Q: My six-year-old was recently diagnosed with mild asthma. I've heard that living in the city can make asthma worse. Should we consider moving to the suburbs?
City living does seem to exacerbate asthma in some people, probably because asthma attacks can be touched off by allergies to environmental pollutants that are more common in urban environments. But asthma symptoms often can be controlled by taking steps to minimize allergens in the household, for example, by removing rugs and curtains and by not using perfumes or sprays.
Although asthmatic attacks can be frightening, they can be controlled. Spray inhalers such as Proventil can help open the large airways. In addition, a new drug, Singulair, has been proven safe and effective in treating asthma in children as young as six years old. By reducing airway constriction and mucous production, it limits the frequency and severity of attacks in people with mild to persistent asthma. Singulair is taken in pill form just once a day, in the evening, and helps control nighttime attacks.
Unless you want to move, you might postpone such a drastic measure. After all, your child may encounter new and different allergens in the country. The best course of action is to take your child to a pediatric asthma specialist who can assess the severity of her symptoms and establish an effective asthma management program.
Madu Rao, M.D.
Department of Pediatrics
Q: I am trying to lose weight and I know that I need to eat less fat, but I have heard that some fats are good fats while others are bad fats. What is the difference?
If you are trying to lose weight, you are right to limit your fat intake. In general, fats should make up no more than 30 percent of calories consumed, and some fats should be limited more than others.
Saturated fats should be avoided because they boost your cholesterol levels more than anything else in your diet. High cholesterol levels (240 mg/dl or more) tend to clog blood vessels, leading to an increased risk of heart attack and stroke. Saturated fats are found mainly in foods that come from animals, such as butter, cheese, whole milk, cream, fatty meats, and shellfish, such as lobster or shrimp. However, saturated fats are also found in some vegetable oils - coconut, cocoa butter, and palm kernel oils.
You should also limit your intake of hard margarine and shortening. These foods contain "trans fats" created by the process of hydrogenating vegetable oils. Although they are not as bad as saturated fats, they also appear to boost blood cholesterol levels. The best margarine is "soft" margarine.
Dr. Madu Rao, co-director of Downstate's Asthma Center, with one of his young patients. University Hospital of Brooklyn now has an Acute Care Receiving Center where anyone, young or old, who experiences an asthma attack or cardiac emergency can receive immediate treatment.
"Good" fats are monounsaturated and polyunsaturated fats. They are found in most vegetable oils - corn, olive, and sunflower oil. Cooking with olive oil is a good way to reduce your exposure to "bad" fats. Additionally, most fish (not including shellfish) are low in saturated fats, and fish oils are often a good source of omega-3 fatty acids, a polyunsaturated fat that is good for you.
The nutrition labels on packaged foods will tell you how much saturated fat, total fat, cholesterol, and total calories are contained in a serving. Limiting the intake of saturated fats and cholesterol is the right approach for everyone.
Marlene Price, M.D.
Department of Medicine
Q: The doctor says my 12-year-old daughter has scoliosis. Does this only happen to girls, and what can we do about it?
Scoliosis, characterized by a slight to severe "S"-curve in the spine, is a fairly common condition that frequently goes undiagnosed. It is not limited to girls, but it does occur more frequently in females, and it tends to run in families. Minor curvatures are not easy to see, but parents of young children should be alert for these signs: uneven hem or pant legs; one hip/shoulder/ear higher than the other; viewed from behind with the child bending forward, one shoulder blade or one side of the rib cage is more prominent.
If the curvature is mild, no treatment is necessary, and the condition is unlikely to affect your child's health or appearance. But it should be monitored. All children should be screened by age 12 so that any necessary treatment can begin early.
Miriam Vincent, M.D.
Department of Family Practice