COASTing News………………… August 2004

COASTing News………………….. August 2004
Childhood Origins of ASThma
(608) 263-8539 or Toll-Free 1-877-947-2229
Thank you to the COAST children and their family members who joined us for the
Spring COAST party. Madison Creative Arts Program (MADCaP) provided children’s
entertainment and activities. The COAST children, their families and the COAST staff
had a blast dressing up in costumes, acting out stories, and making puppets.
COAST Kids starting Kindergarten?!
Who could believe that many of the COAST
kids are starting kindergarten? We can’t!
With the start of Kindergarten, we have
devoted this issue to giving you and your
family recommendations on how you can
manage your child’s asthma and allergy
health at school. Here are some of our
suggestions on how to get this process
• COMMUNICATE -- with your child’s
teacher, school nurse, gym teachers,
principal, etc. Have a meeting before school
starts to discuss your concerns.
schools have health FORMS for parents to
complete that detail the child’s health
concern, that is their asthma and allergy
triggers and any prescribed medicines.
• SCHOOL NURSES -- may be able to
work with you, your child and your child’s
physician to help with health concerns and
any necessary medications.
ACTION PLAN -- If your child has an
Asthma Action Plan, make sure a WRITTEN
copy is given to school staff. If a problem
arises, school staff will have something to
refer to.
this information CURRENT (i.e. changes in
medication, expired medication replacement,
The school should always have the
on file. Then, they can reach you in case of
an emergency. In case you can’t be reached,
make sure your EMERGENCY CONTACT(s) is
Information that will be helpful for
school staff…..
• What triggers your child’s asthma?
• What are their warning signals or what
symptoms do they exhibit?
• What should be done when your child is
experiencing symptoms?
• Does your child need a rescue inhaler at
• Where will the rescue inhaler be located
in the school?
• Are there activities that your child should
not take part in?
Other topics that may need to be
discussed with your child’s teacher, school
nurse and principal are… A good description
of what your child “looks like” when they are
experiencing difficulty breathing or an
asthma attack. For some children, their
asthma symptom is coughing, and the
teacher may be expecting a “wheezing”
child, and not see the cough as important.
• Notify school staff ahead of time or
during registration.
• Know the school policies regarding pets.
• Inform the teacher about your child’s pet
COMMUNICATION with all school staff
is your first step.
• Provide the school with WRITTEN
INSTRUCTIONS for response to any
allergic reaction.
• If prescribed, provide the school with an
EpiPen® or Ana-Kit®.
• Provide the school with WRITTEN
INSTRUCTIONS for response to any
allergic reaction.
• If prescribed, provide the school with an
EpiPen® or Ana-Kit®.
• Give your child as much control over food
choices as possible. Let children pack their
own lunches with "allowable" food.
• Provide “allowable” foods for the class on
party days.
• Lastly, you may want to consider a MedicAlert bracelet.
Of course, with back-to-school time,
also comes our first round of fall
viruses! We always hope that your child
stays healthy, but if he/she catches a
cold, please contact us at 263-8539,
(toll free) 1-877-947 –2229, or email us
This website includes: Study timeline-What’s going on next?
Consents--What is the current consent?
Newsletters --Copies of all newsletters
can be found here.
Abstracts --Short reports on findings
Presentations –Powerpoint slides of Dr.
Lemanske’s talks
Staff -- photographs to put faces to the
people you talk with on the phone.
Links --to other sites of interest for people
with allergy and asthma
Upcoming changes in the study
This year, COAST has published two articles,
one about the relationship between pets and
allergic development and the second about
immune development in children. We
currently have 2 articles out to publishers,
(one about the nasal wash technique and one
about the viruses cultured in children) and a
third article is nearly ready to be sent (the
relationship of viral infection and immune
development). As a result of these findings
and information reported from other
researchers, we must continually upgrade
our study in order to assure that we are
examining the cellular proteins that appear
to be important in immune development.
As a result, here are some changes that will
be presented to you in the form of new
consents at your next visit:
COAST had originally scheduled that a “Cold Air
Challenge” be completed on the parents and child
At the time that the protocol was written, this
seemed to be the newest and best method for
.determining if your child had “twitchy airways”—
a feature of some lung diseases including asthma
medically termed “airway hyperresponsiveness”.
However, this test, although being done on many
children in Sweden, hasn’t gained acceptability or
use in the United States.
Therefore, we have returned to the “routine”
method that is used in research studies, and the
method used by asthma specialists to evaluate
airway hyperresponsiveness. In fact, one of our
children had this test done by his asthma
specialist when he was about 3 years old. The
new consent indicates doing this test at age 6.
This test is called a “Methacholine Challenge”
Methacholine is a parasympathomimetic drug
which means it is a chemical that causes smooth
muscle to constrict or get tight. So a “challenge”
with this drug means that your child will inhale
methacholine in the form of a mist (like a
nebulizer). As a result, if your child has a
tendency to have airway hyperresponsivenss,
methacholine will cause the airways of the lung
to narrow by constricting the smooth muscles
surrounding the airways. The amount of
methacholine that is inhaled will slowly increase
as the challenge progresses. A breathing test
(spirometry) will be done after each dose, so
study personnel will know when the airways
narrow. The test is “positive” if the airways
narrow by 20% with a certain dose. If this
amount of narrowing occurs, albuterol will be
given to return the airways to not being tight.
If the airways do NOT get tight during the
expected doses of the methacholine, the test is
stopped. It is important to know that a positive
test does not mean your child has asthma—it
merely means that the your child’s lungs have the
potential of being hyperresponsiveness to
irritants, weather changes, etc. A negative test
is usually more informative, as it indicates that
the likelihood of your child having asthma, or
developing it, are very small.
Because the medicine may cause the airways to
narrow, your child may experience mild asthma
symptoms during this challenge. These
symptoms would go away on their own in 15-45
minutes. However, we will give your child
albuterol at the end of the test to make the
symptoms disappear quickly. We expect that
some of the children may not have the skills
necessary to actually do the test at age 6, and if
this is the case we will repeat the attempt to
complete the test at age 7.
Optional Nutrition Study Consent
Dr. HuiChuan Lai has started a study that
compares diet and obesity and any possible
relationship to asthma. The study is titled: Diet
and Obesity as Environmental Risk Factors for
Asthma. This research study is an option for you
because your child is in the COAST study.
This portion of the study involves some
additional time to complete three questionnaires,
but does not involve any additional procedures or
Once you are scheduled for your COAST visit,
we will send you a copy of the consent for your
review and for you to ask any questions.
T Regulatory Development
Dr. Jim Gern, co-investigator of COAST, recently received funding to study another factor in blood that
may be important in the development of the immune system, and particularly important in the development
of allergies and asthma. This funding will make it possible to go back to the original cord blood, and every
annual blood sample, and test for the presence and function of the T regulatory cell (cells that regulate
immune responses to keep things in balance) and compare it to such things as the development of eczema,
food allergies and wheezing. This research study is an option for you because your child is in the COAST
study. The only additional “work” for this study is that the COAST staff will schedule one home visit to
collect “dust” samples from your home in the “living” room, the child’s bedroom and the child’s bed. Our
goal would be to complete these visits over the next two years.