control group.All were pretreated with prednisolone and an antihistamine for 2 days prior to the day of accelerated injections.Localized reactions to shots affected two patients (5%) within 3 months, but these patients resumed a conventional regular vaccination schedule following the reactions. Three patients (8.1%) complained of localized reactions on the day of injection that were mild and did not require treatment.”Our interest is to make this a safe procedure,” Dr. Smits said. “I predict in 5 years all allergists will be doing this.”Dr. Smits noted that better compliance should result with the rapid schedule, as patients start to feel better faster, within 1 month or 2.At 3 months, 92% of patients were compliant, as were 75% after 1 year, Dr. Smits said, “which is an improvement over our [usual] rate of 60%, and the published rates.

 

Should Natural Remedies for Asthma Include Chiropractic Care?

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I am not the first one to jump on the idea that chiropractic care can fix everything (although, I could put forth a good argument that a chiropractor well versed in lifestyle changes is the most powerful player on your provider team).  However, over the years there has been a surprising amount of research as it relates to the affect of manipulation on respiratory conditions such as asthma.

Or maybe it shouldn’t be so surprising.  The ribs, after all, do articulate with the spine.  If the joints of the thoracic spine are dysfunctional and not moving optimally, then you can guess that the rib joints that meet up with the thoracic spine are going to have issues as well.

Ribs not moving well leads to reduced movement of the chest cavity, which THEN could lead to a lower respiratory volume.  You can see where this all leads.

Yes, it leads to this particular study, which reviewed 8 different studies that have been done in the past on the affect of manual therapies on respiratory disease in children.  Of these, 6 studies showed some type of a benefit.  Not too shabby.

I remember a patient some years back who had such bad asthma that he would cough any time I adjusted his thoracic spine.  It would take several goes, with some water drinking in between.  He had been “managed” by his pulmonologist for many years.  But never once did the subject of this patient drinking several cans of Mountain Dew per day ever come up.

After I explained to him how bad this was for his lungs, he stopped cold turkey.  Just a few short weeks later you would have no idea there was anything wrong with him. No more coughing during his thoracic adjustments.

Based on this, it would make sense for every pediatrician to recommend at least a trial of chiropractic care for any children with respiratory problems.  And, if that chiropractor is well versed enough in lifestyle changes to recommend vitamin D, fish oils and avoidance of trans fats and refined carbohydrates, life is going to be good.

Based on this, do you think every child with respiratory problems should see a chiropractor for a short course of treatment to see if it helps?

 

Asthma prevalence in schoolchildren – (06-09-03)

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Asthma prevalence in schoolchildren: associations with indoor pools

One thing I always remember about vacations as a child was the smell of chlorine that meant that the hotel had an indoor pool. How was I supposed to know that I was endangering my health playing in those pools? Sometimes I look back and can’t quite figured out how we survived out childhoods..Occup

Environ Med — Abstracts: Bernard et al. 60 (6): 385

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