“We’ve shown that the gene being changed is directly associated with asthma and severity of the asthma,” Dr. Kari Nadeau of Stanford University, the senior study author, told a press conference at the 2013 meeting of the AAAAI in San Antonio, Texas.

The new study shows that exposure to polycyclic aromatic hydrocarbons (PAHs) in the air directly led to a change in a gene known as FOXP3. This gene exists inside regulatory T-cells, whose job is to suppress inappropriate immune responses, such as the airway inflammation associated with asthma. This alteration in the gene makes it harder for the T-regulatory cells to do their job, leading to worsened asthma symptoms.

The study also associated PAH exposure with higher overall levels of IgE antibodies, which play a major role in any allergic response.

For the study, researchers observed a group of children and teens at two sites in California: Fresno, which is known for heavy air pollution and a high rate of asthma (about 22 percent), while Stanford, a lower-pollution area, was used as a control group. Measurements were taken of PAH levels in the air, the children were given lung function tests, and also gave blood and urine samples.

The children who had been exposed to PAHs for three months before the testing were more likely to have altered FOXP3 genes, decreased T-regulatory cell function and high levels of IgE antibodies. All three differences make asthma more likely, and its impact more severe.

“Exposure to high PAH quantities may be having an effect at the molecular level, possibly leading to new cases of asthma,” said Nadeau in a press release. This altered version of FOXP3 was even found in individuals from the area who didn’t have asthma – and it is unknown whether this change is reversible.

More than 100 chemicals are classified as PAHs, which form when an organic substance is burned incompletely. Sources include oil, gas, coal, tobacco, or even meat from a barbecue (when drippings fall onto the flames, PAHs are formed which then adhere to the meat). Man-made PAHs can also be found – in tars as well as some plastics, dyes and pesticides.

See Allergic Living‘s full coverage of the 2013 AAAAI allergists conference.

First tip: The great thing about asthma is that if you learn to control it, asthma  won’t control you. Some kids ask us why they have to take the controller inhaler when their asthma doesn’t seem to be acting up. This is because using that controller every day is the best way to get a “handle” on asthma; it keeps swelling and mucous away.

Grief Relief: With that control, you shouldn’t have to get out your reliever inhaler as often. But when you do need it, don’t be embarrassed. After all, it really is a relief. And consider: almost 1 out of 10 kids have asthma; you aren’t alone!

Friends: Talk to close friends about your asthma and why you take medication. In your class, you may also be surprised to discover how many kids have medication for asthma or other health issues.

Puffer: If you do need your reliever inhaler, it will work best if you use a spacer. Why? More medicine will get down into your lungs. If you’re not comfortable with your current inhaler/puffer, speak to a parent about seeing an asthma educator and your doctor, and possibly switching to a different medication. There are dry powder inhalers available that work without a spacer. Remember, getting the medicine into your lungs helps you control the asthma with the goal of using less medication. Control means you are active and doing things you love – hanging out with friends, playing sports – or maybe a guitar.

*Certified Respiratory Educators and Certified Asthma Educators help patients gain control of asthma, and COPD. For more information about the educators, visit the Canadian Network for Respiratory Care (CNRC) at www.cnrchome.net. Ingrid Baerg, RN, CAE and Angela Alexander, RN, CAE work at the Asthma Education Clinic at B.C. Children’s Hospital.

Why should Canadians care about banning smoking in cars carrying children? Because second-hand smoke is more concentrated in a confined space. Within a vehicle, poisons found in smoke can reach high levels in a short amount of time.

A 2006 study in the American Journal of Preventive Medicine found that breathing in smoke from a single cigarette for only five minutes in a car exposes a person to the same amount of smoke as spending the equivalent time in a smoky bar. Babies and children are most vulnerable because they breathe more rapidly and take in more harmful chemicals for their size than adults do. Second-hand smoke affects their developing respiratory, immune and nervous systems.

In the United States, the Surgeon General recently released a report on the profound impact of second-hand smoke on children, revealing that kids exposed to second-hand smoke have an increased risk of sudden infant death syndrome (SIDS), acute respiratory infections such as bronchitis and pneumonia, middle ear infections, more severe asthma, respiratory symptoms and slowed growth of the lungs. The report concludes that there simply is no safe level of exposure to second-hand smoke; even brief exposures can prove harmful.

There is growing evidence as well that kids who are exposed to second-hand smoke in the womb and as infants have more behavioural problems, shorter attention spans, and lower marks than peers who aren’t exposed to smoke.

Since babies and children are powerless to protect themselves from this risk, The Canadian Lung Association is asking Canadians to take a stand with the “Clean Air for Kids” lobby. “This campaign is about protecting Canada’s children from the harmful effects of second-hand smoke,” said Nora Sobolov, president of The Lung Association. “Working together with Canadians, we are confident that action can be taken to ensure kids are not subjected to smoking in cars.”

What can you do? If you want to send a message directly to your provincial or territorial representative, visit The Lung Association.

Related:
• Discussion: Smoking outside “still harms kids”
• The dangers of third-hand smoke
• 15 ways to clean up your home’s air

First published in Breathing Space, a supplement of Allergic Living magazine.

However, a leading Canadian pediatric allergist says acetaminophen – which is the active ingredient in these popular fever-reducing drugs – is safe for children if used properly. “There’s no proof that acetaminophen causes asthma,” says Dr. Allan Becker, a researcher with the Manitoba Institute of Child Health. Even the study authors say acetaminophen remains the medicine of choice for babies with high fevers. But they stress the importance of following the guideline that its use be limited to those cases, and not used casually.

The study reported that children who had been given acetaminophen once a year or more in their first year of life showed a 46 per cent higher risk of asthma symptoms by 6 or 7 years of age compared to those who hadn’t had the drug. The findings also indicate that the asthma risk increased threefold in 6-year-olds and 7-year-olds taking the tablets one or more times a month.

Researchers gathered the data from children in 73 countries, including Canada, as part of third phase of the International Study of Asthma and Allergies in Children (ISAAC) program. The findings were published in The Lancet, the well-known British medical journal.

This study shows an association between the use of acetaminophen and the definition of asthma in the survey, explains Dr. Becker. In a questionnaire, parents were asked whether their child had experienced wheeze – a whistling noise in the chest – in the past 12 months. “In the two participating Canadian centres, Hamilton and Saskatoon, 20 per cent and 17 per cent respectively answered yes to that question,” says Dr. Becker.

However, a sub-group of these parents was shown a video of a child with asthma wheezing, instead of getting the questionnaire. Only 12 and 10 per cent of this group answered that they had seen ‘wheezing’. “This tells us that many parents who said their child was wheezing really don’t understand what we mean when we say ‘wheezing’,” said Dr. Becker.

Stay tuned. Researchers have called for a large randomized trial to settle the acetaminophen debate once and for all.

First published in Breathing Space, a supplement of Allergic Living magazine.

Since being diagnosed with asthma when he was 4 years old, Brett Favaro has suffered pneumonia and bronchitis, asthma attacks, and been to numerous doctors. Now 22, he still has a nebulizer, a machine that delivers asthma medication in a fine mist through a facemask, in his bedroom.

But if you’re picturing a skinny kid, wheezing on the sidelines, you’ve got the wrong guy. Favaro was a competitive swimmer for 13 years, culminating with a stint as captain of the varsity swim team at Simon Fraser University in Vancouver. He’s also competed in cross-country running, taken tae kwon do lessons, and played basketball. Plus, he’s an avid weightlifter. Favaro says that with the support of his doctor, “I was able to do everything that everyone else did. I just had to be more mindful of my ability to breathe than other people.”

Growing up, Favaro achieved what experts say is possible for all asthmatic kids. “If they have good control, they can be competitive to any level,” says Dr. Brian Lyttle, a pediatric respirologist in London, Ontario. Good control usually means taking a corticosteroid (such as Flovent or Pulmicort) every day to reduce inflammation, minimizing exposure to triggers such as cigarette smoke and allergens, and having a fast-acting reliever puffer on hand in case of an asthma attack.

While exercise is important for everyone, it plays a special role for people who have asthma. “The better shape you’re in, the better your lungs function,” says Dr. Michael Clarfield, a sports medicine specialist and former team physician for the Toronto Maple Leafs. “When you’re getting diminished function from your asthma, the more function you had to start with, the better off you will be.”

Dr. Alan Kaplan, a doctor in Richmond Hill, Ontario who chairs the Family Physician Airways Group of Canada, looks at it this way: “Exercising will teach your muscles to learn to work with what you’ve got. So even if you do have lung impairment, it’s still important to exercise and to teach your muscles to be able to exercise even at lower oxygen levels.”

It’s not that asthmatic kids should ignore their symptoms and push themselves into respiratory distress; rather, with the right combination of medications, and in a supportive environment with minimal triggers, all kids with the disease should be able to reach their athletic goals.

Katherine Smith, 14, a Canadian whose family lives in Phoenix, has certainly not let asthma deter her athletic pursuits. A bout with pneumonia at age 1 left her with diminished lung function, and she also has bad seasonal allergies. When she was about 9 years old, her parents noticed she had difficulty breathing when she ran or played sports at school. “If she had to do anything that required any endurance, all of a sudden she was gasping for air,” says her dad, Doug Smith.

With the right medications and a good attitude, Katherine has thrived. She pitches for a competitive softball team that placed ninth out of 70 teams at last year’s U.S. national championships. “She treats the asthma meds as something ‘I’ve just got to do to prepare,’ ” says Smith, “like going to conditioning class, or to her trainer.”