Clinic Update During COVID 19 Pandemic

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: 

https://www.cdc.gov/coronavirus/2019-nCoV/index.html 

https://www.thoracic.org/patients/patient-resources/resources/coronavirus-patient.pdf 

CPAP , A Medical Aesthetic?

 

Coronary artery disease, cerebrovascular events, cardiac arrhythmias... What about fine lines and wrinkles?  Looks like we have the whole sleep apnea marketing approach wrong.

Patients With OSA Are Perceived as Younger Following Treatment With CPAP.

Yagihara F1, Lorenzi-Filho G2, Santos-Silva R3.

Abstract

BACKGROUND: 

The aim of this study was to compare the effects of CPAP treatment and placebo intervention on the facial appearance of patients with OSA.

METHODS: 

Patients with severe OSA were randomized to receive either CPAP treatment or nasal dilator (placebo) intervention for 1 month. The sequence was interposed by 15 days of washout with no treatment. Patients were evaluated by using questionnaires, polysomnography, and facial photographs at baseline and at the end of both interventions. In an electronic survey, the photographs were presented in a randomized order to 704 observers who rated the perceived age, health, attractiveness, and tiredness of the patients. Observers were unaware of the patients' conditions.

RESULTS: 

Thirty patients (age, 46 ± 9 years; 21 men; apnea-hypopnea index, 61.8 ± 26.2) were evaluated. During each intervention period, patients used CPAP 6.0 ± 1.7 h per night on 94% of the nights and the placebo intervention on 98% of the nights. After CPAP treatment, patients were rated younger (47.9 ± 3.5 years) than they appeared at baseline (53.9 ± 4.0 years) and following the placebo treatment (49.8 ± 3.7 years) (P < .001). Linear regression analysis identified that CPAP adherence, total sleep time, and percentage of total sleep time with oxyhemoglobin saturation < 90% were predictors of a decreased age rating following CPAP treatment.

CONCLUSIONS: 

Patients with severe OSA had a younger appearance following 1 month of CPAP treatment. This benefit can serve as an additional source of motivation for patients with OSA to comply with CPAP treatment and may facilitate OSA management.

Read abstract here.

Good Sleep Hygiene in Adolescents With Asthma Linked to Improved Attention

A real world comparison of this study seems to fit what we know.  Child and adolescent sleep patterns are woefully bad.  It's no surprise then that attentiveness and other quality of life factors can improve immensely when we "clean up" our sleep habits. Dr. Susarla

Adolescents with asthma who practice good sleep hygiene may experience improvements in sleep and attention span, better quality of life in school, and lower rates of dysfunction during the daytime, according to a study published in the Journal of Asthma. 

This study included 41 participants with persistent asthma (mean age, 14.83±1.28 years; 51.2% male adolescents). Measures included demographic information (sex, age, race/ethnicity, education, caregiver marital status, and family income), information on asthma, sleep hygiene via the adolescent sleep hygiene scale (ASHS), quality of sleep via the Adolescent Sleep Wake Scale (ASWS), quality of life via the Pediatric Quality of Life Index (PedsQL), and attention span via the psychomotor vigilance task (PVT).

To investigate associations among variables related to asthma, as well as between demographic features and dependent variables, Pearson product-moment correlations were used. The predictive power of sleep hygiene on sleep quality, quality of life (school-related or otherwise), and attention span was calculated using linear regressions. Because the sample size was smaller than the recommended 73 participants, effect sizes were used to interpret results. Cohen's f² effect sizes were categorized as large (0.35), medium (0.15), or small (0.02).

Read article here.

Can We Predict Childhood Asthma Earlier?

Predicting and appropriately diagnosing early childhood asthma is still a challenge, particularly with some "conventional wisdom" that diagnosing under 5 is too early. Can we arrive at a set of criteria where treatment is indicated? Health care providers needs tools to help direct us when early intervention is needed.  Predictive scores like the Pediatric Asthma Risk Score may bring us closer to the mark. Dr. Susarla

A new quantitative personalized tool to predict asthma development in young children predicted asthma development reliably according to results of a study published in the Journal of Allergy and Clinical Immunology.

Data from the Cincinnati Childhood Allergy and Air Pollution Study, a birth cohort of infants born to atopic parents between 2001 and 2003 in Cincinnati, Ohio, and Northern Kentucky was used to develop a quantitative personalized tool called The Pediatric Asthma Risk Score to predict asthma development in young children. The sensitivity and specificity of the Pediatric Asthma Risk Score were compared with those of the Asthma Predictive Index in the Isle of Wight study, which was a United Kingdom whole population birth cohort study.

Read article here.

Antibiotics in Childhood Asthma

Most experts agree that there is little role in use of antibiotics in chronic or acute treatment of asthma.  In addition, antibiotic overuse may delay diagnosis and management of a chronic condition and undermine medical provider recommendations. 

After all, if an inflammatory lung condition is repeatedly conflated with an infectious process, families may lose faith in medical care and seek treatment options elsewhere.

Dr. Susarla

Children with asthma are prescribed antibiotics at a higher rate than those without asthma, according to a study published in BMJ Open. Furthermore, the diseases for which they are prescribed typically do not call for antibiotics.

This underscores the importance of measured distribution of antibiotics among physicians to avoid overprescribing and its consequences, which include further infection and microbial resistance.

This population-based retrospective cohort study included data from 26,750 participants with asthma and 330,916 without asthma, all of whom were aged 5 to 18 years old. Asthma was defined by ≥2 respiratory drug prescriptions within 1 year after receiving an asthma code. Data were collected from The Health Improvement Network (THIN) in the UK and Integrated Primary Care Information Database (IPCI) in the Netherlands. Rates of antibiotic prescriptions were compared using a Poisson regression model, and use indications were compared between individuals with and without asthma using Fisher's exact or chi-square tests.

Read article here.

New Severe Asthma Guidelines Recommend FeNO Monitoring

If your patients end up on high dose asthma therapy or have frequent exacerbations, reassessment is needed.  Exhaled nitric oxide testing provides a method for non-invasive point of care assessment for asthma and asthma control and can help direct therapy for severe asthma.  The latest iteration of GINA guidelines acknowledges this. Dr. Susarla

In a significant advancement in the treatment of severe asthma, the latest diagnosis and management guide from the Global Initiative for Asthma (GINA) makes new recommendations for assessment tools.

The new guide now recommends fractional exhaled nitric oxide (FeNO) monitoring as an assessment tool to determine whether patients who are on high-dose inhaled corticosteroids or low-dose oral corticosteroids have residual inflammation.

In a statement accompanying the new guidelines, Dr. Helen Reddel, Chair of the GINA Science Committee and a research leader at the Woolcock Institute of Medical Research in Sydney, Australia, explained that difficult-to-treat and severe asthma are currently high priority due to their “physical, emotional and financial burden for patients and their families.”

 “Clinicians in both low and high income countries need practical advice about how to assess and treat patients for whom conventional asthma therapies don’t seem to be working, and about how treatment strategies, including biologic therapies if available, can be implemented into patient care,” Reddel said.

Utilizing FeNO measurements can provide a potential predictor of positive responses to anti-immunoglobulin E (anti-IgE) therapy for patients with severe, allergic asthma, and is a tool to identify refractory type 2 inflammation in patients on high-dose inhaled corticosteroids therapy.

“The new GINA guidelines build on an earlier US Agency for Healthcare Research and Quality (AHRQ) report in terms of the strength of FeNO as a practical tool that improves outcomes for asthma patients,” said David Acheson, Senior Vice President of US Commercial at Circassia Pharmaceuticals, Inc., a specialty pharmaceutical company focused on respiratory disease which announced the new recommendations on December 5.

Read article here.

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.