Doctor’s Blog

July 15, 2010

Patients are More Likely to Take Asthma Medications if Doctors are Engaged in Monitoring Use

According to a recent study in the Journal of Allergy and Clinical Immunology, as reported in Healthday, patients with asthma were more likely to take their asthma medications if doctors followed them closely. Researchers at the Henry Ford Hospital in Detroit found that patients were more likely to take their inhaled corticosteroids consistently for asthma control when their doctors monitored medication use carefully and reviewed electronic prescription information (such as how often prescriptions were filled). The study included 193 doctors.
 
These findings are nothing new. For example, in a study conducted some years ago, patients were taught how to use a metered-dose inhaler. Later, when they were brought back for a second visit, only half of them performed it correctly. This goes to show that an ongoing doctor-patient relationship is extremely important.
July 15, 2010

New Jersey Urged to Continue Funding Anti-Tobacco Programs

In June, the Newark Star-Ledger reported that New Jersey advocates are asking Gov. Chris Christie to continue funding anti-tobacco programs. In the past, New Jersey contributed $30 million a year to anti-tobacco programs. This year, due to budget cuts, funding dropped to $7.5 million. If Gov. Christie's proposed budget is approved, funding would be eliminated entirely. Fred Jacobs, former state health commissioner and the current chairman of anti-smoking organization NJ BREATHES, said that if funding fails, “New Jersey will be the worst state in the country when it comes to the support of tobacco-control programs.”
 
As we’ve reported earlier in our blog, tobacco smoke – including second-hand smoke – is a powerful trigger of asthma symptoms, not to mention contributing to other health problems. We’re hopeful that legislators can see their way to maintaining funding for anti-tobacco programs. 
June 9, 2010

U.S. Cigarette Brands Can Put Smokers at Higher Risk

According to a new study conducted by the Centers for Disease Control and Prevention, U.S. cigarette brands expose smokers to higher levels of cancer-causing agents than brands from three other countries. The newly published paper in Cancer Epidemiology Biomarkers and Prevention shows these major carcinogens and cancer-causing agents in tobacco products to be tobacco-specific nitrosamines [TSNAs]. The study is summarized on the CBS News website at http://www.cbsnews.com/stories/2010/06/01/health/main6537898.shtml.
 
The CDC enlisted 126 regular smokers in Australia, Canada, Britain and the U.S. (specifically New York and Minnesota). All participants smoked one brand routinely, typically the most popular brands in their country. Minnesotans smoked Marlboro, Newport, Marlboro Light and Camel Light, while those in New York smoked Marlboro, Newport, Newport Light, Camel Light and Marlboro Menthol. Researchers determined how much TSNA smokers were exposed to by measuring the chemicals in cigarette butts after a day of smoking. They also used urine samples to learn how much of the TSNA was broken down in the body.
 
More Reasons to Quit
In addition to the risk of lung cancer, tobacco smoke is a powerful trigger of asthma symptoms. Smoke from cigars, cigarettes and pipes can damage airway cilia (hair-like structures that help to clear mucus out of the airways). Tobacco smoke may also cause excess mucus production leading to airway inflammation, triggering an attack.
 
Second-hand smoke (smoke from a burning cigarette and smoke exhaled by a smoker) may be even more harmful than actually smoking. The smoke that is given off the ends of cigars and cigarettes contain harmful substances such as tar, nicotine and carbon monoxide in higher concentrations than the smoke inhaled. This smoke is quite harmful to people who already have asthma, causing wheezing, coughing and shortness of breath.
 
Lastly, second-hand smoke harms children with asthma more than adults. Children’s airways are smaller and therefore, increased mucus production can affect them faster. Early airway damage from second-hand smoke can affect their lung function later in life. These children tend to develop lung and sinus infections more frequently, making their asthma that much harder to control.
May 18, 2010

Is it a Food Allergy or Food Intolerance?

A recent article in the New York Times (available online at http://www.nytimes.com/2010/05/12/health/research/12allergies.html) sheds light on the misconceptions of food allergy. As practicing allergists, we see many patients who think they have a “food allergy” when in reality they have a “food intolerance.”
A food allergy occurs when the immune system reacts to a certain food. The body creates allergic antibodies to the food, known as immunoglobulin E (IgE), which react with the food and cause histamine and other chemical mediators to be released. A true food allergic reaction usually involves hives, asthma, angioedema (swelling) or other symptoms.
Food intolerance, on the other hand, does not involve the immune system and is not life-threatening. A common example is lactose intolerance, which is caused by a deficiency in the enzyme needed to break down milk sugars. Symptoms may include abdominal cramps, bloating and diarrhea. Another example is headache due to sulfite-containing foods such as processed cheeses and certain wines.

It’s very important to know that a positive allergy skin or blood test (both detect food specific IgE levels) does not always mean you’re allergic to a food. Many times you can eat a food without symptoms despite a positive test. In addition, a positive test does not tell you how severe an allergy is. That’s why it’s very important to be seen by an allergist who can skillfully put together the clinical history of food reactions with appropriate testing to obtain an accurate diagnosis and minimize false positive results.

April 29, 2010

Need Help in Paying for Drugs?

With the economy in the state it is, many patients are having a difficult time paying for expensive drugs. The pharmaceutical industry has long provided free or low-cost medicines provided that strict financial requirements are met. Many companies have different rules, so it is not a “one size fits all.”

Applications are available from the drug companies themselves or by going to these websites that are patient-advocate groups. These sites generally guide patients in filling out the information.
 
Most patient-assistance programs require enrollees to have incomes at or below 200% of the federal poverty level, or about $42,000 for a family of four, but some allow as much as 400%.
 
Patient-assistance programs
Discount drug cards
Obtaining low-cost generic
www.needymeds.org. Patients can search and download applications etc.
www.togetherrxaccess.com or1-800-444-4106 Nine major drug companies free card:20%-40% for more than 300 drugs.
www.rxoutreach.com or1-800-769-3880. Offers more than 350 generic meds at $20-$95 for 180 day supplies.
www.pparx.org or 1-888-477-2669. Helps to match patients with more than 475 programs.
Discounts range from 15%-50%
www.xubex.com or 1-800-699-8239. Over 250 generic drugs 90 day supply most for $20-$30
www.rxassist.org. Allows patients to search online for tip sheets on getting low-cost meds and other information.
Discounts range from 15%-50%
Wal-Mart, Target, Safeway and other chains at $4. Several have reduced costs of generic drugs to $10-$15.


 

April 14, 2010

Could Higher Vitamin D Levels Improve Asthma Symptoms?

 
A recent study in the American Journal of Respiratory and Critical Care Medicine examined vitamin D blood levels in adult asthma patients, and showed that those with the highest levels of vitamin D had better lung function. Low vitamin D levels were associated with a worse response to steroid therapy and increased production of TNF-alpha, an inflammatory substance secreted by cells.
 
The authors also found that participants who weighed the most had the lowest levels of vitamin D, suggesting that the lack of vitamin D may be a factor linking obesity and asthma. The lead investigator of the study, Rand Sutherland, MD, MPH, was quoted on WebMD as saying, “The next question to answer is whether giving supplemental vitamin D will lead to clinical improvements in patients with asthma.”
 
Further studies to address the potential benefits of increasing vitamin D supplements for asthma patients are needed. For now, it is recommended that you get the current daily recommended dosage of vitamin D based on age.
 
Infants 0–12 months
200 IU
Children 1–18 years
200 IU
Adults 19–50 years
200 IU
Adults 51–70 years
400 IU
Adults 71 years and older
600 IU
Pregnant and lactating women
200 IU
 
For infants, children, and adolescents, the American Academy of Pediatrics advises daily intakes of 400 IU, twice the official recommendation of 200 IU.
 
Vitamin D is found in many dietary sources, such as fish, eggs, fortified milk and cod liver oil. The sun also contributes significantly to the daily production of vitamin D, and according to the Mayo Clinic, as little as 10 minutes of exposure is thought to be enough to prevent deficiencies. Vitamin D toxicity can occur with overdosing, so patients should be careful not to take excessive amounts. 
April 8, 2010

H1N1 Update

Visits to doctors for influenza-like illness are now stable and relatively low nationally. However, the majority of the influenza viruses identified so far continue to be 2009 H1N1 influenza A viruses. These viruses remain similar to the virus chosen for the 2009 H1N1 vaccine and remain susceptible to the antiviral drugs oseltamivir and zanamivir, with rare exception. It is still recommended that persons get vaccinated with the H1N1 vaccine, if they have not already done so, should another wave of flu activity occur.

April 1, 2010

What does a black box warning mean?

The FDA places a “black box” warning on the package insert of prescription drugs that might cause serious adverse effects. Recently, long-acting bronchodilators such as Foradil (formoterol) and Serevent (salmeterol) have appeared on this list. The FDA is concerned about the safety of these drugs when used alone.

 
These medications, also called LABAs, are powerful bronchodilators that last approximately 12 hours. Most often, LABAs are combined with inhaled corticosteroid drugs (ICS). LABAs relax the bronchial smooth muscles, but do not address the inflammation of the airways. Inhaled corticosteroids act by reducing this inflammation.
 
The reason for the concern is that children and adults (especially African Americans) may be subject to increased and severe asthma attacks when given LABAs alone. This can lead to hospitalization and even death.
 
However, this situation has been noted for patients on LABAs alone and does not apply if the combination is given. Nevertheless, the FDA cautions that patients should avoid the combination when possible, and LABAs should never be given alone to treat asthma symptoms on a regular basis.
 
Our note: We agree with this approach. We try to give the least amount of medicine that we can to relieve not only symptoms, but also the core of the asthma problem — inflammation.
February 1, 2010

Dr. Permaul Settling In

My first six months at Two River Allergy and Asthma Group have been wonderful. Thank you all for being so welcoming! As time goes on, I look forward to fostering relationships with each of you. You will soon see that one of my basic tenets for excellent patient care is education. Understanding your allergic and/or immunologic condition is the first step in treatment. I also encourage questions and love to be challenged. I trust that my educational and medical training will speak for itself.

I want to thank our fantastic staff, including Dr. Picone, for being so warm and accommodating. It has really made my transition to private practice very smooth. I was born in New York City and have lived in major cities such as Philadelphia and Boston, so moving to Red Bank has been an exciting change. I welcome any suggestions for things to do in and around Monmouth County!

January 29, 2010

H1N1 Vaccination Update

On January 15, the Centers for Disease Control and Prevention (CDC) reported that “about 11,000 Americans have died of swine flu as of last month.” The World Health Organization’s Executive Board recently reported that although the H1N1 flu virus remains active in many countries, “the overall pattern is decreasing.”

Whether there will be a third wave of H1N1 infections during the late winter and spring months remains to be seen. It is also not clear whether the H1N1 strain will replace other seasonal influenza viruses. To date, about 1 in 5 Americans have been vaccinated against H1N1, according to the government’s first detailed estimates of vaccination rates against this pandemic.

January 22, 2010

Winter Months Bring Indoor Asthma Triggers

While many people think of allergies as being seasonal (spring and fall), the winter months can wreak havoc for many allergic asthma sufferers. Some asthma patients are very sensitive to indoor allergens, especially when spending more time indoors during the winter and increasing exposure.

Common indoor allergens are dust mites, pets (saliva, hair and dander), molds and cockroach droppings. When inhaled, these allergens can trigger inflammation and obstruction of the airways, making it hard to breathe.

You can help prevent allergy-induced asthma symptoms in the home by implementing a few simple measures. Your asthma medication may also need to be adjusted during the winter months. If you fit this description, we can discuss these steps at your next visit.

January 15, 2010

Shortage of Pediatric Subspecialists

NJVoices Guest Blog recently reported on a disheartening topic regarding pediatric subspecialists. The American Association of Medical Colleges predicts that by the year 2025, the United States will face a shortage of at least 125,000 physicians for all medical specialties.

Hitting a little closer to home, a recent analysis by the New Jersey Council of Teaching Hospitals already shows critical shortages for most pediatric specialties in New Jersey, including pediatric allergists. This will undoubtedly affect children with allergies and asthma. Over the next decade, the shortages are expected to worsen. For more details, please visit http://blog.nj.com/njv_guest_blog/2010/01/shortage_of_pediatric_speciali.html. A statewide Physician Workforce Policy Task Force convened by the New Jersey Council of Teaching Hospitals has called for the creation of a state Center for Medical and Health Workforce Planning to track and address the shortage.

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