Respiratory Health Association of Metropolitan Chicago News

Calls for cleaner air in Union Station

Tue, 07 Feb 2012 00:00 CST

From WBEZ:

Illinois U.S. Senator Dick Durbin is calling for better air quality in Chicago's Union Station. In 2010 the Chicago Tribune found high levels of diesel soot and air pollution on platforms and in train cars at Union Station.

Joel Africk with the Respiratory Health Association of Metropolitan Chicago said it's a serious problem.

"The diesel exhaust we're talking about contains 40 chemicals that have been proven to cause cancer. Diesel exhaust pollution causes asthma attacks, it causes heart attacks," Africk said.

Federal agencies along with Metra and Amtrak did their own study and instituted some changes in response. One result was Metra installing filters to each train car which it says reduces pollution inside cars by 75 percent on average.

But Durbin said the ventilation system in an adjacent building isn't working and is causing exhaust to back up in the station. Durbin sent a letter to the owners of the old Post Office on Monday asking them to fix their system. Amtrak filed a complaint in court last week asking the same.

At the press conference Monday, the company that owns the old Post Office delivered a written statement that said they're sending three of their extractor fans in for repairs this week.

When news of this new statement reached Durbin, he said, "I'm glad to see that they're here - welcome. And I didn't have to serve a subpoena to bring them."

Breastfeeding OK for moms with asthma

Mon, 06 Feb 2012 00:00 CST

From WebMD:

New moms with asthma can safely breastfeed without worrying that the practice will increase their child's asthma risk, a new study shows.

Researchers followed children in the United Kingdom from birth until around age 12 to assess the impact of breastfeeding, if any, on lung development.

They found that kids who were breastfed as babies had modestly better lung function than those who were not - and breastfeeding seemed to convey the most protection to children whose mothers had asthma.

The findings appear to contradict several earlier studies that raised concerns that breast milk may not always be best for babies born to mothers with the respiratory disease.

The new study was published online ahead of print in the American Journal of Respiratory and Critical Care Medicine.

"We found evidence for improvement in some aspects of lung function in children who were breastfed, which was strongest in those whose mothers had asthma," says researcher Claudia E. Kuehni, MD, of the University of Bern's Institute of Social and Preventive Medicine in Bern, Switzerland.

"This is reassuring for new mothers with asthma," she says. "Like other mothers, they should be encouraged to breastfeed."

Kuehni and colleagues analyzed data from almost 1,500 children born in the early to mid-1990s who were enrolled in a larger child development study.

Parents provided information on breastfeeding history when their children were 12 months old, and the children had a series of tests to assess lung function between the ages of 8 and 14.

Children who were breastfed for at least four months showed evidence of significantly better lung function by one measure.

Being breastfed as babies was associated with better scores on all the lung function measures among children whose mothers had asthma.

The evidence as a whole suggests that breastfeeding is beneficial for lung development, even when mom has asthma, says pediatrician Roya Samuels, MD, of Cohen Children's Medical Center in New Hyde Park, N.Y.

She says it is clear that babies who are breastfed tend to be healthier overall, with fewer ear infections, respiratory illnesses, and gastrointestinal problems.

"Moms with asthma can absolutely be reassured that breastfeeding will provide significant benefits for their children," she says.

She says the new study finds no support for the theory that new moms with poorly controlled asthma may expose their babies to hormones through their breast milk that cause inflammation and increase asthma risk.

"No research has been able to prove this theory or debunk it, until now," she says.

Commuters continue to breathe diesel exhaust at Chicago's Union Station

Mon, 06 Feb 2012 00:00 CST

From Chicago Tribune:

Thousands of commuters continue to breathe high levels of lung-damaging diesel exhaust at Chicago's Union Station, in part because of nagging maintenance problems at the Old Post Office that straddles the southbound tracks.

Testing by Amtrak has determined that ventilation fans at the shuttered post office building repeatedly malfunction. At times, the system of 11 ducts and fans has operated at just 53 percent of its design capacity, according to a letter to U.S. Sen. Dick Durbin from Joseph Boardman, Amtrak's president and chief executive.

On Monday, Durbin, Amtrak officials and local transit executives will threaten legal action to force Bill Davies, the British developer who bought the former post office building in 2009, to follow through on promises to fix the problem.

City officials already have cited Davies' International Property Developers with two violations of Chicago building codes related to the ventilation system.

"This owner's failure to remedy the situation shows a disregard for the air quality in the station area and for the people who use the station," Boardman wrote in a letter obtained by the Tribune.

Targeting Davies is the latest response to a 2010 Tribune investigation that revealed high levels of noxious diesel soot inside Metra passenger cars. The newspaper's testing and a follow-up study by Metra found the worst pollution problems are on trains leaving the south platform at Union Station.

For most people, exposure to diesel pollution occurs during their daily commutes. The exhaust is a complex mix of toxic substances such as benzene, arsenic and formaldehyde, many of which can cause cancer. It also is filled with tiny particles, commonly called soot, that can inflame the lungs, trigger asthma attacks and cause premature death.

Legal agreements require the owners of skyscrapers built above the Union Station tracks to maintain ventilation ducts and fans that suck diesel fumes out of cramped tunnels shared by Amtrak and Metra trains. But commuters and employee unions have complained for years about thick blue clouds of locomotive exhaust that linger above the tracks.

Davies, a Liverpool-based developer who last year proposed turning the post office building into an office tower and shopping mall, is represented locally by Daley & George, the law firm of former Mayor Richard Daley's brother Michael.

In an email response to questions Sunday, Martin Mulryan, Davies' project manager, said the firm is "committed to improving the ventilation and maintenance systems, with the goal of making the building a model for environmental standards."

Amtrak, Metra and city officials have singled out the building as a significant hurdle in their efforts to improve air quality for train passengers.

In response to the Tribune investigation, Metra upgraded air filters on each of its passenger cars to reduce diesel pollution. The rail service also switched to cleaner fuel to curb the amount of soot emitted by its locomotives.

With help from Durbin, Metra obtained federal funds to install equipment on some of its locomotives that automatically shuts down the engines if they idle longer than 10 minutes. It also is rebuilding two of its aging locomotives to substantially reduce harmful emissions.

Vaccines aren't just for kids (but too few U.S. adults are getting immunized)

Mon, 06 Feb 2012 00:00 CST

Shots are never fun no matter what your age, but according to a report by the Centers for Disease Control and Prevention (CDC), adults may dread them (almost) as much as children. Each year, 45,000 Americans die from vaccine-preventable diseases. Despite that, U.S. adults are not getting the immunizations they need.

According to the report published in the Feb. 3 issue of the CDC?s Morbidity and Mortality Weekly Report, three vaccines - tetanus, diphtheria and acellus pertussis, or Tdap; human papillomavirus (HPV) vaccine and a vaccine for shingles - showed small increases among adults in 2010. The rate of coverage climbed from 1.6% to 8.2%.

"There were some modest increases in coverage but for very few vaccines," Dr. Carolyn B. Bridges, associate director of adult immunization at the CDC and co-author of the report, told HealthDay. "Coverage is much lower than we would like to see it."

Some other vaccines also improved their rates slightly: the number of young women who got at least one dose of the human papillomavirus (HPV) vaccine, which guards against 70% of cervical cancers, grew more than 3.5%, to 20.7%. And 16.6% of whites aged 60 and older received a shingles vaccine, up more than 5%.

But other adult vaccine coverage showed virtually the same numbers as the CDC?s 2009 estimates: hepatitis A hovered at 10.7% and hepatitis B at 42%. Similar results were found for pneumonia vaccines.

Why are adults not protecting themselves? Bridges cites a simple lack of information and irregular visits to the doctor. Adult vaccine schedules are also trickier than children's.

"They are not just based on age, like most of the pediatric vaccines," Bridges told HealthDay. "Adult vaccines are recommended only for a certain age or if you have a high-risk medical condition or certain occupation or travel. So it's a little bit complicated."

Adults should also be aware of what vaccines they may have missed as children. According to Bridges, some adults may not have had vaccines for measles, mumps and rubella and should be vaccinated now.

To improve these low vaccination rates, the CDC recommends improved education, better access to vaccines, physician reminders and recall systems.

Rapid infant growth linked to asthma in study

Mon, 30 Jan 2012 00:00 CST

By HealthDay:

Rapid growth during the first three months of life is associated with an increased risk of asthma symptoms in preschool children, a new study indicates.

The findings suggest that early infancy might be a critical period for the development of asthma, said the researchers at Erasmus Medical Center in the Netherlands.

They examined data collected from 5,125 children who were followed from the fetal stage until they were 4 years old.

The researchers found no link between fetal growth and asthma symptoms. But in children with normal fetal growth, accelerated weight gain from birth to 3 months of age was associated with increased risk of asthma symptoms, such as wheezing, shortness of breath, dry cough and persistent phlegm.

The study appears online ahead of print in the American Journal of Respiratory and Critical Care Medicine.

Previous research has shown an association between low birth weight and increased risk of asthma symptoms in children. This is the first study to examine specific fetal and infant growth patterns on asthma risk.

"Our results suggest that the relationship between infant weight gain and asthma symptoms is not due to the accelerated growth of fetal growth-restricted infants only," researcher Dr. Liesbeth Duijts said in a journal news release. "While the mechanisms underlying this relationship are unclear, accelerated weight growth in early life might adversely affect lung growth and might be associated with adverse changes in the immune system."

She added: "Further research is needed to replicate our findings and explore the mechanisms that contribute to the effects of growth acceleration in infancy on respiratory health. The effects of infant growth patterns on asthma phenotypes [observable characteristics] in later life should also be examined."

UVa researcher finds common asthma treatment unbeneficial

Mon, 30 Jan 2012 00:00 CST

By The Daily Progress:

A new study led by a University of Virginia researcher has found that a common asthma treatment didn't benefit children and actually put them at greater risk for colds, sore throats and bronchitis.

"It's a treatment that's been used for years in children with asthma, and adults, and it was based on an unproven belief that acid reflux had an important contribution for asthma control, the idea that people with reflux would cough and wheeze due to reflex as much as due to asthma," said UVa's Dr. Gerald Teague, the study's senior investigator.

The treatment was widely used for both adult and pediatric patients, Teague said.

("Treating acid reflux may help ease symptoms caused by either condition," reads a question-and-answer piece written by a medical doctor on the Mayo Clinic's website.)

The pediatric study was a follow-up on a very similar, but not identical, study in adults, he said. The adult study found no benefit to the treatment, while the pediatric study found no benefit, plus the increased risk of some maladies. Even those children with acid reflux saw similar results.

For the pediatric study, patients with poorly controlled asthma from about 15 different study sites were divided into two groups. One group had Prevacid added to inhaled asthma treatments, while the other got a placebo.

They were studied for six months, and the degree to which their asthma came under control was noted.

"We really don't understand the relationship between reflux and asthma like we thought we did," Teague said.

Teague said the use of a treatment against one disease to indirectly fight another is a common tactic in modern medicine.

"It is common in medicine, because, you know, diseases are often interrelated," Teague said.

The results were published last week in the Journal of the American Medical Association, according to a UVa news release.

Researchers weren't able to find a really good study to show them how common the reflux-treatment-to-combat-asthma strategy is, but Teague said it's highly prevalent.

"This drug is huge," he said.

He said he hopes the study will change the way doctors treat children.

Teague is now studying why severe asthma affects different parts of the lungs differently.

Comparison of the US and Australian cystic fibrosis registries

Mon, 30 Jan 2012 00:00 CST

Abstract

BACKGROUND AND OBJECTIVES: National data registries for cystic fibrosis (CF) enable comparison of health statistics between countries. We examined the US and Australian CF data registries to compare demographics, clinical practice and outcome measures.

METHODS: We compared the 2003 US and Australian registries. Differences in pulmonary and growth outcomes were assessed by creating models controlling for differences in age, gender, genotype, and diagnosis after newborn screening.

RESULTS: Data on 12 994 US and 1220 Australian patients aged ≤18 years were analyzed. A significant difference was noted in the proportion who had been diagnosed after newborn screening (Australian 65.8% vs United States 7.2%; P < .001). Australian children had significantly greater mean height percentile (41.0 vs 32.6; P < .001) and weight percentile (43.5 vs 36.1; P = .028) than US children. Mean forced expiratory volume in 1 second (FEV1) percent predicted adjusted for age, gender, and genotype was similar in the 2 countries (P = .80). Patients diagnosed after newborn screening had higher mean FEV1 (5.3 [95% confidence interval (CI): 3.6?7.0]) percent predicted and BMI (0.26 [95% CI: 0.09?0.43]). Mean FEV1 of Australian patients diagnosed after newborn screening was lower by 5.2 (95% CI: 2.8?7.6) percent predicted compared with US children.

CONCLUSIONS: Children diagnosed with CF after newborn screening benefited from better lung function and BMI than those diagnosed clinically. The benefit of newborn screening on lung function was significantly less in Australian children compared with US children. Statistical comparisons between CF registries are feasible and can contribute to benchmarking and improvements in care.

Analysis of quality indicators for children in the emergency dept. for asthma

Mon, 30 Jan 2012 00:00 CST

Abstract

OBJECTIVE: To test the hypothesis that an association exists between process and outcome measures of the quality of acute asthma care provided to children in the emergency department.

METHODS: Investigators at 14 US sites prospectively enrolled consecutive children 2 to 17 years of age presenting to the emergency department with acute asthma. In models adjusted for variables commonly associated with the quality of acute asthma care, we measured the association between 7 measures of concordance with national asthma guideline-recommended processes and 2 outcomes. Specifically, we modeled the association between 5 receipt/nonreceipt process measures and successful discharge and the association between 2 timeliness measures and admission.

RESULTS: In this cohort of 1426 patients, 62% were discharged without relapse or ongoing symptoms (successful discharge), 15% were discharged with relapse or ongoing symptoms, and 24% were admitted. The composite score for receipt of all 5 receipt/nonreceipt process measures was 84%, and for timeliness measures, 57% receive a timely corticosteroid and 92% a timely β-agonist. Our adjusted models showed no association between process and outcome measures, with 1 exception: timely β-agonist administration was associated with admission, likely reflecting confounding by severity rather than a true process-outcome association.

CONCLUSIONS: We found no clinically significant association between process and outcome quality measures in the delivery of asthma-related care to children in a multicenter study. Although the quality of emergency department care does not predict successful discharge, other factors, such as outpatient care, may better predict outcomes.

Maternal asthma medication use and the risk of selected birth defects

Mon, 30 Jan 2012 00:00 CST

Abstract

OBJECTIVES: Approximately 4% to 12% of pregnant women have asthma; few studies have examined the effects of maternal asthma medication use on birth defects. We examined whether maternal asthma medication use during early pregnancy increased the risk of selected birth defects.

METHODS: National Birth Defects Prevention Study data for 2853 infants with 1 or more selected birth defects (diaphragmatic hernia, esophageal atresia, small intestinal atresia, anorectal atresia, neural tube defects, omphalocele, or limb deficiencies) and 6726 unaffected control infants delivered from October 1997 through December 2005 were analyzed. Mothers of cases and controls provided telephone interviews of medication use and additional potential risk factors. Exposure was defined as maternal periconceptional (1 month prior through the third month of pregnancy) asthma medication use (bronchodilator or anti-inflammatory). Associations between maternal periconceptional asthma medication use and individual major birth defects were estimated by using adjusted odds ratios (aOR) and 95% confidence intervals (95%CI).

RESULTS: No statistically significant associations were observed for maternal periconceptional asthma medication use and most defects studied; however, positive associations were observed between maternal asthma medication use and isolated esophageal atresia (bronchodilator use: aOR = 2.39, 95%CI = 1.23, 4.66), isolated anorectal atresia (anti-inflammatory use: aOR = 2.12, 95%CI = 1.09, 4.12), and omphalocele (bronchodilator and anti-inflammatory use: aOR = 4.13, 95%CI = 1.43, 11.95).

CONCLUSIONS: Positive associations were observed for anorectal atresia, esophageal atresia, and omphalocele and maternal periconceptional asthma medication use, but not for other defects studied. It is possible that observed associations may be chance findings or may be a result of maternal asthma severity and related hypoxia rather than medication use.

New lung cancer test predicts survival

Mon, 30 Jan 2012 00:00 CST

From AFP:

Clinical trials in the United States and China have shown that a new gene-based test for patients with lung cancer beats standard methods in predicting survival, researchers reported Friday.

The findings, published in the British medical journal The Lancet, should help doctors to make more accurate prognoses and better choices for treatment, the scientists said.

Lung cancer is the most lethal type of the disease worldwide, claiming some 1.4 million lives -- more than breast, colon and prostate cancers combined -- each year.

The experimental test measures the activity of fourteen genes within cancerous tissue, and is especially effective is assessing a form called non-squamous non-small cell cancer, commonly brought on by tobacco use.

"This has the potential to help hundreds of thousands of people every year to survive longer," said David Jablons, the main architect of the study and a professor at the University of California in San Francisco (UCSF).

Currently, doctors classify early-stage lung cancers by their size, location and microscopic profile.

Known as staging, this type of assessment guides decisions on the use of supplementary treatment -- including chemotherapy -- after cancerous tissue is removed.

A more precise prognosis would mean "more people who might benefit from additional therapy could receive it after surgery, before any residual cancer has had a chance to grow," Jablons explained in a statement.

Previous research has shown that chemotherapy given in early-stage lung cancer helps thwart recurrence when there is evidence of lymph node involvement.

The problem, however, is that this especially insidious form of the disease is hard to spot early on.

Only some 30 percent of patients in the United States, for example, are detected in the earliest stage, and even then survival is far from guaranteed -- 35 to 45 percent of patients identified with Stage One lung cancer die within five years.

"The prognostic test would address the inability to identify these patients," Jablons said.

In the US trial, the new testing method -- designed at UCSF and developed by the California-based company Pinpoint Genomics -- used an algorithm to calculate the risk of death after examining the tissue of 361 patients at the UCSF Medical Center as low, medium or high.

All of these patients had had surgery to treat non-squamous, non-cell lung cancer.

The algorithm was then applied to 433 other patients with the earliest stage of the same type of cancer, and their survival rate was monitored over five years.

The method accurately identified patients with high, intermediate and low risks of death, the researchers said.

A similar study in China, conducted by the China Clinical Trials Consortium, confirmed the results.

A disclosure notice in The Lancet notes that Jablons and several of the co-authors have paid consultant relationships with Pinpoint Genomics.