Website of the week
The General Practice Airway Group is one organisation that I have a great deal of time for. It produces some excellent material on all things relating to respiratory problems.
This PDF is part of their ‘Opinion’ series and deals with the management of asthma in children. There are only two pages and they are packed with relevant information. That is the beauty of something produced by GPs for GPs — no waffle or messing about with irrelevant minutiae. What we need is the nitty-gritty, and it is all packed in here.
Why go there: top class information.
Information from: General Practice Airways Group.
All there is to know
If you have a need to get to grips with all the elements of asthma in the under-fives, then this is the place for you.
There is a great deal of information in this nine-page PDF, it is up to date and reliable and includes a discussion about viral-associated wheeze.
The text is aided by a series of helpful tables, such as those on important points in history and examination. There are practical tips too, such as the proper use of spacers in young children, and the indications for referral — all good stuff.
Why go there: to get the complete picture.
Information from: Primary Care Respiratory Journal
So what happens to preschool children who develop wheeze in later life?
The natural history of the condition was looked at in this US study.
Reading the conclusion will give you most of the information you need.
The main message appears to be that patterns of wheezing prevalence and levels of lung function are established by the age of six, and do not appear to change significantly by age 16 in children who start having asthma-like symptoms during the preschool years. This trial involved over 800 children, but is this enough to be sure?
Why go there: addresses an important problem.
Downside: no preventive strategies are offered.
Information from: American Journal of Respiratory and Critical Care Medicine.
Dirt and asthma
It has been suggested that modern babies grow up in an environment that is so clean that they do not have adequate exposure to microbes, and so do not develop a decent level of immunity to many things including atopy.
This abstract sums up an attempt to see if early indoor microbial exposure reduces the risk of asthma.
The short answer seems to be yes, it does. Maybe that is why my children are wheeze-free, because they spent half their infancy crawling around the constant piles of DIY dirt.
Why go there: only takes a minute.
Downside: raises as many questions as it answers.
Information from: Journal of Allergy and Clinical Immunology.
Anyone who reads this column regularly will know that I am something of a sceptic when it comes to so-called natural remedies. I can fully understand a parent wanting to try an alternative to repeatedly dosing their child with steroids, but I like to see the evidence.
Yamoa is an extract of a tree bark found in Ghana and this website admits the mechanism of action is not known.
It is recommended by Dr Eccles, who is not a made-up character, but a bona fide British-qualified physician.
He is also promoting this compound at nearly £50 a bottle. Patients should think carefully before going down this route.
Why go there: you learn about West African gum trees.
Downside: no convincing evidence.
Information from: The Natural Remedies Clinic.
Dr Barnard is a former GP in Fareham, Hampshire