Green mucus anxiety and managing childhood respiratory events. Part 1: Expectations
||Professor Richard Harvey MD PhD.
Rhinologist, surgeon and educator.
About the author: Professor Harvey leads innovative research into the causes of chronic sinus disease and novel therapies to manage the condition. As program head, Rhinology and Skull Base Surgery, at UNSW and Macquarie University, he is asked to speak nationally and internationally on changing the traditional paradigms in upper airway and sinus care. His research has provided fundamental shifts in the way sinus disease is managed.
As nose and sinus specialist, I’m often asked for advice, by parents, on managing recurrent respiratory symptoms during childhood. The symptoms of nasal discharge, congestion and cough, are common during childhood and may even appear persistent as the break between events is short. While there are some significant medical problems that can produce true ‘persistent’ nasal symptoms, with no return to normal function in between, most respiratory events during childhood are ‘episodic’ and represent part of the normal exposure and immune development that occurs during these years.
Unfortunately, the medical marvel of antibiotic development, which changed the mortality associated with severe bacterial infections such as pneumonia, sepsis and meningitis, is now over applied in our community. There is a growing concern that modern health therapies applied inappropriately and unnecessarily to our population, and especially children, is not only wasteful but harmful to health. A great example of this is the overuse of antibiotics to manage recurrent respiratory exacerbation in childhood. These events are viral and don’t represent bacterial infections. I intentionally avoid the use of the term ‘majority of events’ as this is misleading and an unnecessary ‘disclaimer’ as the number of viral respiratory events that become bacterial and need treatment is much less than 1%. Unfortunately, 50% of children still leave an consultation from a local family doctor with a course of antibiotics1 and while this is an improvement from the 1990’s, when sadly, up to 75% of all antibiotic prescriptions were used on children2, it still remains unacceptably too high.
Mucus production observed by parents drives much of this anxiety3. And, in particular, green or discoloured mucus. As a parent myself, its normal behaviour to want to help our children when they are ill, however, understanding the nature, duration and frequency for these mucus producing events is critical to ensuring that care or interventions we offer our children are both safe, effective and appropriate.
The green color of mucus is produced from myeloperoxidase or MPO. This enzyme arises from white blood cells (neutrophils) and presents 5% of the dry weight neutrophils4. The green pigment iron-containing heme groups within MPO. Neutrophils and MPO are normally expressed (100 fold) during viral respiratory events. Green mucus is not a sign of ‘bacterial’ infection but simply an immune response from our children.
Viral events are common in childhood. Communal day-care, centralised schooling and urban living all provide much closer human contact at an earlier stage in life compared to our ancestors. One of the resulting effects is frequent viral respiratory events, as multiple serotypes are quickly transmitted. The frequency of these events is 4 episodes a year5(Table) and duration of viral events commonly 10 days6. Thus the average ‘healthy’ child should expect to have 40 days or more with respiratory symptoms (and green mucus) as part of their normal immune growth and development.
Over a series of postings we will discuss the expectations, symptom management and prevention strategies for childhood respiratory events.
1. Jansen AG, Sanders EA, Schilder AG, et al. Primary care management of respiratory tract infections in Dutch preschool children. Scand J Prim Health Care 2006;24:231-236.
2. Acute respiratory infections: the forgotten pandemic. Communique from the International Conference on Acute Respiratory Infections, held in Canberra, Australia, 7-10 July 1997. Int J Tuberc Lung Dis 1998;2:2-4.
3. Taylor JA, Kwan-Gett TS, McMahon EM, Jr. Effectiveness of a parental educational intervention in reducing antibiotic use in children: a randomized controlled trial. Pediatric Infectious Disease Journal 2005;24:489-493.
4. Schultz J, Kaminker K. Myeloperoxidase of the leucocyte of normal human blood. I. Content and localization. Archives of Biochemistry & Biophysics 1962;96:465-467.
5. Leder K, Sinclair MI, Mitakakis TZ, et al. A community-based study of respiratory episodes in Melbourne, Australia. Aust N Z J Public Health 2003;27:399-404.
6. Lambert SB, O’Grady KF, Gabriel SH, et al. Respiratory illness during winter: a cohort study of urban children from temperate Australia. J Paediatr Child Health 2005;41:125-129.
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Benefits of Having Parents use Nasal Aspirator on Infants in a Pediatric Practice
||Ronda Miller-Ernest, DNP, APRN-BC
About the author: Ronda is a Board Certified Pediatric Nurse practitioner who has been practicing in a private pediatric office for 27 years.
Some of the most common concerns I hear from parents in their infants first six months of life are; “My baby always sounds stuffy.” My baby won’t nurse because “they can’t breathe and suck with this stuffy nose.” “If I could only clear their nose they would feel better!”
In the first few months of life infants are obligatory nose breathers. Their narrow nasal passages are very sensitive to dry air, especially in the winter months when the forced warm air heating systems used in most homes, are turned on. Where I practice the low humidity climate also tends to aggravate the nasal mucosa dryness. Infants are too young to sniff or take deep nasal breaths in to clear their nose. They are totally dependent on an outside resources to help clear their nasal passages or external moisture to relieve the symptoms of dryness.
In my practice I have a large refugee population who commonly don’t understand the concept of a humidifier and/or cannot afford one, however the nasal oral aspirator is something I can demonstrate in the office with a saline solution sample. With the demonstration this is easily understood even with a language barrier and very portable to take home with them. Due to NeilMeds’ generous sample availability I can stock them in my office.
I have found that instructing parents on the use of the NeilMed Naspira and frequently in combination with the saline nose drops that the infant eats better; feels better, parents feel they can finally do something to help their infant and by clearing the airways it can decrease additional unnecessary sick appointments. This device is simple to use, affordable, easy to clean and requires very little extra office time for instruction.
Soothe your child’s cold the natural way
||Monika Pis, PhD, CPNP
About the author: Monika Pis, PhD, CPNP is a primary care pediatric nurse practitioner with a specialty in health promotion and risk reduction. Her interests are nutrition and functional medicine.
During the flu season, viruses circulate in our communities cause upper respiratory symptoms such as runny nose or nasal congestion making our children cranky and uncomfortable. Antibiotics do not work for viral illness and over-the-counter medications are either not effective or unsafe for children younger than 6 years of age. However, there are safe and effective evidence-based natural remedies that will stimulate your child’s immune system and improve comfort while her body fights off the viral infection and tries to heal.
• Saline nasal rinses
Saline nasal rinses are very effective in managing nasal symptoms related to an upper respiratory infection, such as a cold or even sinus infection. The exact mechanism of action is not known, but the saline rinses may improve the function of the nasal mucosa by removing inflammation and cleansing the nasal cavity.
You can perform a saline nasal rinse on an older child by instilling saline solution into one nostril and allowing it to drain out of the other one. These rinses can be performed by using a neti pot, low positive pressure squeeze bottle, or gravity-based pressure bottle with a nasal spout.
For a younger child, you can use a saline nasal mist or spray. Since saline solution is not medicated, it can be safely used several times a day as needed even in infants.
• Chicken soup
Eating chicken soup while sick is no longer an old wife’s tale. A study published in the CHEST Journal, the official publication of The American College of Chest Physicians, provided evidence that chicken soup has anti-inflammatory properties and helps relieve symptoms of an upper respiratory infection (1).
Another study published in The American Journal of Therapeutics suggested that chicken soup contains an anti-inflammatory substance called carnosine that could help in warding off viral infections such colds (2).
Since it is the broth that has medicinal properties, it is not a big deal if your child does not want to finish the noodles or even the veggies. An option for picky eaters would be sipping on the broth from a mug.
Pineapple contains a powerful anti-inflammatory enzyme bromelain that provides relief for sore throats and upper respiratory infections. It also thins out mucus in the respiratory system and reduces coughing.
In a double-blind trial of patients with acute sinusitis, 87% of patients who took bromelain reported good to excellent results compared with 68% of those who took placebo (3).
To get the befit of pineapple, when your child is sick with an upper respiratory infection, offer her the fresh fruit, or make a slushy of coconut milk, pineapple chunks, and ice.
1. Rennard, B., et al. Chicken soup inhibits neutrophil chemotaxis in vitro (2000). CHEST, 118(4):1150-7.
2. Babizhayev, M., et al. Management of virulent influenza virus infection by oral formulation of nonhydrolized carnosine and isopeptide of carnosine attenuating proinflammtory cytokine-induced nitric oxide (2012). Am J Ther., 19(1):e25-47.
3. A double blind clinical evaluation of bromelain in the treatment of acute sinusitis (1967). Headache, 7: 13-7.
The Importance of Nasal Hygiene
||Michele A. Streeter, MD
Board certified Otorhinolaryngologist with a special interest in Allergies & Rhinology
About the author: Dr. Michele A. Streeter is a general otorhinolaryngologist treating many diseases of the head and neck. She pursued an interest in allergies to help treat chronic rhinosinusitis patients who are not completely helped by traditional medical and surgical interventions. She is successfully treating a variety of allergy conditions with sublingual immunotherapy in addition to traditional methods.
Many patients come to me complaining of chronic sinus infections and headaches. The vast majority of them simply have uncontrolled allergy symptoms. I frequently recommend the use of daily nasal irrigations to help patients control their symptoms in addition to medications. Even if a patient does not have allergies, they may have a number of environmental irritants that will cause nasal symptoms. These irritants may be secondhand smoke or chemicals like bleach and ammonia. My practice is in Colorado, so we are constantly battling the dry conditions associated with living in a semiarid desert. Keeping the nose moist and clean is a constant battle. Patients on oxygen or CPAP machines tend to have very dry noses as well. The NeilMed sinus irrigation system is a mainstay of my therapy. When patients want holistic approaches to help their symptoms, what can be more holistic than salt water treatments? The irrigations are also a must for my post-operative sinus patients.
How to Fight Fatigue Related to Allergies
||Thomas Chacko, MD
About the author: JDr. Chacko is an expert in the field of allergy and immunology. He has recently been featured on the cover of Atlanta Magazine Top Doctors Issue. Dr. Chacko has many accolades, including serving as an expert consultant for both CNN and Fox News, repeated selections as a “National Top Doctor” by US World & News Report, and repeated “Patient Choice” and “Most Compassionate Doctor” awards by vitals.com. Dr. Chacko has a special interest in food allergies, severe hayfever, refractory sinus disease and asthma. http://atlantaallergydoctor.com/
Far too many people deal with constant fatigue today. Unfortunately, individuals don’t always know what causes their symptoms. Fatigue often manifests itself during the day after a restless night of sleep. It’s a vicious cycle that never seems to end. These days, a number of health conditions can cause fatigue, but few people seem to consider allergies as the culprit. Fighting allergy fatigue requires a comprehensive approach.
Allergies Affect People Day and Night
Chances are high that individuals with allergies know they have them. They’ll spend their days sneezing, coughing, and feeling congested. Typically, people realize how allergies affect themselves during the day. Not all sufferers recognize that allergies can worsen the quality of their sleep. The immune system targets allergens, and this frequent immune response disrupts the body in various ways.
How to Tackle This Situation
To fight allergy fatigue, individuals need to remove allergens wherever possible. Dust, pollen, and even pet hair can cause symptoms like breathing issues at night. A bed should be covered throughout the day by a mattress encasement and pillow covers. Likewise, a person should vacuum their home’s floors often and keep windows closed. An air purifier that removes allergens can make sense for certain households.
Allergy sufferers can take steps to protect their own body, too. For instance, allergy medications can be purchased over the counter at drug stores. Antihistamines and decongestants are popular options to fight back against allergy symptoms. Individuals can take a nightly bath or shower before bed. In doing so, they wash away allergens and particles on their skin and hair.
Fewer Allergens Means Less Fatigue and Better Sleep
After taking these steps, individuals can expect their constant fatigue to lessen. Symptoms could improve in leaps and bounds for some sufferers. Fewer allergens in the home and bedroom will lead to higher quality sleep. From there, a person can expect to feel more rejuvenated in the morning and have more energy during the day. Those that suffer from severe allergies can still reduce their fatigue and other symptoms in noticeable ways!