By Christen Brownlee, Contributing Writer

Not only is it safe for people with asthma to exercise, but doing so could reduce their risk of asthma symptoms or attacks, according to a new evidence review in The Cochrane Library.

Many people with asthma report avoiding exercise because they’re afraid it could trigger symptoms including shortness of breath, wheezing or a full-blown asthma attack, said review author Kristin V. Carson.

These fears might be encouraged from misreading their symptoms, their family’s beliefs about exercise and asthma, or even from their physicians.

Over time, Carson explains, patients can become out of shape, losing muscle mass and cardiovascular fitness. That makes any future attempts at physical activity significantly harder, increasing the chances that patients will become fatigued and breathless and further discouraging physical activity.

“This results in a spiraling cycle,” she says, in which patients are even more likely to avoid exercise.

To determine whether exercise was a danger to asthmatics, Carson and her colleagues reviewed previous studies that looked at the effects of physical training on people with asthma , comparing patients who received no or minimal physical activity to those who exercised for at least 20 minutes, twice a week, over the course of four weeks.

The researchers found that the patients who had exercised—using physical training as varied as running outdoors or on a treadmill, cycling, swimming or circuit training—were no more likely to have a serious asthma-related problem than those who weren’t exercising or who did light exercising such as yoga.

Additionally, Carson said, their findings showed that patients in exercise programs improved their cardiovascular fitness, which in turn could reduce asthma symptoms over time.

Some limited evidence from the included studies also suggested that exercise improved patients’ quality of life, she added, which could contribute to other health benefits and improved psychological well-being.

“We found no reason for people with stable asthma to refrain from regular exercise,” Carson said. “Physicians should encourage their patents with stable asthma to engage in physical training programs.”

Len Horowitz, M.D., a pulmonary specialist at Lenox Hill Hospital in New York City who wasn’t involved in this review, agrees that asthma patients shouldn’t shy away from exercise.

However, even though research suggests that exercise is safe for asthmatics, he says that many people will still use their asthma as a reason to avoid physical activity.

“Not everyone wants to exercise,” he said. “When patients think exercise makes them symptomatic or makes them risk an attack, it’s a good excuse not to do it.”

Horowitz notes that may professional athletes have asthma, which hasn’t negatively affected their careers.

However, he explains, some patients do have exercise-induced asthma, in which vigorous or prolonged exercise can trigger symptoms.

He advises patients in his practice to take precautions if they’re susceptible, including pre-treating themselves with an albuterol inhaler, avoiding exercise that exposes their lungs to cold, dry air (such as running outside in the winter) and building their activity levels gradually.

Health Behavior News Service is part of the Center for Advancing Health

The Health Behavior News Service disseminates news stories on the latest findings from peer-reviewed research journals. HBNS covers both new studies and systematic reviews of studies on (1) the effects of behavior on health, (2) health disparities data and (3) patient engagement research. The goal of HBNS stories is to present the facts for readers to understand and use for themselves to make informed choices about health and health care.

Hookworm (Photo: CDC)

By Katherine Kahn, Contributing Writer
Health Behavior News Service

Purposely infecting patients with hookworms or whipworms to treat hay fever and other immune-related diseases has been experimented with since the 1970s.

A new review by The Cochrane Library concludes that current evidence doesn’t yet support the use of this therapy.

However, worm therapy does appear to be safe, the review’s lead author says.

“Allergic diseases affect hundreds of millions of people worldwide, especially in industrialized countries,” says review author Ashley Croft, M.D., a public health physician at the headquarters of the Surgeon General, Whittington Barracks, in Lichfield, UK. “Existing treatments for allergies, which mostly involve pharmacotherapy, are often expensive, dangerous, or ineffective. If worm therapy can be shown to be effective and safe, it will represent an important new clinical option for treatment.”

Croft theorizes that worm therapy might work if having intestinal worms “‘tones up’ the immune system of their human hosts, so that the host stops being over-responsive to common allergens. This helps the worms avoid detection and destruction by the host’s immune system.”

“It’s generally appreciated that in the 20th century a whole series of immunological diseases have emerged out of nowhere,” Weinstock explains, including hay fever, asthma, inflammatory bowel diseases, and multiple sclerosis. “Why did these diseases emerge? If you look around the world, these diseases are fairly common in industrialized countries, but in less developed countries, they are relatively rare.”

 Key Points

• Since the 1970s, worm therapy has been used as an alternative treatment for hay fever under the assumption that it might calm overactive immune systems.

• No long-term studies have been conducted to demonstrate that worm therapy relieves hay fever symptoms.

• An evidence review of available studies of worm therapy shows no benefit for hay fever sufferers, and that while safe it may cause minor digestive problems.

The cause, Weinstock believes, is the tremendous improvement in hygiene—and that includes lack of exposure to intestinal worms, such as hookworms and whipworms. “Up until the 20th century, everybody had worms,” Weinstock says.

The lack of worm infections in modern societies, Weinstock conjectures, has led to over-reactive immune systems and an increase in immune-related diseases.

Croft’s review examined evidence from two placebo-controlled, double blinded studies that enrolled a total of 130 adults who had either intermittent or persistent allergic rhinitis.

One study used hookworm larvae, which enter through the skin and travel to the intestines and the other study used pig whipworm eggs that participants swallowed.

Participants who used worm therapy had no reduction in hay fever symptoms or percentage of days when symptoms were minimal. They also had no changes in lung function or quality of life scores.

Croft cautions that these studies are too small to truly evaluate effectiveness. “It did come as a surprise, therefore, that we found that people with allergic rhinitis who took worms were less likely to have to take tablets as rescue medication during the grass pollen season.”

Weinstock also says that the studies to date haven’t been designed very well and says it was surprising researchers found any response at all since the study follow-up times were too short.

“To treat an allergy, you probably have to have a treatment strategy that’s at least six months long,” before evaluating effectiveness, he says. The studies ran for only three months and six months, respectively, after initiating worm therapy.

“Our main finding was that worm therapy is safe,” says Croft. “In participants who took worms there were some gastrointestinal side effects, such as abdominal pain and diarrhea, but these were transient and were not so severe as to cause people to drop out of the trials.”

Croft says that there is enough evidence to support continued research in worm therapy. “Clinical trials in worm therapy are not expensive to run and the potential benefits from this new form of therapy are very great,” he says.

Health Behavior News Service is part of the Center for Advancing Health

The Health Behavior News Service disseminates news stories on the latest findings from peer-reviewed research journals. HBNS covers both new studies and systematic reviews of studies on (1) the effects of behavior on health, (2) health disparities data and (3) patient engagement research. The goal of HBNS stories is to present the facts for readers to understand and use for themselves to make informed choices about health and health care.

“Bugs,” the two year old boy said as he pointed to an irritated patch of skin on his face. Mary Leitao looked closer, and although she found no visible insects, she was startled to find colored fibers sprouting from her son’s skin. It was a summer evening in 2001 that would change the lives of the Leitao family for years to come.

A medical researcher turned stay-at home mom, Leitao had never seen anything like it and neither had her husband, Edward, an internist at South Allegheny Internal Medicine.  Mary Leitao took her son to be examined by numerous doctors, but none provided a satisfactory explanation. Many suggested that it was a form of psychosis called “delusional infestation” or the conviction of being infected with parasites.

Images from the CDC study in PLoS One

Believing instead that she had discovered a new disease, Leitao named the condition Morgellons and in 2004 established a non-profit organization called the Morgellons Research Foundation (MRF).

Through the efforts of the MRF, the CDC (Centers for Disease Control and Prevention) conducted a three-year government study to research Morgellons.

The results, released last week, indicated that there was no diseased organisms or parasites present in the 115 case-patients.

The protruding fibers were found to be mostly skin fragments or clothing fibers stuck to the skin.

According to the report, the physical ailments were manifestations of “delusional infestation.”

From a recent article in WebMD, individuals with delusional infestation tend to be hyper-aware of normal body sensations and interpret them as medical illness.  The article notes, “This stress has real physical effects on the body and leads to a spiral of worsening physical symptoms…”

The suggestion that thoughts and stress can be manifested as physical maladies may be counterintuitive to anatomy-based medicine, but research increasingly supports the idea. For instance, The Washington Post reported, ”Nocebos[inert pills provided with a negative expectation] often cause a physical effect, but it’s not a physically produced effect,” said Irving Kirsch, a psychologist at the University of Connecticut in Storrs who studies the ways that expectations influence what people experience.

The CDC study, published by the open-access journal PLoS One, is available online.

The CDC also has an information page about Morgellons Disease.

The idea that the condition may be more mental than physical has always been unpopular among those who identify themselves with the disease. It has impelled them to fight on two fronts – working to gain credibility and help from the medical community and fighting the unfortunate stigma of mental illness.  With the significant setback of the CDC report, how many may be wondering, what next?  

I have compassion for those suffering from Morgellons.  No one should have to live with the painful symptoms or the mental anguish of feeling isolated, abandoned and uncared for. Yet, perhaps it’s time to consider the mental nature of the condition. Yet, perhaps it’s time to consider the mental nature of the condition. But I’m not proposing psychotherapy – but a spiritual approach.”

For instance, in the recent Jan. 29 issue of the Concord Monitor, a woman describes her recovery from disease as she changed her thought to a more prayerful perspective.  Shifting thought away from the body to seeking a greater understanding of her spiritual nature worked for her.

As the mental factors of many diseases become more widely understood, spiritual treatments, such as Christian Science, that focus on thought can be a valuable resource. The MRF website reports that fear and hopelessness are common among those who suffer from Morgellons. Working spiritually to lessen and eliminate these unhealthy mental states may be the best next step.

This article first appeared on Blogcritics.

A retired architect, Bill Scott writes about spirituality and health for Blogcritics.org and also serves as the Christian Science Committee on Publication for Washington State.

November through March winter weather often causes stagnant air that traps air pollution from outdoor burning, wood stoves, and fireplaces gets trapped near the ground, officials said.

Who is at highest risk?

Breathing polluted air can cause short and long-term health problems. People with heart and lung diseases are more likely to develop serious health problems. Sometimes, older adults have heart or lung disease that they’re not aware of, and it puts them at risk. Kids spend more time outside, where they’re exposed to air pollution for longer periods. Children’s lungs are more easily damaged because they’re still developing.

Exercise and air pollution:

When air quality is poor, people should limit outdoor activities and reschedule them for a time when air quality is better. When people exercise, they breathe more air and air pollution into their lungs. If you decide to exercise, choose a less strenuous exercise such as going for a walk instead of a run. And avoid exercising in higher pollution areas such as near highways or in neighborhoods with a lot of wood smoke.

How to check air quality

Be sure to check air quality (http://www.airwatchnw.org) before heading out for outdoor activities, especially if you’re in a high-risk group. Often air pollution can’t be seen or smelled, so it’s hard to judge air pollution levels.

Burn bans:

Several burn bans have been issued across the state recently because of poor air quality. Smoke contains fine particles and toxic gases that can be breathed deep into lungs. Some counties in the state are under a burn ban. Before you burn, check to see if your county is under a burn ban (www.waburnbans.net).

To learn more:

• More information about how air quality can affect your health (www.doh.wa.gov/ehp/smokefactsheet.pdf) is on the Department of Health website.

Mildew from a wooden soap dish - Photo by Bob Baylock

By Glenda Fauntleroy, Contributing Writer
Health Behavior News Service

A new evidence review finds that ridding homes and offices of mold and dampness can help reduce respiratory infections and troubling symptoms for asthma sufferers across the globe; however, the best way to eliminate the mold remains unclear.

Mold is one of the most important environmental triggers of symptoms such as coughing and wheezing, according to National Institute of Environmental Health Sciences.

“Mold is found in many homes with basements, in apartments and walkouts that are partially or fully below ground, and in buildings that have been flooded or have poor humidity control,” said Peter Thorne, head of the occupational and environmental health department at the University of Iowa. “Homes and office buildings alike have problems.”

But does “remediating” or relieving homes, offices and schools of dampness and mold make a big difference? Lead reviewer Riitta Sauni at the Finnish Institute of Occupational Health in Tampere, Finland, said that results are mixed.

PHOTO: Bob Baylock under Creative Commons license

Key Points:

• Ridding homes and office buildings of mold can reduce the incidence of respiratory illness and decrease asthma-related symptoms, a new Cochrane review finds.

• While removing mold from offices and homes can reduce coughing and wheezing, the best method for mold removal remains to be determined.

• Mold can be costly to remove from buildings, which can be re-infected even after cleaning and fungicide treatments.

“We were happy to find evidence that remediation of mold-damaged houses decreased the severity and amount of symptoms in patients with asthma and respiratory infections,” Sauni said. “Unfortunately, we did not find evidence that remeditation could prevent these diseases.”

The review appears in the September issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates research in all aspects of health care. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing trials on a topic.

Remediation of mold and dampness requires total or partial renovation of a building, or cleaning with a fungicide or bleach solution. Sauni and her team looked at eight studies with 6,538 participants who had their homes, schools or workplaces remediated by a mixture of these methods.

The reviewers say that because the available studies did not offer high-quality evidence and sample sizes were small, “drawing hard conclusions was difficult.”

Nonetheless, the review found that when compared to doing nothing at all, repairing houses decreased asthma-related symptoms as well as the amount of respiratory infections in adults.

Remediation also decreased the number of acute care visits in children and students’ visits to physicians for common colds.

In one South Wales study, for instance, 115 members of the group who had their homes remediated with the complete removal of visible mold, a fungicide treatment and installation of a fan, were more likely to see improvement in their respiratory symptoms for six and 12 months afterwards, compared to those in the control group whose homes were not cleaned.

The reviewers, however, could not determine which method of remediation was superior to significantly improving asthma symptoms.

“The studies have shown that after cleaning and fungicide treatment, a large number of the buildings were soon re-infected with molds, and also a partially remediated office building had to be repaired more thoroughly,” Sauni said, adding that mold removal can be costly.

“Sometimes, if the structures are damaged widely, the easiest and most cost-effective possibility is to pull down the damp building and build a new one,” she said.

The reviewers concluded that better research is necessary to give evidence of improved outcomes.

Health Behavior News Service is part of the Center for Advancing Health

The Health Behavior News Service disseminates news stories on the latest findings from peer-reviewed research journals. HBNS covers both new studies and systematic reviews of studies on (1) the effects of behavior on health, (2) health disparities data and (3) patient engagement research. The goal of HBNS stories is to present the facts for readers to understand and use for themselves to make informed choices about health and health care.