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The U.S. National Library of Medicine says some asthmatics should keep a peak flow diary. Here are the agency’s suggestions for what to record:
The number of each peak flow reading.
Any symptoms or possible triggers that preceded an asthma attack.
Any recent changes affecting your asthma medications.

“We found that exposure to cigarette smoke appears to increase the thickness of the epithelium, or lining, of the airways in the lung,” Martine Broekema, lead author of the study and a researcher at the University of Groningen in the Netherlands, said in a news release from the American Thoracic Society. “This may be the underlying cause of the fact that smoking asthma patients experience more asthma symptoms, such as shortness of breath and phlegm production, compared to nonsmoking asthma patients.”

The researchers looked at 147 people with asthma symptoms, including 35 smokers, 46 ex-smokers and 66 people who had never smoked.

People who currently smoked had more cells that produce mucous than did those who never smoked, the researchers found. “These pathological findings were associated with the severity of phlegm production reported by the asthma patients, suggesting a causal relationship between the two,” Broekema said. “Smoking asthmatics also showed a distinct inflammatory profile in their lungs compared to never-smoking asthmatics.”

“Furthermore, our data suggest that smoking cessation can reverse the thickening of the lining of the airways,” she said.
In the big picture, “this study shows again how important smoking cessation is for pulmonary health, and this appears to be especially true for asthmatic patients,” Broekema said. “The good news is that quitting appears to have a measurable benefit in these individuals.”

In theory, lowering indoor humidity should lower concentrations of moisture-loving dust mites - a major trigger for asthma-related breathing problems.

To test this, Dr. Neil C. Thomson, at the University of Glasgow, and colleagues measured breathing patterns over 12 months in 119 men and women who were about 42 years old on average and had asthma for 9 to 30 years.

Specialists retrofitted each home with a humidity-lowering ventilation system. They also steam-cleaned carpets, and replaced mattress covers and bedding, to clear dust mites.

In half the homes the ventilation systems actively exchanged indoor and outdoor air. In the other “control group” half, the systems had operational motors but non-operational fans to help ensure the groups remained “blinded” to what was actually happening, the researchers report in the journal Allergy.

Thomson’s team found no overall difference in dust mite concentrations between the homes with and without a working ventilation system.

Also, their comparison of morning breathing tests done at the start of the study and again at 3, 6, 9, and 12 months, showed no difference between those living with or without operational ventilation.

However, participants living in homes with working ventilation systems showed an overall significant improvement in evening breathing tests, while those with non-working systems worsened in these tests.

This may be partially due to the slightly reduced humidity, and dust mite levels found in the bedrooms and bedding of participants with active ventilation systems. But ventilation may also have improved overall air quality, Thomson speculated in an email to Reuters Health.

The finding came in the largest genome-wide association study (GWAS) reported to date involving Parkinson’s disease. GWAS studies look in the DNA on all of the chromosomes in a specific population of individuals for common genetic associations with a disease. To date, such studies have been done on relatively small numbers of samples and have not been able to identify genetic variations of smaller effect in Parkinson’s disease. But now, GWAS studies in very large sample sets are able to identify these elusive genetic variations.

Collaborating scientists in the United States and Europe pooled nearly 14,000 DNA samples and data to confirm that mutations in the alpha-synuclein (SNCA) gene and microtubule associated protein tau (MAPT), both present in the general population, are risk factors for sporadic Parkinson’s disease.

In an independent study from Japan, researchers also identified a different combination of genetic variants as risk factors in people of Japanese descent, a finding that highlights the power of GWAS in comparing risk factors among different populations.

The findings presented in the Nov. 15, 2009, online issue of Nature Genetics were supported in part by the National Institute on Aging (NIA), National Institute of Neurological Disorders and Stroke, National Cancer Institute, and the National Institute of Environmental Health Sciences, all components of the National Institutes of Health.

Parkinson’s disease, which affects about 1.5 million Americans, is a progressive neurologic disorder caused by the degeneration of nerve cells in the portion of the brain that controls movement. The likelihood of developing the disorder increases with age and involves a combination of environmental risk factors and genetic susceptibility. GWAS studies require large numbers of DNA samples — a hurdle the international team of researchers overcame through collaboration.

“Because previous Parkinson’s GWAS were too small and lacked power, we worked together to compile and analyze the large data sets needed to identify the elusive genetic variations that play a role in this complex disease,” said Andrew B. Singleton, Ph.D., chief of the NIA Laboratory of Neurogenetics, who co-led the study with Thomas Gasser, M.D., of the Hertie Institute for Clinical Brain Research, University of Tubingen, and the German Center for Neurodegenerative Disease, of Tubingen, Germany. “With this better understanding of the underlying genetic variants involved in the progress of this disorder, we have more insight into the causes and underlying biology of this disease. We hope this new understanding will one day provide us with strategies to delay, or even prevent, the development of Parkinson’s disease.”

The two-phase GWAS first analyzed DNA samples of 1,713 people with the disease and 3,978 free of the disorder, all of whom were Europeans. The findings were then replicated in a similar group of 3,361 people with Parkinson’s disease and 4,573 without the disorder. Following the initial findings implicating SNCA and MAPT variants as risk factors for typical Parkinson’s disease, the team then compared results with researchers performing a GWAS study in a group of Japanese people (2,816 with Parkinson’s disease and 3,401 free of the disorder). This second GWAS also revealed the strong association for SNCA but not for MAPT. Additionally, both GWAS studies found evidence for two additional risk variants; the first, which was strongest in the Japanese population, was named Park16; the second is close to a gene, LRRK2, which Dr. Singleton’s and Dr. Gasser’s groups previously found contains mutations that cause an inherited form of Parkinson’s disease.

“These findings support the notion that the sporadic and rare familial forms of the disease are related and that common genetic variability plays a role in developing the disorder,” said NIA Director Richard J. Hodes, M.D. “Future GWAS involving greater numbers of DNA samples will likely reveal additional common genetic risk factors. As we continue to use these and other novel approaches to understand complex diseases, we move closer to a complete understanding of the genetic basis of Parkinson’s disease.”

The researchers also found that black females continue to have a higher rate of sexually transmitted diseases (STDs) than any other racial or ethnic group.

Last year, there were about 1.2 million reported cases of chlamydia and nearly 337,000 reported cases of gonorrhea in the United States, according to the Sexually Transmitted Disease Surveillance, 2008, report.

Among the other findings from the report:
Gonorrhea rates among blacks were higher than any other racial or ethnic group and 20 times higher than among whites. While blacks represent 12 percent of the U.S. population, they accounted for about 71 percent of reported gonorrhea cases, 48 percent of chlamydia cases, and 49 percent of syphilis cases.
Black females aged 15 to 19 had the highest rates of chlamydia and gonorrhea (10,513 per 100,000 and 2,934 per 100,000, respectively), followed by black women aged 20 to 24 (9,373 per 100,000 and 2,770 per 100,000, respectively).
There were 13,500 cases of syphilis in 2008, an increase of nearly 18 percent from 2007. About 63 percent of the cases were among men who have sex with men. However, syphilis rates among women increased 36 percent from 2007 to 2008 (1.1 cases per 100,000 versus 1.5 cases per 100,000), compared with a 15 percent increase among men (6.6 cases per 100,000 versus 7.6 cases per 100,000).

“We cannot ignore the glaring racial disparities in rates of STDs, particularly when we consider the hard truth that gonorrhea rates among African-Americans are 20 times those of whites,” Dr. John M. Douglas Jr., director of the U.S. Centers for Disease Control and Prevention’s Division of STD Prevention, said in a news release.

“Research has shown that socioeconomic barriers to quality health care and higher overall prevalence of STDs within minority communities contribute to this pervasive threat. It is imperative that we improve access to effective STD prevention and treatment services in local communities for those who need them most,” he said.

Early testing, diagnosis and treatment are essential to prevent long-term health consequences of sexually transmitted diseases. Each year in the United States, untreated STDs lead to complications that cause at least 24,000 women to become infertile, according to the CDC.

Of the almost 19 million new cases of sexually transmitted diseases that occur each year in the United States, almost half are among those aged 15 to 24 years. STDs cost the nation’s health-care system as much as $15.9 billion a year, the CDC said.

The University of Adelaide study included more than 500 women whose diet and supplements were assessed during pregnancy. The women’s children were checked for asthma at age 3.5 years and at 5.5 years. Asthma was found in 11.6 percent of children at 3.5 years and in 11.8 percent of children at 5.5 years.

“In our study, supplemental folic acid in late pregnancy was associated with an increased risk of asthma in children, but there was no evidence to suggest any adverse effects if supplements were taken in early pregnancy,” Michael Davies, an associate professor at the university’s Robinson Institute, said in a news release from the school.

The researchers also said they found no association between asthma and dietary folate, which is found in green, leafy vegetables, certain fruits and nuts.

Pregnant women are advised to take a supplemental dose of 400 micrograms of folic acid per day in the month before and during the first trimester of pregnancy to reduce the risk of neural tube birth defects.

“Our study supports these guidelines, as we found no increased risk of asthma if folic acid supplements were taken in pre- or early pregnancy,” Davies said. “However, these guidelines may need to be expanded to include recommendations about avoiding use of high-dose supplemental folic acid in late pregnancy.”

The condition rarely causes pain or discomfort, but without treatment a child’s appearance can be permanently disfigured, according to the Children’s Medical Center of Akron.

Doctors often spot scoliosis during routine physical exams, but parents should also learn its warning signs:
Hemline, pant legs or shirt sleeves that appear to be uneven.
Uneven arm length.
Uneven shoulder heights.
A slight limp.
Complaints of sore back, numbness or tingling.
One breast that’s more prominent than the other.

The American Lung Association says parents should be on the lookout for these potential red flags that an asthma attack may be imminent:
A frightened facial expression and posture that indicates the child can’t relax.
Restless sleep.
Coughing, particularly at night.
Sweating, pale skin, rapid breathing and flaring of the nostrils.
Labored breathing with the lips pursed.
Vomiting and fatigue.
Sunken areas between the ribs or in the neck.

“The introduction of PUVA for the treatment of psoriasis was a major advance for patients with severe psoriasis, as it offered them an outpatient therapy rather than other treatments that required hospitalization,” said Dr. Pariser. “However, studies show that high cumulative exposure to oral PUVA is associated with an increase in the risk of non-melanoma skin cancer, particularly squamous cell carcinoma, which is why dermatologists often reserve PUVA for psoriasis patients who have not responded favorably to other treatments.”

In an effort to minimize the total dosage of PUVA, dermatologists often combine PUVA treatments with other therapies (such as retinoids) or in rotation with other treatments. In addition to the increased risk of skin cancer and skin aging with long-term use, other common side effects of PUVA include redness, itching, dryness, irregular pigmentation, nausea and vomiting. PUVA also is not recommended for use in children or in patients with certain medical conditions, which is why dermatologists closely evaluate patients before PUVA is considered as a treatment option for psoriasis.

Targeted Phototherapy (Excimer Laser)
With the introduction of the 308 nm monochromatic xenon-chloride laser for psoriasis in 1997, the use of phototherapy to treat localized lesions became more practical and more widely available. Excimer lasers selectively target affected lesions without treating unaffected skin – therefore minimizing the potential risk of exposing uninvolved skin to UV radiation. Another advantage is that because only the affected areas are treated, higher doses can be administered in fewer treatment sessions.

Although numerous studies have demonstrated that treatment with the excimer laser can clear psoriasis, there is limited information about the duration of remission and the recommended dosage and scheduling of therapy. Dr. Pariser explained that most patients experience long-term improvement following treatment with the excimer laser, and currently the dose of energy delivered is guided by the patients’ skin type and thickness of the psoriasis plaques.

“Typically, patients receive treatment with the excimer laser two to three times a week, with a minimum of 48 hours between treatments,” said Dr. Pariser. “Side effects are minimal and are limited to the treatment area, with redness, burning and darkening of the skin being the most common. There have been cases where blistering has occurred with the use of higher doses of energy, but for the most part treatments are well-tolerated – even in children.”

Patient Considerations for UV Light Therapy
Like all treatments for psoriasis, some patients make better candidates for UV light therapy than others. Dr. Pariser added that before UV light therapy is considered, all patients must have a complete history and physical examination and be made aware of the potential long-term risks of this treatment.

“Patients with a known history of lupus (a chronic inflammatory disease) or xeroderma pigmentosum (a genetic disease characterized by extraordinary sensitivity to sunlight) should not be treated with phototherapy,” said Dr. Pariser. “In addition, patients with atypical nevi, multiple non-melanoma skin cancers, multiple risk factors for melanoma, a history of melanoma, a history of photosensitivity disorder, or who are taking photosensitizing medications or are immunosuppressed as a result of organ transplantation should be screened carefully before starting UV light therapy.”

Recommended dosing guidelines for both BB-UVB and NB-UVB vary by skin type, with light-skinned patients receiving much smaller initial and incremental doses of UV light than darker-skinned patients.

“For the right patients and with close monitoring by a dermatologist, UV light therapy can be a safe and effective treatment for psoriasis patients who might not have responded well to other traditional therapies or for various reasons might not be good candidates for systemic medications,” said Dr. Pariser. “Dermatologists can recommend the best treatment plan for patients with mild to severe psoriasis, helping them improve their condition and overall quality of life.”