Global strategy for asthma management and prevention

Expert Panel Report 2: Guidelines for the Diagnosis and Management of Asthma

OBJECTIVE — To systematically review the incidence of posttransplantation diabetes (PTD), risk factors for its development, prognostic implications, and optimal management. RESEARCH DESIGN AND METHODS — We searched databases (MEDLINE, EMBASE, the Cochrane Library, and others) from inception to September 2000, reviewed bibliographies in reports retrieved, contacted transplantation experts, and reviewed specialty journals. Two reviewers independently determined report inclusion (original studies, in all languages, of PTD in adults with no history of diabetes before transplantation), assessed study methods, and extracted data using a standardized form. Meta-regression was used to explain between-study differences in incidence. RESULTS — Nineteen studies with 3,611 patients were included. The 12-month cumulative incidence of PTD is lower (10% in most studies) than it was 3 decades ago. The type of immunosuppression explained 74% of the variability in incidence (P 0.0004). Risk factors were patient age, nonwhite ethnicity, glucocorticoid treatment for rejection, and immunosuppression with high-dose cyclosporine and tacrolimus. PTD was associated with decreased graft and patient survival in earlier studies; later studies showed improved outcomes. Randomized trials of treatment regimens have not been conducted. CONCLUSIONS — Physicians should consider modification of immunosuppressive regimens to decrease the risk of PTD in high-risk transplant recipients. Randomized trials are needed to evaluate the use of oral glucose-lowering agents in transplant recipients, paying particular attention to interactions with immunosuppressive drugs. Diabetes Care 25:583–592, 2002

A systematic review of the literature

Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma

Asthma is a serious health problem throughout the world During the past two decades, many scientific advances have improved our understanding of asthma and ability to manage and control it effectively However, recommendations for asthma care need to be adapted to local conditions, resources and services Since it was formed in 1993, the Global Initiative for Asthma, a network of individuals, organisations and public health officials, has played a leading role in disseminating information about the care of patients with asthma based on a process of continuous review of published scientific investigations A comprehensive workshop report entitled "A Global Strategy for Asthma Management and Prevention", first published in 1995, has been widely adopted, translated and reproduced, and forms the basis for many national guidelines The 2006 report contains important new themes First, it asserts that "it is reasonable to expect that in most patients with asthma, control of the disease can and should be achieved and maintained," and recommends a change in approach to asthma management, with asthma control, rather than asthma severity, being the focus of treatment decisions The importance of the patient-care giver partnership and guided self-management, along with setting goals for treatment, are also emphasised

https://erj.ersjournals.com/content/erj/31/1/143.full.pdf

Global strategy for asthma management and prevention: GINA executive summary.

Prevalence of Gastroesophageal Reflux Symptoms in Asthma

The Effect of a Peak Flow-Based Action Plan in the Prevention of Exacerbations of Asthma

https://skolenforoverskud.dk/Artikler%20-%20Buteyko/A%20randomised%20controlled%20trial%20of%20the%20Buteyko.pdf

A randomised controlled trial of the Buteyko technique as an adjunct to conventional management of asthma.

A consecutive sample of 378 adults with asthma were assessed at a university asthma program and then interviewed 1 year later regarding their need for emergency department (ED) asthma treatment The purpose of this prospective cohort study was to determine whether any of their initial features could predict their subsequent need for ED asthma treatment At one year, a total of 73 of the subjects had attended emergency departments for asthma On entry, the 73 subjects had demonstrated more self-reported lifestyle restriction from asthma and more hospital admissions ED visits for asthma as well as poorer asthma control or than had the 305 subjects who had not required ED asthma treatment since entry to the cohort This study suggests that special attention should be paid to subjects with asthma that interferes with their lifestyle and to those who have needed hospital admission for asthma

Predicting emergency department utilization in adults with asthma: a cohort study.

BACKGROUND: Asthma is common and is often poorly controlled in adolescent subjects.OBJECTIVE: To determine the impact of an age-specific asthma program on asthma control, particularly on exacerbations of asthma requiring emergency department treatment, and on the quality of life of adolescents with asthma.METHODS: The present randomized, controlled trial included patients who were 15 to 20 years of age and had visited emergency departments for management of their asthma. The interventional group attended an age-specific asthma program that included assessment, education and management by a team of asthma educators, respiratory therapists and respiratory physicians. In the control group, spirometry was performed, and the patients continued to receive usual care from their regular physicians. The outcomes were assessed by a questionnaire six months after entry into the study.RESULTS: Ninety-three subjects entered the study and were randomly assigned to the intervention or control group. Of these, only 62 patients were available for review after six months. Subjects in both the control and the intervention groups showed a marked improvement in their level of asthma control, reflected primarily by a 73% reduction in the rate of emergency department attendance for asthma. Other indexes of disease control, including disease-specific quality of life, as assessed by questionnaires, were improved. There was, however, no discernible difference between the subjects in the two groups, with the exception of an improvement in favour of the intervention group in the symptom (actual difference 0.7, P=0.048) and emotional (actual difference 0.8, P=0.028) domains of the asthma quality of life questionnaire. The overall quality of life score favoured the intervention group by a clinically relevant difference of 0.6, but this difference did not reach statistical significance (P=0.06).CONCLUSIONS: Although all subjects demonstrated a significant improvement in asthma control and quality of life, the improvement attributable to this intervention was limited to two domains in disease-specific quality of life.

/pdf/asthma-in-adolescents-a-randomized-controlled-trial-of-an-2zd0s2dqvj.pdf

Margot F. Underwood

Papers

Prevalence of Gastroesophageal Reflux Symptoms in Asthma

The Effect of a Peak Flow-Based Action Plan in the Prevention of Exacerbations of Asthma

A randomised controlled trial of the Buteyko technique as an adjunct to conventional management of asthma.

Predicting emergency department utilization in adults with asthma: a cohort study.

Asthma in adolescents: a randomized, controlled trial of an asthma program for adolescents and young adults with severe asthma