Results

Table 1 shows the patient characteristics of the 307 patients with COPD. There were 100 (32.9%) active smokers at recruitment; 303 had a history of smoking, with a mean consumption of 50.5 pack years (SD, 35.9). Also, 262 patients (86.5%) were taking a median dose of 1,000 mg of beclomethasone equivalents (IQR, 500-1,000) of inhaled steroids; 41 patients (13.3%) were not taking inhaled steroids, and the dosage was unknown for four patients Viagra Generic. The patients recorded diary card data for 1,037 patient years and experienced 2,606 exacerbations, a median of 2.13 per patient per year (IQR, 0.94-3.32). Of these, 676 exacerbations were experienced by 212 patients in the warm seasons, and 1,052 exacerbations by 251 patients in the cold seasons: 197 patients experienced exacerbations in both seasons, and outside of the two seasons, 878 exacerbations were experienced.

Table 1—Characteristics of the 307 Patients

Data are given as mean (SD) unless otherwise indicated. Smoking history missing for four patients at recruitment. IQR = interquartile range

Patients were under observation in summer for a median 352 days (IQR, 224-523) and in winter for a median 338 days (IQR, 222-525).

There were 55.6% more exacerbations in the cold seasons compared with the warm seasons. The average temperature in the warm seasons was 16.7°C (range, 6.4 to 28.2), and in the cold seasons, 6.6°C (range, —3.5 to 15.6).

Exacerbation Recovery and Temperature

The median recovery time from all symptoms in the warm seasons was shorter at 9 days (IQR, 5-16; n = 595) compared with 10 days in the cold seasons (IQR, 6-19; n = 892; P = .005).

Instead of looking at ADHD meds and their possible side effects, let us take a look at alternative ways of taking care of ADHD for a change. I was very interested to read about the work of Dr. Tiffany Field who is a well known expert in children’s mental health. Her work has concentrated recently on the effects of massage for ADHD children.

She studied 28 adolescents and found that those who had received massage therapy were doing much better in class afterwards. There was much less restlessness and fidgeting and they were able to concentrate better. Their teachers also noticed the same improvement and they were completely unaware of Dr. Tiffany’s experiment.

This was a very limited experiment and a very small sample. Obviously more work needs to be done. What were the real reasons for improvement and what indeed would the lasting impact be, if any, on the child’s behavior? It will be interesting to read of further work in taking care of ADHD.

Having the cut off age at 7 is now causing some controversy because it appears that some ADHD symptoms, depending on the context and the environment, can actually emerge after that age. The new DSM, due out in 2013 is going to take this into consideration and raise the cut off age from 7 to 12. That at least is the proposal and there seems to be enough evidence now that this may be a valid strategy to adopt.

The problems of co-morbid disorders with ADHD was brought home to me recently when I read on the forum about a fourteen year old boy who had not only ADHD but was also suffering from bipolar depression and also ODD (Oppositional Defiant Disorder). This child had been through eighteen different medications before they found the right combination.

It is stories like these that force us to sit up and take notice. That alarm should and must be that medications for ADHD are not the first options in taking care of ADHD. It had been proved over and over again that child behavior modification techniques (perhaps with some kind of medication, not necessarily psychostimulants) is really the only way to go.

That is why I have built a website on this topic to help you through the jungle. Why not check it out right now so that you can get a few straight answers about taking care of ADHD.