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PubMed1999

The Chicago Asthma Surveillance Initiative: a community-based approach to understanding asthma care.

Nearly all of the asthma surveillance literature focuses on national-, regional-, or state-based estimates of prevalence, health-care utilization (specifically hospitalizations, emergency department, and ambulatory care visits), and mortality. Although these are important events, they reveal little about asthma's impact at the community level and provide little information that could be used to design specific interventions for improving clinical outcomes. A useful representation of asthma care across a community could guide an effective community response to the burden of asthma. The goal of the Chicago Asthma Surveillance Initiative (CASI) is to develop a community-wide surveillance program that characterizes and monitors asthma care in the Chicago area, beyond existing public health surveillance. To accomplish this, CASI surveyed Chicago-area hospitals, emergency departments, primary care physicians, specialty care physicians, pharmacists, managed care organizations, the general public, and persons or families affected by asthma to learn about asthma care and its outcomes. A variety of techniques (including brochures, slide kits, and the Internet) were used to achieve rapid public dissemination of study findings. The value of this comprehensive community-based data surveillance effort will rest on how the community uses this information to stimulate new efforts to improve asthma care and reduce untoward outcomes.

Asthma↗

PubMed2000

Trends in hospital readmission for asthma: has the Australian National Asthma Campaign had an effect?

OBJECTIVES: To describe patterns of hospital readmission for asthma in South Australia from 1989 to 1996, in relation to implementation of the National Asthma Campaign. DESIGN AND SETTING: A comparison of hospital admissions in South Australia of patients aged between one year and 49 years for three conditions: asthma (or respiratory failure with asthma as an underlying condition) and two control conditions--diabetes and epilepsy. Individuals were identified by Medicare number and date of birth. OUTCOME MEASURES: Hospital readmission within 28 days and within one year. RESULTS: Overall, by 1996, there was a statistically significant decline in the risk of readmission for asthma within 28 days of 18% and within one year of 17% compared with 1989 readmission rates. There were no reductions in the risk of readmission for diabetes or epilepsy, suggesting that the decline in risk of readmission for asthma was greater than the underlying effects of general changes in hospital casemix. CONCLUSIONS: The decline in risk of readmission may reflect changes in asthma severity or improved management practices. However, hospital readmission rates still remain high, and to further reduce readmissions for asthma there is a need to identify factors related to presentation for asthma at accident and emergency departments.

Adolescent↗

PubMed2006

Meta-analysis: effect of long-acting beta-agonists on severe asthma exacerbations and asthma-related deaths.

BACKGROUND: Long-acting beta-agonists may increase the risk for fatal and nonfatal asthma exacerbations. PURPOSE: To assess the risk for severe, life-threatening, or fatal asthma exacerbations associated with long-acting beta-agonists. DATA SOURCES: English- and non-English-language searches of MEDLINE, EMBASE, and Cochrane databases; the U.S. Food and Drug Administration Web site; and references of selected reviews through December 2005. STUDY SELECTION: Randomized, placebo-controlled trials that lasted at least 3 months and evaluated long-acting beta-agonist use in patients with asthma. All trials allowed the use of as-needed short-acting beta-agonists. DATA EXTRACTION: Outcomes measured were Peto odds ratio (OR) and risk difference of severe exacerbations requiring hospitalization, life-threatening exacerbations requiring intubation and ventilation, and asthma-related deaths. The OR for asthma-related deaths was obtained from the Salmeterol Multi-center Asthma Research Trial (SMART). DATA SYNTHESIS: Pooled results from 19 trials with 33 826 participants found that long-acting beta-agonists increased exacerbations requiring hospitalization (OR, 2.6 [95% CI, 1.6 to 4.3]) and life-threatening exacerbations (OR, 1.8 [CI, 1.1 to 2.9]) compared with placebo. Hospitalizations were statistically significantly increased with salmeterol (OR, 1.7 [CI, 1.1 to 2.7]) and formoterol (OR, 3.2 [CI, 1.7 to 6.0]) and in children (OR, 3.9 [CI, 1.7 to 8.8]) and adults (OR, 2.0 [CI, 1.1 to 3.9]). The absolute increase in hospitalization was 0.7% (CI, 0.1% to 1.3%) over 6 months. The risk for asthma-related deaths was increased (OR, 3.5 [CI, 1.3 to 9.3]), with a pooled risk difference of 0.07% (CI, 0.01% to 0.1%). LIMITATIONS: The small number of deaths limited the reliability in assessing this risk, and 28 studies did not report information on the outcomes of interest. CONCLUSIONS: Long-acting beta-agonists have been shown to increase severe and life-threatening asthma exacerbations, as well as asthma-related deaths.

Adrenergic beta-Agonists↗

PubMed1999

[Prevalence of diagnosed asthma in pediatric population of Asturia. Regional work group on infantile asthma in primary care of Asturia].

OBJECTIVE: The aim of this study was to know the prevalence of physician-diagnosed asthma and related epidemiological variable among children between 0 and 13 years of age in Asturias (Spain). PATIENTS AND METHODS: A population based prevalence study was performed. A team of 44 researches evaluated the clinical records of children living in 24 different healthcare zones of Asturias. The total number of children included in the study was 27,511. Asthma during the infant period (0-23 months) and preschool age (2-5 years) was defined according to clinical criteria and asthma during school age (6-13 years) was established according to clinical criteria and pulmonary function. Prevalence of physician-diagnosed asthma following these criteria, sex and age-class distribution and the prevalence of current asthma (presenting symptoms during the previous 12 months) were studied. The study is dated as of January 1, 1998. RESULTS: The child sample included in this study represents 23.9% of the Asturian pediatric population. Asthma was diagnosed in a total of 3,170 children, of these 243 were infants, 915 preschoolers and 2,012 were of school age. Asthma prevalence calculated over the whole pediatric population was 11.5% with a breakdown by age groups of 7.6% for infants, 13.5% for preschoolers and 11.5% for school age children. Of all asthmatic children, 73.3% were symptomatic during the previous year. Males represented 61.5% of all asthmatic children. CONCLUSIONS: 1. Asthma prevalence is high with this illness being the number one health problem in children in Asturias. 2. The highest percentage of children suffering from asthma experienced symptoms during the previous year. 3. A predominance of this disease in males was confirmed.

Adolescent↗

PubMed2000

Possible occupational asthma among adults presenting with acute asthma.

BACKGROUND: Little is known about the risk of occupational asthma or its causative agents in South Africa. The objective of this study was to determine the proportion of adult asthmatics whose asthma may be occupational, and the main agents or occupations involved. DESIGN AND SETTING: A descriptive surveillance study of adult patients presenting with acute asthma to the casualty units of two large public hospitals in Cape Town. METHODS: A brief questionnaire was completed by the casualty staff for a sample of 140 adult asthmatic patients. Respondents were classified as having possible occupational asthma on the basis of adult-onset asthma, exposure at time of onset to a known or suspected cause of occupational asthma, and symptoms that improved away from work. RESULTS: Eighteen patients (12.9%, 95% confidence interval (CI) 7.8-19.6%) met the criteria for occupational asthma. The main occupational categories in this group were spray painters (4 patients) and domestic workers (4 patients), with cleaning agents, dyes and paints being the most commonly reported exposures. A total of 36 patients (25.7%, 95% CI 18.7-33.7%) reported work aggravation of their asthma. CONCLUSIONS: A clinically significant proportion of adult-onset asthmatics, men and women, may have occupational causation, while an even larger proportion may have occupational aggravation. Since early intervention favourably influences prognosis in occupational asthma, all practitioners dealing with adult asthmatics should explore occupational factors.

Acute Disease↗

PubMed2004

Dental anxiety, dental health attitudes, and bodily symptoms as correlates of asthma symptoms in adult dental patients with asthma.

PURPOSE: The purpose of this study was to examine the relationship between asthma symptoms and dental anxiety, dental health attitudes, and physical symptoms and sensations such as watery eyes, upset stomach, headaches, and nausea in a group of adult dental patients with asthma. These variables are believed to be highly related to stress levels, which can exacerbate asthma symptoms during dental treatment. METHODS: Four self-report questionnaires and a demographic information form were completed by 60 adults with asthma in a waiting room of a private dental practice prior to receiving treatment. These instruments assessed dental anxiety, dental health attitudes, bodily symptoms, and asthma symptoms. Bivariate correlations were computed and tested for significance. They were followed by multiple regression analysis to analyze the relationship between the predictor variables-dental anxiety, dental health attitudes, and bodily symptoms, to the dependent variable-asthma symptoms. RESULTS: Pearson product correlations between the study variables revealed a statistically significant relationship between dental anxiety and bodily symptoms (r = 0.23, p < 0.05), and asthma symptoms and bodily symptoms (r = 54, p < 0.01). The analysis of variance indicated that the overall regression model (R2 = 30) was statistically significant (F(3,56) = 7.92, p < 0.01). Bodily symptoms was the only significant variable in the model. CONCLUSION: Dentists and dental hygienist should be attuned to adult patients who have asthma and exhibit signs of anxiety and/or other physical symptoms, or indicators of stress that can exacerbate asthma during or prior to dental treatment.

Adolescent↗

PubMed1992

Morbidity associated with asthma and audit of asthma treatment in out-patient clinics.

A study was undertaken to determine the extent of morbidity associated with asthma and to audit the management of asthma in two out-patient clinics of two district hospitals. Patients were recruited for the study during a 3-month period from December 1990 to February 1991. Seventy asthmatic patients were studied. Eighty-six percent of the patients had their sleep disturbed by asthma, 77% took daily medication regularly, 63% felt that their activities were restricted by asthma, 60% had at least one acute exacerbation in the preceding six months. Of those who had their peak expiratory flow rate (PEFR) measured, 40% had a PEFR below 50% predicted, and only 11% had normal PEFR (greater than 80% predicted). The morbidity of asthma was thus considerable. On the other hand, the drug treatment of these asthmatics was grossly inadequate. They were prescribed on average 2.1 item of drugs, which for most patients comprised an oral beta agonist and a theophylline. Only 43% of the patients received inhaler therapy, but no patients were given steroids, inhaled or oral. The drug treatment was unrelated to the severity of patients' asthma. Further, objective measurement of severity was under-used in the assessment of asthma, only 8.5% of patients ever had their PEFR recorded. This study has found that asthma is poorly managed in out-patient clinics. We need to improve the training of doctors in the optimal management of asthma.

Adolescent↗

PubMed2005

Asthma induced by isocyanates: a model of IgE-independent asthma.

Developments in the understanding of causes and natural history of asthma induced by isocyanates may allow improved preventive strategies for occupational asthma (OA), and may also lead to improved understanding of mechanisms involved in IgE-independent nonoccupational asthma. Studies of genetic markers in OA induced by isocyanates suggest that HLA class II genes, glutathione S-transferase and NAT1 genotypes may predispose to development of this type of OA. Specific IgE antibodies against isocyanates are not always found in subjects with OA caused by isocyanates, leading most researchers to consider this type of OA, as a model of IgE-independent asthma. Evidence for cell-mediated immunity in OA induced by isocyanates has been provided by bronchoalveolar lavage, bronchial biopsy and induced sputum studies. The pathology of this type of asthma is similar to that of nonoccupational asthma, with cells such as eosinophils and T lymphocytes that exhibit signs of activation, and with thickening of the reticular layer of the basement membrane. Animal studies have shown that isocyanate asthma is driven primarily by CD4+ T cells and is dependent upon the expression of Th2 cytokines. However, animal models are not always reflective of human responses. OA induced by isocyanates similarly to nonoccupational asthma, is a multifactorial condition, and it is likely that complex gene-environment interactions play a role. Better understanding of these interactions is important for affected workers, and also has potential relevance for nonoccupational asthma.

Animals↗

PubMed1998

Worldwide variation in prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema: ISAAC. The International Study of Asthma and Allergies in Childhood (ISAAC) Steering Committee.

BACKGROUND: Systematic international comparisons of the prevalences of asthma and other allergic disorders in children are needed for better understanding of their global epidemiology, to generate new hypotheses, and to assess existing hypotheses of possible causes. We investigated worldwide prevalence of asthma, allergic rhinoconjunctivitis, and atopic eczema. METHODS: We studied 463,801 children aged 13-14 years in 155 collaborating centres in 56 countries. Children self-reported, through one-page questionnaires, symptoms of these three atopic disorders. In 99 centres in 42 countries, a video asthma questionnaire was also used for 304,796 children. FINDINGS: We found differences of between 20-fold and 60-fold between centres in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema, with four-fold to 12-fold variations between the 10th and 90th percentiles for the different disorders. For asthma symptoms, the highest 12-month prevalences were from centres in the UK, Australia, New Zealand, and Republic of Ireland, followed by most centres in North, Central, and South America; the lowest prevalences were from centres in several Eastern European countries, Indonesia, Greece, China, Taiwan, Uzbekistan, India, and Ethiopia. For allergic rhinoconjunctivitis, the centres with the highest prevalences were scattered across the world. The centres with the lowest prevalences were similar to those for asthma symptoms. For atopic eczema, the highest prevalences came from scattered centres, including some from Scandinavia and Africa that were not among centres with the highest asthma prevalences; the lowest prevalence rates of atopic eczema were similar in centres, as for asthma symptoms. INTERPRETATION: The variation in the prevalences of asthma, allergic rhinoconjunctivitis, and atopic-eczema symptoms is striking between different centres throughout the world. These findings will form the basis of further studies to investigate factors that potentially lead to these international patterns.

Adolescent↗

PubMed1955