RICHARD G.M. MORRIS MA, D.Phil, FRSE, FMedSci, CBE, FRS Centre for Cognitive and Neural Systems, School of Biomedical Sciences, College of Medicine and Veterinary Medicine, The University of Edinburgh, 1 George Square, Edinburgh, EH8 9JZ, United Kingdom. Tel: +44(0) 131 650 3518; Fax: +44(0) 131 651 1835; Mobile: +44 (0) 773 647 7190 27 June 1948; Worthing, England.
Member of a medical scheme? Know your guaranteed benefits When children cannot breathe If your child suffers from asthma or pneumonia, What are the signs and symptoms of asthma?
know that your medical scheme is obliged to help The signs and symptoms include: them breathe. This edition of CMScript aims to clarify your at night, or while laughing (where coughing child's entitlements under the prescribed may be the only symptom of asthma minimum benefits (PMBs) for the following conditions listed in the Medical Schemes Act: • less energy during play • an acute (sudden) asthmatic attack; • complaints of chest tightness or chest • pneumonia due to the respiratory syncytial virus (RSV) in persons under the age of • whistling sound (wheezing) when breathing • see-saw motions in the chest caused by • asthma (as a chronic, life-long condition), as difficult breathing included in the Chronic Diseases List (CDL) under the PMBs.
• tightened neck and chest muscles Although asthma and pneumonia affect both adults and children, this CMScript focuses on children younger than three. What is asthma?
Symptoms can change from one asthma episode to the Asthma is a condition caused by the next in the same child. But not all wheezing or coughing inflammation of air passages in the lungs. is caused by asthma. In children younger than five, the most common cause of asthma-like symptoms The condition is characterised by repeated attacks is upper respiratory viral infections such as the of breathlessness and wheezing. The severity and or the respiratory syncytial virus (RSV).
frequency of attacks varies from one person to the next. What triggers an asthma attack?
"Coughing may be Common triggers of asthma attacks include: the only symptom of • viral infections such as flu or RSV • bacterial infections such as sinus infections asthma present." • allergic rhinitis, commonly called "hay fever" (symptoms which affect mostly the nose and eyes and which occur when you inhale something you are allergic to, like dust or An asthma attack is frequently triggered by an external factor, including dust and pollen.
• irritants such as pollution, cigarette smoke, Asthmatic attacks are sudden and unexpected, and perfume, dust or other chemicals can be life-threatening in instances where quick- • allergies such as food and preservatives relief medicine (inhaled drugs called bronchodilators) • sudden changes in temperature or humidity are insufficient to treat the attack. Asthma attacks • exposure to cold air which do not respond to treatment with an inhaler • emotional stress or trauma are emergencies and must be treated as such.
• exercise (in children this includes playing) • heartburn (gastro-oesophageal reflux Asthma can be acute or chronic.
• medication, specifically aspirin or other non- inflammatory drugs such as ibuprofen Any one of the above can trigger an asthma attack.
How is asthma diagnosed in children?
Children suffering from asthma (and other Diagnosing asthma in small children is not easy as respiratory infections) may need to see additional they may not be able to "perform" some of the tests healthcare providers such as a physiotherapist that may be required. Their persistent coughing and/or and dietician. Physiotherapists assist in the wheezing may also be the only symptom they exhibit. treatment of the condition and help with the development of a respiratory exercise plan. Your doctor may request one or more of the Dietary advice is required when a food allergy • lung function test (to see how well your child proves to be one of the triggers of asthma. Certain food types, such as milk products, may worsen the • peak flow measurement (the fastest speed at symptoms of a respiratory infection. Correct eating which your child can exhale) plans should be developed and reviewed regularly to ensure that the child gets all the required nutrients.
• skin or blood test for allergies • arterial blood gas (to determine the pH of the What is pneumonia?
blood, the partial pressure of carbon dioxide Pneumonia is an infection of the lungs (a lower and oxygen, and the bicarbonate level) respiratory tract infection) that can be caused • eosinophil count (a type of white blood cell) by nearly any class of organism known to cause infections in humans, including viruses and bacteria. How is asthma treated?
The prescribed algorithm for asthma may not What are the signs and symptoms on
necessarily always be clinically appropriate for children. pneumonia?
Alternative paediatric management is included in this The signs and symptoms of pneumonia include: benefit if it is supported by evidence-based medicine, taking into account cost-effectiveness and affordability.
• the symptoms and signs which are also The treating provider should create an asthma action sneezing, sore throat, cough plan with you. The plan must include advice on how to: • avoid asthma triggers • monitor symptoms • cough with sputum • use the medicines • shortness of breath • handle emergency situations Two classes of medicine are used to treat asthma: • long-term control medicine, which prevents How is pneumonia diagnosed in children?
Your child's doctor may suspect pneumonia if they • quick-relief medicine, which is also used examine your child and hear coarse breathing and cracking noises in the chest, and wheezing. A chest x-ray may be ordered to confirm the diagnosis. Long-term control medications must be used on a regular basis to prevent both symptoms and Sputum samples can be tested for traces of attacks even when you do not have symptoms. the organisms that cause pneumonia. The This class of medicine is not used for treatment severity of the condition can be determined during an attack; quick-relief medicines are using a white blood cell count test. used to relieve symptoms during an attack. "Not all wheezing or How is RSV pneumonia treated?
The treatment for pneumonia caused by the coughing is caused by respiratory syncytial virus (RSV) in children under three is medical management as prescribed by the PMB Regulations. Medical management includes medicines, oxygen and ventilation if needed.
What are your child's PMB entitlements?
The same medicines are used to treat adults and Both asthma and pneumonia are included in the PMB children, but the method of administration may Regulations in the Medical Schemes Act 131 of 1998.
differ. Children may use a nebulizer rather than an inhaler because they can find it difficult to use Minimum treatment for both is prescribed in the an inhaler correctly. Children who use an inhaler Diagnosis and Treatment Pairs (DTPs) section of the should also use a spacer device which helps Act: it is "medical management". Medical management them to get the medicine into the lungs properly. includes oxygen therapy and ventilation if needed.
In addition to the treatment described in DTPs, The Communications Unit would like to thank asthma is also included in the PMB Regulations Ronelle Smit, Dr Selaelo Mametja, Dr Boshoff as a chronic disease with a specific medicine Steenekamp and Annemari van Vuuren for algorithm. The algorithm only specifies the medicine making this edition of CMScript possible. to be used, but the Regulation extends to the diagnosis, treatment and care of the condition.
Prescribed minimum benefits Hotline: 0861 123 267
(PMBs) are defined by law. Fax: 012 430 7644
They are the minimum level of diagnosis, treatment and care The clinical information furnished in this article is intended for information purposes only and that your medical scheme must professional medical advice must be sought cover – and it must pay for your in all instances where you believe that you PMB condition/s from its risk pool may be suffering from a medical condition. and in full. There are medical The Council for Medical Schemes is not liable interventions available over and for any prejudice in the event of any person above those prescribed for PMB choosing to act or rely solely on any information published in CMScript without having sought conditions but your scheme may the necessary professional medical advice. choose not to pay for them. A designated service provider (DSP) is a healthcare provider (e.g. doctor, pharmacist, hospital) World Health Organisation ( that is your medical scheme's first choice when you need treatment or care for a PMB condition. You can use a non-DSP voluntarily or involuntarily but be aware that when you choose to use a non-DSP, you may have to pay a portion of the bill as a co- Medicinenet.com ( PMBs include 270 serious health conditions, any emergency condition and 25 chronic To access other editions of CMScript please click diseases; they can be found on our website by accessing the link Obtain the medicine list (formulary) of your medical scheme so that your doctor can prescribe medicine from this list. This will prevent the scheme from charging you a co-payment on your asthma medicine.
5[alpha]-reductase type 2 gene variant associations with prostate cancer risk, circulating hormone levels and androgenetic alopecia
Int. J. Cancer: 120, 776–780 (2006)' 2006 Wiley-Liss, Inc. 5a-Reductase type 2 gene variant associations with prostate cancerrisk, circulating hormone levels and androgenetic alopecia Vanessa M. Hayes1,2*#, Gianluca Severi3,4*, Emma J.D. Padilla1, Howard A. Morris5, Wayne D. Tilley5,6,Melissa C. Southey7,8, Dallas R. English3,4, Robert L. Sutherland1,2, John L. Hopper4, Peter Boyle8 and Graham G. Giles3,41Cancer Research Program, Garvan Institute of Medical Research, St Vincent's Hospital, Sydney, Australia