Dr. Howard Smith Reports

Vidcast:  https://youtu.be/ZIK07yBWRcA

A study just published online by the New England Journal of Medicine is challenging the way we manage asthma.  

For decades, inhalation of the short-acting bronchodilator albuterol, sold as Proventil and Ventolin, has been the recommended treatment for attacks with the addition of an inhaled steroid for maintenance of easy breathing. A collaborative group from New Zealand, Australia, and Britain now demonstrates that the inhaled steroid+long acting bronchodilator combo budesonide-formoterol, marketed as Symbicort, and only used when needed not only works effectively to stop asthma attacks but also prevents them with less steroid exposure for the patient.

The study included 688 adult asthma patients in 3 treatment groups who randomly received either as-needed albuterol, as-needed budesonide-formoterol, or daily budesonide with the addition of albuterol as needed.  The results showed that as-needed steroid+long-acting bronchodilator reduced the incidence of severe asthma attacks by 40% when compared with as-needed short-acting bronchodilator and 44% when compared with daily steroid.  Also important was the finding that only using the steroid when needed versus daily reduced the amount of steroid exposure by by more than half.

The take away: as-needed steroid+long-acting bronchodilator, budesonide-formoterol is more effective and safer for asthma treatment and prevention than as-needed short-acting albuterol or daily steroid budesonide with added albuterol when necessary.  

If you or your child is asthma, speak with your doctors about this newer strategy.

Richard Beasley, D.Sc., Mark Holliday, B.Sc., Helen K. Reddel, Ph.D., etal. Controlled Trial of Budesonide–Formoterol as Needed for Mild Asthma.  NEJM Online: May 19, 2019

DOI: 10.1056/NEJMoa1901963

#Asthma #albuterol #budesonide #bronchodilators

Vidcast:  https://youtu.be/ZIK07yBWRcA

A study just published online by the New England Journal of Medicine is challenging the way we manage asthma.  

For decades, inhalation of the short-acting bronchodilator albuterol, sold as Proventil and Ventolin, has been the recommended treatment for attacks with the addition of an inhaled steroid for maintenance of easy breathing. A collaborative group from New Zealand, Australia, and Britain now demonstrates that the inhaled steroid+long acting bronchodilator combo budesonide-formoterol, marketed as Symbicort, and only used when needed not only works effectively to stop asthma attacks but also prevents them with less steroid exposure for the patient.

The study included 688 adult asthma patients in 3 treatment groups who randomly received either as-needed albuterol, as-needed budesonide-formoterol, or daily budesonide with the addition of albuterol as needed.  The results showed that as-needed steroid+long-acting bronchodilator reduced the incidence of severe asthma attacks by 40% when compared with as-needed short-acting bronchodilator and 44% when compared with daily steroid.  Also important was the finding that only using the steroid when needed versus daily reduced the amount of steroid exposure by by more than half.

The take away: as-needed steroid+long-acting bronchodilator, budesonide-formoterol is more effective and safer for asthma treatment and prevention than as-needed short-acting albuterol or daily steroid budesonide with added albuterol when necessary.  

If you or your child is asthma, speak with your doctors about this newer strategy.

Richard Beasley, D.Sc., Mark Holliday, B.Sc., Helen K. Reddel, Ph.D., etal. Controlled Trial of Budesonide–Formoterol as Needed for Mild Asthma.  NEJM Online: May 19, 2019

DOI: 10.1056/NEJMoa1901963

#Asthma #albuterol #budesonide #bronchodilators

Vidcast: https://youtu.be/MtNakRwjYu0

Health News You Should Use, the latest medical discoveries and commonsense advice that you can use in a practical way to keep yourself and your family healthy.  

Here are this weeks stories and a selections of news from the past several weeks:

Prophylactic Antibiotic Dose Improves Instrumented Vaginal Deliveries 

How Much Coffee Is Too Much

Sunscreens Won’t Lower Your Vitamin D But May Be Toxic

Meditation Could Backfire

Losing Your Appendix May Bump Up Your Parkinson’s Risk

Recreational Sports Improve Grades

Avocado Kills Hunger

Skin-sparing Mastectomy A Safe Alternative

Cialis Helps Heart Failure

Nuts to High Blood Pressure

An Early Diagnosis of Autism Is Possible

Morning Workouts Drive Better Thinking

E-Cigarettes Are Contaminated With Bacteria and Fungi

A Simple Test Predicts Lasting Concussion Effects

Late Pregnancy Ultrasound Benefits Mother, Baby, and Bottomline

Children’s Author Roald Dahl Speaks About Measles

For more information, you’ll find all the references for the stories and a copy of show notes on my website at: https://www.drhowardsmith.com/may-2019-2nd-week-health-news

#Coffee #hypertension #Obstetrics #antibiotics #postpartuminfection #episiotomy #forceps #vacuum #Sunscreens #vitaminD #melanoma #Meditation #badtrip #anxiety #Appendix #appendicitis #Parkinsons #Intramuralsports #GPA #flunking #avocado #hunger #dieting #obesity #overweight #mastectomy #skinsparing #nipplesparing #cialis #viagra #heartfailure #walnuts #hypertension #Autism #ASD #earlyintervention #earlydiagnosis #Morningexercise #measles #encephalitis #MMR #vaccination #cognition #ecigarette #bacteria #fungi #endotoxin #Concussion #romberg #recovery #3rdtrimester #ultrasound #breech #csection

Vidcast: https://youtu.be/MtNakRwjYu0

Health News You Should Use, the latest medical discoveries and commonsense advice that you can use in a practical way to keep yourself and your family healthy.  

Here are this weeks stories and a selections of news from the past several weeks:

Prophylactic Antibiotic Dose Improves Instrumented Vaginal Deliveries 

How Much Coffee Is Too Much

Sunscreens Won’t Lower Your Vitamin D But May Be Toxic

Meditation Could Backfire

Losing Your Appendix May Bump Up Your Parkinson’s Risk

Recreational Sports Improve Grades

Avocado Kills Hunger

Skin-sparing Mastectomy A Safe Alternative

Cialis Helps Heart Failure

Nuts to High Blood Pressure

An Early Diagnosis of Autism Is Possible

Morning Workouts Drive Better Thinking

E-Cigarettes Are Contaminated With Bacteria and Fungi

A Simple Test Predicts Lasting Concussion Effects

Late Pregnancy Ultrasound Benefits Mother, Baby, and Bottomline

Children’s Author Roald Dahl Speaks About Measles

For more information, you’ll find all the references for the stories and a copy of show notes on my website at: https://www.drhowardsmith.com/may-2019-2nd-week-health-news

#Coffee #hypertension #Obstetrics #antibiotics #postpartuminfection #episiotomy #forceps #vacuum #Sunscreens #vitaminD #melanoma #Meditation #badtrip #anxiety #Appendix #appendicitis #Parkinsons #Intramuralsports #GPA #flunking #avocado #hunger #dieting #obesity #overweight #mastectomy #skinsparing #nipplesparing #cialis #viagra #heartfailure #walnuts #hypertension #Autism #ASD #earlyintervention #earlydiagnosis #Morningexercise #measles #encephalitis #MMR #vaccination #cognition #ecigarette #bacteria #fungi #endotoxin #Concussion #romberg #recovery #3rdtrimester #ultrasound #breech #csection

Vidcast:  https://youtu.be/9DzvBHZ9CzU

The author of “Charlie and the Chocolate Factory” and “Matilda,” Roald Dahl, wrote in 1988 about his experience when his daughter developed measles. 

"Olivia, my eldest daughter, caught measles when she was seven years old. As the illness took its usual course I can remember reading to her often in bed and not feeling particularly alarmed about it. Then one morning, when she was well on the road to recovery, I was sitting on her bed showing her how to fashion little animals out of coloured pipe-cleaners, and when it came to her turn to make one herself, I noticed that her fingers and her mind were not working together and she couldn’t do anything.

'Are you feeling all right?' I asked her.

'I feel all sleepy,' she said.

In an hour, she was unconscious. In twelve hours she was dead.”

Dahl went on: “The measles had turned into a terrible thing called measles encephalitis and there was nothing the doctors could do to save her. That was...in 1962, but even now, if a child with measles happens to develop the same deadly reaction from measles as Olivia did, there would still be nothing the doctors could do to help her. 

On the other hand, there is today something that parents can do to make sure that this sort of tragedy does not happen to a child of theirs. They can insist that their child is immunized against measles.

...I dedicated two of my books to Olivia, the first was ‘James and the Giant Peach’. That was when she was still alive. The second was ‘The BFG’, dedicated to her memory after she had died from measles. You will see her name at the beginning of each of these books. And I know how happy she would be if only she could know that her death had helped to save a good deal of illness and death among other children." 

Now listen to this…. He adds ironically in 1988: “It is not yet generally accepted that measles can be a dangerous illness. Believe me, it is. In my opinion parents who now refuse to have their children immunized are putting the lives of those children at risk.

In America, where measles immunization is compulsory, measles like smallpox, has been virtually wiped out.  Here in Britain, because so many parents refuse, either out of obstinacy or ignorance or fear, to allow their children to be immunized, we still have a hundred thousand cases of measles every year. Out of those, more than 10,000 will suffer side effects of one kind or another. Many will develop ear or chest infections. About 20 will die.”

Roald Dahl would do anything to bring back his child.  All that you have to do to prevent the same tragedy from befalling your children is to see that they get the MMR vaccine.

https://io9.gizmodo.com/read-roald-dahls-heart-rending-endorsement-of-measles-v-1682995322

#measles #encephalitis #MMR #vaccination

Vidcast:  https://youtu.be/9DzvBHZ9CzU

The author of “Charlie and the Chocolate Factory” and “Matilda,” Roald Dahl, wrote in 1988 about his experience when his daughter developed measles. 

"Olivia, my eldest daughter, caught measles when she was seven years old. As the illness took its usual course I can remember reading to her often in bed and not feeling particularly alarmed about it. Then one morning, when she was well on the road to recovery, I was sitting on her bed showing her how to fashion little animals out of coloured pipe-cleaners, and when it came to her turn to make one herself, I noticed that her fingers and her mind were not working together and she couldn’t do anything.

'Are you feeling all right?' I asked her.

'I feel all sleepy,' she said.

In an hour, she was unconscious. In twelve hours she was dead.”

Dahl went on: “The measles had turned into a terrible thing called measles encephalitis and there was nothing the doctors could do to save her. That was...in 1962, but even now, if a child with measles happens to develop the same deadly reaction from measles as Olivia did, there would still be nothing the doctors could do to help her. 

On the other hand, there is today something that parents can do to make sure that this sort of tragedy does not happen to a child of theirs. They can insist that their child is immunized against measles.

...I dedicated two of my books to Olivia, the first was ‘James and the Giant Peach’. That was when she was still alive. The second was ‘The BFG’, dedicated to her memory after she had died from measles. You will see her name at the beginning of each of these books. And I know how happy she would be if only she could know that her death had helped to save a good deal of illness and death among other children." 

Now listen to this…. He adds ironically in 1988: “It is not yet generally accepted that measles can be a dangerous illness. Believe me, it is. In my opinion parents who now refuse to have their children immunized are putting the lives of those children at risk.

In America, where measles immunization is compulsory, measles like smallpox, has been virtually wiped out.  Here in Britain, because so many parents refuse, either out of obstinacy or ignorance or fear, to allow their children to be immunized, we still have a hundred thousand cases of measles every year. Out of those, more than 10,000 will suffer side effects of one kind or another. Many will develop ear or chest infections. About 20 will die.”

Roald Dahl would do anything to bring back his child.  All that you have to do to prevent the same tragedy from befalling your children is to see that they get the MMR vaccine.

https://io9.gizmodo.com/read-roald-dahls-heart-rending-endorsement-of-measles-v-1682995322

#measles #encephalitis #MMR #vaccination

Vidcast:  https://youtu.be/CU2WZFt3CZ8

A planned ultrasound at 36 weeks will detect undiagnosed breech presentations in time to allow intervention and prevention of dangerous fetal distress and emergency c-sections.  This recommendation springs from a study by public health specialists at Britain’s University of Cambridge.

The investigators screened nearly 3900 women during their first pregnancies with a 36 week ultrasound.  The screening detected a 4.6% incidence of breech presentation more than half of which were unsuspected.  The women were given the choice of attempting to turn the baby, so-called external cephalic version, or a an elective c-section. Those whose babies would not reposition underwent the elective c-section.

In the UK, the 36 week ultrasound that costs about 13 pounds or US$17, would prevent about 15,000 undetected breech presentations, more than 4,000 emergency c-sections and 8 baby deaths a year.  The effects are even more dramatic when extrapolated to the US population.

If you are pregnant, would might want to ask your obstetrician about a 36 week ultrasound.  It would save much heartache later on.

David Wastlund, Alexandros A. Moraitis, Alison Dacey, Ulla Sovio, Edward C. F. Wilson, Gordon C. S. Smith. Screening for breech presentation using universal late-pregnancy ultrasonography: A prospective cohort study and cost effectiveness analysis. PLOS Medicine, 2019; 16 (4): e1002778 DOI: 10.1371/journal.pmed.1002778

#3rdtrimester #ultrasound #breech #csection

Vidcast:  https://youtu.be/CU2WZFt3CZ8

A planned ultrasound at 36 weeks will detect undiagnosed breech presentations in time to allow intervention and prevention of dangerous fetal distress and emergency c-sections.  This recommendation springs from a study by public health specialists at Britain’s University of Cambridge.

The investigators screened nearly 3900 women during their first pregnancies with a 36 week ultrasound.  The screening detected a 4.6% incidence of breech presentation more than half of which were unsuspected.  The women were given the choice of attempting to turn the baby, so-called external cephalic version, or a an elective c-section. Those whose babies would not reposition underwent the elective c-section.

In the UK, the 36 week ultrasound that costs about 13 pounds or US$17, would prevent about 15,000 undetected breech presentations, more than 4,000 emergency c-sections and 8 baby deaths a year.  The effects are even more dramatic when extrapolated to the US population.

If you are pregnant, would might want to ask your obstetrician about a 36 week ultrasound.  It would save much heartache later on.

David Wastlund, Alexandros A. Moraitis, Alison Dacey, Ulla Sovio, Edward C. F. Wilson, Gordon C. S. Smith. Screening for breech presentation using universal late-pregnancy ultrasonography: A prospective cohort study and cost effectiveness analysis. PLOS Medicine, 2019; 16 (4): e1002778 DOI: 10.1371/journal.pmed.1002778

#3rdtrimester #ultrasound #breech #csection

Vidcast:  https://youtu.be/RvII1BZlmOU

Pediatric sports medicine specialists at the University of Colorado report that a simple test, the Romberg test, can predict which children will suffer lasting effects from a concussion and would benefit from proactive therapy.  Their study was just published in the Journal of Neurosurgery;Pediatrics.

The data from more than 350 children and adolescents with a mean age of nearly 15 years showed that an abnormal Romberg balance test was the best predictor of prolonged symptoms after the traumatic brain injury.  This test was more predictive than other variables including self-reported headache severity, headache frequency, confusion, forgetfulness,  inattention, memory lapses, fatigue, and dizziness failed to correlate with the duration of issues post-concussion.

The Romberg test is simple to perform.  The subject stands with feet together and eyes closed.  The test is deemed positive if the individual cannot maintain balance with minimal movement.

This finding is important because a positive Romberg test will triage children who have sustained concussions into timely physical and psychological therapy.

Howell DR, Potter MN, Kirkwood MW, Wilson PE, Provance AJ, and Wilson JC. Clinical predictors of symptom resolution for children and adolescents with sport-related concussion. Journal of Neurosurgery: Pediatrics, 2019 DOI: 10.3171/2018.11.PEDS18626

#Concussion #romberg #recovery

Vidcast:  https://youtu.be/RvII1BZlmOU

Pediatric sports medicine specialists at the University of Colorado report that a simple test, the Romberg test, can predict which children will suffer lasting effects from a concussion and would benefit from proactive therapy.  Their study was just published in the Journal of Neurosurgery;Pediatrics.

The data from more than 350 children and adolescents with a mean age of nearly 15 years showed that an abnormal Romberg balance test was the best predictor of prolonged symptoms after the traumatic brain injury.  This test was more predictive than other variables including self-reported headache severity, headache frequency, confusion, forgetfulness,  inattention, memory lapses, fatigue, and dizziness failed to correlate with the duration of issues post-concussion.

The Romberg test is simple to perform.  The subject stands with feet together and eyes closed.  The test is deemed positive if the individual cannot maintain balance with minimal movement.

This finding is important because a positive Romberg test will triage children who have sustained concussions into timely physical and psychological therapy.

Howell DR, Potter MN, Kirkwood MW, Wilson PE, Provance AJ, and Wilson JC. Clinical predictors of symptom resolution for children and adolescents with sport-related concussion. Journal of Neurosurgery: Pediatrics, 2019 DOI: 10.3171/2018.11.PEDS18626

#Concussion #romberg #recovery