Transient Tachypnea of the Newborn May be an early Clinical Manifestation of wheezing symptoms.

Tachypnea means rapid breathing.  Some newborns have a disorder called “Transient Tackypnea of the Newborn (TTN)”.  This means that the baby has episodes of rapid breathing starting shortly after birth.  This usually normalizes within 2-5 days. TTN occurs more frequently in babies born by cesarean, babies born pre-term (before their due date) and in male babies.  For the most part, TTN resolves well without long term effects.  Some studies have shown a higher rate of wheezing problems in preschool children who had TTN at birth.

Research question:  Is TTN associated with increased risk of wheezing problems in children in early life?  What factors play a role in the increased risk?

Researchers analyzed the records of all children born at term in Manitoba in 1995.

They looked at their birth records as well as records of children diagnosed with a wheezing related respiratory illness in the first 7 years of life.  This includes seeing the doctor or hospital for acute bronchitis or bronchiolitis, chronic bronchitis, asthma or a prescription for asthma medications.

Findings:

2.4 % of children born in Manitoba in 1995 developed TTN at birth. 

Children who had TTN were more likely to have wheezing problems in early life.  These wheezing problems may be longer term than originally thought and may develop into asthma.

Risk factors for developing TTN are:

• birth weight greater than 4500gm (10 lbs)
• being male child
• living in urban (city) environment
• babies born by cesarean section
• mother with asthma

Children whose mothers have asthma are more at risk of developing TTN.  These children are also genetically more at risk of developing asthma. TTN may therefore be the first indication of asthma rather than a cause of asthma.

Certain chemicals are released in the baby during vaginal delivery that helps clear the lungs of fluid. The surge in this chemical is absent during a cesarean section, possibly leading to TTN.

Environmental factors may also play a role in the increased risk.  Most children admitted to the intensive care with TTN had also received antibiotics for 48 hours.  Early antibiotic use changes the normal bacteria in the baby’s intestines, putting them at increased risk for developing allergies.  

Conclusion: TTN is associated with higher risk of asthma. TTN may therefore be an early sign of asthma. It is possible that the combination of genetic risk (mother with asthma) and an environmental change (use of antibiotics, cesarean birth) together increases the risk of asthma.

Transient tachypnea of the newborn may be an early clinical manifestation of wheezing symptoms. Liem JJ, Huq SI, Ekuma O, Becker AB, Kozyrskyj AL. J Pediatr. 2007 Jul;151(1):29-33.

Ask the Researcher: Sulphite Allergy

Have you ever done any research on asthma and sulphite allergies? Have you heard of these two being related?

Sulphite sensitivity has been extensively studied.  Although rare, it is more frequently associated with severe asthma. Sulphite allergy is rarely associated with a rash. An allergist can help determine if symptoms are caused by a sulphite allergy by doing a "sulphite challenge".  During a sulphite challenge, the allergist will give the patient some foods with sulphite and observe the patient's response. This can help identify the casue of the symptoms the patient is experiencing.

Asthma is not Enough: Continuation of Smoking Among Parents with an Asthmatic Child

Exposure to environmental tobacco smoke (ETS) is associated with poor asthma control in children, frequent asthma exacerbations, increased rates of hospital use and reduced rates of recovery after asthma exacerbations. Passive smoke exposure has been shown to increase airway sensitivity in asthmatic children. On diagnosis of asthma in a child, parents are educated to decrease ETS exposure to their children. The amount of smoking in the general population has decreased significantly over the past decade.

Research question: Are parents likely to stop smoking once they know their child has asthma?

In 2002-2003, the SAGE survey was sent to 12, 556 households with children born in 1995 in Manitoba. The survey focused on the health of the child and the child’s family, including whether or not a child had asthma and if smokers were present in the home in 1995 and in 2002/2003.

Findings: A total of 1151 surveys indicated that a smoker was in the home in 1995 when their child was born. In 2002/2003, the prevalence of smoking in the home had decreased from 32.2% to 23.4% and was similar for participants living in both urban and rural locations.

Just over 12% of households reported that their child had asthma in 2002/2003. Among this group, 40% had someone who smoked in 1995.

Homes with an asthmatic child were more likely to have a smoker present in 1995 and in 2002/2003. Parents of asthmatic children were less likely to quit smoking or smoke outside.

Conclusion: Parents of a child with asthma who participated in the study were not more likely to change their smoking behaviour than parents without an asthmatic child. Many parents continue to smoke in spite of having children with asthma. Parental smoking behaviour did not change if there was a positive family history of asthma, if they lived in a rural or urban location, or if they were from a low-or high-income household.  Having a child with asthma is not enough to motivate a parent to quit smoking.

Asthma is not enough: continuation of smoking among parents with an asthmatic child.Liem JJ, Kozyrskyj AL, Benoit CM, Becker AB. Can Respir J. 2007 Sep;14(6):349-53

Dr. Becker talks about the SAGE Study

Happy World Asthma Day! 

Why not celebrate with Dr. Becker, one of the lead investigators of the SAGE study?  Watch this short video that describes the goals and some findings of this very important research.

Stay tuned for more events related to World Asthma Day.

Normalization Strategies of Children With Asthma

Asthma rates have increased dramatically in the past 40 years.  12% of Canadian children now live with this chronic disease. Chronic asthma can psychologically affect children.  Children have reported having feelings of  anger, fear, frustration, guilt, loneliness and anxiety. Exploring one’s self-identity is an important task of early adolescence. Children want to be considered “normal”, and be treated by their peers as such.  Living with a chronic illness may affect how children view themselves and their health.

Research Question: How do older children and adolescents perceive living with a chronic illness?  What strategies do they use to help them cope with asthma and “feel normal”?

Researchers interviewed 22 boys and girls 11 years of age. 7 children had mild asthma, 9 had moderate asthma and 6 had severe asthma. Questions were designed to have kids describe their experiences of living with asthma and compare their health to that of their peers.  Children were also asked how they would describe asthma to a friend who had been recently diagnosed?

Findings:

• All children but one acknowledged that asthma had an impact on their  life at least some times and to varying degrees.
• Children describe asthma attacks as painful, “it takes your breath away”, affecting their ability to complete or participate in an event.
• Asthma also affects children emotionally. Some girls said that asthma made them feel different or weird and that asthma was scary. One boy felt that asthma prevented him from getting good marks in gym which made him feel horrible.  
• Asthma sometimes stops children from doing what other kids can do.  These feelings were  motivation for developing strategies to minimize the impact and normalize their life.

What do children do to “normalize” asthma?

• 16 children saw their health as just the same and pretty good.
• 6 children saw their health as all right, but not perfect, due to asthma attacks.
• Many emphasized their abilities and minimized their differences.
• All mention wheezing and coughing but then tend to say “it’s really not that hard to live with” – children look at the activities they can and do take part in rather than those they don’t.
• Children take pride in participating in all activities, at time finding ways to adapt their participation (playing goal).
• Children don't necessariy change their activities but may decrease their physical exertion during an activity.
• All view medications as an important part of managing asthma and permitting participation in activities. 

Conclusion: Children with asthma see themselves as different but develop normalization strategies to fit in with their peers. Children see the use of medication as a means of achieving normalcy.

Understanding a young’s person’s desire to integrate with peers and live as normally as possible could help provide a more holistic dimension to care.  Also asking questions about normalization strategies may help uncover true asthma control.  The desire to keep up with peers may be a way to motivate a young person to follow measures required to maintain asthma control.

Normalization strategies of children with asthma. Protudjer JL, Kozyrskyj AL, Becker AB, Marchessault G. Qual Health Res. 2009 Jan;19(1):94-104. Epub 2008 Nov 7.

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