New study raises questions
Giving babies antibiotics could raise their risk of developing asthma, according to researchers at the University of British Columbia (UBC). A study published in CHEST, the peer-reviewed journal of the American College of Chest Physicians, shows that children under age one who were treated with an antibiotic were twice as likely as untreated children to develop asthma in childhood. In addition, the use of multiple antibiotics in infants appeared to further increase the risk of developing asthma.

The cause for this could be a "state of excess hygiene," according to Dr. Fawziah Marra, coauthor of the study and associate professor of pharmaceutical sciences at UBC. "Limited exposure to germs can lead to an oversensitive immune system, which mounts an over-the-top response to such nonthreatening agents as pollen and dust mites," she says. "The result is an allergic reaction, which in some people can include the airway inflammation that's the hallmark of asthma."

However, Dr. Francisco Noya, director of the Asthma Centre at Montreal Children's Hospital, cautions that the study does not prove that antibiotics cause asthma – it just shows an association. "It could well be that children who are going to develop asthma happen to be treated more frequently with antibiotics because they have more frequent illnesses," he says.

Take antibiotics seriously
The development of antibiotics has given us a strong weapon against illness, but it's important to remember that they only work against bacteria – which means they're an ineffective treatment for viruses such as colds and flu. Babies are commonly prescribed antibiotics for such problems as ear infections and bronchitis, even though these illnesses are not typically bacterial, says Marra, and the antibiotics are not always necessary.

Remember that there's good bacteria and bad bacteria – and antibiotics don't distinguish between the two. One thing that may help your body out while taking antibiotics is to supplement with probiotics – active "good" bacteria – to replace the beneficial bacteria being destroyed by the antibiotics. Naturopath Ashima Suneja of Toronto clinic The Centre for Health recommends taking a broad-spectrum probiotic while taking antibiotics. These are available in supplement form and should be taken at least two hours apart from the antibiotics for maximum efficacy.

Bottom line: sometimes antibiotics are necessary. But it's important that doctors prescribe them only when they believe there is no other effective treatment, and that parents take responsibility for administering the medication properly.

Page 1 of 3 – Could your child have asthma? Learn the symptoms of childhood asthma on page 2.

"When I first see a family the school-age child will almost always tell me that what bothers them most about having asthma is not being able to play with friends," says Dr. Sheldon Spier, head of the Division of Pediatric Respiratory Medicine at Alberta Children's Hospital in Calgary. "Parents worry most about missing school, waking at night, and going to the emergency room. The most important starting point is to diagnose asthma and then accept the diagnosis. Then treatments can begin."

Prevention
"Anyone can get asthma and at any age," says Kay Khan, registered nurse and clinical educator at the Asthma & Airways Centre of the University Health Network in Toronto. "However, the risk of developing asthma is much greater if there is a history of asthma and allergies in the family. Things that can trigger asthma symptoms can vary from one individual to another."

Khan lists some basic ways to reduce common asthma triggers in the home environment:

• Have an allergy skin test to identify allergic triggers and use measures such as dust mite covers for mattresses and pillows and using washable toys
• Don't smoke and avoid strong smells and fumes from cleaning products, candles, burning wood in the fireplace or using a gas stove
• Practice dust and mold control measures: use wooden flooring instead of carpets, keep the furnace and ducts clean and take care of damp areas
• In the summer, keep windows and doors closed to limit pollen levels in the home
• If your child is allergic to animals, don't have pets -- or, at the very least, limit their movement throughout the home

How to tell if your child has asthma
"You should suspect asthma if your child coughs or has breathing difficulty in the middle of the night (coughing while lying down to go to sleep may be a post-nasal drip), or after five to 10 minutes of exercise," says Dr. Spier. "At this point you should see your family doctor in order to get more advice. A thorough examination of your environment for irritants and possible allergic triggers should be done. Allergy testing should be considered for many children in order to help confirm and identify possible triggers."

In addition, says Dr. Noya, "if the child seems to be having an acute asthma attack and the parents do not know what to do, the child should be taken to an emergency room."

Diagnosis and testing have many components. The Lung Association (www.lung.ca) has detailed information on what takes place during asthma testing and diagnosis.

Page 2 of 3 – Explore asthma treatments and helpful resources on page 3.

Treatment
Bernie Bolley, registered nurse and health initiatives coordinator at the Lung Association of Saskatchewan, lists three components of asthma management:

1. Education
The person with asthma should know about:
• their personal asthma triggers and how to avoid them
• their medications and how to take them

2. Environmental control
• All homes and cars should be smoke free
• Indoor humidity should be kept below 50 per cent
• The furnace filter should be cleaned regularly

3. Medication
The two main types of medications used to manage asthma are controllers and rescuers.

Controllers:
• help to control asthma over the long term
• must be taken regularly
• prevent and treat the swelling in the airways
• are slow-acting and have no immediate effects

Rescuers:
• are used only when needed as a rescue for fast relief of breathing problems
• relax the muscles that surround the airways
• usually come in blue inhaler devices
• should not be used regularly (more than three times a week) as regular, frequent use may actually worsen the asthma

Learn more about asthma:
Calgary Health Region
Information about asthma for both parents and children, including a “road map” section, which outlines what to do if you think your child may have asthma.

The Lung Association
Detailed information on various aspects of asthma.

The Asthma Association of Canada
Visit Dr. Airway and the Asthma Agent team.

Page 3 of 3 – Did you know scientists have found a link between antibiotic use and asthma development? Learn more on page 1.