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PubMed1988

Do patients understand asthma? A community survey of asthma knowledge.

Four hundred and twenty-one subjects who attended metropolitan pharmacies in Melbourne that were selected at random were surveyed about the characteristics of, and their knowledge about, their asthma. An unexpectedly-high morbidity was found among 232 persons with asthma, who were aged between 16 years and 75 years. Forty per cent of subjects had been hospitalized at least once for asthma and 15% of subjects were taking maintenance corticosteroid agents by mouth. Twenty per cent of subjects currently were smoking cigarettes (15 cigarettes per day on average). When knowledge of asthma was examined by a questionnaire, the median score of questions that were answered correctly was less than 50% of the total. The best knowledge scores were associated with subjects: who had been exposed in the past to information about asthma; who had attended a private medical specialist; who were non-smokers; and who had achieved the highest levels of schooling. Among the serious misconceptions which were evident in the areas of use of medication were: that sustained-release theophylline agents acted quickly during acute attacks of asthma (62% of subjects); that antihistamine agents should be taken as soon as possible during an asthma emergency (72% of subjects); that six inhalations of beclomethasone were advisable during an asthma emergency (49% of subjects); that systemic corticosteroid agents were effective within 20 minutes of administration (87% of subjects); and that deaths of asthma usually were due to precipitous attacks without time for any intervention (73% of subjects). Only 42% of subjects considered that up to six puffs at once of a beta-agonist aerosol for an asthma emergency may be appropriate. The identification of such misconceptions is quite practical during routine consultations. The correction of such misconceptions may improve the morbidity and mortality that is due to asthma.

Adolescent↗
PubMed2003

Prevalence of asthma and asthma action plans in South Australia: population surveys from 1990 to 2001.

OBJECTIVES: To assess trends in the prevalence of self-reported doctor-diagnosed asthma, associated asthma related morbidity, and the uptake of written asthma action plans in South Australia, 1990-2001. DESIGN, SETTING AND PARTICIPANTS: Surveys by telephone interview of the South Australian population between 1990 and 2001, and interview of participants in their own homes by trained health interviewers. MAIN OUTCOME MEASURES: Asthma prevalence, percentage of patients with written action plans, and asthma associated morbidity. RESULTS: The reported prevalence of doctor-diagnosed asthma has increased from 8% (95% CI, 6.4%-9.6%) in 1990 to 12.8% (95% CI, 11.4%-14.2%) in 2001. Morbidity, as measured by wakening at night (daily or weekly) and days lost from normal activities because of asthma, has remained constant over the decade. The percentage of patients with written asthma action plans increased to a peak of 42.3% (95% CI, 40.3%-44.3%) in 1995, but then declined to 22.2% (95% CI, 20.7%-23.7%) in 2001. CONCLUSIONS: The prevalence of asthma has increased while morbidity has remained constant, indicating that the burden of asthma has increased. The associated decline in the percentage of patients with asthma action plans in recent years is cause for concern.

Asthma↗
PubMed2000

Guideline for the management of chronic asthma in adults--2000 update. South African Pulmonology Society Adult Asthma Working Group.

OBJECTIVE: To make recommendations for the cost-effective management of asthma incorporating recent advances in the understanding and treatment of asthma since the last guideline statement in 1992. The guideline is applicable to adults and children over 12 years of age. OPTIONS: Asthma should be graded according to standard severity criteria. The principle of 'hit early, hit hard' with corticosteroids to achieve rapid control is encouraged; thereafter treatment should be tailed down to the lowest dose of corticosteroids that maintains the aims of asthma treatment. OUTCOMES: The aims of asthma management should be achieved; these include: (i) avoidance of causative and trigger factors; (ii) abolition of symptoms and ability to lead a normal lifestyle; (iii) restoration of normal (or best possible) lung function; (iv) reduction of the risk of severe attacks; and (v) optimisation of treatment with minimal side-effects. EVIDENCE: Based on a selective review of randomised, controlled studies to support an evidence-based approach to treatment. BENEFITS, HARMS AND COSTS: Appropriate management of asthma should lead to a reduction in morbidity and mortality of asthma and a consequent reduction in cost of asthma care. Side-effects of corticosteroids are placed in perspective together with a strategy to minimise these effects. RECOMMENDATIONS: Asthma should be managed with inhaled corticosteroids as the most important anti-inflammatory treatment, except in the case of mild intermittent asthma which may be treated with beta 2 agonists on a pro re nata (prn) basis. It is preferable to add long-acting beta 2 agonists to low-dose inhaled corticosteroids before increasing corticosteroids. Leukotriene receptor antagonists are currently recommended for use in combination with inhaled corticosteroids pending further data on their long-term benefits. Differentiation of asthma from chronic obstructive pulmonary disease (COPD) is important. Early referral to a pulmonologist in difficult cases is encouraged. VALIDATION: Endorsed by the South African Pulmonology Society, the Allergy Society of South Africa and the South African Medical Association. The guideline is compatible with those of other international societies.

Adrenal Cortex Hormones↗
PubMed2001

Development and implementation of the home asthma telemonitoring (HAT) system to facilitate asthma self-care.

National Asthma Education and Prevention Program (NAEPP) suggests using asthma action plans for patient self-care. Recent studies reported that many asthma patients had difficulties in following action plans on a daily basis and had low compliance to medication regimens. The goal of our study was to design and evaluate the Home Asthma Telemonitoring (HAT) system aimed to help asthma patients to follow their self-care plans according to the NAEPP recommendations. Our study resulted in the development of the system which provided patients with continuous individualized help in the daily routine of asthma self-care and notified heath care providers if certain clinical conditions occurred. This allowed early recognition of potentially dangerous situations and timely intervention. The evaluation of the HAT system underwent several stages. First we showed, that the HAT system provides reliable reciprocal exchange of all relevant information between a physician and asthma patient in home settings. Further evaluation demonstrated that lung function test results collected during home asthma telemonitoring are comparable to those collected under the supervision of trained professionals, and Internet-based home asthma telemonitoring can be successfully implemented in a group of patients without previous computer experience. Preliminary results of an on-going HAT evaluation showed higher patient compliance to asthma action plans in comparison to the compliance reported for patients in standard care. The clinical impact of HAT on asthma outcomes is being currently evaluated in a randomized clinical trial funded by NIH. HAT has a potential for improving clinical outcomes and quality of life in the studied patient population and may be a model for monitoring and self-management of patients with other chronic health conditions.

Asthma↗
PubMed2003

[Prevalence of symptoms of asthma, allergic rhinitis, conjunctivitis and atopic eczema: ISAAC (International Study of Asthma and Allergies in Childhood) in a population of schoolchildren in Zagreb].

OBJECTIVE: Numerous studies of the population prevalence of asthma, allergic rhinitis, and atopic eczema revealed some international differences. However, the International Study of Asthma and Allergies in Childhood (ISAAC) was the first one using a standardized methodology to evaluate the prevalence of these diseases, and to make comparisons within and between countries. The results showed marked variations in 12-month prevalence of asthma, allergic rhinoconjunctivitis, and atopic eczema symptoms with 20-fold (range 1.6-36.8%), 30-fold (range 1.4-39.7%), and 60-fold (range 0.3-20.5%) differences between the centres with the highest and the lowest prevalence, respectively. AIM: Our aim was to gain the insight into the prevalence of allergic diseases in Zagreb, Croatia by the methods of internationally standardized protocol, proposed by the ISAAC Steering Committee. METHODS: Original questionnaires, translated from English into Croatian, consisting of questions about the child's demographic characteristics, core modules on wheezing, rhinitis and eczema, and supplementary modules, were completed by parents of 10-year-old children (4th grade) attending 18 elementary schools in a city of Zagreb. Total of 1047 questionnaires were returned and analysed after the inconsistent responses were eliminated by phone calling. DISCUSSION: Phase one of the ISAAC study has shown a wide variation in the prevalence of asthma, allergic rhinoconjunctivitis, and atopic eczema symptoms throughout the world, with differing international patterns for the different disorders. Four prevalence ranges have been established for better illustration of the geographic distribution of asthma prevalence: (I) < 5%; (II) 5 to < 10%; (III) 10 to < 20%; (IV) > or = 20%. The highest 12-month prevalences of asthma symptoms were found in developed countries (UK, Australia, New Zealand, Republic of Ireland, and most centres in North, Central, and South America), being in prevalence range IV. The lowest prevalences (range I) were found in several Eastern European countries, Indonesia, Greece, China, Taiwan, Uzbekistan, India, and Ethiopia. According to the results of our study, a continental part of Croatia with a 12-month prevalence of wheezing of 6.02% corresponds to range II. Prevalence of asthma symptoms was greater in males, which is consistent with the results of the younger age group previously analysed. For allergic rhinoconjunctivitis and atopic eczema symptoms grouping of centres with a high prevalences into specific regions was less well defined than for asthma. Centres with the highest prevalences were scattered across the world. In contrast, centres with the lowest prevalences were similar to those for asthma symptoms. Our results of the 12-month prevalence of allergic rhinoconjunctivitis (12.13%), and atopic eczema (7.83%) symptoms were somewhere between the two extremes. As with asthma symptoms, the prevalence of rhinoconjunctivitis symptoms was greater in males. Contrary, the difference in prevalence of atopic eczema symptoms between the sex groups has not been found. The worldwide variations in prevalence of asthma, allergic rhinoconjunctivitis, and atopic eczema symptoms suggest that environmental factors may be critical to the development of these disorders in childhood. Furthermore, different patterns of geographical distribution of particular disorders suggest that major risk factors for them may be different or may involve different latency periods and time trends. Therefore, studies that include objective clinical assessment are required. CONCLUSION: According to our results, Zagreb is a city with relatively low prevalence of allergic diseases symptoms. Larger sample size of at least 3000 subjects is required to provide sufficient precision for estimates of symptom severity, and to generate adequate number of subjects with particular disorders for further analyses. Therefore, we recently increased our sample size to more than 3000 subjects, and started ISAAC Phase two (clinical examination, measures of bronchial hyperresponsiveness, measures of atopy, measures of environmental exposure to aeroallergens, and genetic analyses) in Zagreb, Croatia.

Asthma↗
PubMed2005

Childhood asthma diagnosis and use of asthma medication.

AIM: To determine the burden of asthma in children. METHODS: A cross sectional, randomised, computer assisted telephone survey of a community based sample of 2020 children aged 5-14 years in western Sydney (New South Wales) over a 20 day period from June 2000 to July 2000. RESULTS: Main outcome measures were carer reported history of asthma diagnosis, hospital presentation/admission for asthma, recent use of anti-asthma medications, and recent respiratory symptoms. Diagnosed asthma was reported in 31% (of whom 42% were diagnosed aged 2 years or under) and asthma medications used in the previous year by 21% of children. Factors significantly associated with a reported asthma diagnosis included: male gender (OR: 1.51), birth in Australia (OR: 1.64), living in an English speaking household (OR: 1.47), Aboriginality (OR: 2.32), possession of a health care card (OR: 1.28), previous pneumonia (OR: 2.4) or pertussis (OR: 2.0), and a recent episode of croup (OR: 1.9). Exposure to tobacco smoke and immunisation status were not significant. DISCUSSION: We confirm a high prevalence of asthma and medication use for asthma. The high proportion of children diagnosed asthmatic at 2 years or under (when asthma cannot be diagnosed reliably) suggests overdiagnosis of asthma may contribute to the apparent high prevalence.

Adolescent↗
PubMed1994

Management of childhood and adolescent asthma. 1994 consensus. South African Childhood Asthma Working Group.

OBJECTIVE: To make recommendations regarding the treatment of chronic asthma to achieve effective control; to emphasise that asthma is a clinical diagnosis; to stress the central role of inflammation in asthma; to recommend alternative agents for practice where certain drugs are not available; and to address new agents that have been introduced for the treatment of asthma. OPTIONS: A new severity grading of mild, moderate and severe asthma is proposed to aid in the selection of medication. This severity assessment uses four features; attack frequency, nocturnal symptom frequency, hospital admissions and peak flow. Since asthma can vary with time, regular reassessment with a view to reassignment of individual grading is necessary. OUTCOMES: Goals of effective control strive to ensure that the asthmatic leads a normal life free from symptoms with regular school attendance, restful sleep, normal growth and development, minimal acute attacks and avoidance of hospital admissions. EVIDENCE: Previous local and international consensus statements. BENEFITS, HARMS, COSTS: Early diagnosis, accurate grading and effective control reduce morbidity and mortality and will be cost-saving. Pharmaco-economic evaluations of the cost of asthma show that medications per se represent a small percentage of the overall cost of asthma. RECOMMENDATIONS: Inhaled therapy is preferred, even in young children, as aerosol devices for all ages are available. Mild asthma is treated with intermittent short-acting beta-agonists, moderate asthma with regular cromoglycate and severe asthma with regular inhaled steroids. Environmental control, specialist referral and hazardous and unnecessary therapy are also addressed.

Adolescent↗
PubMed1995

The impact of a summer asthma camp experience on asthma education and morbidity in children.

BACKGROUND: This study examines whether an educational program emphasizing self-management skills can be successfully implemented in an asthma camp setting, and the degree to which this camp experience would affect asthma-associated morbidity among children attending such a program. METHODS: Ninety asthmatic children between the ages of 6 and 12 years who were attending a summer asthma camp were enrolled in the study. A precamp questionnaire was sent to the parents of these children to assess asthma morbidity during the preceding 12 months and to determine the prevalence of the use of peak flow meters and spacer devices by their children. At camp, children received educational sessions on asthma self-management, including training in the proper use of spacer devices and peak flow meters. Follow-up questionnaires were sent to the parents at 1 and 6 months after camp to assess the use of these devices and to measure subsequent asthma morbidity. RESULTS: Precamp use of spacer devices among all participants was 51.9%; the 1-month and 6-month post-camp use of spacer devices significantly increased to 92.4% (P < .001) and 85.9% (P < .001), respectively. The precamp use of peak flow meters was 50.0%; the 1-month and 6-month postcamp use was increased to 95.0% (P < .001) and 87.7% (P < .001), respectively. Six-month follow-up revealed a significant decrease in urgent outpatient visits for asthma exacerbations and a significant decrease in school day absences due to asthma. CONCLUSIONS: An asthma camp is an effective environment for a patient education program emphasizing self-management skills. Children with moderate to severe asthma who attend such a camp may experience a decrease in subsequent asthma-associated morbidity.

Ambulatory Care↗
PubMed1996

Asthma: an important disease to otolaryngologists--Part I: Suspecting and diagnosing asthma.

Asthma is a chronic inflammatory disease of the lower respiratory tract which is triggered by exposure to allergens or other airway irritants. This inflammation results in airway hyperresponsiveness, bronchial muscle spasm, mucous gland hypersecretion and mucosal edema, which combine to create symptoms such as cough, wheezing and respiratory distress. Because the inflammatory process is highly variable, asthma is a disorder with many possible presentations. It may therefore proceed for years without clinical recognition, and may challenge the most astute diagnostician. It is important for otolaryngologists to be able to suspect, diagnose and treat asthma. This is so because asthma is a common disease in the otolaryngologic patient population, both as one of the options in the differential diagnosis of respiratory complaints, and as a comorbid condition which may complicate the treatment of other medical or surgical problems. Furthermore, both the understanding of asthma's pathophysiology, and its optimum treatment methods have undergone radical changes during the past decade. This three-part discussion reviews our modern understanding of asthma, and proposes diagnosis and treatment guidelines which can assist otolaryngologists in effectively managing their asthmatic patients. Part one summarizes current information on the pathophysiology and increasing prevalence of asthma, its clinical variability, the assessment of asthma sensitivity, and methods for diagnosis of asthma. Parts two and three cover the strategy for asthma management, and the use of both adjunctive and anti-inflammatory therapies for asthma control.

Asthma↗
PubMed1998

Prevalence of asthma and asthma-like symptoms in an adult population sample from Verona. ECRHS Verona. European Community Respiratory Health Survey.

The aim of the study was to assess the prevalence of asthma and asthma-like symptoms in the general population of Verona. A screening questionnaire, with seven questions on respiratory symptoms, was sent by mail to 3000 randomly selected subjects, aged 20-44 yrs. After three subsequent mailings, nonresponders were interviewed by telephone. The overall response rate was 92%. At least one respiratory symptom was reported by 44% subjects. The prevalence of the most frequent symptoms differed according to the type of contact: early respondents (i.e. those who responded by mail) were more likely to report symptoms than late respondents (i.e. those who were interviewed by telephone). Wheezing was reported by 11.3% of males and 8.0% of females (p < 0.01). The allergic rhinitis and hay-fever prevalence was 16.9% with no differences owing to sex or age. The prevalence of an "episode of asthma" (defined as a self-reported attack of asthma or treatment for asthma) and of "current asthma" (defined as a self-reported attack of asthma, treatment for asthma or wheezing other than due to a cold with dyspnoea in the last 12 months) was 4.1 and 4.7%, respectively. No differences were found on the basis of age and sex. The prevalence of asthma was greater in urban (5.0%) than in suburban (2.7%) areas (p < 0.05), where lower pollution levels were registered. The greater prevalence in urban areas suggests that some factors related to the urban environment could play a role in the development of asthma and asthma-like disorders.

Adult↗
PubMed2000

Inhaled short acting beta2-agonist use in asthma: regular vs as needed treatment.

BACKGROUND: Inhaled beta2-adrenergic agonists delivered by inhalation are very widely used in asthma. There has been much controversy of the use and possible consequences of the use of these agents for regular, as opposed as-needed use in asthma. OBJECTIVES: This review to assessed the clinical trial evidence to test whether using regular use of short-acting beta2-agonists reduced asthma control and pulmonary function; worsened symptoms, airway reactivity and quality of life; and increased the rate of exacerbations. SEARCH STRATEGY: A search was carried out of the Cochrane Airways Group "Asthma and Wheez* RCT" register using the terms: regular AND [beta agonist OR bronchodilator OR salbutamol OR albuterol Or terbutaline OR isoproterenol OR reproterol OR fenoterol]. Bibliographies of existing trials were searched and primary trial authors and pharmaceutical companies were approached for additional trials. SELECTION CRITERIA: Randomised controlled trials in which the short-acting beta2-agonist was given regularly in the experimental group, together with an inhaled bronchodilator for relief of symptoms ('rescue use'). The control group consisted of matching placebo inhaled regularly, with an inhaled bronchodilator for as-needed 'rescue use'. DATA COLLECTION AND ANALYSIS: Data were extracted and quality assessments were made by both reviewers. Parallel group and cross-over trials were analysed separately. Where possible data were pooled using a fixed effects model. MAIN RESULTS: Over 800 abstracts were identified, following a review, 60 papers were requested for full assessment by both reviewers. 34 trials from 30 papers met the entry criteria. Data from 31 outcomes were analyzable. There was little difference between the treatments for nearly all outcomes. In cross-over studies, evening peak flow was better with regular treatment, weighted mean difference (WMD) 13.1 l/min (95% confidence interval 24.3, 1.9). In contrast, the FEV1 was better with as-needed treatment (WMD 157 ml (95% CI: 123, 192). Bronchial hyper reactivity was slightly better in the as-needed group, standardised mean difference 0.23, 95% CI: 0.52, 1.12. REVIEWER'S CONCLUSIONS: These results support current guidelines. There is little advantage in using short-acting beta2-agonists regularly, and potentially some small clinical disadvantage.

Adrenergic beta-Agonists↗
PubMed2000

Anti-leukotriene agents compared to inhaled corticosteroids in the management of recurrent and/or chronic asthma.

BACKGROUND: Inhaled corticosteroids are the cornerstone of anti-inflammatory asthma treatment. Anti-leukotrienes agents are currently being studied as alternative first line agents in the management of mild to moderate chronic asthma. OBJECTIVES: The aims of this review study are to compare the safety and efficacy of anti-leukotriene agents with inhaled glucocorticoids and to determine the dose-equivalence of anti-leukotrienes in mcg of inhaled corticosteroids in the management of chronic asthma. SEARCH STRATEGY: The searched Medline (1966 to 1999), Embase (1980 to 1999), Cinahl (1982 to 1999) and reference lists of review articles and trials; we contacted colleagues and international headquarters of anti-leukotrienes producers. SELECTION CRITERIA: Randomised controlled trials were included if they compared leukotriene antagonists with inhaled corticosteroids during a minimal 30-day intervention period in asthmatic patients aged 2 years and older, and if measures of effectiveness other than compliance were included. DATA COLLECTION AND ANALYSIS: Assessments of methodological quality and data extraction were performed independently and blindly by two reviewers. The primary outcome was the rate of exacerbations requiring systemic corticosteroids. Secondary outcomes included lung function, indices of chronic asthma control, adverse effects and withdrawal rates. MAIN RESULTS: Of 137 identified studies, ten met the inclusion criteria. Two are currently published in full-text. Most focused on subjects with mild-to-moderate chronic asthma; two included children. Trial duration was 6 to 12 weeks with a few un-blinded trials lasting several months. Daily dose of inhaled corticosteroids varied from 250 to 400 mcg of beclomethasone-equivalent; various anti-leukotriene preparation were tested. There was no difference in the rate of patients with exacerbations that required systemic steroids [4 trials, Relative Risk (RR)=1.3, (95% Confidence Interval (CI): 0.9, 1.9)]. Few trials contributed data to other outcomes. Improvement in lung function (FEV1 [N=3 trials, Standardised Mean Difference (SMD)=0.3 (95% CI: 0. 2, 0.4)]: morning PEFR [3 trials, SMD=0.4, (95% CI: 0.2, 0.5)]) and in quality of life [N=3 trials, WMD=0.3, (95% CI: 0.1, 0.4)] favoured inhaled corticosteroids. A difference in favour of inhaled corticosteroids was observed for symptoms [N=3 trials, SMD=0.3, (95% CI: = 0.2, 0.4)], night awakenings [N=2 trials, WMD= 0.6, (95% CI: 0. 3, 0.9)], and rescue beta2-agonists [N=3 trials, SMD= 0.3, (95% CI: 0.2, 0.4)] Side effects were not different between groups, but anti-leukotriene therapy was associated with increase risk of "withdrawals for any cause" [N=3 trials, RR=1.4, (95% CI: 1.1, 1.9)] and "withdrawals due to adverse effects" [N=3 trials, RR=1.9, (95% CI: 1.1, 3.3)] REVIEWER'S CONCLUSIONS: Anti-leukotriene agents had a similar rate of exacerbations compared to inhaled corticosteroids, but inhaled steroids produced better lung function and quality of life as well as reduced symptoms, night awakenings and need for rescue beta2-agonist. Reliable conclusions cannot yet be drawn regarding the efficacy of this treatment due to the paucity of trials published in full text.

Administration, Inhalation↗
PubMed2002

Incidence and remission of asthma: a retrospective study on the natural history of asthma in Italy.

BACKGROUND: The knowledge of the natural history of asthma from birth to adulthood could provide important clues for its cause and for the understanding of epidemiologic findings. OBJECTIVE: This study is aimed at assessing the incidence and remission of asthma from birth to the age of 44 years by using data from 18,873 subjects involved in a large, nationally representative, cross-sectional study carried out in Italy from 1998 through 2000. METHODS: The onset of asthma was defined as the age at the first attack, and remission was considered present when a subject was neither under treatment nor had experienced an asthma attack in the last 24 months. Person-years and survival techniques were used for the analysis. RESULTS: The average annual incidence rate for the 1953 to 2000 period was 2.56/1000 persons per year. Incidence peaked in boys less than 10 years of age (4.38/1000 persons per year) and in women 30 years of age or older (3.1/1000 persons per year) and showed a generational increase (incident rate ratio = 2.63 and 95% CI = 2.20-3.12 for 1974-1979 vs 1953-1958 birth cohort). The overall remission rate was 45.8% (41.6% in women and 49.5% in men, P <.001). Asthmatic patients in remission had an earlier age at onset (7.8 vs 15.9 years, P <.001) and a shorter duration of the disease (5.6 vs 16.1 years, P <.001) than patients with current asthma. The probability of remission was strongly (P <.001) and inversely related to the age at onset (62.8% and 15.0% in the <10- and > or =20-years age-at-onset groups, respectively). CONCLUSION: With respect to its natural history, asthma presents 2 different forms: early-onset asthma, which occurs early in childhood, affects mainly boys, and has a good prognosis, and late-onset asthma, which generally occurs during or after puberty, mainly affects women, and has a poor prognosis. The minority of patients with early-onset asthma who do not remit represents more than 35% of patients with current asthma in the general young adult population.

Adolescent↗
PubMedDate not supplied

Update on National Asthma Education and Prevention Program pediatric asthma treatment recommendations.

The National Asthma Education and Prevention Program (NAEPP) published an update on selected topics from the 1997 Guidelines for the Diagnosis and Management of Asthma and provided new evidence-based recommendations for asthma treatment. Selected topics on the long-term management of asthma in children addressed the efficacy of inhaled corticosteroids (ICSs) compared with other asthma medications (i.e., as-needed beta(2)-adrenergic agonists and other controllers) in mild and moderate persistent asthma and the safety of long-term ICS use. The effects of early intervention with ICSs on asthma progression also were evaluated. An important new aspect of the treatment update entails the recommendation of ICSs as the controller medication of choice for all severities of persistent asthma in children. Additionally, on the basis of studies in adults, the Expert Panel suggested that long-acting beta(2)-adrenergic agonists are now the preferred adjunct to ICSs in children with moderate or severe persistent asthma. Based on long-term data in children, ICS therapy was deemed safe in terms of growth, bone mineral density, ocular effects, and hypothalamic pituitary adrenal axis function. Although members of the NAEPP Expert Panel determined that the effects of early intervention with ICSs on decline in lung function have not been adequately studied, they found that the effects on asthma control were substantial.

Administration, Inhalation↗
PubMed1997

Characteristics of inner-city children with asthma: the National Cooperative Inner-City Asthma Study.

Asthma morbidity has increased dramatically in the past decade, especially among poor and minority children in the inner cities. The National Cooperative Inner-City Asthma Study (NCICAS) is a multicenter study designed to determine factors that contribute to asthma morbidity in children in the inner cities. A total of 1,528 children with asthma, ages 4 to 9 years old, were enrolled in a broad-based epidemiologic investigation of factors which were thought to be related to asthma morbidity. Baseline assessment included morbidity, allergy evaluation, adherence and access to care, home visits, and pulmonary function. Interval assessments were conducted at 3, 6, and 9 months after the baseline evaluations. Over the one-year period, 83% of the children had no hospitalizations and 3.6% had two or more. The children averaged 3 to 3.5 days of wheeze for each of the four two-week recall periods. The pattern of skin test sensitivity differed from other populations in that positive reactions to cockroach were higher (35%) and positive reactions to house dust mite were lower (31%). Caretakers reported smoking in 39% of households of children with asthma, and cotinine/creatinine ratios exceeded 30 ng/mg in 48% of the sample. High exposure (> 40 ppb) to nitrogen dioxide was found in 24% of homes. Although the majority of children had insurance coverage, 53% of study participants found it difficult to get follow-up asthma care. The data demonstrate that symptoms are frequent but do not result in hospitalization in the majority of children. These data indicate a number of areas which are potential contributors to the asthma morbidity in this population, such as environmental factors, lack of access to care, and adherence to treatment. Interventions to reduce asthma morbidity are more likely to be successful if they address the many different asthma risks found in the inner cities.

Allergens↗
PubMed2006

Variability in asthma severity in pediatric subjects with asthma previously receiving short-acting beta2-agonists.

OBJECTIVE: An analysis of 5 double-blinded, randomized, 12-week asthma trials was undertaken to evaluate pediatric subjects (4 to 11 years; n=276) who were previously receiving short-acting beta2-agonists alone and subsequently received treatment with placebo. At baseline, all subjects met National Asthma Education and Prevention Program criteria for moderate/severe asthma. STUDY DESIGN: Asthma severity was categorized individually for symptoms, albuterol use, and morning peak expiratory flow and then overall taking into account all three parameters. RESULTS: Subjects spent the majority of weeks (55%) in the moderate/severe category. Subjects spent approximately 48%, 31%, and 22% of weeks in intermittent, mild, and moderate/severe categories and 57%, 27%, and 15% of weeks, respectively, based on asthma symptoms and albuterol use. Subjects spent approximately 62%, 31%, and 8% of weeks in intermittent/mild, moderate, and severe categories, based on peak expiratory flow; however, >35% of subjects exhibited >or=15 changes in asthma severity classification, based on peak expiratory flow. CONCLUSIONS: Asthma is a disease with varying symptomatology, and pediatric subjects frequently move between severity categories, especially in children with inadequate asthma control. These data also emphasize that asthma severity cannot be determined in many pediatric subjects by discrete, point-in-time assessments of lung function, albuterol use, or asthma symptoms. Failure to recognize this problem may contribute to underestimation of disease severity in pediatric subjects.

Adrenergic beta-Agonists↗
PubMed2005

Effect of educational programs on asthma control and quality of life in adult asthma patients.

This study investigated the effectiveness of different educational programs in obtaining better asthma control and asthma-related quality of life (QoL). In 60 adult patients with moderate persistent asthma we tested the benefit of individual verbal instructions (IVI), written information ("asthma booklet", B), and integrated asthma classes ("asthma school", AS). At the enrollment and at the end of the study, all participants completed the questionnaires regarding their asthma-related knowledge (ArK) and QoL. During the 12-week period all patients recorded their asthma symptoms, morning and evening peek expiratory flow rates (PEFR), and the use of rescue medication. AS and IVI groups showed a significantly greater improvement in QoL than the B group. AS group obtained the highest ArK but no difference in the level of improvement among the groups has been documented. The improved average asthma symptom score and decreased utilization of the rescue medication were documented in all groups without significant differences among them. We also found significant improvements in both morning and evening PEFR in IVI group as well as in the morning PEFR in AS group. We conclude that among tested educational interventions the AS caused the best improvement in QoL while IVI produced the best overall response in both parameters of the asthma control and QoL.

Adult↗
PubMed1999

Effect of an emergency department asthma program on acute asthma care.

STUDY OBJECTIVE: To examine the effect of an emergency department program on acute asthma care. METHODS: We conducted a before-after study of an acute asthma quality improvement initiative in an urban teaching hospital with 65,000 annual ED visits. In mid-1994, a multidisciplinary group identified deficiencies in acute asthma care, developed and implemented a local version of the National Asthma Education Program's practice guidelines (including a standard asthma order sheet), and provided new peak flow (PF) meters. The "before" group comprised all adults with acute asthma seen during January 1994 (n=51); "after" groups comprised all adults with acute asthma seen during October 1994, February 1995, and June 1995 (n=145). Data were compared across months using a nonparametric test for trend. RESULTS: Although patient demographic characteristics and asthma severity were similar across months, ED process of care significantly changed. Initial PF measurements were obtained in 20% of patients before intervention, compared with 82%, 84%, and 83% during the postintervention months ( P for trend <.001). Follow-up PF readings were obtained in 22%, 70%, 78%, and 62% ( P <.001). Median delays to beta-agonist and steroid therapy decreased by approximately 16 minutes ( P <.001) and 34 minutes ( P =.04), respectively. Outcomes improved, with median ED length of stay decreasing by 58 minutes ( P =.01), and fewer inpatient admissions ( P =.05); there was no significant change in 4-week relapse to our hospital. CONCLUSION: A guideline-based ED asthma program changed clinical practice and improved acute asthma care in a sustained fashion. The effect of this intervention on cost and other outcomes is uncertain.

Acute Disease↗