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Thoracic Medicine

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Sleep Medicine

Latest News

The Wall Street Journal reported recently on the topic of sleep deprivation as to which cities around the World are the most and least sleep deprived. Brisbane leads the way with the earliest bed time and earliest wake up time.

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According to new research, risk of being obese by age 21 was 20 percent higher among 16-year-olds who got less than six hours of sleep a night, compared with their peers who slumbered more than eight hours.

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As we get older there is a strong relationship between reduced amount and quality of sleep. Recent research has found specific cluster of neurons that have linked insomnia and more sleep fragmentation. The reduction of these neurons can be from normal aging but has also been seen in Alzheimers disease.

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A bedtime routine might sound like something that's only necessary for the grade-school set, but following a nightly schedule can greatly improve the sleep of adults, too. Sleep experts recommend establishing a bedtime routine, both to calm and relax you as you get ready to sleep and so you aren't inadvertently giving yourself jet lag.

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Researchers at NYU Langone Medical Center and elsewhere, using a mouse model, have recorded the activity of individual nerve cells in a small part of the brain that works as a "switchboard," directing signals coming from the outside world or internal memories. Because human brain disorders such as schizophrenia, autism and post-traumatic stress disorder typically show disturbances in that switchboard, the investigators say the work suggests new strategies in understanding and treating them.

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The death rate from asthma in Australia has fallen by almost 70 per cent since the 1980s, according to a new report released by the Australian Institute of Health and Welfare

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Aspirin and Other Drugs That May Trigger Asthma

Many people with asthma have sensitivities to certain drugs that can precipitate an asthma attack. If you have asthma, you need to be aware of which medications may be triggers. You do not need to avoid these medications unless you know they are asthma triggers for you. If these medications have never triggered your asthma, it is still best to take the medications with caution because a reaction can occur at any time. pillsontable

Below is a list of the most common medications known to trigger symptoms of asthma. However, if you are prescribed any medication that you think may be causing your asthma to worsen, discuss it with your doctor.

  • A) Aspirin and other painkillers. Approximately 10% to 20% of adults with asthma have sensitivity to aspirin or a group of painkillers called non-steroidal anti-inflammatory drugs -- or NSAIDS -- such as ibuprofen (Motrin, Advil) and naproxen (Aleve, Naprosyn). These drugs are frequently used to treat pain and reduce fevers.

Asthma attacks caused by any of these medications can be severe and even fatal, so these drugs must be completely avoided in people who have known aspirin sensitive asthma. Products with acetaminophen such as Tylenol are considered safe for people who have asthma. It is important that people with aspirin sensitivity read labels of all over-the-counter drugs used to treat pain, colds and coughs, and fever. Also inform your doctor so that these medications are not prescribed for you. If you have any questions whether a certain medication could trigger your asthma, seek advice from your health care provider.

  • B) Aspirin Sensitivity, Asthma, and Nasal Polyps. Some people with asthma cannot take aspirin or NSAIDs because of what’s known as Samter’s triad -- a combination of asthma, an allergic reaction to aspirin, and nasal polyps. Nasal polyps are small growths that form from long-term inflammation of the lining of the nasal cavity.

This aspirin sensitivity occurs in about 10% to 20% of people with asthma and 30% to 40% of those who have asthma and nasal polyps. Many people who are sensitive to aspirin and NSAIDs have nasal symptoms, such as runny nose, postnasal drip, and congestion, along with asthma symptoms, such as wheezing, cough, and shortness of breath. Talk to your doctor about options other than aspirin and NSAIDs if you have this allergy.

  • C) Beta-blockers. Beta-blockers are commonly prescribed medications used to treat numerous conditions including heart conditions, high blood pressure, migraine headache, and, in eye drop form, glaucoma. Your health care provider must determine the need for these medications and you can take a few trial doses to see if they affect your asthma. It is important that you inform all of your health care providers who may need to prescribe these types of medications that you have asthma. This includes even your eye doctor.

Examples of beta-blockers are metoprolol, sotalol, atenolol, carvedilol  

asthmatic

  1.  Evidence Concerning Noncardioselective ß Blockers. Multiple studies over the past 20 years demonstrated on average that regular use of nonselective ß blockers (carvedilol) compared with placebo caused a 14% reduction in FEV1 and a 23% decrease in the FEV1 response after ß-2 agonists were given. No significant increase in respiratory symptoms or ß-2 agonist inhaler use was seen in any of the trials. However, the decrease in ß-2-agonist response seen with nonselective ß blockers may indicate an increased risk for a clinically significant adverse effect during an asthma exacerbation.
  2. Evidence Concerning Cardioselective ß Blockers. Over the past 20 years, non-selective ß blockers have largely been replaced with cardioselective blockers. Cardioselective ß blockers (atenolol, metoprolol) are ~20 times more potent at blocking ß-1 receptors than ß-2 receptors. At therapeutic doses the ß-2 blocking effect, and therefore the risk of bronchoconstriction, is negligible. 
  3.  Patients with obstructive airway disease(asthma, COPD, emphysema, bronchiectasis) and concomitant congestive heart failure or ischemic heart disease. it is common practice to give ß-2 agonists while withholding ß blockers. There are studies that have documented an association between ß-2 agonist use and the development of congestive heart failure, acute myocardial infarction, or cardiac death. This association may be explained by ß-agonist stimulation causing tachycardia, hypokalemia (low blood potassium), and arrhythmia, especially in the presence of cardiac comorbidities or hypoxemia (low oxygen).
  • D) ACE inhibitors . These are other types of medications used to treat heart disease and high blood pressure. These drugs can cause coughs in about 10% of the patients who use them. This cough is not necessarily asthma. But, it can be confused with asthma or, in the case of unstable airways, can actually trigger wheeze and chest tightness. If you are prescribed an ACE inhibitor and develop a cough, speak with your doctor.

Some ACE inhibitors are Accupril, Enalapril, Captopril, Monopril, Prinivil, Zestril.

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