Showing papers in "Journal of Asthma in 2005"
TL;DR: It is suggested that maternal oily fish intake duringregnancy may protect offspring from asthma; however, eating fish sticks during pregnancy may increase asthma risk in children.
Abstract: Maternal fish consumption during pregnancy may affect children's asthma risk by modulating early-life immune development. Type of fish intake may be important because of differences in fatty acid content. To test this hypothesis, we conducted a nested case-control study, selecting subjects from the Children's Health Study, a population-based study of school-aged children in southern California. Cases had physician-diagnosed asthma and controls were asthma-free by age 5 years. Mothers or guardians provided information on fish consumption during pregnancy in telephone interviews. We computed odds ratio (OR) and 95% confidence interval (CI) by using conditional logistic regression models that accounted for the sampling. In children born to mothers with a history of asthma, the OR of asthma was 0.20 (95% CI = 0.06-0.65) when mothers ate oily fish at least monthly during pregnancy compared with no consumption (p(trend) = 0.006). Maternal oily fish consumption during pregnancy did not benefit children of non-asthmatic mothers. In contrast, fish stick (a source of trans-fats) consumption during pregnancy increased asthma risk in children (OR = 2.04; 95% CI = 1.18-3.51). Our results suggest that maternal oily fish intake during pregnancy may protect offspring from asthma; however, eating fish sticks during pregnancy may increase asthma risk in children.
144 citations
TL;DR: It is confirmed that both asthma hospitalization and mortality rates decreased during the study period and the black to white racial disparity in asthmaospitalization has narrowed for children younger than 10 years of age.
Abstract: Objective. To study the recent trends in asthma hospitalization and mortality rates by age, gender, and race categories in the United States. Methods. The National Hospital Discharge Survey Database for the years 1995 to 2002 was used to examine trends in asthma hospitalization. An International Classification of Diseases Ninth Revision, Clinical Modification (ICD-9-CM) code of 493.0 was used to identify primary hospitalization for asthma. Hospitalization rates were estimated using U.S. Census Bureau population estimates as denominators. Mortality data was obtained from the Center for Disease Control and Prevention Mortality Database. Death from asthma was identified using ICD-9-CM codes (493.0) for the years between 1995 and 1998 and ICD-10 codes (J45–J45.9) for 1999 and afterwards. Asthma hospitalization and mortality rates were estimated per 10,000 and per 100,000 populations, respectively. Crude relative risks (RR) were estimated to compare risks between various groups. Results. During the study perio...
110 citations
TL;DR: As a result of the assessment of the patients' level of asthma control during the office visit, physicians changed their patterns of prescribing controller therapy in patients with uncontrolled asthma.
Abstract: Control of asthma symptoms is, unfortunately, not a reality for many people with asthma. Asthma control is an ongoing challenge, requiring a multidisciplinary treatment approach. The National Asthma Education and Prevention Program (NAEPP) of the National Heart, Lung, and Blood Institute published its Guidelines for the Diagnosis and Management of Asthma in 1997, but the extent of implementation of recommendations in physician's practices remains to be determined. We sought to determine if a systematic implementation of the NAEPP practice guidelines would impact physician's treatment decisions for patients with asthma. The Asthma Care Network is a large, national, point-of-care program developed to assist health care providers in the assessment and management of their patients with asthma. Outcome measurements for the program included level of asthma control, activity limitation, sleep disruption, use of rescue medications, use of controller medications, and urgent care services. A total of 4,901 primary care physicians at 2,876 practice sites enrolled more than 60,000 patients. Nearly three fourths of patients reported symptoms consistent with a lack of asthma control (mean 74%, range 69-81%). Approximately 68% of pediatric patients and 78% of adult patients reported limited activities due to asthma in the past week. Sixty-two percent of pediatric patients and 68% of adult patients reported more than two symptomatic days in the past week. Approximately 40% of the patients surveyed were not using controller therapy. The overall percentage of patients reporting uncontrolled asthma who were prescribed a controller medication increased from 60% to 81%, and the use of inhaled corticosteroids containing medications among these patients increased by 52%. As a result of the assessment of the patients' level of asthma control during the office visit, physicians changed their patterns of prescribing controller therapy in patients with uncontrolled asthma.
102 citations
TL;DR: For young rural children, an interactive asthma education intervention was associated with increased asthma knowledge and self-efficacy, decreased symptom reports, but not increased quality of life.
Abstract: The goal of this study was to determine the effectiveness of an asthma educational intervention in improving asthma knowledge, self-efficacy, and quality of life in rural families. Children 6 to 12 years of age (62% male, 56% white, and 22% Medicaid) with persistent asthma (61%) were recruited from rural elementary schools and randomized into the control standard asthma education (CON) group or an interactive educational intervention (INT) group geared toward rural families.Parent/caregiver and child asthma knowledge, self-efficacy, and quality of life were assessed at baseline and at 10 months post enrollment. Despite high frequency of symptom reports, only 18% children reported an emergency department visit in the prior 6 months. Significant improvement in asthma knowledge was noted for INT parents and young INT children at follow-up (Parent: CON = 16.3; INT = 17.5, p < 0.001; Young children: CON = 10.8, INT = 12.45, p < 0.001). Child self-efficacy significantly increased in the INT group at follow-up; however, there was no significant difference in parent self-efficacy or parent and child quality of life at follow-up. Asthma symptom reports were significantly lower for the INT group at follow-up. For young rural children, an interactive asthma education intervention was associated with increased asthma knowledge and self-efficacy, decreased symptom reports, but not increased quality of life.
101 citations
TL;DR: The authors' observations suggest that acute exacerbations of asthma are associated with increased oxidative stress that is evident from some of the parameters in the plasma, and failure to observe simultaneous changes in all parameters of oxidative stress may be due to the possibility of their responses being dissociated in time or compensatory changes occurring in some of these.
Abstract: Oxidant-antioxidant imbalance may play an important role in the pathogenesis of asthma, especially during acute exacerbations. To compare the systemic oxidant-antioxidant status in patients with acute exacerbations and stable asthma, we measured a wide range of parameters of oxidant-antioxidant balance in leukocytes, plasma, and red cells of 32 patients with acute exacerbations and 97 patients with stable asthma. These included measurement of superoxide anion generation by leukocytes, lipid peroxidation (measured as TBARS), total nitrates and nitrites, protein carbonyls, and protein sulfhydryls in plasma. Antioxidant status was evaluated by measuring the red cell superoxide dismutase and catalase activity, total blood glutathione, glutathione peroxidase activity in red cell and plasma, and total antioxidant capacity (assessed as ferric reducing antioxidant power) in plasma. Plasma total antioxidant capacity and total protein sulfhydryls were found to be decreased (p 0.05). Our observations suggest that acute exacerbations of asthma are associated with increased oxidative stress that is evident from some of the parameters in the plasma. Failure to observe simultaneous changes in all parameters of oxidative stress may be due to the possibility of their responses being dissociated in time or compensatory changes occurring in some of these.
80 citations
TL;DR: The facts argue that rhinosinusitis and asthma are not simply localized disease processes but part of a systemic inflammatory disease affecting the respiratory tract and provide a compelling rationale for combined treatment strategies.
Abstract: An observation made initially on clinical grounds and epidemiologic evidence, i.e., that rhinosinusitis and asthma are closely linked diseases is now supported by a growing body of scientific evidence. Most recent evidence supports the characterization of rhinosinusitis and asthma as two compartmental expressions of a common mucosal susceptibility to exogenous stimuli. In addition, there is evidence that the compartmental processes can affect and amplify each other via a systemic intermediary. The bone marrow is involved in this process, and IL-5 may be a key cytokine for orchestrating the systemic interaction. These facts argue that rhinosinusitis and asthma are not simply localized disease processes but part of a systemic inflammatory disease affecting the respiratory tract. They also provide a compelling rationale for combined treatment strategies with consideration of the treatment of rhinosinusitis as a means of improving asthma control and monitoring for signs of bronchial involvement in those with rhinosinusitis.
80 citations
TL;DR: Asthma-related deaths peaked in the winter months and were over four times more likely than non-asthma deaths to have acute upper respiratory infections, influenza, or acute bronchitis listed on the death record.
Abstract: Objectives. Most analyses of asthma mortality in the United States have relied solely on underlying cause-of-death data, which may underestimate the magnitude of asthma-related mortality. We used multiple cause-of-death data to examine asthma-related mortality trends in the United States. Methods. Data were selected from the United States Multiple Cause-of-Death Files, 1990–2001. Mortality rates and 95% confidence intervals were computed to examine differences in asthma mortality over time and by age, race/ethnicity, and gender. Location of death and seasonal variations in asthma mortality were also assessed, as well as the impact of seasonal respiratory infections. Results. We identified 135,668 asthma-related deaths in the United States over the 12-year period, representing an age-adjusted mortality rate of 4.4 per 100,000. Only 45% of the asthma-related deaths had asthma recorded as the underlying cause. Whites and older adults were less likely to have asthma listed as the underlying cause. Asthma mort...
78 citations
TL;DR: These findings are the first to provide preliminary evidence suggesting that mental health problems are common among pediatric asthma patients in an inner-city clinic and suggest thatmental health problems in Pediatrics may be associated with elevated levels of medical service use for asthma.
Abstract: Objective. To determine the screen-positive prevalence of anxiety disorders and depression among pediatric asthma patients in an inner-city asthma clinic and to investigate the association between probable diagnoses of anxiety disorders and depression and medical service use among inner-city pediatric asthma patients. Method. In this pilot study, a consecutive sample of pediatric asthma patients aged 5–11 in the waiting room of an inner-city asthma clinic was screened for mental disorders using the DISC Predictive Scales (DPS), which produces probable DSM-IV diagnoses. In addition, data on health service use for asthma were collected. Statistical analyses were performed to examine the relationship between probable anxiety disorders and depression and health service use for asthma among pediatric asthma patients. Results. Approximately one in four (25.7%) pediatric asthma patients in an inner-city asthma clinic met criteria for a probable diagnosis of current anxiety disorders or depression (past 4-week pr...
78 citations
TL;DR: The role of cromolyn sodium (now available as an HFA aerosol) in the treatment of asthma is reexamines and the science behind current understanding of asthma pathophysiology is complemented.
Abstract: Cromolyn sodium (Intal®) has been available in the United States to treat asthma for more than 30 years. Its clinical efficacy in patients with mild or moderate persistent asthma is well documented, and its extensive clinical record of safety remains unique among antiasthma medications. The history of cromolyn sodium complements the science behind current understanding of asthma pathophysiology. Cromolyn sodium was the first nonsteroid, antiasthma drug that blocked chemical mediator release at the cellular level. However, the younger generation of health care providers may not be familiar with the medication due to the plethora of antiasthma agents that have recently become available. This review reexamines the role of cromolyn sodium (now available as an HFA aerosol) in the treatment of asthma.
56 citations
TL;DR: The CQ and HQ were shown to be simple, valid and reliable instruments for the assessment of asthma knowledge of consumers and health care professionals and to direct educational resources more appropriately.
Abstract: Background. This study aimed to develop and validate two asthma knowledge questionnaires, one for consumers (CQ) and one for health care professionals (HQ) to fill an existing gap in the literature. Methods. Following development and pilot testing, the revised CQ and HQ were administered to respiratory physicians, pharmacists and people with asthma and without asthma. Results. Both the CQ and HQ were shown to be reliable with Cronbach's alpha of 0.78 and 0.92 respectively. Both were also found to have good content, face, construct and discriminant validity. Conclusion. The CQ and HQ were shown to be simple, valid and reliable instruments for the assessment of asthma knowledge of consumers and health care professionals and to direct educational resources more appropriately. Future research will evaluate the utility of these instruments in clinical practice.
54 citations
TL;DR: Beside treatment with medication, stopping smoking and avoidance of triggers are factors, which may have a high impact on asthma control.
Abstract: The aim of this study was to evaluate which factors are associated with asthma control experienced by asthma patients. In a cross-sectional study patients aged 16-60 years with mild to moderate asthma were selected. The influence of the following factors on asthma control was studied in a multivariate model: age, gender, socioeconomic status, smoking, perceived hyperresponsiveness (PHR, responding with asthma symptoms to one or more triggers), allergy (Phadiatop), long-acting bronchodilating agents, and inhaled corticosteroids. Asthma control was measured by means of the Asthma Control Questionnaire (ACQ) as developed by Juniper. Forced expiratory volume in 1 second (FEV1) was measured by means of a portable spirometer. In this study with 311 patients, mean ACQ score was 1.39 (range 0-4.43). A stepwise backward linear regression analysis showed that low socioeconomic status (beta 0.425; p=0.001), current smoking (beta 0.555; p<0.001), high dose of inhaled corticosteroids (beta 0.364; p=0.04) and perceived hyperresponsiveness for increasing number of different triggers (PHR for 1 trigger beta 0.833; p=0.03; 2 triggers beta 0.810; p=0.03; 3 triggers beta 0.995; p=0.01; 4 triggers beta 1.131; p=0.002; 5 triggers beta 1.182; p=0.002) are independent predictors for poorer asthma control. Beside treatment with medication, stopping smoking and avoidance of triggers are factors, which may have a high impact on asthma control.
TL;DR: A gap in the provision of asthma education, written action plans, and spirometric testing for patients diagnosed with asthma among primary care physicians in Alberta is indicated.
Abstract: Background. Despite significant improvements in asthma treatment and the dissemination of national and international guidelines for asthma management, there are ongoing concerns that suboptimal care is being provided for patients with asthma. Objective. To determine the current practice patterns of asthma care among primary care physicians. Design. A cross-sectional study. Setting. Province of Alberta, Canada (population: 3 million people). Participants. Patients, 5 years of age or older, who had a physician's diagnosis of asthma, and had at least two visits for asthma between 1996 and 2001. Measurement and Results. Charts of 3072 distinct patients (from 45 unique primary care physicians) were reviewed. Previous emergency department visits or hospitalizations were experienced by 20% of the sample. A total of 25% of patients had documented evidence that they had performed spirometry. More than half of the patients had no documented evidence that they had received any form of asthma education; only 2% of th...
TL;DR: The preliminary findings suggest that the addition of HFA-BDP, compared with CFC-FP in patients with poorly controlled asthma despite receiving moderate to high doses of inhaled steroids, has a greater effect on parameters reflecting small airway patency presumably secondary to reduction in inflammation.
Abstract: Inflammation in asthma extends into the small airways ( 2 mm. Therefore, inflammation in the small airways of patients with asthma may not be adequately treated with these preparations. Some inhaled corticosteroids, on the other hand, are compounded with alcohol, resulting in a solution producing an aerosol that has a mean particle diameter of < 2 mm. This study was designed to compare the addition of equivalent amounts of two inhaled corticosteroids (one a suspension and one a solution) to the treatment of patients with asthma, which was uncontrolled despite treatment with moderate to high doses of inhaled corticosteroids and usually additional controller medications. The study was performed with 30 patients, � 18 years of age. Subjects were randomized in a single-blind fashion to receive, in addition to their current asthma therapy, either CFC-FP 220 mg each morning and 110 mg each evening (n = 10) or HFA-BDP 160 mcg twice daily (n = 20). Pre- and postbronchodilator spirometry, single breath nitrogen washout for closing volume and residual volume by plethysmography were assessed before and after 3 months of therapy. In the subjects who received HFA-BDP, the ratio of closing volume (CV) to vital capacity (VC) and residual volume (RV) decreased significantly ( p = 0.0214 and 0.0433, respectively), whereas forced expiratory flow over 25 – 75% of the vital capacity (FEF25 – 75%), forced expiratory volume in 1 second (FEV1), and morning peak flow improved significantly ( p = 0.0014, 0.0184, and 0.0321). Improvements from baseline of CV, CV/VC, and postbronchodilator FEF25 – 75%, were statistically significant in the HFA-BDP group compared with the CFC-FP group ( p = 0.0049, 0.0194, and 0.0355, respectively). These preliminary findings suggest that the addition of HFA-BDP, compared with CFC-FP in patients with poorly controlled asthma despite receiving moderate to high doses of inhaled steroids, has a greater effect on parameters reflecting small airway patency presumably secondary to reduction in inflammation.
TL;DR: Tailor-made antismoking campaigns are needed at schools to reduce misconceptions among asthmatic adolescents about the risks of smoking and a personal intervention approach aimed particularly at smoking parents of an asthmatics may make them aware of the consequences for their offspring and help them to stop smoking.
Abstract: Background. Smoking may have serious consequences for asthmatics. Nevertheless, studies have shown that smoking behavior among asthmatics is similar to or even higher than that of nonasthmatics. Since the relationship between parental smoking and child smoking is well established, this study examined whether the association between parental and child smoking behavior is similar for asthmatic and nonasthmatic adolescents. The impact of parental smoking history was also explored. Methodology. A cross-sectional sample of 10,087 Dutch adolescents was used to assess the prevalence of asthma and smoking behavior. Moreover, respondents had to report whether one of their parents currently smoked, had stopped, or had never smoked. In case a parent was a former smoker, the respondent had to report his or her own age at the moment that the parent stopped smoking. Results. Logistic regression analyses showed that, compared with nonasthmatic adolescents, asthmatic adolescents were more likely to have smoking parents. Furthermore, similar associations were found between parental smoking and adolescent smoking among asthmatic and nonasthmatic adolescents. The time at which maternal smoking ceased was associated with a decreased likelihood for ever smoking for both asthmatic and nonasthmatic adolescents. Conclusions. Asthmatic adolescents need to become more aware of the health risks of smoking. Therefore, tailor-made antismoking campaigns are needed at schools to reduce misconceptions among asthmatic adolescents about the risks of smoking. In addition, a personal intervention approach aimed particularly at smoking parents of an asthmatic child, may make them aware of the consequences for their offspring and help them to stop smoking.
TL;DR: Daily asthma symptoms compared to monthly spirometry and FeNO and total monthly symptom scores correlated with both forced expiratory volume at 1 sec (FEV1) and Fe NO, and it is proposed that FeNO should be used as an additional monitoring tool for asthma.
Abstract: Asthma is the most common chronic disease of childhood. Asthma severity is monitored by spirometry. However, this does not directly measure airway inflammation. Exhaled nitric oxide (FeNO) is a proposed method to measure airway inflammation non-invasively. Previous studies have shown that FeNO correlates with endobronchial biopsies and symptoms in patients with asthma. We monitored daily asthma symptoms compared to monthly spirometry and FeNO. Total monthly symptom scores correlated with both forced expiratory volume at 1 sec (FEV1) and FeNO. FeNO had a strong correlation than FEV1. FeNO and FEV1 were not correlated. We propose that FeNO should be used as an additional monitoring tool for asthma.
TL;DR: Patients with asthmatic symptoms but normal lung function have increased alveolar NO concentration and mildly elevated bronchial NO flux suggesting a more peripheral inflammation than in patients with asthma.
Abstract: Some patients with asthmatic symptoms and eosinophilic airway inflammation have normal lung function and thus do not meet the current diagnostic criteria of asthma. Exhaled nitric oxide (NO) measurement at multiple exhalation flow rates can be used to assess alveolar and bronchial NO output and inflammation. We tested whether alveolar or bronchial NO output is increased in subjects having asthmatic symptoms but normal lung function. Exhaled NO concentration was measured at three exhalation flow rates (100, 175, and 370 mL/s) to assess alveolar NO concentration and bronchial NO flux in 23 patients with asthmatic symptoms but normal lung function ("asthmatic symptoms group"), 40 patients with asthma, and 40 healthy control subjects. The asthmatic symptoms group had increased bronchial NO flux (1.7 +/- 0.3 nL/s, p = 0.016) and alveolar NO concentration (1.8 +/- 0.2 parts per billion (ppb), p = 0.010) compared with healthy controls (0.7 +/- 0.1 nL/s and 1.0 +/- 0.1 ppb, respectively). Patients with asthma had even higher bronchial NO flux (2.5 +/- 0.3 nL/s, p = 0.024) but normal alveolar NO concentration (1.1 +/- 0.2 ppb, p = 0.664). In asthmatic symptoms group, alveolar NO concentration correlated positively with blood eosinophil count and negatively with small airway function (FEF50% and FEF75%). In conclusion, patients with asthmatic symptoms but normal lung function have increased alveolar NO concentration and mildly elevated bronchial NO flux suggesting a more peripheral inflammation than in patients with asthma.
TL;DR: It is suggested that asthma development may be a point on the trajectory of chronic obesity disease or asthma appears with obesity as a concurrent disorder.
Abstract: Results of cross-sectional studies suggest an association between body mass index and asthma. However, it is not clear whether the occurrence of asthma precedes increased body mass index or vice versa. From 1971 to 1975, the First National Health and Nutrition Examination Survey collected height and weight data and information about doctor-diagnosed asthma from 14,407 subjects aged 25-74. In 1982 through 1985, information was again obtained on doctor-diagnosed asthma with a follow-up rate of 84.8%. We took this opportunity to examine the relationship between body mass index (BMI) and asthma in this cohort. Subjects with subnormal BMI and subjects admitting current or history of doctor-diagnosed asthma were excluded from the cohort. Mean follow-up was 10 years (range 6.7-13 years). Analyses were adjusted for race and gender. Logistic regression analysis was conducted with asthma as the dependent variable and BMI modeled as a categorical independent variable (BMI groups). At baseline and at follow-up, increasing BMI was associated with increased prevalence of asthma. During the observation interval, however, no increased incidence of asthma associated with increasing BMI was noted. In comparison with normal BMI, the relative risk (RR) for development of doctor-diagnosed asthma in elevated BMI was 1.0 (95% confidence interval 0.9-1.2), for markedly elevated BMI was 1.0 (0.8-1.3), and for severely elevated BMI was 1.1 (0.8-1.5). Race did not affect this relationship. African Americans had an increased risk of asthma, but the risk was unassociated with increasing BMI. Gender did not affect this relationship. The disease burden of asthma appeared in normal weight and slightly overweight women rather than obese and markedly obese women. These results suggest that asthma development may be a point on the trajectory of chronic obesity disease or asthma appears with obesity as a concurrent disorder.
TL;DR: A Phase IV, 4-week, open, randomized multicenter parallel group trial compared correct use and acceptability of Diskus®, Turbuhaler®, and Easyhaler® powder inhalers among 326 inhaler naive asthmatics/symptomatics.
Abstract: A Phase IV, 4-week, open, randomized multicenter parallel group trial compared correct use and acceptability of Diskus, Turbuhaler, and Easyhaler powder inhalers among 326 inhaler naive asthmatics/symptomatics. The subjects were asked to read the instruction leaflet before taking one dose at the first visit. The correct use was evaluated when the subject took the dose. After that, the subjects were instructed in correct use. The use of the devices was also videotaped at every visit, and independent referees judged correct use. Acceptability was evaluated by a questionnaire. At the first visit, the proportions of subjects who used the devices correctly were as follows: Easyhaler, 45%; Diskus, 43%; and Turbuhaler, 51%. The corresponding figures at the last visit were 84%, 89%, and 81%. The differences at any visit were not statistically significant. Acceptability was greater for Easyhaler and Diskus for three of eight items throughout the study, all pertaining to receiving the powder from the device and control of the inhalation of the powder. Patient education in the use of devices is important, because only half of the subjects used the devices correctly, and still after 4 weeks 10-20% could not use the devices satisfactorily, regardless of which device.
TL;DR: Prevalence of asthma in this population is elevated and the ISAAC written questionnaire successfully identified inner-city children at risk for asthma in New Orleans.
Abstract: This study investigates the prevalence of asthma and asthma-related symptoms in New Orleans inner-city schoolchildren. A cross-sectional survey of 1535 elementary, middle, and high schoolchildren (aged 5–18) was conducted by using the International Study of Asthma and Allergies in Childhood (ISAAC) written questionnaire. Lifetime prevalence of wheezing was 39.4%, and lifetime prevalence of asthma was 24.4%. Wheezing during the previous 12 months was reported by 25.7% of the sample. Twenty-one percent of respondents reported having one or more attacks of wheezing per year, with 5.6% reporting four or more attacks per year. Many participants reported sleep disturbance (15.4%), with 6.2% reporting sleep disturbance more than once a week. The 12-month rate of speech limitation due to asthma exacerbation was 6.6%. Exercise-induced asthma was reported by 16.9% of the students, and nocturnal cough (not associated with cold) was reported by 27.3%. Overall, boys reported higher rates of symptoms than girls, and yo...
TL;DR: In this article, it was hypothesized that in a cross-sectional survey of asthma in adolescent children, eNO may contribute to the detection of this disease, and significant positive correlations were found with eNO and number of positive skin prick tests.
Abstract: Exhaled nitric oxide (eNO) is a potential tool in epidemiological studies of asthma. It was hypothesized that in a cross-sectional survey of asthma in adolescent children, eNO may contribute to the detection of this disease. A cohort of Australian school children in two educational years (n = 107, aged 14.7 +/- 2.3 years, 42.9% female) were surveyed in terms of exhaled nitric oxide (eNO), which was compared with other indicators of asthma: asthma symptoms, atopy [skin prick tests (SPT)], hypertonic saline bronchial reactivity, sputum inflammatory cells and eosinophilic cationic protein. Significant positive correlations were found with eNO and number of positive skin prick tests (p = 0.001; n = 98), symptoms (p = 0.05; n = 107), sputum eosinophils (p = 0.025; n = 83), and sputum eosinophilic cationic protein (p = 0.009; n = 83). There was no significant relationship with airway hyperresponsiveness (p = 0.3; n = 15). eNO had a negative predictive value for asthma of 83%, and a positive predictive value of 54%, which is comparable with most current tests for diagnosing asthma. eNO appears to be a useful indicator of atopy and airway inflammation, but in this population it was not closely related to airway hyperresponsiveness.
TL;DR: It was concluded that the test of acute bronchodilator responsiveness has limited diagnostic value in separating asthma and COPD.
Abstract: Background. Acute responsiveness to inhaled bronchodilators is often used to differentiate between bronchial asthma and chronic obstructive pulmonary disease (COPD). The response can be expressed in terms of a change in FEV1 and FVC in several ways—as absolute change, change as percent of baseline value, or as percent of predicted value with different thresholds for a positive test. A comprehensive evaluation of the diagnostic value of these different methods of expressing the acute bronchodilator response has not been carried out. Methodology. Response to inhaled salbutamol was measured by spirometry in 200 asthmatics and 154 patients with COPD. The sensitivity, specificity, and positive and negative predictive values of different methods of expressing responsiveness were calculated. Receiver operative characteristic curves were obtained. Results. None of the expressions of response gave a clear-cut separation between the two diseases. A ΔFEV1≥ 0.2 L gave the most satisfactory combination of sensitivity ...
TL;DR: An increased risk of lung cancer mortality associated with asthma among nonsmokers without a history of cancer is observed, consistent with prior reports.
Abstract: Objective. Although smoking is the most important risk factor for lung cancer, nearly 10% of lung cancer is not attributable to smoking. Insights into risk factors for lung cancer other than smoking will become increasingly important, given decreasing trends in the prevalence of smoking. Prior research suggests asthma may increase the risk of lung cancer, particularly among nonsmokers. Methods. We used Cox regression analyses of data from a nationally representative sample of 9087 adults aged 30–75 years included in the NHANES II Mortality Study (1976–1992) to estimate the relative risk (RR) of death from lung cancer associated with self-reported asthma, independent of smoking. Results. Age-adjusted prevalence of smoking was 36.0%, and the age-adjusted prevalence of asthma was 6.1% (6.2% among nonsmokers) at baseline. During approximately 17 years of follow-up, 196 adults died of lung cancer (ICD-9 160–165). Among 6144 nonsmokers, the RR of lung cancer death comparing adults with asthma to those without w...
TL;DR: A need to develop interventions to improve quality of life and self-management of asthma among PD patients is indicated, independent of pulmonary function, asthma medication class, and sociodemographic status.
Abstract: The purpose of this study was to assess the associations between panic disorder (PD) and health services use, health-related quality of life, and use of short-acting β2-agonists among individuals with asthma. We studied 21 adults with comorbid asthma and panic disorder (asthma-PD) and 27 asthma patients without PD (asthma-only). Participants attended a single session at a laboratory to complete the study. A retrospective chart review was conducted to assess use of health care resources for asthma treatment during the past 12 months. Patients completed the Asthma Quality of Life Questionnaire and lung function testing. Asthma-only and asthma-PD patients displayed no differences on asthma severity, as measured by spirometry and asthma medication class. Asthma-PD patients had more visits to their primary care physicians for asthma (p < 0.01) and reported a lower quality of life related to asthma (p < 0.01) and greater use of short-acting β2-agonists (p < 0.05) than asthma-only patients. These findings were i...
TL;DR: Clinician-assessed poor compliance was useful in distinguishing between two groups that differed significantly in terms of asthma morbidity indicators, self-management practices, and psychosocial characteristics, which have been previously shown to be associated with hospital admissions, near-fatal attacks, and fatal asthma.
Abstract: Our aim was to determine whether clinician-identified poor compliance is useful in identifying, from among adults with severe asthma, patients with characteristics likely to put them at risk of adverse outcomes. Patients with severe asthma (previous hospital admissions and/or prescribed step 4-5 treatment according to British Thoracic Society guidelines) considered by clinicians to be either compliant (C, N = 41) or poorly compliant (PC, N = 92) with aspects of their recommended management (attendance at appointments, taking medication, and monitoring asthma) provided data on symptoms, health service use, medication, self-management practices, physical and psychological comorbidities, and sociodemographic/socioeconomic characteristics. Cross-sectional univariate analyses were used to examine whether the groups differed with respect to self-reported indicators of asthma morbidity and self-management. Logistic regressions were additionally used to explore psychosocial factors independently associated with patients being identified as PC. Compared with C patients, PC patients had significantly poorer self-reported asthma control in terms of medication use, symptoms, time off work, asthma-specific quality of life, primary care visits, emergency attendances, and hospital admissions. This was coupled with poorer self-management practices. Patients identified as PC also had higher levels of physical and psychological comorbidities, were younger, and faced more difficult social and economic circumstances. We identified significant psychological (anxiety) and social (younger age, not working, number of benefits, adverse family circumstances) factors independently associated with patients being identified as PC. Among adults with severe asthma, clinician-assessed poor compliance was useful in distinguishing between two groups that differed significantly in terms of asthma morbidity indicators, self-management practices, and psychosocial characteristics, which have been previously shown to be associated with hospital admissions, near-fatal attacks, and fatal asthma. We conclude that clinician-assessed poor compliance is a useful marker for identifying patients at risk of these adverse outcomes.
TL;DR: Perceived control of asthma in patients participating in a behavior modification–based asthma education program was related to generic and disease-specific QOL and an improvement in PCAQ was associated with improved QOL following asthma education.
Abstract: The purpose of this study was to determine the relationship between patients' perception of asthma control and generic and asthma-specific quality of life (QOL) post-completion of a behavior modification-based adult asthma education program. A secondary objective was to examine associations between changes in perceived control of asthma and generic and asthma-specific QOL. Outcome measures were collected via an asthma management questionnaire (AMQ), generic (SF-36) and asthma-specific (AQLQ) QOL questionnaires, and a perceived control of asthma questionnaire (PCAQ). The cohort (n = 55) consisted of predominately female (75%), married (56%), middle income (46%) patients with severe asthma (65%) who had completed a university or college education (20%) and were working full-time (42%). The mean age was 45.2 (SD = 17.5) years. Perceived control of asthma and generic and asthma-specific quality of life significantly improved after completing the behavior modification-based adult asthma education program. Significant associations were found between perceived control of asthma (PCAQ) and both generic (SF-36) and asthma-specific QOL (AQLQ). Baseline PCAQ was related to all four domains and the total score of the AQLQ and 5 of the 8 domains of the SF-36. PCAQ was related to 3 of the 4 AQLQ domains at 3 months and total AQLQ score at both 1 and 3 months post-education. PCAQ was related to all 8 domains of the SF-36 at 1 month; and 4 of 8 domains at 3 months. Change in PCAQ (deltaPCAQ) was related to change in symptom score, emotional functioning, and total AQLQ score from baseline to 1 month and change in symptom score from baseline to 3 months. In conclusion, perceived control of asthma in patients participating in a behavior modification-based asthma education program was related to generic and disease-specific QOL. An improvement in PCAQ was associated with improved QOL following asthma education. Using the PCAQ as part of an asthma educational needs assessment may be a quick, simple way to identify and target education towards asthma patients with low perceived control.
TL;DR: The results suggest that inhaled corticosteroids can potentially decrease salivary total IgA but that host factors are also important in the development of oral candidiasis.
Abstract: Background. Inhaled corticosteroids are used for the treatment of bronchial asthma. Systemic side effects are rare, but local problems, such as oral candidiasis, can occur. Only a proportion of patients encounter this problem, and the mechanism of oral candidiasis induced by inhaled corticosteroids remains obscure. According to reports in immunodeficient patients, oral candidiasis is related to deficiencies in topical immunity, such as salivary IgA. Objectives. We evaluated differences in salivary IgA between asthmatics in whom Candida was detected or not detected from the pharynges, respectively. Methods. Saliva was collected from 18 healthy controls and 37 asthmatic patients treated with inhaled corticosteroids. The amounts of total IgA and the Candida-specific IgA of the saliva were measured. Fungal culture of the pharyngeal wall was also performed. Results. There were no differences in salivary total IgA and Candida-specific IgA between healthy controls and culture-negative asthmatic patients. Salivar...
TL;DR: A detailed analysis of a large number of studies on the epidemiologic changes resulting in an increase in atopic disease suggests that, although the hygiene hypothesis has merit, the stimuli responsible for the new epidemiology remain enigmatic.
Abstract: The hygiene hypothesis was developed in response to data suggesting that the increase in allergic diseases as well as asthma was secondary to a reduced exposure to infectious stimuli. Indeed, the epidemiologic changes, resulting in an increase in atopic disease, have been impressive and intriguing. Furthermore, although there clearly is a genetic component to atopic diseases, genetics cannot account for a marked increase in the incidence and prevalence of allergic manifestations within a few generations. Thus, environmental factors have been suggested as responsible for the changing prevalence. There are two—not mutually exclusive—possibilities, namely, that substances that promote atopy have been added to the environment or that factors that provided protection from allergic disease were lost from the environment. Both outdoor and indoor pollution, along with a long list of other environmental factors, have been proposed. It is of interest that in many developed countries, certain types of pollution have...
TL;DR: There is a need for year-round vigilance and improved compliance with asthma therapy, especially during the summer when asthma attacks are perceived to be infrequent, and to identify seasonality.
Abstract: Seasonal trends in asthma-related hospitalizations are widely recognized; however, little is known about trends in asthma-related intensive care unit (ICU) admissions or intubations. The objective of this study is to examine monthly rates of asthma-related ICU admissions and/or intubations as a percent of total asthma-related admissions and to identify seasonality. This analysis was performed in a database of 285 hospitals representing > 3 million annual inpatient visits. Asthma-related hospital admissions for patients aged 5 and older were identified with a primary diagnosis of asthma (493.xx) during calendar years 2001–2002. The percents of the total admissions per month were compared. Monthly means were calculated and data were presented as moving averages. A total of 76,916 hospital admissions were identified with a primary diagnosis of asthma. Just over 10% (n = 7,803) were admitted to the ICU and/or intubated, with the majority among patients > 35 years of age (> 70%). A peak in asthma-related hospi...
TL;DR: The response to inhaled allergen challenge was reproducible and confirms the utility of this technique as a model in which to screen compounds for further testing in asthmatic patients.
Abstract: The possible roles of secretory phospholipases A2 (sPLA2) in asthma include the release of arachidonic acid from cellular membranes, generation of lysophospholipids, sPLA2-mediated activation of cPLA2 with increased leukotriene production, and surfactant degradation. LY333013 is a potent inhibitor of sPLA2. This study examined the impact of two doses of LY333013 vs. placebo on allergen-induced bronchoconstriction following inhaled allergen challenge in atopic asthmatics. Fifty subjects were randomly assigned to treatment, and 40 subjects completed the study. A double-blind, placebo-controlled, random order, crossover study design was used. LY333013 had no impact on the primary outcome variables of the areas under the FEV1 response curve early (0-3 hours) (AUC(early)) and late (3-8 hours) (AUC(Iate)) following inhaled allergen challenge. No significant drug-related adverse effects were observed. The response to inhaled allergen challenge was reproducible and confirms the utility of this technique as a model in which to screen compounds for further testing in asthmatic patients.
TL;DR: Although an increase in the prevalence of overweight/obesity was not detected in asthmatic children and adolescents, the results reported here suggest a preventive surveillance of calorie intake and a promotion of physical activity in children requiring long-term treatment with inhaled glucocorticosteroids.
Abstract: The prevalence of asthma and obesity, two often associated conditions, is influenced not only by age and gender but also by lifestyle factors. This study aimed to determine whether, in a Mediterranean northern Italian region, Liguria, an increased prevalence of obesity could be detected in asthmatic children and adolescents and to evaluate the possible relationship between body mass index (BMI) and the characteristics and/or severity of asthma. BMI was determined in 554 asthmatic subjects (2.2-16.1 years) and 625 age-matched controls; BMI was expressed as a continuous variable in standard deviation score (SDS) units, determined as difference between the individual observed value and the reference mean for age and sex, divided by the corresponding standard deviation (BMI-SDS). Overweight/obesity was set at BMI-SDS of 2 or more. BMI-SDS was significantly higher in controls than in asthmatics (p = 0.04); however, the proportion of overweight/obesity subjects (BMI-SDS > or = 2) was similar in controls and in asthmatic patients (p = 0.08). Evaluation of the asthmatic group revealed that BMI-SDS was independent of gender (p = 0.57), atopic sensitization (p = 0.69), and comorbidity with other allergic symptoms (p = 0.60). By contrast, BMI-SDS was lower in preschool-age children than in school-age children and adolescents (p < 0.0001), in subjects with a high rate of acute respiratory tract infections (p = 0.04), and in those not treated with inhaled corticosteroids (IGCs) (p = 0.02). Although an increase in the prevalence of overweight/obesity was not detected in asthmatic children and adolescents, the results reported here suggest a preventive surveillance of calorie intake and a promotion of physical activity in children requiring long-term treatment with inhaled glucocorticosteroids.