New provincial health data compiled by the Ontario Asthma Surveillance Information System (OASIS) in Ontario, Canada, confirm what emergency department (ED) personnel in hospitals across Ontario already know; thousands of schoolchildren will begin arriving at their doors over the next week or so needing medical attention for asthma flare-ups.
According to the new OASIS metrics, the 38th week of the year (the week of Sept. 14) continues to be the peak time for asthma attacks among young people. This phenomenon, known among health-care professionals as the “September Spike” sends large numbers of schoolchildren and their family members to EDs and doctors’ offices in the weeks following commencement of the new school year.
“We’ve noticed that the spike isn’t localized to any particular region, as rates throughout Ontario are higher than average during this time period,” says Dr. Teresa To, Senior Scientist at The Hospital for Sick Children (SickKids), Director of OASIS and Adjunct Scientist at the Institute for Clinical Evaluative Sciences (ICES). “The good news, however, is that all signs point to the 2014 September Spike being less severe than previous years. It is important to identify contributing factors to the asthma flare-ups in September and take steps to help prevent them.
“With these strategies, and better asthma care in general, were seeing a gradual but significant decline in the numbers of children being treated for severe asthma symptoms in the back-to-school period,” says Dr. To in an OLA release.
The OLA notes that experts think rhinoviruses such as the common cold virus are the main cause of asthma flare-ups in September. When children go back to school, it’s back to close quarters with classmates and the viruses they carry, and viruses, including the common cold, are the number one cause of asthma flare-ups in children. Children then bring the cold germs home from school and spread them to their parents and younger siblings, explaining why there is also a smaller but still significant increase in preschooler and adult asthma flare-ups in September, immediately following the schoolchildren’s spike. “We’ve noticed that the spike isn’t localized to any particular region, as rates throughout Ontario are higher than average during this time period,” Dr. To observes. “The good news, however, is that all signs point to the 2014 September Spike being less severe than previous years.”
Dr. To has been involved in over 50 funded research projects as an investigator, and currently, with over one million dollars in research funding, she is the principal investigator of four funded research projects, all of which are focused on measuring and quantifying impacts of asthma, and has developed a population-based research program that focuses on childhood asthma. Using pediatric health databases, Dr. To examines factors that influence the health of children with asthma and their health outcomes. Her current asthma care research program spans from the acute, primary care settings to the population levels. Dr. To also maintains a cross-appointment at the Institute for Clinical Evaluative Sciences (ICES) that allows her to use administrative databases to study the healthcare utilization, access to care and practice patterns for a variety of medical and surgical conditions.
Other possible causes potentially contributing to September asthma flare-ups include: not taking prescribed controller medicine during the summer vacation; the stress of returning to school; allergic triggers at school, such as mold, dust and animal dander on classmates clothes; and more pollution as school buses and commuters return in full force after the holidays.
“One in five children in Ontario schools has asthma,” says Carole Madeley, director of respiratory health programs with the Ontario Lung Association (OLA). “Despite significant advances in treatment and management, parents and school staff should be aware that asthma is a serious disease that can be fatal.”
Researchers Improve Severe Asthma Care Through New, Antibody-based Treatment
New on the asthma research front, a team of researchers at McMaster University and St. Joseph’s Healthcare in Hamilton, Ontario, have successfully evaluated a new, antibody-based drug for certain patients with severe asthma. The drug, named mepolizumab is a humanized monoclonal antibody that recognizes interleukin-5 (IL-5), and can replace traditional, steroid-based treatments for a specific subset of patients, resulting in improved outcomes and reduced side effects
Patients with severe asthma often require high doses of steroid-based treatments that can significantly impair their quality of life. A new drug is the only therapy that has been proven to be effective in well-established clinical trials to help reduce doses of steroid-based treatments such as prednisone for those with severe asthma.
The study and manuscript, published in the New England Journal of Medicine, was led in Canada by Dr. Parameswaran Nair, M.D., Ph.D., staff respirologist, Firestone Institute for Respiratory Health at St. Joseph’s Healthcare Hamilton and professor of respirology at the Michael G. DeGroote School of Medicine at McMaster University. Dr. Nair and his colleagues recruited the largest number of participants for this global study.
In a NEJM editorial entitled “Anti–Interleukin-5 Monoclonal Antibody to Treat Severe Eosinophilic Asthma” (New England Journal of Medicine, 2014; 140908054536006 DOI: 10.1056/NEJMe1408614) Dr. Nair explains that despite the availability of treatments such as glucocorticoids, leukotriene antagonists, long-acting bronchodilators, and a monoclonal antibody directed against IgE, a substantial proportion of patients with asthma continue to have uncontrolled disease. He observes that exacerbations requiring hospitalization and ongoing treatment with a regular maintenance dose of systemic glucocorticoids cause substantial morbidity and impair the quality of life of these patients.
He observes that recognition of the components of airway disease and the underlying mechanisms of those abnormalities provides a logical starting point on the path toward the development of strategies to target and mitigate these factors, such as bronchial thermoplasty to treat severe asthma. And another approach aimed at the inflammatory component of asthma is use of monoclonal antibodies against specific type 2 helper T-cell cytokines (e.g., interleukin-4, interleukin-13, and interleukin-5), since these proteins are thought to be major drivers of the inflammatory component of asthma.
He concludes that anti–interleukin-5 therapy offers an important advance in our ability to care for patients with severe eosinophilic asthma, particularly as a method of decreasing exacerbations in patients who are dependent on daily use of oral glucocorticoids (provided they do not have any parasitic infestations), and that it is reasonable to consider anti–interleukin-5 therapy for patients with severe asthma who are receiving high doses of systemic glucocorticoids and who continue to have an elevated eosinophil count in sputum or blood regardless of their atopic status.
“This new drug is the only therapy that has been proven to be effective in well-established clinical trials to help reduce doses of steroid-based treatments such as prednisone for those with severe asthma,” says Dr. Nair in a McMaster U. release, adding that the paper reconfirms the team’s observation published in the New England Journal of Medicine in 2009.
Patients with severe asthma often require high doses of steroid-based treatments that can significantly impair their quality of life. These high doses can cause debilitating side effects including mood swings, diabetes, bone loss, skin bruising, cataracts and hypertension.
Previous research at the Hamilton institutions has identified specific types of patient with severe asthma have an overabundance of a particular type of white blood cell (eosinophils) present in their sputum. These patients often suffer from the most severe asthma symptoms and can only be treated through steroid-based medications such as prednisone.
“This is an exciting example of personalized medicine for asthma,” Dr. Nair says. “This discovery now tells us by using a simple blood or sputum eosinophil count, we can identify which asthma patients can benefit from this new treatment.”
The OLA, a registered charity that provides programs and services to patients and health-care providers, invests in lung research and campaigns for improved policies on lung health, suggests that in terms of practical, self-help measures, parents of children with asthma can use its Week 38 checklist to reduce likelihood of a rush trip to the ED:
Management: make sure both parent and child know how to manage asthma attacks, including the proper use of controller and reliever medicines, and that any questions the child may have about managing asthma at school are answered.
Cleanliness And Hygiene: be proactive about avoiding viral infections with regular and thorough hand washing. Teach children and everyone else in the family correct hand-washing technique, using plenty of soap and running water, or id no sink is handy, rubbing hands with a hand-sanitizer for at least 20 seconds is a workaround.
Triggers: make sure the child knows what his or her asthma triggers are and how to avoid them.
Action Plan: have your health-care provider give you a written asthma action plan and ask them or a certified respiratory educator how to use it. You can obtain an asthma action plan at http://www.on.lung.ca/ or call 1-888-344-LUNG (5864).
Professional help: see a health-care provider if a child’s action plan or medicine is not keeping asthma under control and needs adjusting. Work with a certified respiratory educator to learn how to better manage asthma.
Vaccination: make sure both the child and family members get a regular seasonal flu shot as soon as it becomes available in the fall.
The Ontario Asthma Surveillance Information System (OASIS) was created using health administrative data housed at ICES to provide a population-based longitudinal surveillance system for asthma. OASIS provides information to support asthma-related health planning, surveillance, health economic analysis, policy research and development, public education, public accountability, program evaluation, research, and professional education.
More information about the Week 38 spike is available at:
Information about lung health issues is available through the Lung Health Information Line 1-888-344-LUNG (5864) or by email at [email protected]
For information about how to keep asthma under control, speak to one of the certified respiratory educators at The Lung Association Lung Health Information Line 1-888-344-LUNG (5864), visit http://www.on.lung.ca or email [email protected]
Ontario Lung Association
Ontario Asthma Surveillance Information System (OASIS)
Toronto Hospital For Sick Children
New England Journal of Medicine
St. Joseph’s Healthcare