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Asthma In The U.S: Growing Every Year

children_and_pollutionBy Dr. Lawrence Rosen
March 1, 2012

“Asthma in the US: Growing every year” blares the front page of the U.S. Centers for Disease Control and Prevention (CDC) web site on asthma statistics.

The latest findings include the following:

 * The number of people with asthma continues to grow. One in 12 people (about 25 million, or 8% of the population) had asthma in 2009, compared with 1 in 14 (about 20 million, or 7%) in 2001.   
*  About 1 in 10 children (10%) had asthma and 1 in 12 adults (8%) had asthma in 2009

*   About 1 in 9 (11%) non-Hispanic blacks of all ages and about 1 in 6 (17%) of non-Hispanic black children had asthma in 2009, the highest rate among racial/ethnic groups.

 * The greatest rise in asthma rates was among black children (almost a 50% increase) from 2001 through 2009.

Many environmental triggers have been linked to asthma, including exposure to environmental tobacco smoke, air pollution and stress.  One of the most intriguing recent associations was described in a landmark article by Dr. John T. McBride in Pediatrics in November, 2011.  In “The Association of Acetaminophen and Asthma Prevalence and Severity,” Dr. McBride details the link between acetaminophen use and asthma, referencing the abundance of epidemiologic support for the connection in both children and adults.  What is the rationale for the association?  Dr. McBride points out that the plausible hypothesis is the pro-inflammatory effect of acetaminophen on airways mediated by the depletion of glutathione, one of our body’s major antioxidants.  Asthma is marked by an inflammation in the lining of the airways; glutathione, a peptide produced in the liver, reduces inflammation by limiting tissue damage caused by oxidative stress.  Acetaminophen directly depletes glutathione stores via its impact on hepatic metabolism.  Of note, altered glutathione metabolism has also been directly linked to autism.  Might acetaminophen be linked to the rising rate of this and other childhood disorders that are in epidemic proportions? It is certainly plausible and likely to be a factor in specifically vulnerable children.  Though speculative and highly controversial, the common practice of giving acetaminophen prior to childhood vaccinations may impair some children’s ability to effectively detoxify vaccine additives, thereby facilitating immuno- and neurotoxicity.

Fortunately, several natural agents - milk thistle, green tea, coenzyme Q10, n-acetyl cysteine, and ginger - have all been demonstrated to moderate the liver toxicity of acetaminophen.   However, avoiding the medication’s use in the first place may be our best strategy to limit the development of asthma in at-risk children.

It is worth noting that Dr. McBride is a bona-fide expert in childhood asthma.  He is a full Professor of Pediatrics at Northeast Ohio Medical University and a pediatric pulmonologist at Akron Children's Hospital; he completed his pediatric pulmonary training at Harvard/Boston Children’s Hospital, probably the most prestigious fellowship program in the world.  

His conclusion is notable for its certainty and emphasis on precaution:

In my opinion, the balance between the likely risks and benefits of acetaminophen has shifted for children with a history or family history of asthma. I can understand how those responsible for regulation or policy statements of professional organizations might be more comfortable waiting for incontrovertible evidence. There remains a possibility that confounding variables might explain some or all of the association between acetaminophen and asthma. For this reason we need further studies. At present, however, I need further studies not to prove that acetaminophen is dangerous but, rather, to prove that it is safe. Until such evidence is forthcoming, I will recommend avoidance of acetaminophen by all children with asthma or those at risk for asthma and will work to make patients, parents, and primary care providers aware of the possibility that acetaminophen is detrimental to children with asthma.

dr_rosen_bio_pic_3-6-14Lawrence Rosen, MD is an integrative pediatrician and co-author of Treatment Alternatives for Children, an evidence-based guide for parents interested in natural solutions for common childhood ailments. He is the founder of one of the country’s first “green” pediatric practices, The Whole Child Center, in Oradell, NJ, and serves as Medical Advisor to the Deirdre Imus Environmental Health Center at HackensackUMC. Dr. Rosen is a founding member and Past Chair of the AAP Section on Integrative Medicine and is appointed as Clinical Assistant Professor in Pediatrics at UMDNJ. A graduate of New York Medical College and the Massachusetts Institute of Technology, he completed his residency and chief residency in pediatrics at Mount Sinai Hospital in New York. Dr. Rosen has been featured on Good Morning America, CNN, and Imus in the Morning, and he is a frequently cited expert on children’s and environmental health matters. He is a contributing editor and pediatric columnist for Kiwi Magazine, as well as a contributing author/editor for several books, including Integrative Pediatrics, Green Baby, and Pediatric Clinics of North America: Complementary and Alternative Medicine. Dr. Rosen serves on many integrative health advisory boards, including the Holistic Moms Network, Teleosis Institute, and Integrative Healthcare Symposium, Integrative Touch for Kids, PedCAM, Kula for Karma, and MarbleJam Kids.

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