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Is Asthma Worse When You’re Pregnant?

Updated on Jun 30, 2022 | Asthma, OB/GYN, Your Health

Pregnancy can be a difficult time for many women, but especially for those with the added burden of asthma.

Asthma, a chronic disease of the airways of the lungs, is one of the most common medical problems that occurs during pregnancy. Sonali Bose, MD, a pulmonologist at the Mount Sinai – National Jewish Health Respiratory Institute, explains how asthma can affect both the mother and child, and what you can do about it.

Why is my asthma worse when I am pregnant?
Asthma control during pregnancy can be unpredictable. Asthma may get worse during pregnancy because of the effects of hormonal changes associated with pregnancy. Some experts have proposed that changes in the hormone progesterone can have effects on the mother’s airways, such as influencing airway inflammation or its sensitivity, but the exact mechanisms are still unclear.

Another major reason that asthma may get worse during pregnancy is that many pregnant women tend to stop or decrease their asthma medications because they are worried about how these medications may affect their unborn child, which in turn may cause the mothers to have worse control of their asthma.

What are the symptoms of asthma during pregnancy?
Women with asthma may have variable symptoms over the course of their pregnancy. Women with poorly controlled asthma may have more severe respiratory symptoms, such as wheeze, chest tightness, or cough. Some women may be more likely to have an asthma attack, either during the pregnancy or even after delivery.

Is asthma dangerous during pregnancy?
Asthma is a serious disease for all patients, not just pregnant women. However, asthma control can get worse with pregnancy. The detrimental effects of asthma not only affect the mother, but we are increasingly discovering their serious effects on the health and development of the unborn child.

Women with uncontrolled asthma during pregnancy have been reported to have more complications, such as preeclampsia, pregnancy-induced hypertension, and preterm labor. Uncontrolled asthma during pregnancy may lead to poor growth of the fetus and low birth weight. But we need better research studies to improve our understanding of exactly how asthma during pregnancy affects both the mother and child.

Can asthma be transferred from mother to child?
Asthma does run in families. Children of mothers with uncontrolled asthma (for example, those who have had an asthma attack during pregnancy) may have a higher risk of developing asthma and other allergic diseases and chest infections, or have lower lung function during childhood.

How is asthma treated during pregnancy?
The goal for treating asthma during pregnancy is similar to that for patients who are not pregnant: focus on improving asthma control. Inhaled corticosteroids are still the main way of helping control asthma during pregnancy and are effective in treating airway inflammation and preventing an exacerbation. These inhalers appear to be safe in pregnancy, and any risks are thought to be outweighed by the benefits of achieving good asthma control.

However, if an exacerbation occurs, oral steroids may be needed to treat it. In addition, we advise that pregnant mothers try to avoid their known environmental triggers and follow universal precautions to avoid contracting a respiratory infection. It is important to optimize asthma control even before becoming pregnant, because it seems that women who have more severe asthma before getting pregnant may be more vulnerable to having problems during their pregnancy.

Make an appointment with Sonali Bose, MD

How Important Is Getting the Flu Shot?

Updated on Jun 30, 2022 | Cold and Flu, Infectious Diseases, Your Health

Despite all the media attention about the novel coronavirus, now known as COVID-19, influenza is currently a much bigger risk for most people in the United States. Yet many people do not plan to get a flu shot this year. You may be busy, or perhaps you think you might get sick from the shot, or that it’s not necessary. Matthew Weissman, MD, MBA, a primary care doctor with the Mount Sinai Health System, explains why you shouldn’t put it off.

Why should I get the flu shot?

The flu shot is extremely important. It not only prevents you from getting sick from flu, but it can lessen the severity of flu even if it’s not a perfect match for the type that is going around. For instance, my own daughter got the B strain of the flu. Luckily, she had a much milder case of it because she got the shot.

People forget that the flu is a deadly disease. Each season, tens of thousands of people die from the flu, and hundreds of thousands are hospitalized, according to the Centers for Disease Control and Prevention (CDC). Most of the people who died were not vaccinated. If you’re overweight, pregnant, elderly, or a child, or you have other diseases, you’re in a high-risk category. When you add all those up, you’re talking about a wide swath of New Yorkers.

Keep in mind that the flu shot doesn’t just protect you; it protects your co-workers, your classmates, your parents, and your grandparents—including people whose immune systems may not be good enough to build up their own defenses. It’s like a ripple effect, or herd immunity. It would be a great idea to have a workplace event for people to get vaccinated. It’s a smart idea for businesses to help cut down absenteeism this way.

Some people don’t get the shot because they think they’re going to feel sick for a couple days. Is that true or a myth?

People’s responses vary. Some people do feel a little feverish, get a sniffle, or have a sore arm for a bit. That’s actually a good sign, because it means their immune system is revving up to combat the flu. I think that’s a fair price to pay for not being incapacitated for over a week or being at risk of death from a vaccine-preventable illness. And these side effects don’t happen to everybody, and it doesn’t happen every time.

People have all kinds of excuses why they can’t get the flu shot. People are sometimes worried that the shot may cause a bad reaction because they have an egg allergy. But there are lots of ways to deal with that, including some vaccines that were not created using eggs. People should ask their doctor to find out what’s right for them.

Bottom line, the benefit of the flu vaccine outweighs the risk for most people, by far.

Is it too late to get a flu shot this season?

Definitely not. Flu season doesn’t appear to have peaked yet. The flu season is generally during fall and winter. The CDC recommends that everyone six months or older get the flu shot. You can get it any time up until spring, so don’t wait.

Matthew A. Weissman, MD, MBA, is Chair of Medicine at Mount Sinai Downtown and Associate Professor of Medicine (General Internal Medicine), and Pediatrics, at Icahn School of Medicine at Mount Sinai

Is Oat Milk the Best Milk for You?

Updated on Jun 30, 2022 | Diet and Nutrition, Your Health

The popularity of oat milk has exploded in the last few years. From Starbucks adding an oat milk beverage to its menu to Chobani launching a line of oat yogurts, it’s clear that oat milk is more than a fad.

However, is oat milk the best milk for you?

We spoke with Carrie Morowitz, RDN, a senior clinical dietitian at Mount Sinai Health System, about the recent popularity of oat milk and whether you should consider adding it to your diet.

The popularity of oat milk has grown exponentially. What do you think sparked this?

Oat milk has been around for a while, but in the past two years it has become much more popular. I believe that stems from a move to more plant-based products. Now companies are making oat milk-based yogurts, and oat milk is widely available in restaurants and cafes, something we never used to see.

A debate is raging: oat milk vs. almond milk vs. cow’s milk. Is oat milk a healthier option?
In certain ways, oat milk is healthier than other milk options. But in some other ways, it’s lacking. For example, oat milk has more fiber than cow’s milk or nut-based milk. An average cup of oat milk has about two grams of fiber. However, oat milk has more carbohydrates. That’s especially important if you’re trying to monitor your carb intake, or if you have diabetes. A glass of oat milk has about 15-20 grams of carbs, whereas a glass of regular cow’s milk has only about 8 grams. Oat milk is also vegan and contains no soy or nuts. So for people with common allergies or lactose intolerance, it’s a safer option.

Is oat milk gluten free?

Usually, oat milk is considered gluten free. But you need to check for the additives. If it is made with certified gluten-free oats, it’s a good gluten-free option.

Can oat milk replace cow’s milk in a traditional diet?

It depends on the individual. If you have diabetes, oat milk may not be the best option since it’s the highest carbohydrate-containing milk of those other options. If you’re a diabetic who already uses almond milk, I don’t think switching from almond milk to oat milk would be very beneficial. If you are looking to move towards a more plant-based diet, oat milk may be a good option for you. However, make sure to check the label and ensure that there are no added sugars, as a product simply being plant-based can trick you into thinking it’s the healthiest option.

Carrie Morowitz, RDN, is a senior clinical dietitian at Mount Sinai Health System.

What You Need to Know About Lyme Disease Before Taking That Hike

Updated on Jun 30, 2022 | Your Health

Lyme disease can cause swollen joints, chronic fatigue, and a host of ailments that make diagnosis difficult. Erna M. Kojic, MD, Chief of Infectious Diseases at Mount Sinai Morningside and Mount Sinai West, explains the condition and whether you should worry if you feel lethargic a few days after a trek through the woods.

Is there a typical Lyme disease patient?

Each year, 30,000 people in the United States contract Lyme disease caused when a blacklegged tick—also known as a deer tick—carrying the Borrelia burgdorferi bacterium has fed on a person for at least 48 hours. The typical patient is someone who has been hiking, biking, or otherwise been active in a grassy, woody area, like those throughout upstate New York, Long Island, and other parts of the New York metropolitan area. Within a week of contracting a tick bite, they often develop a bullseye rash and experience flu-like symptoms, joint swelling, fever, and fatigue. After visiting an urgent or primary care physician, these patients will receive antibiotic treatment that will cure the disease.

That being said, I often tell people that Lyme disease can be anything, and anything can be Lyme disease. Depending on how long the bacteria has been untreated, it can affect almost any part of the body, including the nervous system and the heart.

According to the Centers for Disease Control and Prevention (CDC), 20 to 30 percent of those infected with Lyme do not get the bullseye rash. Are there other warning signs?

Unfortunately, there are no foolproof warning signs. But there is a blood test for Lyme disease that you can receive if you experience flu-like symptoms after being active in a tick-infested area.

People who are infected can go untreated for a long time if they don’t see a rash and therefore don’t connect their fatigue with Lyme disease. Fortunately, patients with years-long, unmanaged Lyme disease can be treated with intravenous antibiotics.

I thought my chronic fatigue was Lyme, but test results were negative. Should I get tested again?

When we test for Lyme disease, we look for specific antibodies that the body produces in response to infection. However, these antibodies cannot be detected until the bacteria has been present in the body for weeks. If you tested negative for Lyme disease but are still concerned that you have the condition, visit an infectious disease specialist.

I was treated for Lyme, but I still feel fatigued. What should I do?

Although Lyme disease is curable with antibiotic treatment, some people develop something called Post-Treatment Lyme Disease Syndrome, in which joint pain and fatigue linger. This condition is manageable with physical therapy. I advise patients with these lingering symptoms to listen to their body, stay active, and trust that they will get back to their baseline in time.

There is a common misconception that antibiotic treatment does not work, or that Lyme disease patients should remain on antibiotics indefinitely. This is incorrect.

Any advice for people who are at risk of contracting Lyme disease?

I often tell hikers, bikers, or anyone at risk for tick exposure to apply tick-repelling bug spray to bare skin and to treat their clothing with permethrin, an insect repellent. Permethrin is particularly useful as it kills ticks on contact, and it can last on clothing for several washes.

I also tell patients that having had Lyme disease once does not prevent you from getting it again, so tick prevention remains important.

Finally, do not blame everything that is bothering you on Lyme disease. Because the disease is so multi-symptomatic, I have had patients miss serious conditions, like multiple sclerosis, because they believe they have Lyme disease. If you have had symptoms for quite a long time, and you test negative for Lyme disease, you should be looking for something else.

Erna M. Kojic, MD, is the Chief of the Division of Infectious Diseases at Mount Sinai Morningside and Mount Sinai West. She is board certified in Internal Medicine and Infectious Disease as well as a prolific researcher in the area of Human Papillomavirus (HPV) and HIV.

Make an appointment with Dr. Kojic

Learn more about Mount Sinai's Infectious Disease Services

I Feel Sick. Should I Stay Home or Go to Work?

Updated on Jun 30, 2022 | Cold and Flu, Your Health

You wake up in the morning and you know you don’t feel right, but you can’t afford to be sick. Meetings to attend, deadlines to meet, kids to get to school—it’s not going to go away because you don’t feel good. Matthew Weissman, MD, MBA, a primary care doctor with the Mount Sinai Health System, offers some common-sense advice about when to stay home, and when to keep your kids home.

As New Yorkers, we feel this drive to keep going all the time. So many of us feel compelled to go to work even when they don’t feel well. When should people stay home from work?

Lots of us feel this pressure to show up to work, be tough, and work through it. But we’re doing a disservice to our colleagues and ourselves by doing that. Helping each other as good New Yorkers means that if you have symptoms such as fever, sneezing, runny nose, muscle aches, or fatigue, you should stay home. You should give your body—and your colleagues—a break and stay home.

How long should you stay home?

If you have a fever, you should stay home at least 24 hours after the fever goes away. And when flu symptoms are present, you should probably stay home for a week from the time the symptoms start. Maybe you can find an alternative way to work, like working from home, but that’s not an option for everyone. Perhaps you can find time to work when others aren’t around, or find a space that’s a bit secluded. But pushing yourself is never a good idea. It will just take that much longer to recover.

The other thing is that people are contagious 24 hours before they start showing signs of the flu. So that’s even more reason to practice good hand hygiene all the time, get your flu shot, and don’t share drinks, food, or toothbrushes with other people. You really have to be on alert all the time—not just when someone near you is coughing or sneezing.

What about keeping my kids home from school?

I know it’s tough on kids to miss school, so perhaps checking with your pediatrician is a good idea. If it’s just the sniffles and no fever, it may be okay for them to go. Or perhaps they can find a way to video chat into some classes. You certainly want to help prevent spreading colds and flu around the class. That’s why it’s important to teach kids about good hand hygiene, and to cover their cough with their elbow instead of their hands.

Sometimes when you’re sick, you are a bit torn. You wonder if it’s in your head, and you think about all the stuff you have to do.

It’s a balancing act. But think about it as an investment in the future. If you get some rest now, you’ll be more productive at work in the future. It may not be in our nature to slow down, and it may not seem like it’s what everyone else is doing. But it’s really important to protect our ability to function down the line. Because the flu will wipe you out for a week, at least, and then you’re really playing catch up.

The flu isn’t always just a few days of being under the weather. People forget that it’s a deadly disease, and can lead to other complications like pneumonia. So if you’re going to err, it might as well be on the side of safety.

Another thing that people wrestle with is, “Is this just a cold or is it the flu?”

That’s true. Many people confuse the flu with a cold, so it’s important to know the difference and to get checked out when appropriate, since the flu can be deadly. Colds tend to come with just runny noses, sneezing, and head symptoms, while influenza tends to have more bodily symptoms like muscle aches and fever. If it is the flu, treatment like Tamiflu is most effective in the first few days of symptoms. If it’s a bacterial infection, you may need antibiotics. If it’s a cold, the best thing you can do is rest and get plenty of fluids. Many times people come to us and feel they should have antibiotics. It’s important that doctors only prescribe antibiotics when needed; otherwise, patients may experience unnecessary side effects, or the antibiotics may not be as effective when you really need them.

And of course, you have New Yorkers who don’t want to give up their workout. Is it a bad idea to work out when you don’t feel well?

If you really have the flu, you’re going to feel debilitated and not feel like working out anyway. But if you just have the sniffles, you might feel better after a little exercise. Certainly you don’t want to contaminate people. But if you have a slight cold, it might feel better to get the blood pumping and your airways opened up. And you definitely want to wipe down the treadmill with an antiseptic wipe, and wash your hands before and after your workout. The gym is one of those places where you can come into contact with all kinds of germs.

Always listen to your body and let that (and your doctor) be your guide.

Renowned Microbiologists Explain the Coronavirus

Updated on Jun 30, 2022 | COVID-19, Featured, Your Health

The novel coronavirus is transmitted through the air and replicates in the respiratory system and in blood.

The novel coronavirus that began in Wuhan, China, has been labeled a Public Health Emergency by the U.S. government. As confirmed cases of the coronavirus now known as COVID-19 continue to increase in this country and around the world, and additional information unfolds, two renowned microbiologists at the Icahn School of Medicine at Mount Sinai, Peter Palese, PhD, and Adolfo García-Sastre, PhD, recently provided insights into the disease. Dr. Palese is the Horace W. Goldsmith Professor and Chair of the Department of Microbiology, and Professor of Medicine (Infectious Diseases); and Dr. García-Sastre is the Irene and Dr. Arthur M. Fishberg Professor of Medicine (Microbiology, and Infectious Diseases), and Director of the Global Health and Emerging Pathogens Institute.

What is COVID-19?
Dr. Palese: It belongs to a group of viruses known as coronaviruses, to which the SARS (severe acute respiratory syndrome) virus and MERS virus (Middle East respiratory syndrome) belong. It is transmitted through the air and replicates in the respiratory system and in blood.
Dr. García-Sastre: The COVID-19 and the SARS-CoV are closely related and they originated from bats. In the case of the COVID-19, we are not yet sure of its precise origin—whether the virus went directly from bats to humans or whether it went from bats to a host animal and then to humans, which is what happened with SARS. But we believe it originated from bats.

The SARs outbreak in 2003 is different from the novel coronavirus in that it was traced to civet cats and raccoon dogs, which were eaten as a delicacy in some parts of China. The animals were originally infected by bats—either through bites or by breathing in bat urine and feces. MERS, a respiratory illness relatively new to humans and traced to the Arabian Peninsula, is believed to have been spread by camels that were also infected by bats.

How did this novel coronavirus start?
Dr. Palese: Samples of the virus were found in a large fish market in Wuhan where other live animals are kept in cages and sold as food.

Dr. García-Sastre: People went to the market to buy food and were exposed to the virus, which infects through the respiratory tract. Like the flu, it is spread by aerosols.

What are the most important factors to consider as the disease unfolds?
Dr. Palese: The reproduction number, or “R” number, appears to be around 2.5. That means every person who is infected will pass the disease on to 2.5 other people. The influenza virus is a little lower. Measles has a much higher R number of about 18. These are averages. But we have to be vigilant. There are reports that the disease can be transmitted for about 24 hours before symptoms develop. If that is confirmed, it would make it more difficult to contain. The disease caused by the novel coronavirus is accompanied by flu-like symptoms, including very high fever. Fatalities stem from pneumonia and comorbidities, such as old age, asthma, or chronic obstructive pulmonary disease.
Dr. García-Sastre: Don’t panic. The virus does not seem to be associated with very high mortality. It is progressing more quickly than the SARs virus did, but it also appears to be less deadly. The rate of transmission appears to be similar to that of the seasonal flu. That is an estimate because we don’t know for sure whether all of the people who have the disease have been diagnosed. Some may have very mild cases. Another consideration is at what moment does an infected person begin to transmit the virus? With flu, people can transmit the disease before there are symptoms. With SARS, most transmissions happen after there are symptoms.

Are vaccines available?
Dr. Palese: Our government is rapidly developing vaccines and they are in the pipeline, but nothing has been approved as of today.
Dr. García-Sastre: Vaccines may be first available only on an experimental basis.

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