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PubMed2006

Validation of the asthma impact survey, a brief asthma-specific quality of life tool.

BACKGROUND: The Asthma Impact Survey (AIS-6) is a new six question asthma outcome tool for which information on validity has not been published. OBJECTIVE: To provide validation for the AIS-6 as a brief asthma-specific quality of life tool. METHODS: Surveys were sent to a random sample of members of a large managed care organization who were at least 35 years of age and in the two-year period preceding the survey had either (1) at least one documented asthma-related medical encounter, or (2) at least a 6 months supply of asthma medication dispensed. In addition to the AIS-6, the survey included a validated quality of life tool [the mini-Asthma Quality of Life Questionnaire (AQLQ)]; a validated asthma control questionnaire [the Asthma Therapy Assessment Questionnaire (ATAQ)]; a validated symptom severity scale (AOMS); and information regarding demographics, co-morbidities, asthma severity, and asthma management. The results of the AIS-6 were compared to the results of the other tools by means of correlation and factor analysis. Independent predictors of AIS-6 and AQLQ scores were determined by multiple stepwise linear regression analyses. RESULTS: AIS-6 scores were significantly related to female sex, educational level, income, smoking, body mass index (BMI), COPD, steroid use, and hospitalization history in bivariate analyses. The AIS-6 score significantly correlated (r = - 0.84, p < 0.0001) with the AQLQ total score and loaded on the three factors (activity, symptoms, and concern/bother) reflected by the survey information and on which the AQLQ also loaded. Significant but somewhat smaller correlations were found between the AIS-6 and the ATAQ (r = 0.70, p < 0.0001) and the AOMS (r = 0.55, p < 0.0001). Independent predictors were the same for the AIS-6 and AQLQ and included oral steroid use, COPD history, BMI, female sex, educational level, and hospitalization in the past year. CONCLUSION: These data support the validity of the short six-question AIS-6 as an asthma-specific quality of life tool.

Adult↗
PubMed2005

Relationships of asthma knowledge, self-management, and social support in African American adolescents with asthma.

Despite nationwide efforts to manage asthma, the adverse outcomes of asthma continue to increase, especially in African American adolescents. The purpose of this study was to examine the relationships among asthma knowledge, self-management, and social support in African American adolescents with asthma. A correlational descriptive study was conducted using a convenience sample of 53 identified asthmatic adolescents from the Southern metropolitan school system in Alabama. Asthma knowledge was measured by the Parcel Knowledge about Asthma Questionnaire, social support by the Norbeck Social Support Questionnaire, and asthma self-management behaviors by the Asthma Behavioral Assessment Questionnaire. Both asthma knowledge and social support had significant positive relationships (r=0.31, r=0.30, respectively) with asthma self-management behaviors and accounted for 14% of self-management behaviors variability. Further studies are needed to understand how to better manage asthma in adolescents.

Adolescent↗
PubMed2004

Development of the asthma control test: a survey for assessing asthma control.

BACKGROUND: Asthma guidelines indicate that the goal of treatment should be optimum asthma control. In a busy clinic practice with limited time and resources, there is need for a simple method for assessing asthma control with or without lung function testing. OBJECTIVES: The objective of this article was to describe the development of the Asthma Control Test (ACT), a patient-based tool for identifying patients with poorly controlled asthma. METHODS: A 22-item survey was administered to 471 patients with asthma in the offices of asthma specialists. The specialist's rating of asthma control after spirometry was also collected. Stepwise regression methods were used to select a subset of items that showed the greatest discriminant validity in relation to the specialist's rating of asthma control. Internal consistency reliability was computed, and discriminant validity tests were conducted for ACT scale scores. The performance of ACT was investigated by using logistic regression methods and receiver operating characteristic analyses. RESULTS: Five items were selected from regression analyses. The internal consistency reliability of the 5-item ACT scale was 0.84. ACT scale scores discriminated between groups of patients differing in the specialist's rating of asthma control (F = 34.5, P <.00001), the need for change in patient's therapy (F = 40.3, P <.00001), and percent predicted FEV(1) (F = 4.3, P =.0052). As a screening tool, the overall agreement between ACT and the specialist's rating ranged from 71% to 78% depending on the cut points used, and the area under the receiver operating characteristic curve was 0.77. CONCLUSION: Results reinforce the usefulness of a brief, easy to administer, patient-based index of asthma control.

Adolescent↗
PubMed2006

Self-reported asthma was biased in relation to disease severity while reported year of asthma onset was accurate.

BACKGROUND AND OBJECTIVES: The aims of the study were to assess the accuracy of self-reported asthma and notified year of asthma onset. METHODS: The study was performed on a sample of 365 subjects, 18-60 years old, with clinically diagnosed onset of asthma between 1983 and 1986. All subjects were investigated 10 years later, in 1996, with a respiratory questionnaire about the items of asthma and year of onset. The material was analyzed with logistic regression models. RESULTS: Of the 289 subjects who returned the questionnaire, asthma was reconfirmed in 251 subjects. In a logistic regression model, asthma severity was significantly associated with confirmation of asthma. The median difference between the "true" year of onset and the reported year 10 years later, the recall period was zero, with a 10th to 90th interpercentile range of -2 to 6 years. The recall period was not associated with asthma severity, bronchial hyperresponsiveness, smoking, atopy, or sex. CONCLUSION: Self-reported asthma is biased in relation to disease severity, meaning that subjects with mild disease were less prone to report their asthma. Reported year of asthma onset among adults seems to be rather accurate, with no obvious dependent misclassifications.

Adolescent↗
PubMed2004

Attendance for general practitioner asthma care by children with moderate to severe asthma in Auckland, New Zealand.

Attendance for general practitioner (GP) care of childhood asthma varies widely in New Zealand (NZ). There is little current research to account for the variations, although groups such as Māori and Pacific peoples have traditionally faced barriers to accessing GP care. This paper aims to describe and account for attendance levels for GP asthma care among 6-9 year-olds with moderate to severe asthma in Auckland, NZ. During 2002, randomly selected schools identified all 6-9 year-olds with possible breathing problems. Completion of a questionnaire by each parent/guardian indicated which children had moderate to severe asthma, and what characteristics influenced their access to GP asthma care. A multilevel, negative binomial regression model (NBRM) was fitted to account for the number of reported GP visits for asthma, with adjustment for clustering within schools. Twenty-six schools (89.7 percent) identified 931 children with possible breathing problems. Useable questionnaires were returned to schools by 455 children (48.9 percent). Results indicated 209 children with moderate to severe asthma, almost one in every three reportedly making 5 or more GP visits for asthma in the previous year. Māori, Pacific and Asian children were disproportionately represented among these 'high attendees'. Low attendees (0-2 visits) were mainly NZ Europeans. The NBRM (n=155) showed that expected visits were increased by perceived need, ill-health, asthma severity and, in particular, Māori and Pacific child ethnicity. It may be that Māori and Pacific children no longer face significant barriers to accessing GP asthma care. However, more likely is that barriers apply only to accessing routine, preventative care, leading to poor asthma control, exacerbations requiring acute care, and paradoxically an increase in GP visits. That barriers may increase total numbers of visits challenges the assumption, for all health systems, that access can be defined in terms of barriers that must be overcome to obtain health care.

Asthma↗
PubMed2003

Epidemiology of respiratory viruses in patients hospitalized with near-fatal asthma, acute exacerbations of asthma, or chronic obstructive pulmonary disease.

PURPOSE: We compared the prevalence and spectrum of common respiratory viruses among patients with near-fatal asthma, acute exacerbations of asthma, or chronic obstructive pulmonary disease (COPD), and the relation of these findings to acute respiratory symptoms. METHODS: We obtained adequate samples of respiratory secretions from 17 patients hospitalized with near-fatal asthma, 29 with acute asthma, and 14 with COPD. We used a polymerase chain reaction-based method to test for six common respiratory viruses in samples from endotracheal tube aspirates from patients with near-fatal asthma, and from induced sputum specimens from patients with acute asthma or COPD. Respiratory symptoms (runny nose, sore throat, fever, chills, malaise, and cough) were recorded. Quiescent-phase induced sputum specimens were examined from patients who were initially virus positive. RESULTS: Viral nucleic acids were detected in 52% (31/60) of acute-phase specimens and 7% (2/29) of quiescent-phase specimens examined (P <0.001), with similar proportions of virus-positive patients during the acute phase in the three groups: 59% (10/17) of those with near-fatal asthma, 41% (12/29) with acute asthma, and 64% (9/14) with COPD. Picornavirus (47% [n = 8]) and adenovirus (24% [n = 4]) were most commonly identified in near-fatal asthma, whereas influenza virus (36% [n = 5]) predominated in COPD. Virus-positive patients had a significantly increased frequency of runny nose, sore throat, fever, chills, and malaise (odds ratio = 4.1 to 18; P = 0.02 to 0.001). CONCLUSION: Respiratory viruses are associated with hospitalizations for near-fatal asthma, acute asthma, and COPD, with some differences in the spectrum of viruses involved in the different groups of patients. Respiratory viruses are a target for the prevention and perhaps the treatment of these conditions.

Acute Disease↗
PubMed1996

Trial of a "credit card" asthma self-management plan in a high-risk group of patients with asthma.

BACKGROUND: The "credit card" asthma self-management plan provides the adult asthmatic patient with simple guidelines for the self-management of asthma, which are based on the self-assessment of peak expiratory flow rate recordings and symptoms. OBJECTIVE: The study was a trial of the clinical efficacy of the credit card plan in a high-risk group of asthmatic patients. METHODS: In this "before-and-after" trial, patients discharged from the emergency department of Wellington Hospital, after treatment for severe asthma were invited to attend a series of hospital outpatient clinics at which the credit card plan was introduced. Questionnaires were used to compare markers of asthma morbidity, requirement for emergency medical care, and medication use during the 6-month period before and after intervention with the credit card plan. RESULTS: Of the 30 patients with asthma who attended the first outpatient clinic, 26 (17 women and 9 men) completed the program. In these 26 participants, there was a reduction in both morbidity and requirement for acute medical services: specifically, the proportion waking with asthma more than once a week decreased from 65% to 23% (p = 0.005) and the proportion visiting the emergency department for treatment of severe asthma decreased from 58% to 15% (p = 0.004). The patients attending the clinics commented favorably on the plan, in particular on its usefulness as an educational tool for monitoring and treating their asthma. CONCLUSIONS: Although the interpretation of this study is limited by the lack of a randomized control group, the findings are consistent with other evidence that the credit card asthma self-management plan can be an effective and acceptable system for improving asthma care in a high-risk group of adult patients with asthma.

Adolescent↗
PubMed1997

House dust mite avoidance measures improve peak flow and symptoms in patients with allergy but without asthma: a possible delay in the manifestation of clinical asthma?

BACKGROUND: Asthma caused by allergy to house dust mite is a growing problem. Patients with allergy who do not have asthma (yet) might develop asthma depending on exposure to precipitating factors. OBJECTIVE: We sought to determine whether house dust mite avoidance measures have an effect on the development of asthma. METHODS: Patients with allergy (n = 29) who had no diagnosis of asthma (FEV1 of 99.1% +/- 10.6% of predicted, peak flow variability of 5.21% +/- 3.41%, reversibility of FEV1 after 400 microg salbutamol of 3.92% +/- 3.75% according to the reference values) were randomly allocated (subjects blinded) to a treatment (n = 16) and a placebo group (n = 13). House dust mite avoidance treatment consisted of applying Acarosan (Allergopharma, J. Ganzer KG, Hamburg, Germany) (the placebo group used water) to the floors (living room, bedroom), and the use of covers for mattresses and bedding that were impermeable to house dust mite (the placebo group used cotton covers for mattresses only). We tested whether the intervention had an effect on peak flow parameters and asthma symptom scores during 6 weeks of treatment. RESULTS: Significant improvements were seen in the treatment group in symptom scores (Borg score) for disturbed sleep, breathlessness, wheeze, and overall symptom score. Slight but statistically significant improvements in peak flow (morning, evening, and variability) were seen in the treatment group also. No significant changes were seen in the placebo group. CONCLUSIONS: Although this study is not long enough to study the development of asthma, the results indicates that house dust mite avoidance measures had an effect on peak flow parameters and asthma symptoms in patients with allergy but without asthma. These findings might implicate that a shift in developing clinically manifest asthma could be achieved with house dust mite avoidance measures. To give a better answer to whether preventing the development of asthma is possible, larger studies with a longer follow-up period are necessary.

Adolescent↗
PubMed1999

An overview of the recommendations of the Working Group on Asthma and Pregnancy. National Asthma Education and Prevention Program.

Asthma is the most common potentially serious medical disease complicating pregnancy, and uncontrolled asthma during pregnancy may produce both maternal and fetal complications. The Working Group on Asthma and Pregnancy was established by the National Asthma Education and Prevention Program (NAEPP) to address the issues surrounding asthma management during pregnancy, working within the background of the NAEPP's published asthma guidelines. The Working Group's report, published in 1993, presents recommendations and information for diagnosing and managing asthma during pregnancy. Some key points are: (1) asthma should be treated as aggressively in pregnant women as in nonpregnant women; (2) asthma care and obstetric care should be carefully integrated and should include monitoring of fetal growth and development, maternal symptoms, and maternal lung function; (3) as for nonpregnant women with asthma, medications used to treat asthma during pregnancy should include a short-acting symptom reliever medication (usually an inhaled short-acting beta2 -agonist) and long-term daily medication to address the underlying inflammation for all patients with more than mild, intermittent disease.

Asthma↗
PubMed1999

Prevalence of asthma and 'probable' asthma in the Asian population in Blackburn, U.K.

Local research had shown increased asthma admission rates in the Asian ethnic group in Blackburn, U.K. Patients also reported that asthma seemed to develop some years after first arrival in the U.K. A community prevalence survey of respiratory symptoms and asthma was undertaken in three practices with no special asthma interest. The questionnaire was administered by a Health Visitor and language link worker. Of the Asian patients in the practices, 96.6% were studied. The age distribution was similar to that of the local 1991 census. Of the patients, 181/1783 (10.2%) had diagnosed asthma but positive responses to individual questions suggested underdiagnosis of asthma. Asthma prevalence was higher in males up to age 20 (14.6% vs. 8.2%), and aged over 50 (16.5% vs. 10.5%), but higher in females aged 20-49 (5.6% vs. 9.2%). There were no correlations with social class or Jarman index, and no effect of country of origin or duration in the U.K. by multivariate analysis. The prevalence of diagnosed asthma at ages 5-9 and 10-14 was higher than in previous studies. Diagnosed asthma prevalence rates fell in the 20-49 age band but rose again in the over-50s. In all age groups the prevalence of asthma is probably underestimated. Asthma prevalence was not related to social factors. The data show that those born in the U.K. are more likely to describe regular symptoms and to be on regular treatment, but that for those born abroad there was an increasing rate of symptoms and medication use with increasing duration in the country. These observations confirm patient views but are explained by the age/sex distribution of those born in the U.K. compared to immigrants.

Adolescent↗
PubMed2004

Relationship of physician estimate of underlying asthma severity to asthma outcomes.

BACKGROUND: Implementation of national guidelines for the treatment of asthma requires physician estimates of patients' underlying asthma severity. Asthma severity is commonly assigned based on respiratory symptoms. OBJECTIVE: To evaluate the relationship of guideline-based physician assessments to asthma control. METHODS: Data were collected by survey as part of a cohort study of adults with asthma. Physicians estimated the underlying severity of their patients' asthma as mild, moderate, or severe. We evaluated the relationship of these estimates to (1) general health status, asthma symptoms, and patient-reported emergency department (ED) visits and hospitalizations in the previous year and (2) outcomes in the following year. RESULTS: A total of 3,468 adults with asthma had physicians who completed assessments of their severity. Physician evaluation of severity was significantly associated with the patient's recent general health status, asthma symptom control, ED visits, and hospitalizations (P < .001 for all). Future outcomes, including hospitalizations and ED visits for asthma, increased with increasing severity rating (hospitalizations: 5% [mild] vs 11% [moderate] vs 19% [severe]; ED visits: 15% [mild] vs 22% [moderate] vs 32% [severe]; P < .001 for all). CONCLUSION: This study provides evidence of the validity of physician assessments of patients' underlying asthma severity using the strategy recommended by national guidelines.

Adult↗
PubMed2001

Prevalence of mood disorders and relationship to asthma severity in patients at an inner-city asthma clinic.

BACKGROUND: Depressive symptoms are associated with noncompliance and even sudden death in asthma patients. Some studies suggest that low-income, minority, inner-city asthma patients may be at high risk for asthma-related morbidity and mortality in which depression may be a risk factor. Minimal data are available on the prevalence of depression and other mood disorders in asthma patients. OBJECTIVE: In this pilot study, we examined the prevalence of depression and the association between depression and measures of asthma severity in patients at an inner-city asthma clinic. METHODS: Mood disorders were diagnosed using a diagnostic interview given to patients (N = 44) at asthma clinic visits. Inhaled steroid dose, FEV1 percentage, and asthma severity were also obtained. RESULTS: Eighteen patients (41%) had a lifetime mood disorder but only seven of these patients received pharmacotherapy. Patients with a past mood disorder had significantly higher FEV1 percentage predicted values (P = 0.03) than those without a mood disorder. Trends toward less severe asthma (P = 0.13) and lower inhaled steroid dose (P = 0.13) in patients with a mood disorder history were also found. CONCLUSIONS: The data suggest that mood disorders are common, but often unrecognized and untreated in asthma patients. The data also suggest that mood disorders are not necessarily associated with more severe asthma, at least in the population studied.

Asthma↗
PubMed1998

Knowledge, self-management, compliance and quality of life in asthma: a cross-sectional study of the French version of the Asthma Quality of Life Questionnaire.

The Asthma Quality of Life Questionnaire (AQLQ) is a well-validated instrument. Our objectives were to explore the cross-sectional validity of the French version, using usual outcomes of asthma, as well as assessment of knowledge of asthma, self-management and compliance. A self-administered version of the AQLQ was given to 124 consecutive patients recruited from two out-patient clinics and an emergency room in order to reflect a wide range of asthma severity. The other outcomes of asthma measured were the FEV1, patient-perceived asthma severity using a visual analogue scale, compliance, knowledge of asthma condition and self-management autonomy. Correlations were predicted before analysis ( r > 0.5, strong correlation, ++ r = 0.35-0.5, moderate correlation and + r = 0.20-0.35, fair correlation). The AQLQ scores correlated moderately to strongly with asthma severity and fairly with the pulmonary function results. Of the behavioural outcomes assessed, only knowledge of asthma correlated fairly with the AQLQ scores, as expected. This study of the French version of the AQLQ, while showing similar cross-sectional correlations with functional assessment and asthma severity to those observed with the original English version, suggested in addition a positive association between quality of life and knowledge of asthma.

Adult↗
PubMed2000

Effect of hospital asthma nurse appointment on inpatient asthma care.

While asthma nurses are funded by many health authorities within the U.K. National Health Service, for the improvement of clinical management in both inpatient and outpatient settings in secondary care, the effect of asthma nurse appointment on acute asthma care in hospitalized children has been inadequately studied. Here, we test the hypothesis that the employment of a full-time hospital asthma nurse improves quality of care for children admitted to hospital with acute asthma. Prospective in design, the study compares analyses of indicators of good clinical practice for hospitalized asthmatic children (2-16 yrs) before and after the appointment of a hospital asthma nurse. Both management [oxygen saturation check (35/106 vs. 111/126, P<0.05)] and discharge planning [self management plan/asthma education (17/106 vs. 49/126, P<0.05), follow-up arrangements with general practice (8/106 vs. 25/126, P<0.05)] improved. There was, however, no significant change in oral steroid administration, peak flow check, inhaler technique assessment, inhaled drug prophylaxis or arrangements for hospital follow-up at discharge. Employment of a hospital-based children's asthma nurse leads to significant improvement in aspects of routine in-patient asthma management. However, other important areas of in-patient asthma care did not improve following nurse-led interventions. A clearer evidence base may improve compliance with asthma management guidelines, and could make the role of hospital asthma nurse more effective.

Adolescent↗
PubMed2001

[Eosinophilic bronchitis without asthma--an additional rare cause for chronic persistent cough (CPC)? A 30-year old patient with severe CPC due to eosinophilic bronchitis without asthma or hyperreactivity].

In non-smokers the underlying causes for chronic persistent cough (CPC) e.g. chronic cough without diagnostic chest X-ray or pulmonary function test--are usually as follows: several common upper airways diseases, bronchial (cough type) asthma, gastrooesophageal reflux or treatment with an ACE (angiotensin converting enzyme)--inhibitor. In 10% of CPC however the cause remains uncertain. We report a 30 year old non-smoker with severe coughing and repeated vomiting for two months. No laboratory or technical data could be collected suggestive of a common cause of CPC: Upper airways disease, bronchial flow limitation or hyperresponsiveness, ACE inhibitor medication, B. pertussis infection, gastrooesophageal reflux disease (by 24 hours pH-probe) were ruled out. Fiberbronchoscopic findings remained unremarkable, except for the bronchial biopsy specimen, which showed moderate eosinophilic inflammation of the mucosa and marked thickening of the subepithelial layer. Since the cough was non-productive, sputum induction with 3 ml nebulised 3% NaCl solution was performed. 28% of the granulocytes were eosinophil stained. A low quality morning sputum (< 1 ml) showed 21% eosinophilia. Thus, the diagnosis of eosinophilic bronchitis was established. 400 micrograms budesonide dry powder inhalations b.i.d. for one week resolved the cough, treatment was stopped after three weeks. No recurrence was seen two months later. Both the cough type asthma and the eosinophilic bronchitis could represent a form fruste of classical bronchial asthma beyond wheezing or dyspnoea, but with the common main symptom: cough. Since hyperresponsiveness and cough are phenotypic hallmarks of cough variant asthma, in eosinophilic bronchitis--beside cough--another two features of asthma are present: eosinophilic inflammation of the mucosa along with sputum eosinophilia and subepithelial layer thickening. Not surprisingly, eosinophilic bronchial inflammation could be shown in patients with cough variant asthma as well, who--up to 56% during a four year-period--develop classic asthma. The long-term outcome of eosinophilic bronchitis is not known, however. Thus, asthma, cough variant asthma and cough due to eosinophilic bronchitis can mirror different phenotypes or phases of the same entity. CPC due to either the cough type asthma or the eosinophilic bronchitis is like asthma fast responding to inhalative steroids. (Induced) sputum staining should be added to the diagnostic armamentarium of CPC.

Adult↗
PubMed2001

[Treatment of bronchial asthma using a new adjustable combination treatment plan: Asthma Control Plan (ATACO)].

The current guideline of the German Respiratory League (Deutsche Atemwegsliga) recommends the synergistic combination therapy with long acting beta 2-agonists and inhalative corticosteroids only for patients suffering from moderate to severe persistent asthma (step 3 and 4 of the asthma severity scale). Now convenient fixed combinations of these substances are available, which could enhance patient's compliance. A large, randomised, parallel-group study in 8000 mild to moderate asthmatics was designed to compare a flexible asthma control plan with the conventional fixed-dose management with respect to quality of life, symptom control and treatment costs. The fixed combination of 6 micrograms Formoterol and 200 micrograms Budesonide per puff in a new dry powder device was applied either due to a novel flexible asthma control plan "ATACO" (group A) or as a standardised conventional dosing regimen (group B) inhaling two puffs b.i.d. In group A (ATACO) patients reduce the run-in dose after four weeks from two puffs b.i.d. to one puff b.i.d. with the option of doubling the dose immediately, if (pre-defined) asthma deterioration occurs. One week later the dose can be either doubled again or reduced due to the actual asthma symptoms of the patient. After run-in, group B patients continue to take two inhalations b.i.d. In this group, asthma exacerbations will be managed as usual by the physician. In contrast, the ATACO group flexible management plan allows the self-medication: an immediate increase in the dose of the fixed combination will lead to both a fast relief of bronchospasm and an automatically higher dosed corticosteroid treatment for the underlying asthmatic inflammation. Conversely, if later asthma symptoms improve, less reliever and controller medication will be needed and used. The immediate treatment of new onset bronchospasm and asthmatic inflammation by the patient himself could maintain at least the same grade of asthma control, as the conventional group B treatment, improve asthma-related quality of life and decrease treatment costs. If the concept works, fixed combinations of long-acting beta 2 agonists and inhalative corticosteroids could have an impact on future asthma guidelines.

Administration, Inhalation↗
PubMed2006

Women and asthma: lessons from a gender analysis of the asthma in Canada survey.

OBJECTIVE: To compare the degree of asthma control achieved by men and women with asthma in Canada and to explore differences in patient perspectives, treatments used, and health care resources used between men and women with asthma. DESIGN: Population-based cross-sectional telephone interview survey of Canadians with doctor-diagnosed asthma. SUBJECTS AND METHODS: Random digit dialing was used to identify a representative sample of Canadians with asthma. A total of 801 adults were interviewed over the telephone. Analysis was performed on the data from a subgroup of 20- to 50-year-old patients with asthma who participated in the original survey (329 women and 183 men). RESULTS: Women and men were equally likely to be poorly controlled (58% vs. 56%, p > 0.05) as defined by failing to meet two or more of six symptom-based criteria listed by the 1996 Canadian Asthma Consensus (CAC) Guidelines as appropriate treatment targets. However, there were significant differences in medication used; women were more likely than men to use an inhaled corticosteroid in the treatment of their asthma (59% vs. 45%, p < 0.05) and were more knowledgeable about their appropriate use (62% vs. 46%, p < 0.05), and were more likely to be satisfied with their physicians' care. Despite this, women were more likely than men to have required urgent care for their asthma in the year preceding the survey (50% vs. 36%, p < 0.05). CONCLUSION: Women report greater need for urgent asthma care despite more frequent use of inhaled corticosteroids and better asthma knowledge scores than men.

Adult↗
PubMed2004

How frequent are asthma exacerbations in a pediatric primary care setting and do written asthma action plans help in their management?

PURPOSE: In the National Heart, Lung, and Blood Institute Guidelines for the Diagnosis and Management of Asthma, the expert panel recommends that a written asthma action plan be provided for all patients with asthma. Studies evaluating the usefulness of the asthma action plan in children are limited. We aim to determine exacerbation frequency and usefulness of the asthma action plan in managing exacerbations that occur in a pediatric primary care setting. METHODS: Caretakers of asthmatic children attending the general pediatric clinic in an inner-city hospital completed a one-page questionnaire covering topics such as asthma severity, frequency of exacerbations, and possession/usefulness of an asthma action plan. Although controversy exists over the definition of yellow and red zone exacerbations, we defined the yellow zone as symptoms that require albuterol more than three times a day or more than two nights in succession. The red zone was defined as symptoms requiring systemic corticosteroids and/or an urgent physician visit. RESULTS: Seventy of 75 subjects completed the survey. Almost 80% of respondents carried the diagnosis of persistent asthma, whereas the remainder had intermittent asthma. Exacerbation frequency over a 3-month period was determined. Approximately 80% of children experienced at least one yellow zone episode: 42% had one or two yellow zone episodes, and 39.6% had between three and five episodes. Sixty-three percent of patients did not experience a single red zone exacerbation. Almost 75% (44 of 59) of subjects possessed an asthma action plan. Ninety percent (37 of 41) of respondents with action plans found the plan to be useful in managing exacerbations. CONCLUSION: Approximately four of every five asthmatic children seen in this primary care setting experienced a yellow zone exacerbation at least once during a 3-month period. One third experienced at least one red zone episode. Nine of every 10 caretakers with an action plan reported the asthma action plan to be of value in managing exacerbations.

Anti-Asthmatic Agents↗