Current Topics:
Flu Vaccine
The flu season is upon us!
 The flu vaccine is
a vaccine that has been around for decades and is the best
insurance available for not catching the disease.
The vaccine is a "killed" vaccine, so it is impossible
to catch the disease from the vaccine. Side effects are generally
mild and transient. Tell your doctor if your child has any serious
allergy to eggs or any acquired neurological disease. The vaccine
is indicated for every child 6-23 months of age and a child of
any age that has underlying, chronic disease such as asthma,
congenital heart disease, sickle cell anemia, or an immune deficiency.
Additionally, any child that is a household contact of any young
child or one with such a disease should also receive the vaccine.
In previous years, there has been a problem with production
with the flu vaccine and quantities were limited. Now, there
problems appear to have resolved and we expect the flu vaccine
to be arriving in our offices at the beginning of October. With
leading public health experts predicting a severe year for influenza,
the best medicine is prevention with the flu vaccine. Even if
your child does not fit into the above mentioned categories,
the vaccine can prevent a very serious illness.
Call your doctor today to see if your child is a candidate for
the flu vaccine!
Influenza
Influenza,
otherwise known as “the flu”, is a viral
infection of the respiratory tract. It invariably causes a fever
as well as a host of other symptoms which may include runny or
stuffy nose, cough, watery eyes, sore throat, cough, headache,
muscle or body aches, and occasionally vomiting or diarrhea.
In Fort Worth, influenza typically occurs in November through
February. There are many viral illnesses that can mimic the flu,
influenza, but these are usually less severe.
 The flu can be differentiated
from other illnesses with a simple test in the doctor’s
office. Precise, quick diagnosis is helpful in that there are
specific medicines (amantidine, rimantadine,
Tamiflu, etc.) that can treat the flu, but these are only helpful
if started in the first 48 hours of the illness. Once influenza
has been diagnosed, other family members can be treated with
similar medicines to prevent them from contracting the disease.
Unfortunately, these medicines do nothing for other viral illnesses
that can present similarly to influenza.
As mentioned, influenza is a viral illness, so antibiotics do
not help. If a secondary infection arises, such as an ear infection,
pneumonia, etc., your doctor will prescribe an appropriate antibiotic.
The disease is very contagious to household contacts, about
two-thirds of which will become ill. It is spread by respiratory
droplets from a cough, sneeze, etc. The incubation period is
typically less than a week and a patient is considered to be
contagious until they are free of fever less than 100.4 for a
period of at least 24 hours and feel better.
The best treatment for influenza is prevention. A yearly flu
shot can go a long way in insuring a more healthy winter. Prime
candidates for the flu shot include children less than two years
of age, any child with a chronic lung, heart, or immune system
problem, children in day care, and pregnant women. We prioritize
our supply of flu vaccine to help these high-risk patients become
immunized first, but thereafter our supplies are open to any
patient of our who wants a flu shot.
Bronchiolitis
Bronchiolitis
describes an illness that otherwise might be termed a “chest cold.” It is an illness
primarily affecting young infants that commonly presents with
a slight fever (101-103), runny nose, cough, and a “rattle
in the chest.” Bronchiolitis tends to occur during the
winter season, when many of the respiratory viruses proliferate.
Bronchiolitis can be caused by several different viruses, most
frequently though, it is caused by respiratory syncytial virus
or “RSV.”
 Although
some media outlets attempt to portray RSV as the next major
plague, the statistics are such that by two years of age,
95% of children will have had RSV. The majority of people who
catch RSV just get a “bad cold.” A minority of people
who catch RSV get it into their smaller airway, or bronchioles,
and have bronchiolitis. A very small minority of patients, primarily
premature infants or children younger than three months of age,
get bronchiolitis to such a degree that they need to be treated
in the hospital.
Worrisome
signs for the progression of illness include an increased respiratory
rate (>60 breaths per minute), increased work
of breathing (sinking in of the chest with breaths so that the
rib cage is accentuated), lethargy, or difficulty staying awake.
Always call your doctor if you are concerned about your child’s
health.
The treatment of RSV is primarily supportive. Being a viral
illness, antibiotics due not treat it, although antibiotics may
be prescribed for secondary infections such as otitis media,
which commonly occurs simultaneously. Suctioning of the nose
with salt water drops that are available over the counter can
be of large benefit. Humidifiers may help some children. Tylenol
can be used for irritability associated with fever. Bronchodilators
such as Albuterol help a minority of patients. The use of steroids
is controversial.
The course of the illness can be prolonged (for several days
or even weeks) but the initial several days of the illness is
usually the most severe and when the child is the most contagious.
The virus can be spread by aerosol (cough, sneeze, etc.) but
it is primarily spread by contact, so frequent hand washing can
help prevent the spread. Exposed children and adults are more
likely to catch a bad cold from exposure rather than full-blown
bronchiolitis, which, as mentioned above, only occurs infrequently
with exposure.
Asthma
Asthma is a disease
characterized by the periodic inflammation and constriction
of the small airways in response to particular
stimuli and that responds to specific treatment. Asthma is also
sometimes called “reactive airway disease” and, in
the past, might have been termed “recurrent bronchitis.”
 Asthma is largely
an inherited disease. Children who have an immediate family
member who has asthma, allergies, and/or eczema
(also called “atopic dermatitis”) is genetically
predisposed to, but not certain to, develop asthma. An analogy
might be that if a mother has blond hair, her children are likely,
but not certain, to have blond hair, fair skin, and/or light-colored
eyes.
Some breathing tests are available to diagnose asthma. These
tests can only confirm the diagnosis, they cannot rule it out.
These tests require a somewhat mature patient, generally greater
than five years of age. However, we commonly diagnose asthma
in much younger patients, given their clinical course, their
response to medicine, and by ruling out other diagnoses.
There are several
treatment options for patients with asthma. For acute problems,
the primary medicines used act to dilate
or widen the patient’s lower airways to allow more air
to pass through. Medicines such as albuterol, levalbuterol (Xopenex),
and maxair are examples. Medicines may be delivered via a nebulizer
or “breathing machine” or by metered-dose inhaler
or “puffer.” Younger children often need a device
called a spacer to coordinate a metered-dose inhaler. For more
severe attacks, steroids such as prednisone, orapred, or dexamethasone
are used to block the inflammation in the airways.
Some patients with asthma have more persistent or severe symptoms.
For those patients, doctors commonly prescribe a preventive medicine
to block the symptoms. The acute attacks are still treated exactly
the same way, but if a patient uses his/her preventive medicine
daily, such events should only occur rarely. Commonly prescribed
preventive medicines include Advair, pulmicort, flovent, and
singulair.
There are many other ways in which your doctor may help your
asthma. Allergy avoidance or treatment, environmental modifications,
and sometimes even diet changes for infants can be of benefit.
If your child has asthma, there are many things we can do to
help, so let us know how we can better serve you.
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