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Spring is here! So, too, is allergy season and spring sports! It seems this every year at this time a young little league baseball player wheezes as they cross home plate and desperately tries to catch their breath. Players, coaches, umpires, parents watch in dismay, deciding whether they need to call an ambulance. Minutes later the player recovers from this scary situation…until the next time. Could this be an example of exercised-induced asthma (EIA)?

What is EIA?

Dr. Gregory Cali, a local pulmonologist, (lung doctor) was gracious enough to participate in an interview about this problem…exercise-induced asthma (EIA). The topic was chosen in response to an email question from a concerned mother of an athlete with asthma.  Dr. Cali informed me that the first thing to know about exercise induced asthma (EIA) is that EIA is not a distinct disease in itself-but is one manifestation or presentation of asthma. Putting it simply, EIA occurs in patients who have develop narrowing of the bronchial tubes ( bronchoconstriction) when they exercise.  Some experts would rather we use the phrase exercise induced bronchoconstriction which is what happens when someone has an asthma attack.  This bronchoconstriction occurs because of spasm of the tiny muscles of the airways, plugging of the airways with thick mucous, and swelling or edema of the cells lining the airways. 

In fact, it is inflammation of the airways, mostly due to allergies, that is at the root of most cases of asthma. This inflammation causes the bronchial tubes to become over-reactive-and predisposed to narrowing- when exposed to certain triggers.  Exercise is one of those triggers in susceptible people. The patient with EIA complains of chest tightness, wheezing, and shortness of breath when exercising.  Some patients only experience coughing with exercise.  Symptoms are usually worse in cold, dry air. This is believed to be due to the drying and cooling of the airways, which occurs with exercise, especially if the patient opens his or her mouth while exercising.  Nasal breathing is much better at warming and humidifying air and may help to reduce EIA.  

Diagnosing EIA

Dr. Cali feels that the most important point about EIA is to make sure a specific diagnosis is made.  It is difficult at times to differentiate asthma from the normal breathlessness, which occurs with exercise.  The feature of EIA that distinguishes it from normal breathing, or being "out of shape" is the fact that EIA is ALWAYS associated with a decrease in airflow.  This can be measured with either a peak flow meter or a spirometer.  It is also important that a specific diagnosis be made so that a person will not be labeled as asthmatic when they may be "normal" or have other conditions such as heart problems or anemia. 

Dr. Cali also recommends before a person is labeled asthmatic, they have spirometric testing.  An improvement in airflow after inhaling. A bronchodilator is an important indicator of asthma.  Sometimes a bronchial challenge test is needed to diagnose asthma.  In this test, the subject breathes in a known bronchoconstrictor in small quantities and the response is noted.  Patients with asthma almost always respond to the inhaled agent by a reduction in airflow. 

PREVENTION AND MANAGEMENT OF EIA

Inform Coaches – If coaches are made aware, than they can be prepared for the onset of EIA. Provide emergency contacts and medications with instructions, such as inhalers, should be available.

Warm and Moisten Air - Whatever the patient can do to warm and moisten the inhaled air can help prevent EIA.  Nose breathing during exercise or wearing a loose covering over the mouth in cold weather may help.  Sometimes, in severe cases, switching to an indoor sport like swimming may be necessary.

Start Out Slowly - It is important to start out slowly and warm up first before exercising at full tilt. Slowly jog around the track or field before practice or a game to prepare your lungs for full-speed.

Medications – are often necessary.  Quick- acting bronchodilators like Albuterol, used 15-20 minutes before planned exercise, is recommended.  This can be repeated once more during the exercise, but if tightness or wheezing occurs, the exercise should be stopped. Many patients with asthma require preventative treatment with anti-inflammatory medications.  Inhaled steroids and/or leukotriene inhibitors may have to be added if the asthma is not controlled with Albuterol alone.  In fact, some patients with asthma who are overly reliant on quick acting bronchodilator medications can get into serious trouble if they do not use inhaled steroids. Be sure to communicate your needs with your coaches.

Play Smart - In conclusion, people with asthma should not shy away from exercise.  With proper precautions, people with asthma should be able to participate in all kinds of sports activities: baseball, football, soccer, swimming, tennis and running (even a marathon)! The key point is that the asthma needs to be under control and monitored by the patient, parents, coaches and doctor as a team. 

Visit your doctor regularly and listen to your body.     

Medical Contributor: Gregory Cali, DO, pulmonary specialist, Dunmore, PA

EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” via Blog

EVERY SUNDAY in "The Sunday Times" - Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in hard copy

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!

Data shows vaccination rates are declining since 2020

One of the greatest frustrations in modern medicine occurs when a safe, tried, and proven treatment exists to prevent deadly disease, but it is not possible to administer it to the potentially vulnerable victims. Over time, the disease unnecessarily spreads exponentially. Malaria in sub-Saharan Africa where one million die from the disease each year and tuberculosis in Haiti where the highest rate in the Western Hemisphere exists, are two examples. Another such disease that can be prevented with vaccination is the Human Papillomavirus, (HPV). While some strains of HPV lead to cancer an almost 100 percent disease prevention rate is associated with those vaccinated before the age of first potential exposure.

Despite validated scientific evidence of safety for more than 15 years, HPV vaccination skepticism not only persists, but is on the increase. Surveys show that the “anti-vaccine” culture fueled by COVID 19 has carried over to other vaccinations, including HPV. For example, provider orders for HPV vaccines decreased 24% in 2020, 9% in 2021 and 12% in 2022 when compared to 2019.

Many parents belonging to the “anti-vaccine movement” justify their actions with completely unfounded and unsupported fears of autism and other illnesses from the vaccine. However, their decisions affect the health of not only their children, but others as well.

According to Paul Offit, MD, professor of pediatrics, division of infectious diseases director of the Vaccine Education Center at the Children’s Hospital of Philadelphia (CHOP), every year in the United States, thousands of men and women die of cancers that can be prevented with a simple vaccine administered during adolescence to prevent HPV. He states, “It is critical that doctors and parents keep in mind; the disease is NOT ABOUT SEX…IT IS ABOUT CANCER!”

Top 5 Health Initiatives - HPV is one!

The Centers for Disease Control (CDC) has listed the prevention of HPV as a one of its “Top 5 Health Initiatives.” The pressure will be on health care providers to take the time to educate and dispel myths in order for parents to make informed decisions for the health of their children. In fact, local pediatrician Anders Nelson, who spends significant time educating parents and children about the importance of vaccination, requires parents to sign a “Refused HPV Vaccine” form and boasts a 99% compliance rate.

2013 the CDC reported 13.9% of males and 37.6% of females’ ages 13-19 are completing vaccination for Human Papillomavirus (HPV). Despite such low vaccination rates, a 50% reduction in HPV among 14 -19-year-old females was noted. Moreover, studies demonstrate a near 100% success rate to eradicate HPV in children vaccinated between the ages of 9 and 11 years old, leading health professionals to ask a frustrating and burning question: “Why do parents hesitate to vaccinate their children from a potentially deadly virus when a safe and effective cure exists?”

Reasons cited by parents for not vaccinating are challenging to health providers.  Some of the most common responses include misunderstanding of HPV and its impact, unfamiliarity with vaccine recommendations, distrust of vaccine safety, religious and moral issues with mode of disease transmission, and social pressures. It will be the purpose of this column to dispel myths and address these concerns among parents.

What is HPV?

HPV is the most common sexually transmitted disease (STD) in the United States.  It is estimated that nearly all sexually active Americans will at some point become infected with the virus.  HPV is spread by direct skin to skin contact.  Although the infection maybe asymptomatic, it is still possible to spread the virus.  Condoms are not 100% effective to prevent HPV because infected skin may be present outside of the barrier.

Studies have demonstrated that 90 percent of sexually active males and 80 percent of sexually active females will be infected with HPV in their lifetime.  Moreover, 50 percent of HPV infections are high-risk, which can lead to cancer if the body does not clear these infections.

HPV is a family of viruses that primarily produce warts, but a limited number are responsible for cancers. There are a total 120 different subtypes of the virus capable of producing warts on skin or mucus membranes.  Specific strains of the virus show preference for sites of infection, and different disease progressions. For example, most types are responsible for common warts on the hands and feet, however, there are strains with a preference for producing genital/anal disease. Moreover, the HPV causing the most of significant concern are those strains responsible for certain cancers. Some HPV strains will directly interrupt a cells repair cycle, resulting in vulnerability to be transformed into a cancerous cell.  HPV types 16 and 18 are high risk for cancer and account for 70% of all 490,000 cases cervical cancer with 3,900 deaths.  In addition, these two types cause penile, anal and head/neck cancers.   

Prevention of HPV

Prevention is paramount because once infected there is no treatment for HPV infections. Only the associated lesions, including genital warts, recurrent respiratory papillomatosis (RRP), pre-cancers, and cancers are treated.  Treatment options professionals utilize are biopsy, cauterization, cryotherapy, and can be mildly to severely disfiguring.  Biopsy results are used to determine the HPV strain and treatment.  High risk subtypes lead to increased medical observation and have the potential for more invasive treatments which can impair fertility and cause facial disfigurement. 

HPV Vaccination

The most popular HPV vaccine available for use is Gardasil.  It has been proven to safely protect against HPV 16 and 18, which account for 70% of all cervical cancers. Gardasil additionally protects against other high and low risk virus types. 

The Gardasil vaccine was initially developed in the mid 1980’s at various institutions in the US and abroad.  HPV proteins were added to a previous vaccine base that was proved safe and effective.  After almost 30 years of testing and scrutiny by the FDA, Gardasil was deemed safe and released to the public in 2006.

Since distribution of the Gardasil vaccine, 270 million were administered worldwide with less than .032% serious adverse events. The reported vaccine reactions are injection site discomfort, dizziness, and fainting. Furthermore, research has concluded that there is no association with neurological conditions such as Guillain-Barre’ and Autism. 

Gardasil is licensed for use for males and females ages 9 through 26 years. The vaccines are administered in a series of three on a 0, 2, and 6-month schedule.  Studies have shown vaccination earlier in the recommended age spectrum has more advantageous results.  For example, vaccinated children between the ages of 9-11 display an almost 100% prevention of disease.  Sexually activity is not a contraindication to receiving the vaccine, but the vaccine is not recommended to those currently pregnant. 

HPV Vaccination Concerns

Despite the safety and efficacy of the vaccines, one reason reported by parents for not vaccinating their children is the concern that vaccination will increase sexual activity in adolescents. Although disconcerting for parents, a study conducted two years before the introduction of Gardasil by the U.S. Department of Health and Human Services reported that the number of sexually active teens has increased to 30% in ages 15 to 17 and more than 63% in ages 18 to 19. Furthermore, these numbers continued to increase regardless of public programs in sexual education and abstinence. 

Since released in 2006, Gardasil has made a direct impact on HPV prevalence in adolescents.  Even with less than desirable vaccination rates, HPV prevalence among adolescent females age 14-19 is declining.  The decline in affected teens is predicted to lead to decreased future HPV related cancers. These vaccinations are safe, effective, powerful tools at our disposal to protect our children from the detrimental effects of a preventable disease.  If you would like more information on Gardasil, consult your local Family Physician, Pediatrician, or Obstetrician-gynecologists (OB/GYN). Remember the advice of CHOP pediatrician, Dr. Paul Offit regarding the HPV vaccination for adolescents, “it is critical that doctors and parents keep in mind; the disease is NOT ABOUT SEX…IT IS ABOUT CANCER!”

Sources: CDC, Journal of Pediatrics, JAMA, International Journal of Cancer, Journal of Infectious Disease; www.MerckVaccines.com  (GardasilR)

Medical Reviewer & Contributor: Anders Nelson, MD., F.A.A.P. is a pediatrician with offices in Scranton, PA.

EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” via Blog

EVERY SUNDAY in "The Sunday Times" - Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in hard copy

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!

The American Academy of Pediatrics (AAP) cited studies suggesting that heavy use of
electronic media may interfere with children’s speech and language development replace
important playtime with parents and lead to obesity. Studies also have found that more than 90
percent of U.S. kids have used mobile devices and most started using them before age 1. The
pediatricians’ group recommends no screen time for children up to age 2. Moreover, they
recommend total screen time, including TV and computer; use should be less than one hour daily
for ages 2 and older. Pediatricians don’t want parents to overreact. They understand that a little
screen time on occasion is not likely to harm a child, especially if they are typically active and
creative most of the day.
Dramatic increases in virtual education makes this information more alarming. This may be the
year to consider safe and appropriate gifts that promote physical activity. The academy’s website
offers suggestions on ideal toys for young children, including balls, puzzles, coloring books and
card games. Visit: AAP.org or HealthyChildren.org, the official parenting website of the AAP.

American Academy of Pediatricians Toy Recommendations:

Giving gifts to children is a favorite part of the holidays, whether they're wrapped under a tree or exchanged with the lighting of a candle. When choosing a toy for a child, the American Academy of Pediatrics recommends the toy be appropriate for the child's age and stage of development. This makes it more likely the toy will engage the child – and reduces the risk it could cause injury. Below are some additional tips from the AAP on toy selection and safety:

 SOURCE: American Academy of Pediatrics

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”   This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Read all of Dr. Mackarey's articles at: https://mackareyphysicaltherapy.com/forum/

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.