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.

Since the beginning of the year, 640 cases of whooping cough have been reported and confirmed in 23 of the state’s 39 counties. At this time last year, only 94 cases had been reported, Sec. Selecky said.

Red represents cases so far this year; blue cases from last year;

The actual number of cases may be far higher, Selecky said, because only about 10 percent to 12 percent of cases are reported. “This is the tip of the iceberg,” she said.

Infants are most vulnerable to the disease, and there have been at four infant deaths in the state due to whooping cough over the past years.

“We’re very concerned about the continued rapid increase in reported cases,” said Secretary of Health Mary Selecky. “This disease can be very serious for young babies, who often get whooping cough from adults and other family members. We want all teens and adults who haven’t had Tdap [a pertussis vaccine] to be vaccinated to help protect babies that are too young for the vaccine.”

In the epidemic continues at its current rate, the state is on track to see the most cases it has seen since 1942, Sec. Selecky said.

Pertussis

Pertussis, the whooping cough bacteria -- CDC photo

Whooping cough, also known as pertussis, is a highly contagious respiratory illness spread by coughing and sneezing.

It is caused by a bacteria called Bordetella pertussis. The name, pertussis, comes from Latin, from per-‘away, extremely’ + Latin tussis ‘a cough.’

According to the U.S. Centers for Disease Control and Preventing, in the 20th century,  pertussis was one of the most common childhood diseases and a major cause of child death in the United States.

Initially, an infection may seem like just a cold. However, during this phase of the infection, which can last several weeks, a person can spread the disease to others.

Patients typically then go on to develop a severe, persistent–often wracking–cough that can last for several more weeks.

The coughing fits can be prolonged and are often followed by a long inhalation that causes the “whooping” sound that gives the disease its name.

The bouts of coughing can leave victims breathless and unable to eat, drink or sleep. Complications of the infection include pneumonia, seizures and death.

Whooping cough can affect people of all ages — but is most serious in infants, especially those too young to get vaccinated or who aren’t fully protected.

There is a vaccine that can prevent infection, but it is not effective in newborns or infants and it wears off with time.

Related article: Vaccine Hesitancy

Seattle’s Child’s lead article this month is a piece by Laura Hirshfield on “Vaccine Hesitancy”. She writes:

“While there is a small, but vocal, minority of parents who outright refuse all vaccines, much more common are parents who choose to skip or delay their children’s vaccines. In a recent Seattle Children’s Research Institute survey, 77 percent of Washington pediatricians reported regularly seeing parents who ask to vary the recommended vaccine schedule.

“Health officials call these parents “vaccine hesitant” and link the statewide rise in outbreaks of whooping cough, a highly contagious, airborne disease, to the rising number of under-vaccinated kids.”

Read the full article on the Seattle’s Child website.

Health officials therefore recommend that anyone who has contact with newborns and infants be vaccinated or, if they have been vaccinated, to make sure their vaccination is up-to-date.

Sec. Selecky urged parents to make sure their children are fully vaccinated and up-to-date and that teens and adults to check to see whether they need a booster.

Because newborns cannot be vaccinated, pregnant women should make sure they are vaccinated because they can transfer some of their immunity to their newborn that will confer some protection during the first months of life.

In addition, being vaccinated will reduce the risk that they will contract the infection and spread it to their child.

“Many adults don’t realize they need to be vaccinated, or they assume they have been,” said State Health Officer Dr. Maxine Hayes. “We’re asking everyone to verify with their health care provider that they’re up-to-date on vaccines. We’re also asking everyone to use good health manners — like cover your cough and stay home when you’re sick — that will also help prevent spreading whooping cough.”

For full information about pertussis vaccines and about who should get vaccinated go to the Department of Health’s pertussis information page: http://www.doh.wa.gov/cfh/Immunize/diseases/pertussis/

Free vaccine available

Flu virus - courtesy of NAIAD

The flu season has begun late this year in Washington state, but a recent uptick in cases indicate that the bug has arrived, Washington State Department of Health officials said Thursday.

Influenza season usually runs from November to March, peaking in mid-February in Washington state, but this year the season is off to a slow start.

Infection is common: Each year, about  5 to 20 percent of Americans come down with the flu, according to the U.S. Centers for Disease Control and Prevention (CDC),

Flu symptoms can resemble those of a cold but tend to be more severe, typically causing fever, cough, sore throat, muscle aches, headaches, and fatigue.

Although the vast majority of people recover from the flu, more than 200,000 Americans require hospitalization and about 36,000 die from the infection or its complications, such as a secondary pneumonias, each year.

Most healthy adults can spread the flu before they know they’re sick and for up to seven days after.

Children are two to three times more likely than adults to get sick and are more likely to spread the infection to others.

To avoid spreading the flu, people should wash their hands, cover their cough, and stay home if they’re sick, health officials said.

There is, however, still time to prevent infection by getting vaccinated, Washington state health officials said.

Who should get vaccinated?

Washington State health officials recommend a flu shot each year for everyone six months and older.

Pregnant women are at particularly high-risk of severe complications from flu infections. Vaccination not only can protect them, it also provides some protection for their child after birth.

Some children under age nine may need two doses about four weeks apart to be fully protected, they noted.

For more information about who is at risk and for who vaccination is most important go to www.flu.gov.

Treatment with antiviral drugs

• If you’re sick with flu, antiviral medications can lessen symptoms and help prevent serious complications. They work best when started quickly.

• People at high risk for complications who develop flu-like symptoms should contact their doctor promptly to see if they need medication.

• Those at high risk include people with certain medical conditions, pregnant women and women who recently gave birth, young children, and people 65 years and older.

Flu season is gaining momentum at a time when whooping cough is already very active in many communities in our state, sate health officials noted. Anyone can get whooping cough but it is most serious for infants.

All teens and adults should get a whooping cough booster, called Tdap vaccine, to help stop the spread of this disease and protect babies, they said.

To learn more:

• Go to Flu.gov

To find an immunization clinic:

• Call your healthcare provider,
• visit a local pharmacy,
• use the Department of Health Flu News website
• or call the Family Health Hotline at 1-800-322-2588.

The Flu Vaccine Finder is also a good resource.

By Phil Galewitz

The Obama administration launched a $40 million effort Wednesday to reduce premature births, especially early elective deliveries, but it has no plans to stop Medicaid from paying for those deliveries.

About 10 percent of all deliveries are scheduled — either as induced or Cesarean-section –before 39 weeks and are not medically indicated, according to the Department of Health and Human Services.

Preterm babies, those born before 39 weeks, are at increased risk for death, low birth weight, lung disorders, feeding problems and blood infections, according to the American College of Obstetricians and Gynecologists.

Medicaid, the state-federal health insurance program for the poor, pays for about 40 percent of all deliveries in the United States each year. Medicaid last year stopped paying for several so called “never” events such as preventable complications or wrong site surgery.

But on Wednesday, Medicaid chief Cindy Mann said it has no plans to stop paying for elective deliveries before 39 weeks. “This is not a payment strategy,” Mann said when asked whether Medicaid would keep paying for elective preterm deliveries.

Under the four year initiative called Strong Start announced Wednesday, the federal Center for Medicare and Medicaid Innovation will seek to reduce preterm births by giving money to hospitals and other health providers and community coalitions to improve prenatal care and test new approaches such as group visits for pregnant women and offer case management services at birth centers.

Local Resources: Read LocalHealthGuide’s story about the Seattle-based Global Alliance to Prevent Prematurity and Stillbirth (GAPPS), an initiative launched by Seattle Children’s in 2007.

“Preterm births are a growing public health problem that has significant consequences for families well into a child’s life,” said HHS Secretary Kathleen Sebelius said.

Medicaid spends $20,000 a year on babies born premature in their first year, almost 10 times that of infants born at full term.

More than 500,000 infants are born prematurely in the United States each year, an increase of 36 percent in the past two decades, Sebelius said.

A recent study by the Leapfrog Group, an employer health coalition, showed huge variation in hospitals performing elective preterm deliveries. Rates ranged from less than 5 percent at some hospitals to more than 40 percent, according to Leapfrog’s 2011 data.

Leapfrog CEO Leah Binder said Medicaid and employers should consider stopping coverage for elective preterm births. “We fully support changes in payment to disincentivize the practice,” she said.

Doctor groups often say early deliveries are done at the request of pregnant women. “Women ask for it,” said Dr. Hal Lawrence, executive vice president of the American College of Obstetricians and Gynecologists.

Scott Berns, senior vice president for the March of Dimes, said doctors also need to be educated about the risks of early deliveries.

“More education is needed for doctors and patients,” Berns said.

HHS is working with both ACOG and March of Dimes to reduce the incidence of early elective births.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

Pertussis, the whooping cough bacteria -- CDC photo

The number of cases of whooping cough in Washington state increased by more than 50 percent between 2010 and 2011, the State Department of Health reported Wednesday.

Last year there were 912 cases in the state — the highest in six years — up from 608 cases reported in 2010.

In recent years, adolescents and adults have accounted for an increasing proportion of cases, health officials said.

“The number of reported cases is just the tip of the iceberg,” State Health Officer and pediatrician Dr. Maxine Hayes said. “Many young people and adults who get pertussis may not know they have it and don’t seek medical attention.

Whooping cough, also known as pertussis, is a highly contagious respiratory illness spread by coughing and sneezing.

Initially, an infection may seem like a cold, but patients then go on to develop a severe, persistent–often wracking–cough that can last for weeks.

The coughing fits can be prolonged and are often followed by a long inhalation that causes the “whooping” sound that gives the disease its name.

The bouts of coughing can leave victims breathless and unable to eat, drink or sleep. Complications of the infection include pneumonia, seizures and death.

Whooping cough can affect people of all ages — but is most serious in infants, especially those too young to get vaccinated or who aren’t fully protected.

Adolescents and adults often get a much milder case of whooping cough, but they can still spread it, the Department of Health warned.

There is a vaccine that can prevent infection, but it is not effective in newborns or infants. Health officials therefore recommend that anyone who has contact with newborns and infants be vaccinated or, if they have been vaccinated, to make sure their vaccination is up-to-date.

Who should get the vaccine?

The U.S. Advisory Committee on Immunization Practices has issued new pertussis vaccination recommendations:

• Pregnant women to get pertussis vaccine (Tdap) later in pregnancy (after 20 weeks’ gestation). Women who get Tdap vaccine before or during pregnancy pass on extra protection against pertussis to their babies.

• Anyone who takes care of or has close contact with babies to get pertussis vaccine, ideally at least two weeks before beginning close contact with the infant. This includes siblings of infants who should be up-to-date on DTaP and other recommended immunizations.

• Tdap vaccine is available for adolescents and adults through age 64. But adults 65 and older who expect to have close contact with babies younger than 12 months should get a dose of Tdap to help protect the baby from pertussis.

• Health care workers of all ages who have contact with infants should get vaccinated too.

Protection wears off so you may need a booster

Most people get a series of pertussis vaccines when they’re kids, but protection wears off over time. The Department of Health recommends people substitute a Tdap vaccine for one routine tetanus (Td) booster, which is needed every 10 years; people should get it sooner if they’re in close contact with young kids or live in an area where there are pertussis cases. There’s no minimum time period between getting Td and Tdap vaccines. Only one Tdap vaccine is recommended in a person’s lifetime.

Vaccines available for free for kids under 19

All recommended vaccines are offered to all kids under 19 at no cost through health care provider offices participating in the state’s Childhood Vaccine Program.

Health care providers may charge an office visit fee and a fee to give the vaccine, called an administration fee.

People who cannot afford the administration fee can ask their regular health care provider to waive the cost.

Adults should talk to their insurance carriers about coverage for pertussis vaccine.

To learn more:

• Visit the PKIDS Online pertussis information page.

• Contact your local health agency  or the Department of Health’s Office of Immunization and Child Profile at 360-236-3595.