-----Original Message-----
From: Courant, Genevieve [mailto:[log in to unmask]]
Sent: Friday, September 27, 2002 3:03 PM
To: Piche, Charlene; Baird, Burke; Ghislaine Goudreau (E-mail)
Cc: Lorraine Jones (E-mail); Sheila Poirier (E-mail); Coles, Jody;
Dorsette, Louise; Susan martin (E-mail); Belanger-Gardner, Diane; Jack
Newman (E-mail)
Subject: RE: breastfeeding and asthma
Thanks Charlene,
Indeed I am aware of this study - having made the National Post on Monday!
UK UNICEF has published a statement indicating that the findings of this
study must be treated with great caution (www.babyfriendly.org.UK/). The
authors themselves (Sears et al)list the criteria proposed by Kramer for
assessing adequacy of studies on the effect of breastfeeding on development
of allergy and asthma. Under 'exposure' the criteria of 'sufficient
duration of breastfeeding' and 'sufficient exclusivity of breastfeeding' are
included. I don't think either of these criteria are adequately met in this
study.
Nevertheless, this study is not the first to show an association between
breastfeeding and increased risk of asthma. Another study by Wright et. al
"Factors influencing the relation of infant feeding to asthma and recurrent
wheeze in childhood" (Thorax. 2001;56:192-7) found that although
breastfeeding was reported to be protective against wheezing illnesses (and
I'm not sure how these differ from asthma-but perhaps you could clarify this
for me)when the children were younger than 6 years of age, exclusive
breastfeeding for more than 4 months was found to greatly increase risk for
asthma among atopic older children (6 to 13 years of age) WITH asthmatic
mothers. No relationship between asthma and infant feeding was found in
children who were not atopic or who had mothers who were not asthmatic.
Another Australian study just published in July 2002 in J Allergy Clin
Immunol 110:65-7 by Oddy WH et.al., found that children who had been
exclusively breastfed for their first 4 months were less likely to suffer
from asthma at age 6 years regardless of their mother's asthma status (that
one did not hit the papers as far as I know).
Duration of exclusive breastfeeding has been found to be important in
studies where one is looking at an association between breastfeeding and the
risk of a certain diseases. Dr. Scott Weiss MD, professor of medicine at
Harvard in Boston states that the study by Oddy makes a key point that
"duration of breastfeeding matters". The protective effect is not strong,
"but applied over a lot of people, it can still be an important factor."
(Recall that the Sears study is looking at children who were not breastfed
or those in whom breastfeeding was attempted but was d/c before the child
was 4 weeks old ("non-breastfed") versus children who were breastfed (and
also received formula though authors don't report detailed information on
amounts) for 4 weeks or more (mean duration of breastfeeding of 21.1 weeks
SD 16.6)). Weiss pointed out the strengths of the Oddy study that
distinguish it from other studies of breastfeeding and asthma i.e. the
particularly large sample size (2600) and the detailed information gathered
on breastfeeding duration.
It is important to remember that breastmilk is the physiological normal for
the infant gut and every other infant "system". Gut and Lung are also
pretty strategic when it comes to the immune system. Any other fluid/food
introduced into an infant's gut will alter gut flora and the entire gut
"milieu" in ways that we have yet to fully understand the implications of.
While there has been much work on the immunology of breastmilk and the
immunomodulating effects of breastmilk, we still have much to learn.
Hopefully these studies will help improve our understanding in the long run.
Bottom line: Given that a mother (asthmatic herself or not) cannot predict
the future, she should understand that her child is at risk of developing
atopy but is not guaranteed to do so. Regardless of her infant-feeding
choice there are ways that she can reduce her child's risk for asthma, such
as not smoking, not allowing her child to be exposed to second-hand smoke
(and others ways you are more aware of than I). !!?It might even help if
mothers clean less and kids have lots of pets!!!? My understanding is that
the cause of asthma is probably multifactorial. A mother should also be
reminded of the many well-documented benefits of breastfeeding for babies
AND MOTHERS (not much doubt BF helps lower risk of breast cancer (cause of
which is probably multifactorial also).
Genevieve Courant, BNSc, MSc, IBCLC
-----Original Message-----
From: Piche, Charlene
Sent: Thursday, September 26, 2002 07:20
To: Courant, Genevieve
Cc: Baird, Burke
Subject: FW: PulmonologyLinx : Asthma/Atopy Newsletter 09/25/2002 8:43PM
FYI Charlene
___
Breast is best for preventing asthma and allergies - or is it? -- The Lancet
(from Cardiosource)
<a href=http://www.pulmonologylinx.com/thearts.cfm?artid=421721&specid=14>
http://www.pulmonologylinx.com/thearts.cfm?artid=421721&specid=14 </a>
One of the important exposures in early infancy is breastfeeding. Although
it would take a brave paediatrician to argue against the benefits of
breastfeeding, there is no consensus about whether breastfeeding protects
against the development of asthma and allergies ...
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