Influenza activity has continued to markedly increase in the United States, reaching epidemic levels. Since October 1, 2016, a total of 4,317 laboratory confirmed influenza-related hospitalizations have been reported to the Centers for Disease Control and Prevention (CDC). This number represents a rate of 15.4 hospitalizations per 100,000 U.S. residents, which is significantly higher than last year’s rate of 2.5 hospitalizations per 100,000 in the same time frame. A positive factor is that a majority of all the reported flu cases were caused by an influenza type A virus, a strain found in the 2016-2017 vaccine. However, the CDC estimates that as of early November 2016, only two of every five children and adults in the U.S. had received the flu vaccine.
In Pennsylvania, flu activity for this period closely mirrors the national picture. A total of 14,932 laboratory confirmed cases have been reported to the Pennsylvania Department of Health. The southwestern portion of the state has been strongly affected, with the Allegheny County Health Department reporting 1,869 lab confirmed cases, as compared to 62 confirmed cases reported at this time last year.
Flu season generally spreads from November to March. Even though it takes about two weeks for protective antibody levels to fully develop, it is not too late to get a flu shot. It is especially important for those at high risk, such as people with chronic lung conditions, to be vaccinated since they are at greater risk of experiencing serious illness or death as a result of the flu.
Every time you empty a sweeper, imagine that same amount of dirt can be found in your home’s ductwork.
This accumulated dirt clogs the heating system, lowering heating efficiency and requiring more energy and money to heat your home.
More importantly, this accumulated dirt is rebroadcast throughout your home, which is a concern to all of us at Breathe Pennsylvania. We all have different thresholds to different allergens, and if they’re present in higher concentrations, our sensitivities most likely will react to them.
Not surprisingly, there is no standard recommend by the Environmental Protection Agency regarding how often ducts should be cleaned. Some professional duct cleaning companies encourage cleaning every year. Such is probably not necessary, but I am sure there are exceptions based upon system design, age, environmental dirt, number and age of occupants just to name a few.
Duct cleaning doesn’t have to be done professionally. In fact, it can be a fairly easy DIY project, though you probably won’t be able to get to every inch of the duct work. Professional companies may have an advantage here with telescoping tools that enable them to reach every bend.
In addition to cleaning your ducts, change air filters regularly. It might take some time for you to figure out how often filters should be switched out. If you change your filter every six months and the filter is falling apart, it should be changed it more often. If you live alone in a small home and the filter is fairly clean, then it can be changed less often. Keeping a list next to the furnace can help you develop a routine.
Additionally, dirt will build up around returns. These should be checked every time you vacuum near them, and cleaned when necessary.
Giving your system a little sweep can potentially improve your air quality, and that is a start to good breathing.
Respiratory Syncytial Virus Infection (RSV) is a very contagious virus that affects a majority of infants before age 2, and is most common in late fall to early spring. Most children’s RSV appears as a common cold, but a few infant’s RSV can cause serious problems such as an infection in the small airway of the lungs (Bronchiolitis) or pneumonia.
According to the CDC, higher risk is found with:
- Babies born prematurely
- Children younger than 2 who were born with heart and lung disease
- Infants and young children whose immune systems are weakened due to illness or medical treatment
- Infants under 8 to 10 weeks old
With RSV, most of the time it will present as a common cold—cough or runny nose which will last about one to two weeks. More serious issues will present differently and your child’s doctor needs to be called immediately is the following symptoms occur:
- Difficulty breathing
- Cough that is producing mucus that is green, yellow or gray in color
- Child is unusually upset or inactive
- Child refuses to bottle or breast feed
- Dehydration— lack of tears when crying, a dry diaper for longer than 6 hours or dry skin.
If your child is very tired, breathing quickly or has a blue tint to lips or finger nails, immediate medical attention is needed.
There is no vaccine for RSV, but simple steps can be taken to help prevent RSV:
- Wash hands with warm soapy water.
- Clean and disinfect hard surfaces.
- Wash objects that a child may touch or hold.
- Keep your baby away from crowds and allow people to only hold the baby after washing their hands.
- Avoid kissing a child if you have cold like symptoms present.
- For children who have heart or lung disease, limit their time in a daycare setting during times when RSV is most common.
- Keep family, including siblings, away from an infant if they have signs of a cold.
- Never let people smoke near your infant.
Even though there is a medication that helps prevent high risk infants from getting RSV, there is no drug available to treat the actual virus if an infant is infected. Treatment must focus on the infection and the respiratory symptoms.
In home treatments that work best include:
- Keeping nasal passages clear of mucus with a bulb syringe and saline drops.
- Using a cool mist vaporizer.
- Keeping infants hydrated.
- Non-aspirin fever reducers (ask your child’s doctor before use)
While RSV is usually identified as a virus in infants, recent studies have found that older adults are also considered high risk. Adults with RSV may also present the illness as a common cold but older adults with compromised lung disease are considered high risk. RSV in adults can cause pneumonia, or an exacerbation of COPD or congestive heart failure.
Adults can follow the same prevention steps above to help avoid RSV, but need to be aware of changes in health and notify their doctors immediately.
RSV may only be noticed as a common cold in your house but watching for serious signs and symptoms is very important to the health and well-being of your infant and elderly family members. Understanding RSV and using easy steps to prevent it is the first line of defense.
A good night’s sleep is vital for our survival, and proper sleep hygiene can help you get the Zs you need. I spend my nights listening to my husband snoring, with a cat on my chest, and half way through the night my 5-year-old catapults herself into my bed and moves around like she is competing on “Dancing with the Stars.” Whatever your story is, a good night’s sleep is sometimes hard to get.
Sleep hygiene is a variety of different practices to help us get the best night’s sleep and full daytime alertness. Some best practices are as follows:
- Avoid napping during the day. Napping disrupts our normal sleep pattern a night.
- Avoid staring at bright lights such as a smart phone or tablet before bed. Some devices have a “night shift” mode that decreases the brightness of the phone or tablet at a set time.
- Make sure you have a good exposure to natural light. This exposure helps regulate your “sleep-wake cycle.”
- Reading emails or social media before bed can keep the brain active and not allow it to rest properly.
- Large meals before bed can disrupt sleep, and if you’re having sleeping problems, that is not the best time to start trying new foods.
- Avoid caffeine, especially at night before bed. Sometimes a warm drink, such as decaffeinated hot tea, can help you calm yourself before sleep.
- Proper exercise can help promote a good sleep cycle. Engage in vigorous exercise during the day and calming exercise like yoga at night as a pre-bedtime routine.
- Create a calming bedtime routine, leaving negativity behind and out of the bedroom. Your bed should only be associated with sleep and be a pleasant and comfortable nightly retreat.
- Remove triggers in the bedroom that cause you to wake up or stop you from sleeping.
When we establish proper sleep hygiene, we are going to sleep better. The better we rest, the more alert and ready we are for the next day. Sleep is important for proper health, so take the time out every night and give yourself what you deserve—a good night’s sleep.
January is Radon Awareness Month, and Western Pennsylvanians should take the time to learn about it. Radon comes from the breakdown of trace amounts of uranium in our soil. As a gas, it moves up into our homes where it is trapped and presents a danger to us in the form of lung cancer. Even at levels below the recommend remediation level of 4 picocuries per liter of air (pCi/L), radon can still be a danger; however, zero radon is considered impossible to achieve through modern remediation technology.
Pennsylvania measures high in radon levels when compared to other states. According to the Pennsylvania Department of Environmental Protection, 43% of the homes in Allegheny County, 51% in Butler and 58% in Beaver measure high in radon. Because of the high levels of radon in Pennsylvania, lung cancer is usually found and diagnosed later in the disease progression.
What can you do? Test your home. Licensed Measurement Technologists can be found on the state DEP web side. Self-test kits can be found at some local hardware stores, and you can even get one at the Breathe Pennsylvania online store.
Additionally, when you buy a home make sure it is tested. You can’t be forced to buy a home with high radon in Pennsylvania. It is a great opportunity to have a home remediated before you move in. When you are selling a home, please make sure testing protocols are followed. Most home sellers do abide by what is requested of them, but as a former licensed tester I have encountered home owners who cheat to get a positive result.
If you find high levels of radon, immediately call the state DEP for a list of qualified mitigation contractors who can help. If you ignore it or try to fix it yourself, you potentially put your life or someone else’s in danger and you might actually increase radon levels in your home. Knowingly tampering with an ongoing radon test also is illegal. In the end radon can be remediated, and dong so not only benefits present owners, but future ones as well.
When counseling individuals about methods to help them quit smoking or chewing, I’m often asked about whether or not I recommend hypnosis or acupuncture. Hypnosis has existed for hundreds of years, and its clinical value has been debated over time. It is described as a state of mindfulness in which individuals make decisions that they would not ordinarily consciously make. Some describe hypnosis as a relaxing trance in which they are at risk of suggestibility.
There are conflicting results supporting the effectiveness of hypnosis in quitting tobacco. A 2013 study demonstrated a slight increase in the success of quitting smoking as compared to quitting cold turkey, while participants experienced fewer withdrawal symptoms. However, the success rate remained lower than that of nicotine replacement therapy (NRT) or cessation medications like Chantix or Zyban. A 2014 study found that hypnosis was more effective than nicotine replacement therapy for smoking cessation. Keep in mind that while many individuals find hypnosis helpful in their quitting process, it doesn’t work for everyone.
Acupuncture is a form of Chinese medicine which has existed for over 2,000 years. It works by using thin needles that are inserted along pathways or pressure points, which when stimulated, are believed to release pain-mediating chemicals and hormones into the muscles, spinal cord, and brain. Like hypnosis, evidence of acupuncture’s effectiveness in quitting smoking is inconsistent.
Hypnosis or acupuncture may be the best quitting options for individuals who are sensitive to NRT or smoking cessation medications. If you think that hypnosis or acupuncture will help you in your quitting journey, try it. Simply search for a licensed acupuncturist or certified clinical hypnotherapist. What do you have to lose?
American Academy of Medical Acupuncture. (2016). NCCAM acupuncture information. Retrieved from http://www.medicalacupuncture.org/For-Patients/Articles-By-Physicians-About-Acupuncture/NCCAM-Acupuncture-Information
Dickson-Spillman, M., Haug, S., & Schaub, M. P. (2013). Group hypnosis vs. relaxation for smoking cessation in adults: A cluster-randomized control trial. Retrieved from http://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-13-1227
Hasana, F. M., Zagarinsc, S. E., Pischkea, K. M., Saiyeda, S., Bettencourta, A., Beala, L., Macysa, D., Auroraa, S., & McCleary, N. (2014). Hypnotherapy is more effective than nicotine replacement therapy for smoking cessation: Results of a randomized controlled trial. Complementary Therapies in Medicine, 22(1), 1-8.
North Carolina Society of Clinical Hypnosis. (2015). What is hypnosis? Retrieved from http://nchypnosis.org/what-is-hypnosis/
Patients who have Medicare Part D prescription drug plans most likely will see an increase in the cost of their medications next year.
According to a recent article in the AARP Bulletin, premiums for Medicare Part D prescription drug plans will increase next year by an average of 4.6%. Experts say you should look beyond what you’re paying for premiums and pay closer attention to the copays you’ll be charged for medications. One plan that charged $7 permonth for a generic drug will charge $352 permonth for the same drug. The AARP analysis also found enormous differences in copayments charged for a 30-day supply of the same drug. One example is Advair, a bronchodilator used to prevent asthma attacks and COPD flare-ups. In the state of California, the lowest copay for 30 days is $21 with the highest being $170, which is a huge difference.
You should have received your plan’s notice of change in September. It describes the plan’s tier structure, coinsurance (a percentage of the full cost of the drug, not to be confused with copays, which are flat rates) and premium increases. Read your notice carefully.
DONUT HOLE: After your initial coverage limit of $3,700 (minus your deductible) has been reached you are in the “donut hole.” For 2017, Medicare Part D will pay 49% of your generic meds cost and the Brand-Name manufacturer will pay 60% of brand-name drugs, even if your plan’s coverage says “No Gap Coverage” while in the donut hole. When you’ve reached $4,950, you are now in what’s called “catastrophic coverage” and will have a copay of 5%.
It will pay to shop around as there are 40 to 50 Medicare Part D drug plans in each state. Find more information at: medicare.gov/find-a-plan/questions/home.aspx or call Medicare at 800-633-4227. Please don’t call us at Breathe PA as you will have to contact your provider for answers. Good luck!
[Over the last couple of months, we have been outlining asthma management tips and strategies to help early learning practitioners better serve preschool-aged children. This blog is the second in the series. Click here to read the first, here to read the second and here to read the third.]
Early Learning Practitioners often have questions regarding nebulizers that are either brought into the center by parents or for the units kept there. We know that germs love dark, humid, warm places to live and grow. Mold and bacteria can easily grow on this equipment if it is not properly cleaned and disinfected, and that could lead to respiratory issues for a child with asthma.
Let’s start with the easy stuff. The plastic tubing that carries the air to your nebulizer does not require cleaning unless it gets dirty on the outside. Just take time to wipe off the outside of this tubing. You don’t want to place it in water because you don’t want water inside the tubing. Any tubing that shows dirt on the inside should be thrown away. The same is true for the air compressor–you only need to wipe off the outside. You may not know this but your air compressor has filters that need to be changed regularly, too.
To clean your nebulizer, just follow this easy schedule:
- After every use: rinse the nebulizer cup, mask, or mouthpiece thoroughly with warm water, shake off excess water and let air dry.
- At the end of each day: the nebulizer cup, mask, or mouthpiece should be washed with warm soapy water and rinsed with clean water, then laid out on a paper towel over night to dry.
- Once a week: wash with warm soapy water and after rinsing thoroughly, disinfect with white vinegar. To use the vinegar solution, mix 1/2 cup white vinegar with 1 1/2 cups of water. Soak the equipment for 20 minutes and rinse well under a steady stream of water. Shake off the excess water and allow to air dry on a paper towel. Always allow the equipment to completely dry before storing in a plastic, zippered bag.
The nebulizer kit, cup, mask, or mouthpiece should not be used for multiple children. Once a kit is opened and used, it should be for that individual child only and then sent home. If you should happen to get some water in the tubing, just connect it to the nebulizer and turn it on for a few seconds to allow the air to push out the water.
You can learn more by watching an educational video on how to clean and disinfect your nebulizer on our YouTube channel.
Did you know that in 1900, tuberculosis (TB) was a leading cause of death in the United States, second only to pneumonia/influenza? There were 38, 820 TB related deaths reported that year. Since then, the deaths attributed to tuberculosis have steadily decreased to where in 2013, there were 555 TB related deaths. In the U.S. there has been a marked decrease in the number of reported cases, from 84,304 cases when the disease first became reportable in 1953, to 9,421 cases in 2014.
Does this mean that TB is no longer a global health concern? Unfortunately, no. According to the World Health Organization (WHO), there were an estimated 10.4 million new cases of tuberculosis worldwide in 2015. In that same year, reportedly 1.8 million people died of TB.
To focus world attention that tuberculosis, although preventable and curable, remains a very timely and urgent global health issue, WHO has recently published the following 10 Facts About Tuberculosis:
1 –In 2015, six countries accounted for 60% of the 10.4 million new cases of tuberculosis. India was first, followed by Indonesia, China, Nigeria, Pakistan and South Africa.
2 – Tuberculosis was one of the top 10 causes of death worldwide (1.8 million people) in 2015, ranking above HIV and malaria.
3 – In 2015, 1 million children fell ill with TB, and 210,000 children (including 40,000 with HIV) died due to TB. Childhood TB is often overlooked by healthcare providers as it can be difficult to diagnose and treat.
4 – Tuberculosis is the leading killer of people living with HIV. Worldwide, about 35% of deaths among people with HIV is due to TB.
5 – On a positive note, globally, the number of people falling ill with TB is declining. Since 2010, the fastest rate of decline in the mortality rate has been in the Eastern Mediterranean and European regions, the slowest in the African region.
6 – TB occurs in every part of the world, but the majority of cases are in Asia and Africa.
7 – An estimated 480,000 people developed multi-drug resistant tuberculosis (MDR-TB) in 2015. Some of these people acquired an even more serious form of the illness, extensively drug-resistant tuberculosis (XDR-TB), which is a form of tuberculosis that responds to even fewer available drugs.
8 – It is estimated that TB treatment saved 49 million lives globally between 2000 and 2015.However, diagnostic and treatment gaps still persist.
9 – Of the estimated 10.4 million new cases, only 6.1 million were detected and notified in 2015. This led to a gap of 4.3 million cases, undetected and untreated.
10 – In low and middle income countries, investment for tuberculosis prevention and care fell almost $2 billion short of the $8.3 billion needed in 2016. This gap will be widened by 2020 if current levels of funding are not increased.
Vaping, or the inhalation of vapor from an electronic cigarette (e-cigarette), is a controversial topic that advertises many positive health effects. Seen as a healthier alternative to smoking, vaping has been promoted as a replacement to tobacco cigarettes. There are polarizing points of view that claim the extreme harms or harmlessness of e-cigarettes; yet, few of them discuss the effects of e-cigarette use during pregnancy. Should women be encouraged to quit smoking tobacco cigarettes and vape instead?
The harms of smoking tobacco cigarettes during pregnancy are well documented, from higher risk of miscarriage, preterm delivery, and low fetal birth weight. However, the harms of vaping during pregnancy are less clear given
that they haven’t been fully studied. Early studies suggest that e-cigarette vapors, regardless of nicotine content, can affect nervous system development of a fetus.
Many experts believe that since vaping products can contain nicotine, the addictive chemical in tobacco, exposure to the e-cigarette vapor can harm the fetus. Most notably, nicotine exposure can cause changes in the blood vessels, which the fetus relies on for blood, oxygen, and nutrients. It is believed that nicotine exposure increases a mother’s risk of pre-eclampsia and decreases fetal growth. The American Pregnancy Association recommends that pregnant women avoid all nicotine products during pregnancy.
Should women be encouraged to quit smoking tobacco cigarettes and vape instead? No. Quitting smoking, and vaping, is the best thing that you can do for your child. It’s never too late to quit. If you are pregnant, or thinking of becoming pregnant, talk with your doctor about quitting options.
American Association for the Advancement of Science. (2016). Alternative tobacco products may be just as dangerous as cigarettes. Retrieved from https://www.aaas.org/news/alternative-tobacco-products-may-be-just-dangerous-cigarettes
American Pregnancy Association. (2015). Electronic cigarettes and pregnancy. Retrieved from http://americanpregnancy.org/is-it-safe/electronic-cigarettes-and-pregnancy/
Centers for Disease Control. (2016). Smoking during pregnancy. Retrieved from https://www.cdc.gov/tobacco/basic_information/health_effects/pregnancy/
Wickstrom, R. (2007). Effects of nicotine during pregnancy: Human and experimental evidence. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2656811/