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HOUSE CALL WITH DR. SANJAY GUPTA

Allergies Affecting Those with Asthma; What Smog Can be Doing to Your Health; Should You Pay for Your Own Clinical Trials?; Women and Heart Attacks

Aired May 5, 2007 - 08:30   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.


HOLMES: Again, reminding you, we are keeping an eye on this breaking news situation. Devastation in Kansas, specifically Greensburg, Kansas, as we're zeroing in on that community there, where the word is that at least one person has died and close to 60, at least 60 may be injured in this huge tornado that hit last evening in Greensburg. We are keeping an eye on that devastation there. At least 75 percent of the town damaged or destroyed in some way, is the word out of there.
We are covering this story from our severe Weather Center, checking everything that's happening on the Web, where we're getting reports. And we'll bring that all to you here. So please stick with CNN.

NGUYEN: Right now, though, we want to send you to Dr. Sanjay Gupta and HOUSECALL.

SANJAY GUPTA, HOST: Thanks, guys! This is HOUSECALL. We're making the rounds of the most important medical stories this morning. First up, allergies in the air and summer drawing near. It could spell tough times for those with asthma. We're going to take all your questions.

Then, what all that smog can be doing to your health. We're going to have the latest numbers.

And patients paying for their own clinical trials? When government won't pay, should you?

Later, women and heart attacks. The subtle signs that could be red flags on why doctors might miss them.

Let's start though with asthma. It's a disease that leaves millions of people in this country literally gasping for air.

(BEGIN VIDEOTAPE)

BEATRICE AIST, ASTHMA PATIENT: I would cough -- every other word, cough, or trying to get enough air to be able to speak more than three words a phrase.

GUPTA: Beatrice Aist was diagnosed with asthma. And in that moment, she joined more than 20 million other Americans suffering from the chronic lung disease that causes coughing, chest tightness, shortness of breath, and wheezing. DAVID GROSS, DR., WASHINGTON HOSPITAL CENTER: The airways get inflamed. And when they're inflamed, they tend to react and constrict.

GUPTA: It can happen at any age, although it's more common in children. Now there are a number of triggers that can bring on an attack -- allergens like pollen, and animal dander, or environmental irritants like cigarette smoke and air pollution, even exercise.

A recent study found living in certain cities like Atlanta, Philadelphia, and Milwaukee presents bigger challenges for asthma suffers, in part due to those triggers, plus restaurants, bars, and workplaces that still allow smoking. Doctors say even mild asthma can be life-threatening. In fact, every day there are 5,000 asthma- related emergency room visits and 11 deaths, every day. There's no cure, so getting the proper treatment is crucial.

GROSS: With care, we think most of those asthma attacks are preventable. But unfortunately, not all of them are. Some can be incredibly acute.

GUPTA: The standard care is medication, mainly in the form of inhaled steroids.

GROSS: Well, it's really our main line of attack against asthma. And they're very successful and very safe when they're used. And the side effects are very low as well.

GUPTA: Beatrice says after just six months of medication, her symptoms improved significantly.

AIST: Less coughing and a better quality of life. I feel like I'm living.

(END VIDEOTAPE)

GUPTA: All right, so to be clear, here are some warning signs of asthma -- increased shortness of breath or your sleep may be disturbed by coughing - that happens to me sometimes. May also experience tightness in your chest or wheezing. These all reasons to see your doctor and find out whether you might have asthma.

And if you know you already have the disease, check out asthmacontrol.com and see if you're in control or maybe your asthma is. That's something our doctor, Dr. Kathleen Sheeran is always talking to us about that. She's been on our show before. She's an allergy and asthma specialist here in Atlanta. Welcome.

KATHLEEN SHEERIN, ALLERGIST: Thank you.

GUPTA: You know, I'm always surprised we can get you this time of year because this is one of the busiest times of year.

SHEERIN: It is, but it's called you call the patients and ask if they'd mind coming in earlier. GUPTA: Right. And I know a lot of people are probably trying to sign up to get into your clinic. About 70 percent of the time, allergies are associated with asthma. What is the connection there?

SHEERIN: Yes, well, asthma doesn't have to be an allergic disease, but in about 50 percent of the patients, asthma and allergy are connected. And the asthma's actually caused by allergic triggers, such as spring pollen, cats, dogs dust mites.

GUPTA: OK. Now the treatments for these, they haven't really changed a lot.

SHEERIN: No.

GUPTA: From what I understand. But some of the inhalers have, is that true?

SHEERIN: I brought some examples of inhalers. And I think one of the things that patients need to realize is that the medicines, you need to know how to take them. It's not just popping the pill, swallowing a pill. So if you have heart disease, take this pill once a day. But if you have asthma, you need a controller medicine and you need a rescue medicine.

And all of the rescue medicines right now in the country look like this, a meter-dose inhaler.

GUPTA: Right.

SHEERIN: And this one doesn't have any medicine in it. So you shake it up, and you -- it's a puff that comes out. So the patient goes. They hold the breath, count to ten. Or better yet, they use a spacer device that helps them with the timing.

GUPTA: Gotcha.

SHEERIN: So you can see, it's not easy to use. Well, with the controller medicines, those you use for rescue for when you're having trouble. Controller medicines can look like any of these, OK. So if your doctor gives you a prescription and says, "here, go fill the prescription," but doesn't tell you how to use your medicine, then you're in a little bit of trouble.

GUPTA: Got to make sure to ask about that.

SHEERIN: One, you open like this. It has a little garage door. You open it, you put it in your mouth. And you hold until the count of ten.

GUPTA: Got you.

SHEERIN: Well, if you leave the garage door open and you shake, well you still have the powder coming out.

GUPTA: Sneaking out, right, OK. SHEERIN: OK, so here's another powder inhaler. And for this one, you have to take the cap off, twist it, twist it back, put it in your mouth, suck. Well, if nobody tells you about the twisting action, then you're in trouble.

GUPTA: Right. Now are there new guidelines with these? I mean, what should people be doing?

SHEERIN: The new guidelines that are coming out this summer have been previewed by many of us. And what the guidelines basically they are going to say -- there aren't a lot of new medicines, but you need to learn how to take your medicines in order to gain control. And if you're not in control, then your asthma isn't well taken care of.

GUPTA: That may be one of the most important points.

SHEERIN: Absolutely.

GUPTA: You get the medicines, but you got to learn how to take them. Spend time with your doctor. Lots of e-mails coming on. Let's see if we can get to a couple here. We have a question about those steroids now from Kelly in Maryland who writes this, "I've been on steroids to control my asthma for 8 years. What are the long term effects of being on these drugs for so long, and presumably the rest of my life?"

Steroids. Are people worried about that?

SHEERIN: Well, I think the first point for people is that these are inhaled steroids. So they're being inhaled, going directly to the lung, where the problem is. These are not steroids that you take for body building. So it's a different set of medicines completely.

GUPTA: Does it change your system at all, though?

SHEERIN: It can, yes. And most of it's metabolized by the liver and then you get rid of it. But we're lucky that we have some long- term studies on children with asthma. So if it doesn't affect children badly, adults can be a little more reassured. And it was called the camp study, and it's now followed up about 10 or 12 years.

GUPTA: OK.

SHEERIN: And they find that, although the growth can be slowed in the first six months, we have normal attainment of adult height. We don't take care of a lot of short asthmatics, that bones seem to not be affected, eyes, also, no glaucoma and cataracts.

GUPTA: All right.

SHEERIN: That's not to say exceptions don't occur.

GUPTA: But a little bit reassuring though for people.

SHEERIN: In usual doses.

GUPTA: OK, well let's get to another e-mail now.

SHEERIN: Yes.

GUPTA: This is from Jennifer in New Jersey, who asks this question, "Is weight an issue with asthma? If someone is overweight by 20 or 30 pounds and loses that weight, will their asthma get better?"

What about that?

SHEERIN: Well, we have an obesity epidemic in this country and an asthma epidemic. And they seem to be connected. And what we don't know is which came first. Does the asthma come first or did the obesity come first?

Many people who have asthma don't do activities. They become couch potatoes when they shouldn't. And then they gain weight. And you know, which is the cart before the horse.

Now asthma can be made worse by extra weight just by the sheer pounds of having to breathe in and out.

GUPTA: Right.

SHEERIN: So what they've also found in one of the long-term childhood studies is that kids, especially girls, who develop obesity during pre-puberty, between 6 and 12, those kids are much more likely to have asthma than non fat people.

GUPTA: So a bit of a relationship there. Best to lose the weight.

SHEERIN: Absolutely. And lose the weight, so exactly. Not just for your heart, but for your lungs.

GUPTA: All right, Dr. Kathleen Sheerin, lots of good advice there. Thank you. And I know again, it's busy this time of year...

SHEERIN: Yes.

GUPTA: ...so I really appreciate your time.

And if you're thinking about asthma at home as well, there are some free screenings around the country this month due to the American College of Asthma and Immunology. Just go their Web site at acaai.org/public and click on screenings program, find a location near you.

And to check the sneeze factor in your area, go to CNN.com/health. Click the link for own special allergies page that includes a daily allergy report. Don't go anywhere.

When HOUSECALL returns, a controversial clinical trial. Patients actually paying their own way. It's amazing stuff. When funding ends, should patients be picking up the check?

And new numbers as well. A debilitating disease on the rise in women. We'll explain.

Later in the show, tips for enjoying the increasingly warm weather the safe way.

(COMMERCIAL BREAK)

GUPTA: Check out i-Tunes for my podcast. This week, I'm talking about those graduates out there and how to deal with all the stress. There can be a lot of stress.

Now onto another type of stress, though, on the body -- smog. Los Angeles is the most polluted city in the United States for 2007. That's according to the American Lung Association's bad air list. Some good news for L.A., though, the number of days with pollution at its worst is actually lower than in previous years. So take that at what it's worth.

Rounding out the top five - Pittsburgh; Bakersfield, California; Birmingham, Alabama; and Detroit. Judy Fortin is here now with the health risks associated with people living in those areas and what they might be facing.

(BEGIN VIDEOTAPE)

JUDY FORTIN, CNN CORRESPONDENT (voice-over): Smog. You can see it hanging over most big American cities.

GEORGE THURSTON, NYU ENVIRONMENTAL MEDICINE: The thing about air pollution is that it's so pervasive, and that people really don't have any choice but to breathe the air.

FORTIN: Researchers confirm air pollution is making people sick.

THURSTON: Long-term exposure to air pollution does in fact have severe long-term health effects on the population across the United States.

FORTIN: High levels of dirty air can put you at risk for developing cancer. Scientists also link air pollution to an increase in heart disease and stroke. People with asthma or other chronic respiratory diseases are among the groups most sensitive to air pollution. So are children and adults who are active or work outdoors.

The Environmental Protection Agency recommends you learn your city's daily air quality index. When levels are elevated, stay indoors. For HOUSECALL, I'm Judy Fortin.

(END VIDEOTAPE)

GUPTA: All right, thanks, Judy.

Each year about 5600 people are diagnosed with ALS, or Lou Gehrig's Disease. For about 10 percent of them, it's genetic. But for the rest, the cause is unknown. Now researchers search for clues, but their work is often limited by cash flow. The government simply can't fund every clinical trial. And rare diseases like ALS simply aren't at the top of the list. That forces some researchers to look outside the box for funding.

(BEGIN VIDEOTAPE)

GUPTA (voice-over): Two patients, same devastating diagnosis, ameatrophic lateral sclerosis, ALS, Lou Gehrig's disease.

LEE HOLLETT, ALS PATIENT: My right leg was kind of spasmic and very weak.

HENRY GARDNER, ALS PATIENT: I noticed my foot dragging from time to time.

GUPTA: ALS is rare. And drug companies can lose money developing drugs only a small number of people will use. Lee Hollett and Henry Gardner joined a small clinical trial for an experimental drug designed to slow the progression of the disease. Once underway, researchers were running out of money to make the drug and eventually turned to their patients for help.

JAMES BENNETT, DR., UNIVERSITY OF VIRGINIA: What I was really just asking people to do was to put your thinking caps back on and see what you can do creatively to help raise more money. But ethically, yes, it's been a challenge. I would have preferred to have never had to go to the patient community.

GUPTA: Hollett wrote a check for $4500.

HOLLETT: It's no, no real difference from MS folks. You know, riding bicycles to raise funds for research.

GUPTA: Gardner chose not to pay.

GARDNER: I think a trial drug should be provided to, and all of the clinical visits required thereof handled by the university and/or the manufacturer of the drug.

GUPTA: According to medical ethicists, asking patients to pay for drugs they are testing is a questionable practice.

EZEKIEL EMANUEL, DR., NATIONAL INSTITUTES OF HEALTH: I would feel a lot more comfortable about this if there was some independent, objective assessment separate from the investigator.

(END VIDEOTAPE)

GUPTA: Now while those patients disagree about how the trial should be funded, both of them say they were treated fairly. Best of all, they say the drug has actually helped delay the worst of this awful disease. And if you want to investigate clinical trials yourself, this Web site, clinicaltrials.gov is a great place to start.

Drinking and your brain. Find out how much it takes to shrink your brain. I'm not kidding.

Plus, women and their hearts. Learn the subtle signs that could be red lights for women and why doctors often miss them.

And later, how your weight could be affecting your ability to have children. All that's coming up as HOUSECALL continues.

(COMMERCIAL BREAK)

GUPTA: We're back with HOUSECALL. Let's check some of the other medical headlines this week with Judy Fortin. Judy?

FORTIN: Hi, Sanjay. Some interesting medical stories that we're following this week.

According to a study published in "The New England Journal of Medicine," an annual shot of the osteoporosis drug Reclsat (ph) reduces post menopausal women's risk of fractures by 70 percent. Researchers say this is good news for women having trouble sticking with a daily regimen.

And news this week of a rapid increase in the number of women diagnosed with Multiple Sclerosis. Researchers looked at more than 30,000 MS patients. And they found the number of the ratio of females to male was four to one. Study authors don't know why more women are developing MS. And they say that more research is need.

A new study presented by the American Academy of Neurology suggests that people who drink alcohol on a regular basis are shrinking their brain. The study found people who consume two drinks a day consistently had a nearly 2 percent reduction in brain volume. Sanjay, that story will make you think.

GUPTA: It will. I'll have to cut back on my drinking. Hey Judy, have you done any shopping yet for your mom for Mom's Day?

FORTIN: Well, I have. And the big question for me is have my kids gotten anything for me?

GUPTA: Right. Yes, I actually bought something for my mom as well. So...

FORTIN: Good for you.

GUPTA: Good on you, Judy. Thanks so much.

And for everyone out there who's starting to shop for Mother's Day, we have a story to help a women's heart. With heart disease being a leading killer of women, there are things you need to know to save the life of a loved one, or perhaps your own.

(BEGIN VIDEOTAPE)

GUPTA (voice-over): When Cheryl Miller was 51 years old, she woke up in the middle of the night suffering from a pain in her arm. CHERYL MILLER, HEART ATTACK SURVIVOR: It was just kind of a dull ache. And I had thought maybe I had done something, you know, pulled a muscle or something. So I did get up and sat there and read for a while.

GUPTA: When the pain got worse, Miller went to the emergency room. But because she didn't have the typical symptoms of a heart attack, severe chest pain, doctors diagnosed her with a stomach problem.

MILLER: They were going to send me home because I was having esophageal spasms. And I thought, you know, I've had indigestion, and it doesn't feel like this.

GUPTA: But Miller insisted her results be sent to a cardiologist. And she was rediagnosed with a heart attack. According to Dr. Elizabeth Ross, Miller's cardiologist, misdiagnosis of women's heart disease is very common.

ELIZABETH ROSS, DR., WASHINGTON HOSPITAL CENTER: Men, when they have heart disease, frequently have severe chest pain. They may describe it as a crushing or chest pressure-like pain. Women, on the other hand, may not have chest pain at all. They may just be excessively fatigued, or nauseated, or more short of breath.

GUPTA: Experts say more women need to know what their symptoms might be and be proactive like Miller.

ALEXANDRA LANSKY, DR., NY PRESBYTERIAN HOSPITAL: The difference between 30 minutes and 60 minutes could be the difference between life and death.

GUPTA: After all, cardio vascular disease is the number one killer of both men and women in the U.S.

And there is some good news to report on this front, thankfully. While heart disease is still the leading killer, death rates from the disease have dropped over the last six years among heart attack patients who are hospitalized. That's from a new international study. It says that the growing use of powerful medications and the artery- opening procedures, such as angioplasty, are most likely the reasons for the decrease.

Stay right where you are. If you're thinking of expanding your family, learn how an expanded waistline could be making that harder. That's just ahead.

(COMMERCIAL BREAK)

GUPTA: We're back with HOUSECALL. We know obesity causes all kinds of health problems, but fertility issues? Researchers say yes. The heavier a woman is, the more likely she'll have trouble conceiving.

(BEGIN VIDEOTAPE) GUPTA (voice-over): Dorothy Martin is getting her four kids off to school. Recently, she was remarried. She's trying to have another child. But since the birth of her last baby, she's put on some weight. And it's not so easy.

DOROTHY MARTIN, OB/GYN PATIENT: We haven't been that successful so far, but we're still trying.

GUPTA: It's not unusual, according to the National Institutes of Health. Women who are overweight or obese often produce too much estrogen.

CATHERINE SPONG, DR., NATIONAL INSTITUTES OF HEALTH: And it affects hormone levels, it can increase a woman's androgen levels, increase her insulin levels, and can be part of a syndrome called polycystic ovarian syndrome.

GUPTA: In polycystic ovarian syndrome, the ovaries don't produce enough hormones to stimulate an egg to mature and be released, which causes women to become infertile. Some women with PCOS also make too much insulin, which can cause diabetes. And there's even more.

SPONG: The chronic high blood pressure, the diabetes, often arthritis, things like that also make it more difficult once they're pregnant in maintaining and having a healthy pregnancy.

GUPTA: Being overweight can also make invitro fertilization much harder because the hormone inbalance keeps an embryo from implanting itself in the uterus. Dr. David Downing tells his patients the best way to avoid all these problems is to lose weight long before becoming pregnant.

DAVID DOWNING, DR., WASHINGTON HOSPITAL CENTER: It's a very difficult thing to do. It's something which is a long-term goal that takes a lot of exercise and practice and restraint and dietary changes.

GUPTA: And those are changes that Dorothy Martin already knows she needs to make.

(END VIDEOTAPE)

GUPTA: Now to be clear, not all women who are overweight will have a tough time conceiving, but obesity is a factor when it comes to fertility. And once a woman becomes pregnant, excess weight may cause complications with the pregnancy as well. Something to think about.

Just ahead on HOUSECALL, tips for enjoying the rising temperatures while staying healthy.

(COMMERCIAL BREAK)

GUPTA: Welcome back! Well, we're headed towards summer. And depending on where you live, you may already be enjoying some sunny days and some rising temperatures. But keep in mind, the heat can be trouble as well. Here's some quick tips. Make sure to stay hydrated, of course. Put on your sun block as well. Also, remember the inside of your car can really heat up. For example, here's a study from Harvard that shows on a 72-degree sunny day, a car's interior temperature can heat up an average of 40 degrees within one hour.

So enjoy the weather, but remember, the sun and heat can do a number on you before you realize it.

Unfortunately, we're out of time today. Make sure to watch HOUSECALL every weekend for the answers to all of your medical questions. The other five days of the week, you can check out CNN.com/health and i-Tunes for my podcast. Thanks for watching. I'm Dr. Sanjay Gupta. Stay tuned now for your latest headlines in the NEWSROOM.

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