During a period where office visits are reduced when possible and safe, and when some lung function testing maneuvers are avoided (spirometry) because of increased risk for asymptomatic infection spread, it is a great advantage to have quality home monitoring options. The Capmedic device does this and provides the additional benefit of coaching asthma patients through proper lung function and allowing your asthma doctor to monitor compliance. Dr. Susarla
Thursday, September 17, 2020
Tuesday, July 14, 2020
Are children at significant risk for a COVID-19 infection? Although there may certainly be high risk groups, the data do not seem to support this.
Age-dependent effects in the transmission and control of COVID-19 epidemics
The COVID-19 pandemic has shown a markedly low proportion of cases among children1,2,3,4. Age disparities in observed cases could be explained by children having lower susceptibility to infection, lower propensity to show clinical symptoms or both. We evaluate these possibilities by fitting an age-structured mathematical model to epidemic data from China, Italy, Japan, Singapore, Canada and South Korea. We estimate that susceptibility to infection in individuals under 20 years of age is approximately half that of adults aged over 20 years, and that clinical symptoms manifest in 21% (95% credible interval: 12–31%) of infections in 10- to 19-year-olds, rising to 69% (57–82%) of infections in people aged over 70 years. Accordingly, we find that interventions aimed at children might have a relatively small impact on reducing SARS-CoV-2 transmission, particularly if the transmissibility of subclinical infections is low. Our age-specific clinical fraction and susceptibility estimates have implications for the expected global burden of COVID-19, as a result of demographic differences across settings. In countries with younger population structures—such as many low-income countries—the expected per capita incidence of clinical cases would be lower than in countries with older population structures, although it is likely that comorbidities in low-income countries will also influence disease severity. Without effective control measures, regions with relatively older populations could see disproportionally more cases of COVID-19, particularly in the later stages of an unmitigated epidemic.
Monday, May 25, 2020
Here is a look at pediatric and young adult cases of COVID 19 from Washington, DC. Note the higher percentage of cases in infants and older teenagers, in addition to asthma as the most common comorbidity. Other chronic conditions more likely to be associated with ICU admission.
Read article here.
Read article here.
Thursday, April 30, 2020
As data continues to stream in regarding possible risk factors for COVID 19, one missing population besides children in general seems to be .... asthma. COVID 19 and other SARS type viruses are known to enter lung cells (type 2 pneumocytes) through a cell surface receptor known as ACE2. According to this study, there appears to be reduced cell surface expression in people with allergic diseases. This is of course, not enough to clear children with asthma from significant risk, but warrants investigation. Incidentally, nonatopic individuals did NOT have reduced ACE2 expression.
Viral respiratory infections are the most common trigger of severe asthma exacerbations in children and adults. Unexpectedly, large epidemiological studies of the COVID-19 pandemic in China did not identify asthma as a risk factor of severe COVID19 related illnesses.(2) Here, we report that respiratory allergy and controlled allergen exposures are each associated with significant reductions in ACE2 expression. ACE2 expression was lowest in those with both high levels of allergic sensitization and asthma. Importantly, non-atopic asthma was not associated with reduced ACE2 expression. Given that ACE2 serves as the receptor for SARS-CoV-2, our findings suggest a potential mechanism of reduced COVID-19 severity in patients with respiratory allergies. However, it is likely that additional factors beyond ACE2 expression modulate the response to COVID-19 in allergic individuals, and elucidation of these factors may also provide important insights into COVID-19 disease pathogenesis. Strengths of our study include carefully phenotyped cohorts of children and adults. Further, the allergen challenge studies included both upper and lower airway samples, with each demonstrating a consistent impact on ACE2 expression. Limitations include lack of clinical information to directly link ACE2 expression to SARS-CoV-2 infection and illness severity in our study populations. In addition, we do not have data on the ACE2 protein levels to confirm the gene expression data, though previous work suggests a direct association between ACE2 mRNA levels and ACE2 protein levels in the lung.(8)
Sunday, March 29, 2020
An emergency declaration from the State of Texas has made it easier for physicians to take care of patients during a time where routine clinic visits pose substantial risk of infection spread. A host of well marketed telemedicine organizations, some promoted by your insurance company have swooped in, attempting to fill the gap. They are missing one crucial element - YOUR doctor.
Adapted from the Texas Medical Association, here are answers to common questions on the patient side:
Friday, March 27, 2020
Economy does not equal quality.
An anticipated shortage of hospital ventilators has led some organizations to look at potential innovative ways to maximum the use of available hospital equipment. Undoubtedly, these are trying times for critical care docs.
However, numerous organizations have highlighted major potential risks associated with these measures, including this list provided by the Society for Critical Care Medicine:
Monday, March 23, 2020
We have stepped up to protect our patients, our staff and the community during the coronavirus (COVID-19) pandemic. Houston Specialty Clinic has CHANGED almost all clinic office visits to telemedicine, effective immediately due to the urgent need for all of us to reduce the risk of infection.
We will still be OPEN for the following patient visit types:
- Patients requiring regular injections for asthma management
- Urgent visits
Fortunately, the State of Texas has issued an emergency declaration waiving many restrictions on telemedicine. Therefore, our providers are available during office hours for telemedicine consultation for both new AND existing patients.
Please see the following links for useful resources infection prevention: