Asthma Watch

JULY 10, 2011

Ventilator Guidelines Can Help Premature Infants Breathe Easier

Guidelines that minimize the use of mechanical ventilation with premature infants in favor of a gentler form of respiratory support can substantially affect patient outcomes while reducing the cost of care, according to a study appearing in the June issue of Pediatrics. Infants born prematurely are often placed promptly on a mechanical ventilator with intubation and supplemental oxygen to help their immature lungs breathe. The excess pressure placed on the lungs can lead to ventilator-induced inflammation, scarring, and potentially bronchopulmonary dysplasia (BPD), a disabling chronic lung disease.

“While they are sometimes necessary, both supplemental oxygen and mechanical ventilation are essentially toxic to premature babies’ lungs,” said lead researcher Bernadette Levesque, MD, of both Children’s Hospital Boston and the Neonatal Intensive Care Unit (NICU) at St. Elizabeth’s Medical Center in Boston. “These guidelines really represent 5 different interventions aimed at limiting those exposures.”

The study centered on 5 care guidelines intended to encourage the use of a “bubble” continuous positive airway pressure (bCPAP) system rather than mechanical ventilators, and limit exposure to supplemental oxygen. The bCPAP system delivers warmed, humidified oxygen in a way that inflates a premature infant’s lungs more gently. The 5 guidelines—exclusive use of bCPAP, provision of bCPAP in the delivery room, strict intubation criteria, strict extubation criteria, and prolonged CPAP with avoidance of nasal cannula oxygen before 35 weeks of age—were implemented in the St. Elizabeth’s NICU by Children’s staff in 2007.

“There is a long-standing but growing movement away from the use of mechanical ventilators with these children, and while there have been other large studies, they have only focused on provision of CPAP in the delivery room,” Dr. Levesque noted. “We think that by putting all 5 in place at the same time we are giving these children more complete support.” PT

Asthmatic Children at Higher Risk for Flu Complications

Children with asthma are at an increased risk for complications and death from influenza, according to research published online June 6, 2011, in Pediatrics that underscores the importance of vaccination in this population.

A team of investigators led by Fatimah S. Dawood, MD, of the Centers for Disease Control and Prevention’s Influenza Division, conducted surveillance of 5.3 million children aged 17 years or younger for hospitalization with influenza during the 2003-2009 influenza seasons and the 2009 pandemic, and identified those with asthma. The authors found that 701 (32%) of the 2165 children hospitalized with influenza during the 2003- 2009 influenza season had asthma; during the 2009 pandemic, 733 (44%) children had asthma. A comparison of the 2 groups indicated that children with the pandemic strain were significantly more likely than those with seasonal influenza to require intensive care and be diagnosed with pneumonia.

“Complications such as pneumonia and need for intensive care occur in a substantial proportion of children with asthma,” the authors wrote. In the United States, influenza vaccination coverage among children with asthma remains poor, despite long-standing recommendations of immunization, Dawood and colleagues noted.

In this study, only 36% to 52% of children with known vaccination status had received at least 1 dose of the current seasonal influenza vaccine, despite the fact that “influenza vaccination remains the most effective influenza prevention strategy,” they wrote.

FDA Unveils Final Cigarette Warning Labels

On June 21, 2011, the FDA unveiled a series of graphic health warnings required to appear on every pack of cigarettes sold in the United States and in every cigarette advertisement. The measure is designed to prevent children from smoking, encourage adults who smoke to quit, and ensure that all patients understand the dangers of smoking. 

The warnings, which represent the most significant changes to cigarette labels in more than 25 years, are required to be placed on all cigarette packs, cartons, and ads no later than September 2012.

“The introduction of these warnings is expected to have a significant public health impact by decreasing the number of smokers, resulting in lives saved, increased life expectancy, and lower medical costs,” the FDA’s Web site stated.

Featuring jarring images such as a man with a tracheotomy hole and a mouth filled with rotting teeth, the new labels are a result of the Family Smoking Prevention and Tobacco Control Act, which was passed in 2009 to give the government authority to regulate the marketing and labeling of tobacco products.

“These labels are frank, honest, and powerful depictions of the health risks of smoking and they will help encourage smokers to quit, and prevent children from smoking,” said Health and Human Services Secretary Kathleen Sebelius.

In addition to being responsible for 443,000 deaths each year, tobacco use can exacerbate conditions like asthma and result in permanent damage to the airways. Teens who smoke are less likely to experience long-term improvement in their asthma than non-smokers, according to the American Lung Association.

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