April 30th, 2009
I was reading an article in this week’s edition of The New England Journal of Medicine and it made me think. The article focused on asthma in pregnancy. While that is a topic for another time, it got me thinking about the treatment of allergies in pregnant women.
Currently, we are nearing the peak of the Spring allergy season. Most of the patients that I am seeing for the first time arrive on prescription or over-the-counter allergy medications. Pregnancy categories for medications include category A, B, C, D, and X. You want to be on medications in pregnancy category A or B and avoid those in pregnancy category D or X. For drugs in pregnancy category C, caution is advised, but the benefits of the medication may outweigh the potential risks.
First, it is important to think about what medications you are taking if you are thinking about becoming pregnant. You cannot wait until you discover that you are pregnant. You may have to modify your medication regimen when you begin trying to become pregnant. The reason for this is to ensure that there are no harmful effects to the baby from medications prior to learning that you are pregnant. The most critical time in a baby’s development that is affected by medication are the first weeks of pregnancy.
Zyrtec and Benadryl represent antihistamines that are pregnancy category B.
Rhinocort is a nasal steroid that is pregnancy category B.
For those patients that are on allergy shots, guidelines recommend continuing with your shots if there are observed benefits. However, the dose should be held and not increased until after delivery of the baby.
If you are considering becoming pregnant and have a question about your allergy options, contact your physician to ensure the safest options for your child.
April 24th, 2009
The Country Music Marathon is tomorrow and my wife and I will take our kids and the neighbors’ kids (their parents are running the half-marathon) to cheer on the participants. Nashville is a tough course and its usually warm for the race which makes me all the more impressed that someone can actually run that far. I’ll stick to my bike, thank you.
Anyway, this got me to thinking about exercise induced asthma (EIA). How can you tell exercise induced asthma from plain-old being worn out? It’s difficult to do without measuring lung function after exercise, but their are some clinical clues. If you have asthma outside of exercise, then you’re more likely to have EIA. EIA typically occurs during the cool-down phase of exercise rather than during peak exertion. Pre-medicating with albuterol and using longer warm-up and cool-down periods can help control EIA symptoms.
EIA can really knock down one’s lung function. Athletes are trained to work through pain and suffering and will often minimize their breathing difficulties. If you or someone you know is having EIA symptoms, talk to your doctor.
Dr. O
April 10th, 2009
This week’s New England Journal has a great article examining the treatment of gastroesophageal reflux (GERD) in asthmatics. Previous studies have suggested a link between active reflux and active asthma. Recent studies looking at acid-reducing therapy in patients with both asthma and reflux have shown improvement in some measures of asthma control. Current asthma treatment guidelines suggest that in poorly controlled asthmatics, we should be looking for “silent reflux” as a potential cause for the poor control.
This study examined that recommendation by taking poorly controlled asthmatics without reflux symptoms and randomizing them to receive esomeprazole (Nexium) or placebo for 6 months. They also had subjects perform esophageal pH monitoring to assess for the presence of silent reflux.
The study has two important findings: 1) 40% of poorly controlled asthmatics have silent reflux. 2) Treating this with esomeprazole does absolutely nothing to improve asthma.
In a way this renders the further study of acid suppression and asthma useless. If patients are having active reflux, defined as symptoms two or more times a week, then they should receive acid reducing therapy on the basis of their reflux alone, regardless of their asthma status. The study also raises important questions about exactly how GERD makes asthma worse.
Please don’t take this to mean that you should run out and stop you reflux medications. If you have questions, discuss them with your doctors
Dr. O
April 1st, 2009
Tree pollen levels today are extremely high with the predominant species being cedar, maple and pine. Remember to avoid prolonged outdoor activity in the early morning hours and rinse off if you’ve been outside a while. Keep your doors and windows closed in both your car and your house. Run the recirculate vent on your car’s AC. If you’re mowing your lawn by now, wear a mask if you must.
All these measures are helpful, but if your allergies are keeping you cooped up during this beautiful spring weather (at least here in Nashville), it’s time to call your local allergist and get your life back.
Dr. O
