All posts by Stephen J. Klemawesch, MD

More asthma research yields hopeful new controls

For quite some time it has been known that calcium plays a major role in muscle contraction. A number of calcium-altering medicines are used to help heart problems and hypertension by relaxing the smooth muscle found in the heart and arteries. Now there may be an application to asthma.

Smooth muscle is also found in our bronchial tubes; constriction of this muscle that occurs through proteins called calcium-sensing receptors causes asthma.

A recent British study examined the use of a class of drugs used to treat osteoporosis called calcilytics. These drugs were administered to asthmatic mice with dramatic results: the drugs blocked the action of calcium-sensing receptors and thus, prevented the smooth muscle constriction.

The scientists are now starting human studies. This research is very compelling as it offers a mechanism to control asthma that has never before been available.

Zithromax new hero in infant RSV?

The major cause of bronchiolitis in infants, and not infrequently the major cause of subsequent chronic asthma in these children, has been the topic of recent exciting research at Washington University.

The culprit – RSV (Respiratory Syncytial Virus) – seems to succeed because is elicits such a strong inflammatory response in the airways of its tiny victims that they never fully recover.

In the past efforts have been made to try to reduce this inflammation by the use of both inhaled and systemic steroids; however, neither of these have been of any benefit.

Because the antibiotic Zithromax is known to reduce inflammation in adults with COPD and bronchiecstasis, the Washington University researchers decided to try it in RSV. Their study compared the use of Zithromax to placebo in infants with RSV. The outcome was dramatic. The children who received the Zithromax were more than 50 percent less likely to develop chronic asthma than the control group.

This correlated with the fact that the Zithromax group had much lower levels of inflammation in laboratory tests than the control group.

Milk — Aged wisdom for modern dilemma

Dear Dr. K: My chiropractor told me too much milk might actually weaken my bones. I’ve always heard milk is good for teeth and bones. Could he be right?

Actually, he is right. The whole cow milk and health issue has a convoluted history. It dates back to the Great Depression when many Americans were starving and rickets was common. The Federal government stepped in and subsidized the dairy farmers so that milk could be both available and cheap. It also mandated the addition of vitamin D to the milk.

The inexpensive milk allowed Americans to have a ready source of calories, protein and vitamin D which was a true Godsend.

In today’s world, most Americans are not starving and so what was of help in one context has gradually become too much of a good thing.

It’s true that cow milk is a rich source of calcium, but it also contains certain peptides and lectins that actually bind to and remove our existing calcium. If milk intake is high it actually leads to a net reduction in total body calcium.

Last year the British Medical Journal published a 20-year study of 100,000 people. They found a significantly higher risk of fractures in people who drank three or more glasses of milk a day, compared to those whose intake was less.

Studies on Asian-Americans and African-Americans show that their bone density was not as good on the cow-milk rich American diet as their ethnic counterparts living in Asia/Africa, and not consuming so much cow milk.

Cow milk is also the most common cause of food allergy. Also, even in people who are not allergic to milk, it tends to increase nasal and bronchial mucus production.

Finally, cow milk contains D-galactose which induces inflammation in the body. D-galactose has been shown to worsen some forms of arthritis, and to contribute to the development of diabetes and cardiovascular disease.

So, the old, familiar maxim probably applies here: “Everything in moderation.”

Mucky mucus: Lots of fluids and understanding mechanism helps

Feeling stuffed up? Achy around the eyes? Talking funny? Getting up close and personal with the mechanics of your respiratory system can enlighten – and offer fight-back tactics.

Our respiratory system (nose, sinuses and lungs) is lined with a membrane technically described as mucociliary columnar epithelium. The mucociliary part refers to the fact that there are abundant mucus glands, and the top of the cells have little hairs called cilia.

When all is normal, a great system is in operation: the mucus is thin and it sits on top of the ends of the cilia, which beat in a way to move this mucociliary escalator out of the lungs or sinus cavities. The system provides a barrier for microbes, pollutants and allergens from actually getting further into the cells, and also a mechanism for removing these unwanted items from the body.

Unfortunately, both allergic problems and infections can spoil this otherwise wonderful mechanism. They succeed because the inflammation from allergy/infection increases the viscosity of mucus, which is bad for two reasons: 1. The cilia can’t move the paste-like mucus, and 2. The white blood cells that want to attack the microbes find it slow-going trying to “swim” through thick mucus. Then there’s the dastardly aspect of infection: Many microbes have learned the capacity to manufacture mucus-thickening proteins as a way of defending themselves from your body’s immune attack.

So what can you do to bolster your defense against these attackers? The bottom line is to try and keep your mucus thin. Avoid milk and push clear fluids. Water is best. And as Grandma used to advise, a hot, steamy shower can loosen thick mucus. Over-the-counter medicines that work are guaifenesin (found in Mucinex and Robitussin), and N-A-C (N-acetyl cysteine).

Q – Tips: Mediterranean Diet

The Mediterranean Diet has been shown to keep telomere length long. Telomeres are DNA sequences at the end of chromosomes used to repair our chromosomes from damage. The Mediterranean Diet (high in fruits, vegetables, nuts and olive oil — with reduced red meat) reduces oxidative stresses that damage our chromosomes. Damaged chromosomes lead to premature aging, cancer and chronic disease.

Heads-up’ issued for ol’ faithful aspirin: may aggravate respiratory disease

 

A “pay attention” article was recently published in the Journal of Allergy and Clinical Immunology cautioning adults with asthma to be more aware that aspirin may aggravate their condition.

The authors pointed out that while some adult asthmatics with Aspirin Exacerbated Respiratory Disease (AERD) are cognizant of the negative effects aspirin can have on their health, most are not.

Studies have shown that AERD is more likely to occur if adult asthmatics also have chronic sinus problems and/or nasal polyps. Overall, seven percent of asthmatics have AERD, but 15 percent with severe asthma have it.

Unfortunately there is no simple blood or skin test to diagnose Aspirin Exacerbated Respiratory Disease. Right now, only two ways are available for these patients to become aware of the possibility: 1.) Monitoring their breathing symptoms after ingesting aspirin or other NSAIDS (non-steroid anti-inflammatories). 2.) Doing an aspirin challenge in a doctor’s office by measuring baseline pulmonary function tests and then incrementally increasing doses of aspirin, while repeating the pulmonary tests.

 

Dear Doc: Penicillin/Cephalosporin — cross-reactive?

Dear Dr. K: I’m allergic to penicillin but my pharmacist has also labeled me cephalosporin-allergic. I’ve never taken cephalosporin. Should I follow her advice?

I can’t give you an answer with a 100 percent surety, but I can come close. As luck would have it, Kaiser Permanent Health Care just finished a research project on cephalosporin allergy.

Their study included 820,000 patients who received a total of 1.4-million courses of cephalosporin (often prescribed as Keflex). Of these, 66,000 were allergic to penicillin. Only one-half a percent of the 820,000 had an allergy to cephalosporin.

The reason your pharmacy warns of a possible cross-reactivity is that penicillins and cephalosporins share a common structural feature called the Beta-lactam ring. The thing that distinguishes penicillins from cephalosporins are side-chain molecules that attach to the Beta-lactam ring. Luckily, most allergy to penicillin is directed against the side chain and not the ring structure. Hence, there would not be cross-reactivity.

The Kaiser Permanent researchers felt that since the potential for cross-reactivity is so low, penicillin-allergic individuals can go ahead and take cephalosporins in most cases. They did advise members of this group who have had anaphylaxis to consider antibiotic testing prior to receiving cephalosporins. (Also, see first item in Q-Tips this issue.)

Hookworms highlighted again: hitches and hopefulness this time

Do you remember a previous newsletter article about a crazy British physician with asthma? He was able to put his asthma into total remission by ingesting hookworms. The worms end up living in the GI tract and for some strange reason, they switch the body from the allergy-promoting TH-2 mode to TH-1, which eliminated allergy (See Promising New Asthma Drug this issue.)

Now his crazy Australian brethren are doing research on celiac disease and hookworms. The Australian scientists found that by inducing an experimental hookworm infestation in patients with celiac disease, and at the same time giving them small amounts of gluten, they were able to induce a state of gluten tolerance.

As well as the hookworm treatments work, the downside is that the worms cause the patients to become anemic and, thus, are not a viable long-term treatment. The researchers, however, hope these experiments will lead to a safe method of switching TH-2 to TH-1. One never knows where research can lead.