CPAP or Surveillance Device?

An unfortunate spin on an extremely useful technology that can strengthen doctor/patient relationship and improve sleep apnea outcomes when used properly.  Step off regulators!  Dr. Susarla

Last March, Tony Schmidt discovered something unsettling about the machine that helps him breathe at night. Without his knowledge, it was spying on him.

From his bedside, the device was tracking when he was using it and sending the information not just to his doctor, but to the maker of the machine, to the medical supply company that provided it and to his health insurer.

Schmidt, an information technology specialist from Carrollton, Texas, was shocked. "I had no idea they were sending my information across the wire."

Schmidt, 59, has sleep apnea, a disorder that causes worrisome breaks in his breathing at night. Like millions of people, he relies on a continuous positive airway pressure, or CPAP, machine that streams warm air into his nose while he sleeps, keeping his airway open. Without it, Schmidt would wake up hundreds of times a night; then, during the day, he'd nod off at work, sometimes while driving and even as he sat on the toilet.

"I couldn't keep a job," he said. "I couldn't stay awake." The CPAP, he said, saved his career, maybe even his life.

Read article here.

Excess Weight Increases Asthma Risk

Proximity to holidays purely coincidental.  Nonetheless, watch the pounds folks! Dr. Susarla

Children who are overweight or obese are at increased risk for asthma, researchers report.

A retrospective study, published in Pediatrics, included 507,496 children followed for an average of four years. None of the children had incidents of asthma before the start of the study.

The researchers divided the children into three groups: overweight, defined as the 85th to 94th percentile for weight; obese, the 95th percentile or higher; and normal weight, the 25th to 64th percentile.

The study controlled for age, race, health insurance, food allergies, medications and other factors, and found that compared with children of normal weight, the overweight were 17 percent more likely to have been given a diagnosis of asthma and to take an asthma medication. The obese were 30 percent more likely.

The researchers estimate that 23 to 27 percent of asthma cases in obese children can be attributed to the obesity itself. Among all the children, 10 to 13 percent of asthma cases were attributable to obesity.

Read article here.

Does anesthesia in children cause developmental delay?

Many parents I counsel regarding need for flexible bronchoscopy hesitate when they realize anesthesia is involved, albeit even for a short procedure.  This study suggests risk may be exaggerated. Dr. Susarla

Young children who had surgical procedures with general anesthesia prior to primary school entry did not have an increased risk of detectable adverse neurodevelopment outcomes compared with their siblings who did not have surgery, according to a Canadian analysis.

After adjusting for confounding factors, no significant differences were found between exposed and unexposed children in early developmental vulnerability or in each of the major domains of the Early Development Instrument (EDI), a teacher-assessed measure of primary school readiness, reported James O'Leary, MD, and co-authors of the Hospital for Sick Children in Toronto, writing in JAMA Pediatrics.

"These findings further support that exposure to anesthesia and surgery in early childhood is not associated with detectable adverse child development outcomes," O'Leary told MedPage Today.

But "while the findings are generalizable to the majority of young children who have a single surgical procedure performed, it is still not known whether children with repeated or lengthy exposures to surgery and anesthesia are at increased risk of altered neurodevelopment," he added.

Read article here.

Xyrem, narcolepsy therapy for adults AND children

Narcolepsy is debilitating.  In the right child with narcolepsy, sodium oxybate can be life changing.  Dr. Susarla


Sodium oxybate (Xyrem) has been approved by the US Food and Drug Administration (FDA) for the treatment of cataplexy and excessive daytime sleepiness in pediatric patients aged 7 to 17 years old with narcolepsy.

Sodium oxybate is a central nervous system depressant administered as an oral solution and can be given either alone or in combination with other central nervous system depressants. These can include opioid analgesics, benzodiazepines, sedating antidepressants or antipsychotics, sedating anti-epileptic drugs, general anesthetics, muscle relaxants, and/or illicit central nervous system depressants.

The recommended dose for sodium oxybate is 0.5 g/mL, which may only be dispensed to patients enrolled in the XYREM REMS Program because of the risk of serious outcomes that can occur from inappropriate prescribing, misuse, abuse, and diversion.

Narcolepsy resources:

narcolepsynetwork.org

healthysleep.med.harvard.edu/narcolepsy/resources

morethantired.com

Read article here.

Welcome Dupixent!

When new anti-asthma biologics come to the door, always give them a welcome seat. Here is an anti- atopic dermatitis monoclonal antibody that also shuts down a key component of the allergy airway inflammation pathway, now a 12 and up asthma therapy.  Dr. Susarla

Dive Brief:

• Sanofi and Regneron have won an expanded U.S. approval for Dupixent in asthma, securing another indication for the biologic drug which the companies are counting on to deliver blockbuster sales. 
• On Friday, the Food and Drug Administration OK'd the drug for moderate-to-severe asthma patients with an eosinophilic phenotype, or with oral corticosteroid-dependent asthma regardless of phenotype, the companies said. The new indication adds to Dupixent's previously approved use for moderate-to-severe atopic dermatitis.
• Clinical results supporting the approval showed Dupixent cut severe asthma attacks by 67% compared to placebo in patients with high eosinophil counts. Among patients with lower levels of the inflammation marker, however, Dupixent did not separate from placebo in statistical comparison. 

Read article here.

Digital Devices for Insomnia? Researchers say YES

Cognitive behavioral therapy is an intervention the incorporates coping strategies and behavioral modifications to treat a variety of conditions including insomnia.  When done properly it has been shown to be as effective as pharmacotherapy. Dr. Susarla

Digitally delivered cognitive-behavioral therapy not only improved insomnia, but also provided “around-the-clock” health, psychological, and quality-of-life improvements, according to investigators.

Compared with control subjects, patients who used a cognitive-behavioral therapy (CBT) program and associated iPhone app had small improvements in functional health and psychological well-being and large improvements in sleep-related quality of life, the investigators reported.

Those changes were mediated by a large improvement in insomnia, according to Colin A. Espie, PhD, professor of sleep medicine at the University of Oxford (England), and his colleagues.

“These findings indicate that digital CBT improves both daytime and nighttime aspects of insomnia, lending further weight to the clinical guideline recommendation of CBT as the treatment of choice for insomnia,” Dr. Espie and his colleagues reported in JAMA Psychiatry.

Their study included 1,711 adults with symptoms of insomnia that were self-reported and a score of 16 or less on the Sleep Condition Indicator (SCI), which has a range of 0-32. A total of 853 were randomized to receive digital CBT, of whom 413 completed six scheduled 20-minute sessions; an additional 276 adults completed at least one session. The control arm included 858 individuals randomized to sleep hygiene education, of whom 759 went on to receive that intervention.

Read article here.

10 Treatable Traits That Could Predict Asthma Attacks

The science and art of predicting asthma risk may go beyond asthma symptoms and lung physiology and intersect with the presence of chronic disease. Dr. Susarla

With increasing attention on a “treatable traits”—a new classification and precision medicine strategy for asthma and other chronic airway diseases,1 a team of researchers set out to examine whether and which treatable traits could be identified from registry data in persons with severe asthma and used to predict the future risk of asthma exacerbations.2

In their study, published in the journal Respirology, the investigators recorded the prevalence of the treatable asthma traits of 434 participants with severe asthma and 102 participants with non-severe asthma, all of whom were enrolled in the Australasian Severe Asthma Web‐Based Database. The prevalence of participants’ treatable asthma traits were described. They assessed participants at the study’s outset and then every 6 months thereafter for 24 months.

Of the 24 treatable traits the researchers identified, 10 predicted exacerbation risk in the participants with severe asthma, with the 5 strongest as follows:

• Being prone to exacerbations
• Depression
• Inhaler device polypharmacy
• Vocal cord dysfunction
• Obstructive sleep apnea

“Treatable traits can be assessed using a severe asthma registry,” the authors concluded. “In severe asthma, patients express more treatable traits than non‐severe asthma. Traits may be associated with future asthma exacerbation risk demonstrating the clinical utility of assessing treatable traits.”

Read article here.