Previously Appeared in Online Health Website for Children
Summer 2006
Treating GERD with medications
By Pamela Appea
Pediatric gastroenterologists may not be able to agree how many GERD cases there are in the pediatric population, but many agree that GERD is on the rise among both boys and girls from ages 0-17.
But regardless of when GERD starts or when it is diagnosed, pharmacological treatment can and should be available to even the youngest GERD patients.
GERD or gastroesophageal reflux disease in infant children may be difficult to treat for a variety of reasons. Firstly, parents of infants may assume that GERD is colic or simply resign themselves to crying, excessive vomiting and extreme discomfort before they actually seek treatment from a physician.
Secondly, once the child has visited a pediatrician, it may take some time before GERD sufferers are referred to a specialist and received a formal diagnosis. Pediatricians usually want to rule out other factors for vomiting, including allergic reactions to food and/or formula, adverse reactions to second-hand cigarette smoke.
Thirdly, some parents chose to delay seeing a specialist or getting the GERD tests done since they may cause the child discomfort, require fasting and the procedures often feature tubes that go into your nose, down your throat into your esophagus.
Once a pediatric gastroenterologist meets with the child (and his/her parents), it may take some time to find the right medication and the right dosage of medication to effectively treat the GER. Some medications work better than others; there is still more research that needs to be done on pediatric GERD medications as there have been few to no pediatric clinical trials for most FDA-approved GERD medications.
Many doctors agree that young children with gastroesophageal reflux (GER) and GERD benefit from lifestyle changes, before and/or after prescribing GERD medications. Physicians characterize children with GER as “happy spitters.” But GERD suffers frequently refuse food, fail to gain an adequate amount of weight and they are irritable or sad the majority of the time.
Some of physician-recommended lifestyle changes for babies, infants and older children include thickening formula (for infants), more frequent, smaller feedings or meals and upright positioning after feeding or eating.
But even the youngest of GERD suffers should be able to get effective pharmacological-based treatment, as there a number of medications available on the market that are suitable for pediatric populations.
A pediatric gastroenterologist will consider a number of factors when prescribing medications, including the weight of the child, the severity of the GERD and avoiding other medications that may not have appeared to be as effective in the past.
As Dr. Ben Gold, Professor of Pediatrics and Microbiology Director, Division of Pediatric Gastroenterology, Hepatology and Nutrition at Emory, explains, there are a number of different classes of medications that are available for pediatric GERD sufferers. Antacids over the counters medicine, including Maalox. Tums and Rolaids are typically used for the mildest version of esophageal discomfort.
Acid reducers, Histamine 2 receptor blockers, also known as H2 blockers and the proton pump inhibitors (PPIs) are the three main classes of medications used to treat GERD.
Ranitidine, an acid-reducer, more commonly known as Zantac is frequently prescribed for children.
The stronger PPI medications for more severe GERD cases, said Dr. Gold, are very effective.
Lansoprazole (also known as Prevacid) is suitable for ages 1-17; Omeprazole (also known as Prilosec) is suitable for children ages 2-16; and Esomeprazole (also known as Nexium) are some examples of medications suitable for older children ages 12-17, according to Dr. Gold. Some adult GERD medications, including many PPIs have not yet been approved for use in younger children. .
“When it comes to symptom resolution and disease resolution of GERD, PPIs are superior to acid blockers,” Dr. Gold said. He noted, however, that many PPIs have significant side effects. Depending on the dose and the specific medication, these side effects may include abdominal pain, headache, diarrhea, dry mouth, lightheadedness, headache and rash.
Some other studies have found that prescribing drugs like Prilosec for pediatric patients, might mean they could face risks of pancreatitis and/or liver problems.
Many doctors like Dr, Gold stress the importance of taking a conservative approach, and not prescribing stronger medications than necessary, especially if a child has a milder version of GER or GERD.
Physicians typically prescribe a medication to see if it will work, assessing the child to see if the GERD symptoms have improved or not after about two weeks.
Then the pediatric gastroenterologist will consider a stronger dosage or a different medication altogether.
The North American Society of Pediatric Gastroenterology, Hematology and Nutrition released guidelines in 2001 for appropriate medication usage among children with GERD.
In some instances, typically the most extreme cases of pediatric and adolescent GERD, a pediatric gastroenterologist may recommend corrective surgery. These typically are minimally invasive procedures.
One of the more common procedures to treat GERD or reflex is called Nissen fundoplication. This procedure wraps the top part of the stomach around the bottom part of the esophagus creating a collar. Once this procedure has been completed, the collar around the esophagus effectively prevents reflux from occurring.
But as Dr. Gold states, there is a common misperception that surgery is the last resort. He often recommends surgery for patients who have “experienced moderate success” with GERD medications, but who want surgery for a variety of different reasons. Patients, Dr. Gold, may get tired of taking multiple medications and/or continue to have mild to moderate symptoms of reflux.
Saturday, July 01, 2006
Saturday, April 01, 2006
Nonprofit CEO wants to expand talent showcase, Crain's New York Business
Nonprofit CEO wants to expand talent showcase
CRAIN'S
by Pamela Appea
April 2006
Ian Gerard, the chief executive of Gen Art, throws parties for a living.
Sure, the former corporate lawyer must balance 70-plus-hour work weeks, constant traveling and negotiating for corporate sponsors to help produce more than 100 events a year for the nonprofit that helps brings exposure to young and up-and-coming fashion designers, musicians and other artists get exposure.
But Mr. Gerard, 37, makes it all look easy.
In January, though sleep deprived, he sat in his office sipping diet cola and calmly musing about his quest for the perfect work-life balance. Just 15 hours earlier he had been in Utah overseeing a celebrity-studded Sundance party for 1,200 at Legacy Lodge Park Resort, co-sponsored with Starbucks and MySpace.com.
"Ian was out for two hours in the 15-degree weather in his shirtsleeves working the door at Sundance. How many CEOs do you know who would do that?" said Charles Sommer, a friend from Mr. Gerard’s law school days and founder of Doubleagent.com, which offers online advice to men about dating, relationships and style.
As a self-described non-insider, his goal is to find new talent and bring it into the open. "Virtually all of our events are open to the public. We open our events to art enthusiasts, film enthusiasts, music enthusiasts," Mr. Gerard said. "That’s very rare, especially in invite-only cities like New York or Los Angeles."
He co-founded Gen Art in 1993 with brother Stefan and Melissa Neuman, a prominent third-generation Manhattan art collector. Armed with a $5,000 loan from their parents, the brothers and Ms. Neuman corralled a team of volunteers to get the labor of love started.
"Every day has highs and lows and you need to brush off the lows and move on," Mr. Gerard said, crediting the dozens of staffers on Gen Art’s team for helping the non-profit succeed.
The dedication seems to be paying off. The company was among the first to showcase the work of Hollywood designer and P. Diddy confidante Zac Posen. Manhattan-based fashion designer Shoshanna Lonstein Gruss is another longtime fan.
Gen Art has built a wide base of corporate sponsors, and exclusive partnerships for events and it sells tickets and memberships. This year the company should generate revenue of about $5 million, Mr. Gerard said.
Gen Art will open a sixth location in the U.S., or perhaps its first international office, in either Toronto or London this year, Mr. Gerard said. Plans call for a bigger online presence and more events spread over a wider area.
"People want to know what the next generation of talent will be," Mr. Gerard said. "That’s what I want to provide."
NAME: Ian Gerard AGE: 37
RESUME: CEO and co-founder of Gen Art.
Real estate lawyer at Latham & Watkins and at Kalkines, Arky, Zali & Bernstein
EDUCATION: New York University School of Law, Vassar College
TASK: Expanding Gen Art’s online presence with a new Web magazine called Gen Art Pulse (http://www.genartpulse.com/) that covers film, art, music, travel, fashion and design. Developing more events over a wider area.
PERSONAL: Born and raised on Upper East Side. Single, lives in Greenwich Village
HOBBIES: Walking whenever he gets a chance and traveling to Spain and Portugal, Scandinavia and Caribbean Islands.
Friday, March 03, 2006
Expecting times two or three or four
Expecting times two or three or four
Clinic Cares for women pregnant with twins or more
By Pamela Appea
Barbara Luke is a firm advocate of bed rest. At least that’s what she prescribes for women expecting twins, triplets or quadruplets.
Luke, a nutritionists and professor of obstetrics and gynecology at the University of Michigan, founded her 4-year-old clinic to provide personal care and specialized treatment for women expecting multiple babies. The clinic helps to meet a growing need.
Statistics from the National Center for Health show that there were more than 110,000 multiple births in the United States in 1997.
“It’s a huge rise in the last 10-15 years,” Luke said.
Luke, 49, said her method gets results.
Women who go to her clinic have babies that are born later, heavier and healthier than those of mothers who don’t get such counseling, she said.
Luke hopes to reach even more women with her recently published book, “When You’re Expecting Twins, Triplets or Quads” which she co-authored with Tamara Eberlein, a New York mother of twins. Luke’s patients quickly find out that their pregnancies are different from what she calls a singleton pregnancy.
Kristi L. K. Mawby, 31, who lives in Ypsilanti Township, Michigan first went to see Luke when she was eight weeks pregnant back in 1996. The rules laid down by Luke at Mawby’s first appointment were intimidating, Mawby said.
“First you will gain lots of weight,” she recalled Luke saying. “I was hoping not to. Second you will eat protein, red meat, until its coming out of your ears; third was all of the vitamin supplements; fourth you will rest. You will stop working; you will be lazy and gestate.”
“Maybe I was in denial of what a twin pregnancy was about,” Mawby continued.
“At first I thought, “You’ve got to be kidding. It’s not that bad.”
But as Mawby learned more about twin pregnancies, she began to see Luke’s advice as sound. Put on bed rest for eight weeks, Mawby later delivered at 38 ½ weeks. Her twins, a boy and a girl, will be 3 in May.
Although multiple births have become more common, Luke said. many people don’t seem to understand the risks involved, including low-birth weight, learning disabilities and other long-term effects if babies are born prematurely.
Good nutrition and proper care help to significantly reduce these risks, she said. Many expectant mothers of multiples, Luke said, are guilty of not taking care of themselves or continuing a high-paced lifestyle at work and home. And the main detrimental result of not slowing down is the risk of premature delivery, Luke said.
Part of her job as a nutritionist, coach and advocate for women expecting multiples, she said, is to get mothers to relax and take the time to gestate. A multiples pregnancy is different physically, Luke said. Women get larger faster than if they are pregnant with one child.
For example, a woman expecting triplets who is 24 weeks pregnant may look like a woman pregnant with a singleton at 36 weeks, Luke writes in her book.
At first many mothers of multiples are determined to work until their ninth moth, not always realizing that their children may be born a few weeks early and that working can cause stress related problems on the pregnancy. That’s why early on, Luke counsels her patients on the importance of scheduling time off from work well in advance.
Ann Seifart of Jackson took Luke’s advice to heart when she found out she was pregnant with quadruplets in 1996. Seifart, now 46, took off work from her dental hygienist job when she was four months pregnant. Her quadruplets were born at 31 weeks and, though small, all thrived.
“I took things one step at a time,” said Seifart.
“I had success and unfortunately there are women who haven’t.”
Tim Johnson, chair of the OB/GYN clinic at the University of Michigan, said Luke’s clinic and research on multiples is an effective part of the [University of Michigan’s] multidisciplinary effort.
A woman’s regular check-appointment may only be 15 minutes, Johnson said.So that’s why it’s important that a team of nurse-midwives, nutritionists, social workers and other health care providers supplement the prenatal care women expecting multiple babies receive, Johnson said.
“You can imagine why patients love Dr. Luke. The doctors love her and the hospital loves her. Having healthier babies is good for everybody,” Johnson said.
At a patient’s first visit to her clinic, Luke puts the emphasis on nutrition, particularly during the first trimester. The early weeks—the first 13 to 14 weeks— of the pregnancy are the most crucial.“That’s really when the major organs are formed,” Luke said.
“The risks of birth defects are greatest during that period.”Luke finds patients often get unhelpful advice, such as, “Try not to gain too much weight,” from family members and others. Luke’s advice is to eat as much as possible during a multiples pregnancy.
One of her biggest battles, Luke said, is convincing women that during such a pregnancy is not the time to watch her weight.Luke has counseled mothers of 150 sets of twins, a dozen sets of triplets and Seifert, the mother of the quadruplets.
Despite the long hours, Luke said she can’t imagine doing any other type of work.“I really love what I do,” she said. “I realize admire my patients. The women have tremendous strengths.”
And the best thing for the nutritional health expert, she said, is hearing from former patients months or years afterwards about their children.“It’s a vote of confidence that we’re doing it right,” Luke said.
*Copyright 2000 by Pamela Appea for The Ann Arbor News.
Clinic Cares for women pregnant with twins or more
By Pamela Appea
Barbara Luke is a firm advocate of bed rest. At least that’s what she prescribes for women expecting twins, triplets or quadruplets.
Luke, a nutritionists and professor of obstetrics and gynecology at the University of Michigan, founded her 4-year-old clinic to provide personal care and specialized treatment for women expecting multiple babies. The clinic helps to meet a growing need.
Statistics from the National Center for Health show that there were more than 110,000 multiple births in the United States in 1997.
“It’s a huge rise in the last 10-15 years,” Luke said.
Luke, 49, said her method gets results.
Women who go to her clinic have babies that are born later, heavier and healthier than those of mothers who don’t get such counseling, she said.
Luke hopes to reach even more women with her recently published book, “When You’re Expecting Twins, Triplets or Quads” which she co-authored with Tamara Eberlein, a New York mother of twins. Luke’s patients quickly find out that their pregnancies are different from what she calls a singleton pregnancy.
Kristi L. K. Mawby, 31, who lives in Ypsilanti Township, Michigan first went to see Luke when she was eight weeks pregnant back in 1996. The rules laid down by Luke at Mawby’s first appointment were intimidating, Mawby said.
“First you will gain lots of weight,” she recalled Luke saying. “I was hoping not to. Second you will eat protein, red meat, until its coming out of your ears; third was all of the vitamin supplements; fourth you will rest. You will stop working; you will be lazy and gestate.”
“Maybe I was in denial of what a twin pregnancy was about,” Mawby continued.
“At first I thought, “You’ve got to be kidding. It’s not that bad.”
But as Mawby learned more about twin pregnancies, she began to see Luke’s advice as sound. Put on bed rest for eight weeks, Mawby later delivered at 38 ½ weeks. Her twins, a boy and a girl, will be 3 in May.
Although multiple births have become more common, Luke said. many people don’t seem to understand the risks involved, including low-birth weight, learning disabilities and other long-term effects if babies are born prematurely.
Good nutrition and proper care help to significantly reduce these risks, she said. Many expectant mothers of multiples, Luke said, are guilty of not taking care of themselves or continuing a high-paced lifestyle at work and home. And the main detrimental result of not slowing down is the risk of premature delivery, Luke said.
Part of her job as a nutritionist, coach and advocate for women expecting multiples, she said, is to get mothers to relax and take the time to gestate. A multiples pregnancy is different physically, Luke said. Women get larger faster than if they are pregnant with one child.
For example, a woman expecting triplets who is 24 weeks pregnant may look like a woman pregnant with a singleton at 36 weeks, Luke writes in her book.
At first many mothers of multiples are determined to work until their ninth moth, not always realizing that their children may be born a few weeks early and that working can cause stress related problems on the pregnancy. That’s why early on, Luke counsels her patients on the importance of scheduling time off from work well in advance.
Ann Seifart of Jackson took Luke’s advice to heart when she found out she was pregnant with quadruplets in 1996. Seifart, now 46, took off work from her dental hygienist job when she was four months pregnant. Her quadruplets were born at 31 weeks and, though small, all thrived.
“I took things one step at a time,” said Seifart.
“I had success and unfortunately there are women who haven’t.”
Tim Johnson, chair of the OB/GYN clinic at the University of Michigan, said Luke’s clinic and research on multiples is an effective part of the [University of Michigan’s] multidisciplinary effort.
A woman’s regular check-appointment may only be 15 minutes, Johnson said.So that’s why it’s important that a team of nurse-midwives, nutritionists, social workers and other health care providers supplement the prenatal care women expecting multiple babies receive, Johnson said.
“You can imagine why patients love Dr. Luke. The doctors love her and the hospital loves her. Having healthier babies is good for everybody,” Johnson said.
At a patient’s first visit to her clinic, Luke puts the emphasis on nutrition, particularly during the first trimester. The early weeks—the first 13 to 14 weeks— of the pregnancy are the most crucial.“That’s really when the major organs are formed,” Luke said.
“The risks of birth defects are greatest during that period.”Luke finds patients often get unhelpful advice, such as, “Try not to gain too much weight,” from family members and others. Luke’s advice is to eat as much as possible during a multiples pregnancy.
One of her biggest battles, Luke said, is convincing women that during such a pregnancy is not the time to watch her weight.Luke has counseled mothers of 150 sets of twins, a dozen sets of triplets and Seifert, the mother of the quadruplets.
Despite the long hours, Luke said she can’t imagine doing any other type of work.“I really love what I do,” she said. “I realize admire my patients. The women have tremendous strengths.”
And the best thing for the nutritional health expert, she said, is hearing from former patients months or years afterwards about their children.“It’s a vote of confidence that we’re doing it right,” Luke said.
*Copyright 2000 by Pamela Appea for The Ann Arbor News.
Growing concerns about inhaled steroids? Asthma Magazine
Growing concerns about inhaled steroids?
ASTHMA MAGAZINE
By Pamela Appea
Starting your child on inhaled corticosteroids, asthma and allergy experts say, can be one of the most important steps in helping your child better manage his or her persistent asthma.
However, in 1998, the Food and Drug Administration (FDA) began to require inhaled corticosteroids, commonly referred to as steroids, to bear a label stating that kids who take the drug may experience delayed growth. Although parents may be concerned about giving their children these drugs, pediatric asthma and allergy specialists say this concern is unwarranted.
Allergy and asthma experts have found it challenging enough to get their young patients--around 5 million U.S. children have asthma--to use inhaled corticosteroids on a daily basis as recommended by national experts.So with the FDA-mandated labeling change, many experts fear parents are discouraged from choosing to give their children this medicine.
"There is a lot of steroid phobia," says Michael Blaiss, MD, vice president of the American Academy of Allergy, Asthma and Immunology and clinical professor of pediatrics and medicine at the University of Tennessee in Memphis.
Some older studies have shown that, when kids take these corticosteroids, they may experience a slowed rate of growth. The FDA thinks it is still unclear as to whether inhaled corticosteroids pose any long-term risks to a child's final height. These and other questions about corticosteroids are enough to make a parent ask: Are inhaled corticosteroids necessary? Among most pediatric asthma and allergy experts, the answer is a resounding yes.
Asthma experts say the first step is to know what inhaled corticosteroids are. For example, Blaiss explains that the steroids some athletes take to increase performance are in an entirely different class of medication than corticosteroids used for asthma.
When parents hear the doctor say inhaled steroids will be part of their child's asthma treatment, they may negatively associate that medicine with the kind of steroids athletes use.Parents often don't understand the difference and are afraid for no reason, Blaiss says.
"Estrogen is a steroid, yet there is no fear about taking estrogen," says William Berger, MD, president-elect of the American College of Allergy, Asthma and Immunology and clinical professor of pediatrics at the University of California in Irvine.
Taking their inhaled steroids may help children with asthma live fuller lives, he emphasizes, which is why it's important for parents to take their child's asthma seriously. It's important to understand the long-term benefits of inhaled corticosteroids, just as a diabetes patient knows that continuous treatment and medical care are essential.
How inhaled corticosteroids work.Inhaled corticosteroids, delivered through a small asthma inhaler (either a traditional metered dose inhaler or a newer dry powder inhaler), reduce and prevent swelling and inflammation in the bronchi, the airways of the lungs.
Specialists will prescribe specific medications so that kids can have better relief for long-term control of asthma symptoms.
Corticosteroids also come in a nasal inhaler preparation for the treatment of allergic rhinitis, commonly known as hay fever. Inhaled corticosteroids are preventive medicines.
They do not work like quick-relief inhalers and will not stop or relieve symptoms for a child in the middle of an asthma attack. They must be taken on a daily, long-term basis to be effective.
What research shows:Recent studies, including two published reports in The New England Journal of Medicine, found the definitive benefits of inhaled corticosteroids far outweigh the risks. Although children in the study did measure about 0.4 inches shorter than children on nonsteroid drugs after the first year of treatment, the researchers found that this growth lag disappeared in the following years.
So, as Finegold points out, the kids caught up and suffered no permanent loss from their adult height.
In addition, research from the Childhood Asthma Management Program funded by the National Institutes of Health's National Heart, Lung, and Blood Institute showed inhaled corticosteroids provided superior asthma control.
Compared with children on placebo, kids treated with corticosteroids had: 45% fewer urgent care visits 43% hospitalizations 45% less use of oral corticosteroids (used to treat severe exacerbations) 30% fewer days in which additional asthma medication was needed 22% more episode-free days.
Parents can take steps to ensure their child takes inhaled corticosteroids as safely as possible to minimize side effects. When taking these medicines with a traditional inhaler, it is important for the child to use a spacer attached to the inhaler. This device allows more medicine to be breathed into the lungs and less to end up in the mouth and throat, where it is swallowed and produces more systemic side effects. It is also important for the child to rinse, gargle, and spit after taking this medicine.
The focus on the inhaled steroid debate, Berger says, has approached the issue from the wrong angle."
Untreated asthma really hurts a child early growth," he says, a fact that physicians have known for years. Kids will be smaller and weaker if they don't take medications they need, he says.
Also, specialists most often prescribe inhaled corticosteroids to kids who have developed a moderate-to-severe chronic form of asthma, which means the asthma episodes are frequent, debilitating, and affecting quality of life. Most kids do extremely well when given low dosages of inhaled corticosteroids and regular check-ups.
"Five thousand people die from asthma every year," Berger says, including many children.
The best way parents should show their concern is to take the disease seriously and get their kids the treatment they need. Asthma specialists agree that research from the past 25 years has shown inhaled corticosteroids effectively help kids control asthma and lead a productive life in school, on the playground, at home, and beyond.
"These are lifesaving drugs," Berger emphasizes."As with all medications, there are some risks. However, the risks are minimal compared with the benefits."Guidelines to help your child use his or her medications.
Always give medicines as prescribed by your child's doctor.
Do not use medicines after the expiration date on the package.
Have your child rinse and gargle with water after each use to limit the amount of medication
that enters the body by being swallowed. This activity reduces the likelihood of side effects.
Keep medications out of the reach of children.
Understand that it may take a few weeks for these medicines to begin to work.
Using a spacer can help more medicine reach the lungs and less to collect in the mouth and throat, where it will be swallowed.
Source: The Children's Hospital Medical Center of Cincinnati
Copyright 2002 by Pamela Appea for Asthma Magazine.
Reprint orders: Mosby, Inc., 11830 Westline Industrial Dr., St. Louis, MO 63146-3318; phone (314) 453-4350. Reprint no. 78/1/123558doi:10.1067/mas.2002.123558.http://www2.us.elsevierhealth.com/scripts/om.dll/serve?action=searchDB&searchDBfor=art&artType=full&id=a123558
ASTHMA MAGAZINE
By Pamela Appea
Starting your child on inhaled corticosteroids, asthma and allergy experts say, can be one of the most important steps in helping your child better manage his or her persistent asthma.
However, in 1998, the Food and Drug Administration (FDA) began to require inhaled corticosteroids, commonly referred to as steroids, to bear a label stating that kids who take the drug may experience delayed growth. Although parents may be concerned about giving their children these drugs, pediatric asthma and allergy specialists say this concern is unwarranted.
Allergy and asthma experts have found it challenging enough to get their young patients--around 5 million U.S. children have asthma--to use inhaled corticosteroids on a daily basis as recommended by national experts.So with the FDA-mandated labeling change, many experts fear parents are discouraged from choosing to give their children this medicine.
"There is a lot of steroid phobia," says Michael Blaiss, MD, vice president of the American Academy of Allergy, Asthma and Immunology and clinical professor of pediatrics and medicine at the University of Tennessee in Memphis.
Some older studies have shown that, when kids take these corticosteroids, they may experience a slowed rate of growth. The FDA thinks it is still unclear as to whether inhaled corticosteroids pose any long-term risks to a child's final height. These and other questions about corticosteroids are enough to make a parent ask: Are inhaled corticosteroids necessary? Among most pediatric asthma and allergy experts, the answer is a resounding yes.
Asthma experts say the first step is to know what inhaled corticosteroids are. For example, Blaiss explains that the steroids some athletes take to increase performance are in an entirely different class of medication than corticosteroids used for asthma.
When parents hear the doctor say inhaled steroids will be part of their child's asthma treatment, they may negatively associate that medicine with the kind of steroids athletes use.Parents often don't understand the difference and are afraid for no reason, Blaiss says.
"Estrogen is a steroid, yet there is no fear about taking estrogen," says William Berger, MD, president-elect of the American College of Allergy, Asthma and Immunology and clinical professor of pediatrics at the University of California in Irvine.
Taking their inhaled steroids may help children with asthma live fuller lives, he emphasizes, which is why it's important for parents to take their child's asthma seriously. It's important to understand the long-term benefits of inhaled corticosteroids, just as a diabetes patient knows that continuous treatment and medical care are essential.
How inhaled corticosteroids work.Inhaled corticosteroids, delivered through a small asthma inhaler (either a traditional metered dose inhaler or a newer dry powder inhaler), reduce and prevent swelling and inflammation in the bronchi, the airways of the lungs.
Specialists will prescribe specific medications so that kids can have better relief for long-term control of asthma symptoms.
Corticosteroids also come in a nasal inhaler preparation for the treatment of allergic rhinitis, commonly known as hay fever. Inhaled corticosteroids are preventive medicines.
They do not work like quick-relief inhalers and will not stop or relieve symptoms for a child in the middle of an asthma attack. They must be taken on a daily, long-term basis to be effective.
What research shows:Recent studies, including two published reports in The New England Journal of Medicine, found the definitive benefits of inhaled corticosteroids far outweigh the risks. Although children in the study did measure about 0.4 inches shorter than children on nonsteroid drugs after the first year of treatment, the researchers found that this growth lag disappeared in the following years.
So, as Finegold points out, the kids caught up and suffered no permanent loss from their adult height.
In addition, research from the Childhood Asthma Management Program funded by the National Institutes of Health's National Heart, Lung, and Blood Institute showed inhaled corticosteroids provided superior asthma control.
Compared with children on placebo, kids treated with corticosteroids had: 45% fewer urgent care visits 43% hospitalizations 45% less use of oral corticosteroids (used to treat severe exacerbations) 30% fewer days in which additional asthma medication was needed 22% more episode-free days.
Parents can take steps to ensure their child takes inhaled corticosteroids as safely as possible to minimize side effects. When taking these medicines with a traditional inhaler, it is important for the child to use a spacer attached to the inhaler. This device allows more medicine to be breathed into the lungs and less to end up in the mouth and throat, where it is swallowed and produces more systemic side effects. It is also important for the child to rinse, gargle, and spit after taking this medicine.
The focus on the inhaled steroid debate, Berger says, has approached the issue from the wrong angle."
Untreated asthma really hurts a child early growth," he says, a fact that physicians have known for years. Kids will be smaller and weaker if they don't take medications they need, he says.
Also, specialists most often prescribe inhaled corticosteroids to kids who have developed a moderate-to-severe chronic form of asthma, which means the asthma episodes are frequent, debilitating, and affecting quality of life. Most kids do extremely well when given low dosages of inhaled corticosteroids and regular check-ups.
"Five thousand people die from asthma every year," Berger says, including many children.
The best way parents should show their concern is to take the disease seriously and get their kids the treatment they need. Asthma specialists agree that research from the past 25 years has shown inhaled corticosteroids effectively help kids control asthma and lead a productive life in school, on the playground, at home, and beyond.
"These are lifesaving drugs," Berger emphasizes."As with all medications, there are some risks. However, the risks are minimal compared with the benefits."Guidelines to help your child use his or her medications.
Always give medicines as prescribed by your child's doctor.
Do not use medicines after the expiration date on the package.
Have your child rinse and gargle with water after each use to limit the amount of medication
that enters the body by being swallowed. This activity reduces the likelihood of side effects.
Keep medications out of the reach of children.
Understand that it may take a few weeks for these medicines to begin to work.
Using a spacer can help more medicine reach the lungs and less to collect in the mouth and throat, where it will be swallowed.
Source: The Children's Hospital Medical Center of Cincinnati
Copyright 2002 by Pamela Appea for Asthma Magazine.
Reprint orders: Mosby, Inc., 11830 Westline Industrial Dr., St. Louis, MO 63146-3318; phone (314) 453-4350. Reprint no. 78/1/123558doi:10.1067/mas.2002.123558.http://www2.us.elsevierhealth.com/scripts/om.dll/serve?action=searchDB&searchDBfor=art&artType=full&id=a123558
Rural Poor, Uninsured Are Half the Visitors to Health Centers, Community Health Funding Report
Rural Poor, Uninsured Are Half the Visitors to Health Centers
Expanding community-health centers to make it easier for patients to visit their doctors would strengthen the U.S. health-care safety network and enhance continuity of health care for medically underserved individuals and families, a new study indicates.
Primary-care visits by uninsured or Medicaid-insured patients accounted for 65% of visits to community health centers and 43% to hospital outpatient departments, says the study published in the Journal of the American Medical Association. In 1998, about 33 million adults in the United States ages 18 to 64 lacked health insurance and benefits.
The study also shows most patients using HHS-supported health centers are racial or ethnic minorities, people with Medicaid or no health insurance and people living in rural areas, says Dr. Claude Earle Fox, HRSA administrator.
HRSA invests $4.6 billion annually as the main HHS agency in charge of improving health care access for uninsured individuals and families in the United States.
Uninsured individuals say they cannot see a doctor when necessary because of the cost and are less likely to get routine physicals. The report shows long-term uninsured adults often were unable to see a health-care practitioner for cancer screenings, cardiovascular risk-reduction and diabetes care, though they may be at a higher risk of developing chronic disease or other health problems.
“Continuity of care is the heart and soul of wellness for patients, particularly with chronic conditions. Continuos and timely treatment can curb complicated , costly procedures down the road,” says Dr. Marilyn Hughes Gaston, HRSA associate administrator for primary care and assistant surgeon general.
Christopher Forrest and Ellen-Marie Whelan are the lead authors of the study, Primary Care Safety-Net Providers in the United States: a Comparison of Community Health Centers, Hospital Outpatient Departments and Physician Offices.
Info: HRSA, http://www.hrsa.gov;/ http://jama.ama-assn.org/.
Community Health Funding Report
October 27, 2000
Expanding community-health centers to make it easier for patients to visit their doctors would strengthen the U.S. health-care safety network and enhance continuity of health care for medically underserved individuals and families, a new study indicates.
Primary-care visits by uninsured or Medicaid-insured patients accounted for 65% of visits to community health centers and 43% to hospital outpatient departments, says the study published in the Journal of the American Medical Association. In 1998, about 33 million adults in the United States ages 18 to 64 lacked health insurance and benefits.
The study also shows most patients using HHS-supported health centers are racial or ethnic minorities, people with Medicaid or no health insurance and people living in rural areas, says Dr. Claude Earle Fox, HRSA administrator.
HRSA invests $4.6 billion annually as the main HHS agency in charge of improving health care access for uninsured individuals and families in the United States.
Uninsured individuals say they cannot see a doctor when necessary because of the cost and are less likely to get routine physicals. The report shows long-term uninsured adults often were unable to see a health-care practitioner for cancer screenings, cardiovascular risk-reduction and diabetes care, though they may be at a higher risk of developing chronic disease or other health problems.
“Continuity of care is the heart and soul of wellness for patients, particularly with chronic conditions. Continuos and timely treatment can curb complicated , costly procedures down the road,” says Dr. Marilyn Hughes Gaston, HRSA associate administrator for primary care and assistant surgeon general.
Christopher Forrest and Ellen-Marie Whelan are the lead authors of the study, Primary Care Safety-Net Providers in the United States: a Comparison of Community Health Centers, Hospital Outpatient Departments and Physician Offices.
Info: HRSA, http://www.hrsa.gov;/ http://jama.ama-assn.org/.
Community Health Funding Report
October 27, 2000
Kids Learn to Break Cycle of Addiction
Kids Learn to Break Cycle of Addiction
New York—Many children end up homeless because of parental substance abuse; studies show these kids are themselves at high risk of drug or alcohol dependency.
The Dallas-based nonprofit Rainbow Days works to break this cycle by giving homeless and nonhomeless kids individualized life-skills training and support in their schools, communities and homes, Cathy Brown, Rainbow Day’s executive director, tells attendees at an Institute for Children and Poverty conference.
Rainbow Days’ Family Connection program works with kids in small groups to help them deal with decision-making, family, friends and school. Each group gives kids age-appropriate ways to deal with substance-abuse issues.
Program participants also enroll in short-term university camps, summer camps and art groups, where they develop life skills and a strong conviction against using drugs or alcohol. Parents and guardians can participate.
Part of Rainbow Day’s strategy is giving children community-service obligations. Brown says people come to her, asking incredulously, “You have homeless children doing community service?” Brown’s reply: “You bet.” Over 32,000 children and youth have enrolled in Rainbow Days-sponsored programs since its inception, Sandi McFarland, a training administrative specialist tells CYF.
How Rainbow Days got started
After coming to terms with her own alcoholism 19 years ago, Brown realized that her young daughter was also at risk. Using her experience as a teacher and counselor, Brown started working with a small group of children, including her daughter, affected by parental addiction. Rainbow Days became incorporated in 1982.
Soon after, Brown began working with children at a Dallas shelter. Since then, Rainbow Days has spread to homeless shelters across the city.
The program has been honored by the federal Housing & Urban Development Dept.
Some 80% of Rainbow Days’ $2.5 million operating budget comes from federal grants; the rest comes from sources such as the Texas Commission on Alcohol & Drugs, the Texas Criminal Division and the United Way.
Info: Brown, 214/887-0726; www.rdikids.org.
Written by Pamela Appea
Children & Youth Funding Report
Community Development Publications
April 18, 2001
New York—Many children end up homeless because of parental substance abuse; studies show these kids are themselves at high risk of drug or alcohol dependency.
The Dallas-based nonprofit Rainbow Days works to break this cycle by giving homeless and nonhomeless kids individualized life-skills training and support in their schools, communities and homes, Cathy Brown, Rainbow Day’s executive director, tells attendees at an Institute for Children and Poverty conference.
Rainbow Days’ Family Connection program works with kids in small groups to help them deal with decision-making, family, friends and school. Each group gives kids age-appropriate ways to deal with substance-abuse issues.
Program participants also enroll in short-term university camps, summer camps and art groups, where they develop life skills and a strong conviction against using drugs or alcohol. Parents and guardians can participate.
Part of Rainbow Day’s strategy is giving children community-service obligations. Brown says people come to her, asking incredulously, “You have homeless children doing community service?” Brown’s reply: “You bet.” Over 32,000 children and youth have enrolled in Rainbow Days-sponsored programs since its inception, Sandi McFarland, a training administrative specialist tells CYF.
How Rainbow Days got started
After coming to terms with her own alcoholism 19 years ago, Brown realized that her young daughter was also at risk. Using her experience as a teacher and counselor, Brown started working with a small group of children, including her daughter, affected by parental addiction. Rainbow Days became incorporated in 1982.
Soon after, Brown began working with children at a Dallas shelter. Since then, Rainbow Days has spread to homeless shelters across the city.
The program has been honored by the federal Housing & Urban Development Dept.
Some 80% of Rainbow Days’ $2.5 million operating budget comes from federal grants; the rest comes from sources such as the Texas Commission on Alcohol & Drugs, the Texas Criminal Division and the United Way.
Info: Brown, 214/887-0726; www.rdikids.org.
Written by Pamela Appea
Children & Youth Funding Report
Community Development Publications
April 18, 2001
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