Fitness: likely

Wednesday, 19 December 2012

Why are kids in asthma hotspots in NYC more likely to visit the ER? Exercise may be a factor

Dec. 17, 2012 — Asthmatic children in New York City neighborhoods with high rates of asthma make many more visits to the emergency room (ER) than those who live in other parts of the city. While socioeconomic factors such as lack of adequate preventive care are part of the equation (high-asthma neighborhoods tend to be lower income), new research points to a possible biological basis for the disparity. Asthmatic children living in asthma hotspots were twice as likely to experience a common symptom known as exercise-induced wheeze than were those in neighborhoods with lower asthma rates.

Results by researchers at Columbia University Medical Center and Dartmouth-Hitchcock Medical Center appear online in Pediatrics, the journal of the American Academy of Pediatrics.

The study enrolled 195 middle-income children with asthma, ages 7 and 8, living throughout New York City -- in areas with varying asthma prevalence. The children were given a clinical evaluation, and their caregivers completed a health survey that included whether they had experienced exercise-induced wheeze one or more times in the past year.

Overall, 43% of the children had experienced exercise-induced wheeze. Those living in asthma hotspots were twice as likely to have experienced symptoms after exercise and more likely to have visited their doctor in a hurry or an ER because of breathing problems, even after adjusting for neighborhood, income, and other factors.

"Exercise-induced wheeze is very uncomfortable for children. It can present rapidly after beginning any strenuous activity and lead quickly to respiratory symptoms, so it is not surprising that it is a factor in ER visits," said lead author Timothy Mainardi, MD, past fellow at Columbia University Medical Center and currently in practice at Hudson Allergy.

Dr. Mainardi and his colleagues found that one-third of the children experiencing exercise-induced wheeze had not used an inhaler prior to exercising. "The good news," he said, "is that these symptoms are preventable. Parents should talk with their doctor so they can be ready with a plan, including the use of appropriate medication such as a bronchodilator inhaler prior to exercise."

Addressing neighborhood disparities in asthma-related ER visits has been a public health priority for many years. A 2002 report by the New York City Department of Health and Mental Hygiene found that ER visits for asthma were up to 20 times more common in low-income neighborhoods than elsewhere. Since then, asthma-related ER visits have declined, although a gap between higher and lower income neighborhoods remains.

To help explain these differences, the Columbia researchers first looked to see if asthma was more severe in low-income, high-asthma neighborhoods. It was not. "Lung function, airway inflammation, allergy to common asthma triggers, and symptom frequency were similar no matter where the child lived," said senior author Matthew Perzanowski, PhD, associate professor of environmental health sciences at Columbia's Mailman School of Public Health. By process of elimination, the researchers focused on one particular manifestation of the disease: rapid airway constriction brought on by exercise.

Exactly why asthma hotspots have higher rates of this symptom remains a mystery. While inadequate use of a bronchodilator inhaler prior to exercise was part of the story, it didn't fully explain the findings. Allergens and air pollution related to fossil fuel burning were not found to be factors. Neither were differences in physical activity, obesity, or neighborhood conditions such as the number of parks.

"Exercise-induced symptoms," said Dr. Perzanowski, "may identify a distinct population of asthmatics with causes for their exacerbations yet to be determined. The important lesson is that with greater awareness and treatment, we can hope to prevent those unscheduled visits to the doctor and trips to the ER."

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The above story is reprinted from materials provided by Columbia University's Mailman School of Public Health, via EurekAlert!, a service of AAAS.
Note: Materials may be edited for content and length. For further information, please contact the source cited above.

Journal Reference:

Timothy R. Mainardi, Robert B. Mellins, Rachel L. Miller, Luis M. Acosta, Alexandra Cornell, Lori Hoepner, James W. Quinn, Beizhan Yan, Steven N. Chillrud, Omar E. Olmedo, Frederica P. Perera, Inge F. Goldstein, Andrew G. Rundle, Judith S. Jacobson, and Matthew S. Perzanowski. Exercise-Induced Wheeze, Urgent Medical Visits, and Neighborhood Asthma Prevalence. Pediatrics, December 17, 2012 DOI: 10.1542/peds.2012-1072

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

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ACL knee injuries much more likely in female athletes

Nov. 14, 2012 — Female athletes are far more likely than males to suffer serious ACL knee injuries. But many of these injuries could be prevented by doing preseason conditioning and using proper landing techniques after jumping, said Loyola University Medical Center orthopaedic surgeon Dr. Pietro Tonino.

With basketball season underway, Tonino and other orthopaedic surgeons are seeing a significant number of knee injuries in female athletes, ranging from middle school to the pros. Tonino is a sports medicine specialist who has performed thousands of knee surgeries.

Doctors aren't certain why female athletes are more prone to ACL injuries. One reason may be related to how they jump, Tonino said. Due to the shape of the female pelvis, females tend to land from a jump with their knees locked. This puts added pressure on the knee. Females also tend to be more knock-kneed -- with knees close together and the ankles far apart.

To reduce the risk of an ACL injury, Tonino said, an athlete should slightly bend the knees and hips when landing. Position the buttocks as if you were about to sit down, rather than standing upright. Land on your forefoot, not your heel. And strengthen your hamstrings with weight training.

Tonino and other sports medicine physicians recommend athletes participate in summer programs that teach conditioning and injury-prevention techniques. The athlete or her parents should ask the team's certified athletic trainer or team physician about such programs.

Tonino noted that the American Orthopaedic Society for Sports Medicine web site offers these additional tips to prevent basketball injuries:

-- Have a pre-season physical and follow your physician's recommendations for preventing injuries.

-- Maintain proper fitness -- injury rates are higher in athletes who have not properly trained.

-- After a period of inactivity, progress gradually back to full contact basketball through aerobic conditioning, strength training, etc.

-- An athlete should return to play only when cleared by a health care professional.

The ACL (anterior cruciate ligament) is one of the four major ligaments of the knee. It connects the front of the tibia (shinbone) with the back of the femur (thighbone). It helps provide stability to the knee joint. Patients with torn ACLs often experience their knee "giving out."

Minor ACL tears can be treated nonsurgically. But significant ACL tears require surgery. An orthopaedic surgeon removes a tendon from the patient's knee and uses it to replace the torn ligament.

Tonino said surgical instruments and techniques are improving, and ACL surgery is becoming less invasive. But the operation still requires six months of rehab. ACL injuries also can involve torn cartilage, which can limit motion and lead to arthritis.

"Unfortunately, a reconstructed knee will never be as good as the God-given knee," Tonino said. "So we should be doing all we can to prevent these injuries in the first place."