Jul
01
2004

New Asthma Drug Works Slowly But Surely

By | Asthma, Lung Disease

Patients with severe asthma will have a new treatment option. A new medication under the name omalizumab has been studied in clinical trials by Dr. Jean Bousquet of Arnaud de Villeneuve Hospital in Montpellier, France.

In the study it was also determined which patients would benefit most of the new drug. The results are very encouraging: those patients who had the least success with other asthma medications had the best response. However, it is not an instant response. 67 % of the patients showed a good response after 4 weeks of treatment. 87 % of patients showed a response only after having been on the medication for 12 weeks. As a result of this trial it was determined, that patients with asthma should be treated with omalizumab for at least 12 weeks. FDA approval for difficult to manage cases of allergic asthma came in June of 2003 (trade name Xolair, manufacturer: Genentech, Inc). On the other hand, patience is also of essence: if the medication is only administered for a month, a lot of patients with difficult to treat asthma will miss out on the beneficial effects, as opposed to those who persist and reap significant improvement after 12 weeks. One of the downsides of the medicine is the possibility of anaphylactic reactions.

Reference: National Review of Medicine, May 15, 2004, pg. 27

New Asthma Drug Works Slowly But Surely

New Asthma Drug Works Slowly But Surely

More information about asthma: http://nethealthbook.com/lung-disease/asthma-introduction/

Here is a NEJM article (case study involving omalizumab)

Last edited Oct. 26, 2014

Jul
01
2004

Flu Shots For Young Children And Pregnant Moms

By | Asthma, Diabetes, Infectious Disease, Lung Disease

It may be summer, but next winter will be there and along with it the threat of flus.
Flu shots are offered in fall, and especially people with health problems (like asthma or diabetes, just to name a few) and seniors have been the primary target groups for public vaccination programs. U.S. health authorities now have also added young children under 2 to the program.

This step has been taken, as babies and young children are at a substantially increased risk for influenza-related hospitalizations.
The U.S. Centers for Disease Control has just release a new recommendation, that all women who are pregnant during the influenza season should get flu shots. Pregnant women who contract influenza frequently have an increased rate of complications, including pneumonia, tachycardia (rapid heart beat), and contractions.
Even though most pregnant women are young and healthy, their hospital admission rate during the flu season is similar to what you see in the elderly.
Statistics show that generally only 12% of women with uncomplicated pregnancies get vaccinated. With the threat of a severe strain of influenza A, which showed its aggressive and widespread activity last winter, it can be expected that there will be an increased demand for flu shots this year.

Flu Shots For Young Children And Pregnant Moms

Flu Shots For Young Children And Pregnant Moms

References: The Medical Post, May 18, 2004, pg. 8 and 9

Last edited December 8, 2012

Feb
01
2004

Worldwide Alert For Avian Influenza (Bird Flu)

By | Infectious Disease, Lung Disease

There is a new strain of avian influenza that in the beginning was confined to transmission among birds only. However, with 8 deaths in humans reported in Asia by the end of January 2004 (7 children and one adult) there is a fear that the virus is possibly genetically adapting towards transmission between humans, which could cause a worldwide flu epidemic similar to the flu in 1918 where more than 40 million people died.

Presently the avian flu has killed a high percentage of chickens and ducks in Vietnam, China, Thailand, Indonesia, Pakistan, Cambodia, and Laos. Recently Japan, South Korea, and Taiwan have also been added to the countries where the avian flu has arrived in birds. The governments are busy killing chickens off by the millions in an attempt to stop transmission to man.

All of the human cases were found in people who lived close to chicken farms or who handled diseased chickens.
The virus strain has been characterized as the type A, H5N1 strain (= the H5N1 flu), of the avian influenza. This strain has surfaced in the past on two occasions. First, it hit 18 persons in Hong Kong in 1997 of which 8 persons died. With the help of strict isolation methods an epidemic was prevented. Secondly, in March of 2003 a father and son from Hong Kong had traveled to southern China and they returned sick with the flu. The father died, the son recovered. Disease investigation showed that the source of infection in all of these cases was contact with diseased birds or with live, infected poultry in open markets.

Worldwide Alert For Avian Influenza (Bird Flu)

Worldwide Alert For Avian Influenza (Bird Flu)

Unfortunately the present flu vaccines will not give protection against this strain. WHO officials had an emergency meeting at the end of January 2004 to discuss the strategy for preventing a worldwide epidemic with
this new influenza strain. Production of a new vaccine will take several months (up to 6 to 8 months), if it is done in the conventional way. The cheaper antiviral antibiotics such as amantadine and rimantadine that normally would cover an A type influenza are ineffective against this new flu strain. There are newer antiviral antibiotics, which are effective, but they are more expensive. With mass production they could become more affordable and this could interfere with the spread between humans, if the virus should adapt to this transmission behavior.

At the present time migratory birds that are infected with the flu virus are spreading the avian flu to birds in other neighboring countries. In the meantime farmers who are not satisfied with only a 10% reimbursement by their governments for forcefully killed chickens are selling chickens on open meat markets, some of which harbor the avian flu, and this is another possible mode of transmission. David A. Halvorson, a veterinary medicine doctor from the University of Minnesota in Saint Paul stated that the risk for avian flu in the US at the present time is low as the US is not importing any live poultry from Asia.

In an interview between Doug Kaufman from MD Consult and the CDC director Dr. Julie Gerberding on Jan. 29, 2004 it was learnt that 10 patients had died so far in Vietnam and Thailand. Six WHO scientist in Vietnam are working with officials to contain the avian flu in Asia so that it won’t migrate similar to another outbreak of the same type of avian flu strain in Hong Kong in 1997. It appears that the killing of chickens has made some difference. On the other hand the spreading of the disease among wild ducks is of some concern.

The CDC and WHO are working together on this and are pushing for accelerated production of live and of inactivated vaccines against avian flu. This is a type of vaccine, which would make it impossible for future avian flu strains to cross into human hosts. The mass production of antiviral drugs is also being pursued. Dr. Gerberding stated that oseltamivir (brand name: Tamiflu), one of the newer antiviral drugs, would be effective in treating this type of avian flu (cited in Medscape Medical News Jan. 29, 2004).

Dr. Neill, an infection specialist and professor of medicine at the Brown University School of Medicine in Providence, Rhode Island, said that in case of a future human breakout of an epidemic with this flu the following instructions should be followed: 1. cover your mouth and nose with paper tissue when you sneeze or cough 2. frequently wash your hands with soap and water 3. use designated containers for disposal of the used paper tissues 4. symptomatic patients should use face masks to prevent the spread of the flu.

This article is based on the Lancet (The Journal) Vol. 363, Vol. 9406 (Jan. 31, 2004), on news stories from MD Consult and on Medscape news stories.

More info about the Flu: http://nethealthbook.com/infectious-disease/respiratory-infections/flu/

Link to Centers for Disease Control and Prevention on avian (bird) flu

Last edited October 26, 2014

Jan
03
2004

China Blows Alarm Whistle On Smoking

By | Cancer, Health, Heart Disease, Lung Disease, Prevention

The risks of smoking are being addressed in China, where roughly 300 million people or one quarter of the population are puffing away. The number is rising by about 3 million new smokers each year, and according to statistics of the WHO 700,000 die each year from smoking.

In November of 2003 China joined the Framework Convention on Tobacco Control (FCTC), a subsidiary of the World Health Organization. As a member China is now obliged to tighten restrictions on cigarette marketing and consumption.
Due to an economic boom in the country foreign tobacco giants are putting their hope into this rising market, as revenue has decreased elsewhere in the world. So far tobacco taxes, which are collected from the 1.7 trillion cigarettes sold in China amount to 8 billion $US or one tenth of government revenue. In the wake of SARS, however, the realization has come to the forefront, that health care cost have a severe impact on the economy of a country. Despite the seemingly enticing short-term gain from tobacco tax revenue, short cuts in health care can economically damage a country in the long run.

Health officials will have a battle with their counterparts in finance, when it comes to implementing tobacco control. In some areas of the country the sale of tobacco products to children has been banned and an attempt has been made to restrict cigarette commercials.

China Blows Alarm Whistle On Smoking

Quit smoking!

Powerful tobacco lobby groups actively undermine these efforts.
It is encouraging to see at least a beginning of public education about the risks of smoking. However, in a nation where cigarette manufacturing and consumption are the highest worldwide, it will be a long and arduous journey to clear the air to better health.

Based on The Lancet 363, No. 9402 (Jan. 3, 2004)

Last edited December 8, 2012

Jan
01
2004

Flu Season Not Over Yet

By | Health, Infectious Disease, Lung Disease, Prevention

Influenza type A is the cause of many flu epidemics including the one that recently affected the northern hemisphere. It is known to change its surface characteristics from time to time. This has occurred in the southern hemisphere (Australia and New Zealand) during the summer of 2003 and the same new type has caused the recent epidemic in Canada, the US and Europe.

Prior strains of flu viruses in recent years were variants of the Panama strain, that’s why the infection specialists decided in the beginning of 2003 to suggest a Panama strain type vaccine to be used for protection for this flu winter season. However, 70% of the cases tested in Canada by the end of November turned out to be influenza type A/Fujian,full name A/Fujian/411/2002(H3N2), different from type A/Panama, full name A/Panama/2007/99(H3N2), according to Dr. Theresa Tam. She is a specialist in the division of respiratory diseases at the Health Canada Centre for Infectious Disease Prevention and Control. Similar observations regarding a shift from the type a/Panama to the type A/Fujian strain of the flu virus has also been reported in the US and in Europe. It appears that those who have been vaccinated with the type A/Panama vaccine have had partial protection from this new flu as some of the flu virus characterisitics (e.g. the H3N2 determinants) are the same.

Dr. Tam mentioned that the recent deaths in children from the flu in the US, England and Canada would likely be explained by the fact that in the last 3 years there have not been any H3 type flus and the flus that did circulate were relatively mild. This means that children have not developed enough background resistance to fight a flu when it comes. Most adults have background resistance, but older people are loosing some of the resistance due to aging. Dr. Tam explained that not too many children have had the flu vaccination. One would expect that children are most vulnerable for the flu and this explains why these deaths would have occurred.

Flu Season Not Over Yet

Flu Season Not Over Yet

Production of flu vaccines that protect from flus: One of the problems with getting the best match for an upcoming flu season is the lag period between the decision to produce a certain type of flu vaccine and the mass production of the vaccine to serve a world population. This can take 6 to 8 months. A new technique of vaccine production is being investigated, called “reverse genetics”, where the lag period may only be a few weeks.

Dr. Webster, an infectious disease specialist at the St. Jude Children’s Research Hospital in Memphis, has produced a vaccine with this method against an avian flu with the characteristics H5N1(different from the others mentioned above). This is an older flu transmitted by birds that has resurfaced earlier in 2003 again. However, this vaccine that has been produced in cell culture and not in egg cultures, has only been tested in animal models, not in humans yet. Both Dr. Webster and Dr. Tam agree that human trials under FDA guidelines are needed to test these newer vaccines utilizing reverse genetics. Regulatory and patent issues need to be settled for this to happen.

Use of antiviral drugs: Another issue is that type A influenza can be treated with antiviral antibiotics, but every flu season these types of drugs tend to run short. Each country should have a national stockpile of these antiviral drugs (such as Tamiflu) so that enough stock is available in case of a serious epidemic where the vaccine may not fit the flu strain that comes around. This is not happening at the present.

What is needed is that international discussions take place through the Global Health Security Network (right now consisting of the G7 countries and Mexico), Dr.Tam said.

Conclusion: The flu season has started early this season. Many people have died because of a lack of vaccination. Some of those who were vaccinated against the flu may have caught the flu as the fit this year with regard to the vaccine was not the best. However, they likely survived the flu, whereas those who did not have the vaccine were more likely to have experienced the flu more severely and some of these have died. It is not too late to get the flu vaccine before the spring season. Typically there is another peak of the flu between February and April.

Based in part on The Medical Post, Dec.9, 2003 (p.1 and 73).

Last edited December 8, 2012

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Nov
01
2003

Growth Factor In Breast Milk A Key In Protecting Infants From Asthma

By | Lung Disease, Prevention

It has been known for some time that breast milk plays a preventative role in infants. It transmits antibodies and protects from viral illnesses, but it also prevents the infant from developing asthma. Dr. Anne L. Wright, from the University of Arizona in Tucson, and colleagues published a study of 243 infants/mothers in the October issue of the Journal of Allergy and Clinical Immunology (J Allergy Clin Immunol 2003;112:723-728).

They measured cytokines and growth factors in breast milk and examined the infants paying particular attention to wheezing as a symptom of asthma. One of the cytokines, called transforming growth factor (TGF)-beta1, was inversely related to the amount of wheezing in the infants. In other words, the higher the level of this growth factor was in breast milk, the more protected from asthma the infant was. This was a highly significant correlation. After 3 months of being fed with breast milk with the highest level of TGF-beta1 the infants’ asthma rate was reduced by 78% compared to the rate of asthma found in infants fed only short-term with low level TGF-beta1 breast milk.

In their future research the investigators intend to investigate the effects of these breast milk cytokines on the cells, which form the lining of the airways, the immune system and the cells lining the gut in infants. There is already preliminary data to suggest cytokines play an important role in stabilizing these cells.

Growth Factor In Breast Milk A Key In Protecting Infants From Asthma

Breastfeeding prevents asthma

Here is a link to a chapter on asthma from the Net Health Book.

Last edited October 26, 2014

Nov
01
2003

Blood Clots In Legs Can Be Caused From Long Flights

By | Health, Lung Disease, Prevention, Uncategorized

A new study from Australia has shown that the risk for developing blood clots in the legs (deep vein thrombosis) is increased 4-fold in the first two weeks after a long-haul airplane flight. This was published on Nov. 8, 2003 in the British Medical Journal (BMJ. 2003;327:1072) with the lead author being Dr. C.W. Kelman of the Commonwealth Department of Health and Ageing, Canberra.

Data was collected of 5,408 patients who had been hospitalized to Western Australian hospitals for deep vein thrombosis between 1981 and 1999. A total of 153 Australians were admitted with blood clots in the leg veins within 100 days of international flights. 46 of these patients developed their blood clots within 14 days of arrival, which was much more than would have been expected in the general population. The researchers found that between 15 days and 100 days following a long-haul flight the risk of developing clots in the deep veins of the legs was not increased from the background rate of the general population. The patients who had developed their blood clots within 14 days of a long flight had a risk that was 4.17-fold higher than the average population’s risk. Of these patients 76% were thought to have developed the clots as a result of a flight. In terms of a yearly risk, if a person does one long-haul flight per year, the probability of developing a clot in the leg veins would be about 12% higher than in a non-traveling comparison group. As this condition is treated effectively with blood thinners, the death rate is quite low, approximately 1 per 2 million long-haul flights.

Blood Clots In Legs Can Be Caused From Long Flights

Blood Clots In Legs Can Be Caused From Long Flights

This would be much lower than the risk of death from car accidents. The authors suggested that more study is needed to determine the risk factors for developing flight induced deep vein thrombosis. When this is known, investigations will be able to concentrate on blood clot prevention from air travel.

Link to a chapter on pulmonary emboli, which can develop from a deep vein thrombus that breaks loose.

Last edited December 9, 2012

Oct
02
2003

Flu Shot Cuts Death Rate Into Half

By | Infectious Disease, Lung Disease, Prevention

An earlier publication in the New England Journal of Medicine in March 2003 has shown that the death rate of people 65 years or older who were vaccinated against the flu, dropped into half when they were exposed to the flu and were compared to non-vaccinated controls. On Oct. 9, 2003 Dr. Megan Wren, associate director of the internal medicine residency at Barnes-Jewish Hospital and Washington University School of Medicine, reminded physicians that with the upcoming flu season it is important to include everybody who is healthy at age 50 or older (as the CDC has suggested now for 3 years) with influenza vaccination . Many physicians are still not aware that the rules have been changed to incude younger persons.

Below are recommendations of who should get a vaccination (in table form).

Dr. Wren pointed out that the risk from a flu vaccination is minimal. Contrary to public belief the flu vaccine does not cause fever, unwellness or muscle aches. The only effect is a mildly sore arm at the site of injection.

Flu Shot Cuts Death Rate Into Half

Flu Shot Cuts Death Rate Into Half

This year the FDA has approved a live flu vaccine that is administered as a nasal spray. This is a live modified flu virus that has been “trained” to only multiply in the colder nasal cavity, but not in the warmer airways. Like with all live viral vaccines pregnant women are not allowed to take this.

Who should get the flu vaccine ?
Group of people:
Comments:
all people age 50 or over the immune system weakens with age, that’s why complications of the flu are more common in this age group
women who will be in the 2nd or 3rd trimester of a pregnancy during November through to March protects the fetus from the flu virus in the most vulnerable period of the  development of the fetus
chronic heart disease or lung disease (including asthma) the flu affects the lungs and the heart most readily
chronic kidney or liver disease these chronic diseases weaken the immune system
people without a spleen and cancer patients the immune system is weak in these patients
children and adults with any chronic disease including diabetes chronic illnesses weaken the immune system in young and old
people on imunosuppressive medications the immune system is weak in these patients
all close family members of any of the above people the CDC hopes that this stops the spread of the flu into this vulnerable group of patients

Dr. Wren also mentioned that people with chronic illnesses, with immune deficiencies (e.g. AIDS and cancer patients) and healthy patients over the age of 50 cannot take this live vaccine. All others from age 5 to 49 can take it, but presently this is still very costly (one nasal mist application in 2003 is about 50.00$ US).

Last edited December 9, 2012

Oct
02
2003

Ozone And Pollution Linked To Asthma

By | Lung Disease

Ozone and pollutants were the topics of two independent publications in October 2003, one in the New England Journal of Medicine (N Engl J Med) and the other in the Journal of the American Medical Association (JAMA).

Dr. Janneane F. Gent of Yale University School of Medicine in New Haven, Connecticut, and her team studied the effects of ozone and small pollutant particles on 271 cases of asthma in children less than 12 years of age (results published in the Oct. 8 ,2003 issue of JAMA). The researchers asked the question whether the air standards of the Environmental Protection Agency would be safe for asthmatic children. From spring 2001until now (about 2 years) exposure of air pollution was measured.

They found that in terms of particulate matter in the air the minimum standards were acceptable and no worsening of asthma took place because of flucutations in this component of air pollution (fine particulate matter of 2.5 micrometers or less). However, exposure to fluctuating ozone levels considered sofar to be safe were found to have profound effects in terms of worsening the asthma in the group of children being followed. For every 50 parts per billion (ppb) increase (in one hour ozone level) the wheezing of these astmatic children increased by 35% and chest tightness increased by 47%. At the time of the highest ozone exposure from a bad day of pollution, which was still “acceptable” to the standards of the Environmental Protection Agency, there was a 32% increase in shortness of breath and the children had to increase their medications by an average of 8% to cope with their asthma attacks (based on JAMA 2003;290:1859-1867,1915-1916).

Ozone And Pollution Linked To Asthma

Asthma made worse by pollution

A different facet of the asthma problem was dealt with in the Oct. 9, 2003 issue of the New England Journal of Medicine. Dr. Malcolm R. Sears from the McMaster University in Hamilton/Canada reported about a group of 613 children born in Dunedin/New Zealand in 1972 and 1973 who were followed with breathing tests and questionnaires until they reached the age of 26 years. This study showed that it does matter very much what lung irritants the very young asthmatic was exposed to and what lung irritants continue to affect the person later in life.

About half of the study population had at least one wheezing attack during the 26 years of observation. Contrary to popular belief asthma is not something “you grow out of” with age as 26.9% either had wheezing that persisited all the time (14.5%) or where the wheezing came back in adult life(12.4%). Allergies to house dust were associated with a risk of more than double and general airway hypersensitivity was associated with a triple risk of causing wheezing persistence or causing a return to wheezing. Other factors that were contributing to risk were female gender (1.7-fold risk) and exposure to cigarette smoke (1.8-fold risk). Those who started smoking young had the highest risk of asthma persistence and severity.

The more wheezing attacks there were and the more persistent the asthma was, the more permanently abnormal the lung function tests remained. The authors concluded that intervention against factors that lead to asthma must be initiated at a very young age. It is crucial to not allow environmental factors (ozone, pollution, allergens, cigarette smoke etc.) to interact with the asthma gene as this will lead to the more severe and chronic forms of asthma with permently abnormal lung function.

These two studies would reconfirm what the recent Swedish family lifestyle study had found as well. All of these studies point to the importance of the air quality and how the environment affects not only those with asthma, but affects everybody. Asthmatics simply are the tip of the iceberg due to a genetic weakness with which they were born. This makes asthmatics particularly vulnerable to pollution and to other environmental factors.

Link to a chapter on asthma from Dr. Schilling’s Net Health Book.

Last edited October 26, 2014

Sep
01
2003

SARS Due To SARS-Associated Coronavirus (SARS-CoV)

By | Infectious Disease, Lung Disease

A comprehensive paper was recently published online July 22, 2003 (Lancet 2003; 362: 263-70) regarding the causative microorganism of SARS.

Several investigators have collaborated in this study from viral laboratories of Rotterdam/The Netherlands, Hong Kong Special Administrative Region/China , Singapore, London/UK, Hamburg/Germany, Paris/France and Geneva/Switzerland.

This study involved isolation of the SARS-associated coronavirus (SARS-CoV) from SARS patients who died from the disease, propagation of the virus in an experimental animal model (cynomolgus macaques) and causing SARS again with an injection of the isolated virus back into a healthy experimental animal.

This, according to the authors (Dr. Thijs Kuiken et al.), fulfils the Koch’s postulates, which is one of the fundamental laws in microbiology that has to be fulfilled in order to claim a new infective organism. Dr. Robert Koch was a German physician who had detected the causative organisms of anthrax, tuberculosis and cholera and won the Nobel price for physiology and medicine in 1905. He developed the four original Koch’s postulates that were subsequently modified to a total of six. Here is a run down of the postulates and how it relates to SARS:

SARS Due To SARS-Associated Coronavirus (SARS-CoV)

SARS Due To SARS-Associated Coronavirus (SARS-CoV)

1. The specific organism should be present in all cases of animals suffering from a specific disease, but should not be found in healthy animals.

For SARS this was fulfilled as this study, which was based on a thorough analysis of 436 patients in six countries, showed. 75% of the suspected cases were found in postmortem studies to contain the SARS-associated coronavirus (SARS-CoV). In some patients other infectious agents could also be isolated, but the primary causative agent was SARS-CoV.

2. The specific organism should be isolated from a diseased animal and grown in pure culture on artificial laboratory media.

Using an experimental animal model, the virus was able to be isolated from a diseased person and injected into a healthy animal that turned sick with SARS. From this animal the virus could be isolated again from cells of the infected airways and grown in tissue culture.

3. This freshly isolated microorganism, when inoculated into a healthy laboratory animal, should cause the same disease as in the original animal.

As already explained under point 2 above, this has been shown with SARS.

4. The microorganism should be able to be isolated again in pure culture from the experimental infection.

This was proven in this paper regarding SARS. It was even done with genetic markers that were still present after passage from postmortem human tissue into an experimental animal and from the final respiratory tissue isolate of this newly infected animal.

5. The infective agent can be filtered and the filtrate contains the infective agent.

This was proven for SARS and the exact classification of the virus was possible because of the advanced genetic knowledge that is now available.

6. When the virus enters the body or the experimental animal, there are signs of the immune system attempting to rid the body of the infectious organism.

Sophisticated immune tests were performed that showed in more than one way that the immune system attempted to rid the body of SARS, but was eventually overwhelmed in the cases that did not survive.

Summary: This paper has conclusively proven that SARS is caused by a new type of coronavirus, SARS-associated coronavirus (SARS-CoV). In about 12% of cases there was another virus type present, such as human metapneumovirus. This occasionally was also present in lethal SARS cases as a secondary virus. Some other flu-type viruses were also found in the non-SARS cases. However, this paper has shown that SARS-associated coronavirus (SARS-CoV) is what causes SARS.

Link to SARS chapter of Dr. Schilling’s Net Health Book: http://nethealthbook.com/infectious-disease/infectious-disease-infections/severe-acute-respiratory-syndrome/

Last edited October 26, 2014