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PubMed1999

[European Asthma Study. Identifying and treating young adults with epidemiological criteria for asthma in five areas of Spain. Spanish Group of the European Asthma Study].

BACKGROUND AND OBJECTIVES: Asthma's great impact on public health stems from its chronicity and to high prevalence among all age groups and both sexes. To estimate the appropriateness of treatment and management of asthma in Spain during the period of 1991 and 1992, we analyzed data from the European Community Respiratory Health Survey (ECRHS). METHOD: The ECRHS was undertaken with a random sample of 20-to-44-year-olds in Albacete, Barcelona, Galdakao, Huelva and Oviedo. In total, 181 individuals with asthma were identified. Current asthma was defined as the presence of respiratory symptoms associated with asthma within the past 12 months and a positive methacholine challenge test. RESULTS: Subjects who were unaware of having asthma made up 57.5% (CI: 49.9-64.8%), and 35.9% (CI: 27.9-42.3%) were not following any specific treatment. Among asthmatics who reported having continuous or frequent respiratory symptoms, 25.9% (CI: 15.3-39.0%) were not following any treatment. CONCLUSION: Over half the individuals with asthma in 1991 to 1993 were unaware of having the disease at the time of the study or of ever having had it, and approximately one third were not in treatment. The delivery of appropriate treatment in asthma generally, and in asthma with continuous or frequent respiratory symptoms, was markedly inadequate during the period studied.

Adult↗
PubMed2003

Geographical variations of asthma and asthma symptoms among schoolchildren aged 5 to 8 years and 12 to 15 years in Palestine: the International Study of Asthma and Allergies in Childhood (ISAAC).

BACKGROUND: Many studies demonstrated the existence of geographic differences, within and between countries, in the prevalence of asthma, rhinitis, and eczema. However, in Palestine, there are no comprehensive Palestinian data to compare with those from other regional and international centers. OBJECTIVE: To describe the prevalence of asthma and asthma symptoms in schoolchildren in two districts (Ramallah and North Gaza) in Palestine. METHODS: After a two-stage stratified systematic sampling, approximately 14,500 schoolchildren, from the first and second grades of elementary school (ages 5 to 8 years) and eighth and ninth school grades (ages 12 to 15 years), were invited to participate in a survey using International Study of Asthma and Allergies in Childhood phase III questionnaires and protocols. RESULTS: In general, younger children were reported to have a higher 12-month wheezing prevalence rate than older children (9.6 and 7.2%, respectively), and more physician-diagnosed asthma (8.4 and 5.9%, respectively). However, nocturnal cough and exercise-related wheezing were higher in the older age group compared with younger children. Younger children living in North Gaza district showed slightly higher prevalence rates for asthma and asthma symptoms, but older children had higher rates in Ramallah district. After adjustment using logistic regression analysis, male sex, living in inland areas, and younger age were shown to predict 12-month wheezing and physician-diagnosed asthma. CONCLUSIONS: Palestinian children have asthma symptoms rates that are similar to several countries in the Mediterranean region such as Spain and Turkey, but still lower than other Middle East countries such as Saudi Arabia and Israel.

Adolescent↗
PubMedDate not supplied

Impact of changes in asthma severity on health-related quality of life in pediatric and adult asthma patients: results from the asthma outcomes monitoring system.

The goals of asthma treatment have broadened beyond managing traditional clinical markers of disease severity, and now include a focus on benefits of treatment in terms that are most meaningful to patients. Measurement of both generic and disease-specific health-related quality of life (HQL) is advocated because each provides complementary information about how the condition affects everyday functioning and well-being and whether treatments have their intended effects. The purpose of this study was to determine the impact of changes in asthma severity (defined using NHLBI/NAEPP severity staging) on patient-assessed HQL. Two hundred and thirty-three pediatric asthma patients and 269 adult asthma patients were evaluated in a one-year observational study. Analyses were performed to compare the generic and asthma-specific scores for patients whose asthma severity improved, stayed the same, or worsened over one year. The asthma-specific scales are sensitive to changes in disease severity. Of the generic scales, those tapping areas of physical health are more affected than the mental/emotional scales. This confirms that HQL measures are responsive to changes in asthma severity. They complement traditional clinical markers used to evaluate changes in a patient's disease state and thus give the physician another useful tool in following the clinical progress of the child with asthma.

Adult↗
PubMed2000

Asthma in adults: comparison of adult-onset asthma with childhood-onset asthma relapsing in adulthood.

The prevalence of asthma in children and young adults is rising. Although the general features of asthma are similar in children and adults, there are several differences. Studies of the differences between childhood- and adult-onset asthma may provide new insight into the phenotypic heterogeneity of asthma. The aim of this cross-sectional study was to compare the characteristics of asthmatic adults who reported having (n = 84) or not having (n = 235) asthma in childhood. The participating patients were recruited by chest specialists throughout France and were examined from March to November 1995. The specialists completed a standardized questionnaire, and carried out a clinical examination and spirometric tests. Male sex; greater severity, particularly lower spirometry values related to small airways; greater severity and earlier onset of allergy; and maternal history of atopic dermatitis and perennial rhinitis were found to be associated with reported childhood asthma. This study exhibits highly internally consistent results and indicates that subjects who did have childhood asthma and relapse in adulthood appeared to have a potentially more severe form of asthma.

Adult↗
PubMed1999

The outcome of asthma related to workplace irritant exposures: a comparison of irritant-induced asthma and irritant aggravation of asthma.

STUDY OBJECTIVES: (1) To characterize workers' compensation claims accepted on the basis of new-onset asthma associated with accidental high respiratory irritant exposure at work; (2) to compare the frequency, characteristics, and outcomes in this group of workers to workers who were compensated for an exacerbation of preexisting asthma associated with accidental high respiratory irritant exposure at work. DESIGN: A retrospective review was performed of 469 asthma claims accepted by the Ontario Workers' Compensation Board (WCB) between 1984 and 1988. Among these, claims attributed to an accidental high respiratory irritant exposure at work were classified into two groups: one group with reported preexisting asthma prior to the exposure (accidental aggravation of asthma [AAA]) and another group with no previous history of asthma (irritant-induced asthma [IIA]). RESULTS: Of the 469 claims, 89 subjects (19%) had symptoms related to accidental high respiratory irritant exposure in the workplace; of these, 68 subjects (76%) had AAA, 12 subjects (13%) had IIA, and 9 subjects (10%) had possible IIA but were excluded from the analysis because of insufficient data. Those with IIA had a longer duration of work-attributed symptoms (mean, 219 +/- 208 days) than the subjects with AAA (mean, 32 +/- 38 days; p < 0.001). Nine subjects (75%) with IIA were no longer in the same work environment, while 47 subjects in the AAA group (71%) were still in the same work environment (p < 0.001). The most common triggering agent for subjects with IIA was an isocyanate spill; for those with AAA, the most common triggering agent was paint. CONCLUSIONS: The WCB-accepted claims related to accidental, high respiratory irritant exposure at work are more commonly assigned to the category of AAA than to IIA. IIA patients in this claimant group had a longer mean duration of work-attributed respiratory symptoms, perhaps due to a need for a larger (and thus less common) irritant exposure to induce asthma in previously normal subjects.

Adult↗
PubMed2001

International Study of Asthma and Allergies in Childhood (ISAAC): prevalence of asthma and asthma-related symptoms among Brazilian schoolchildren.

We have studied the prevalence of asthma and its symptoms using a standard written questionnaire (WQ) designed for the International Study of Asthma and Allergies in Children (ISAAC). The WQ (questions 1 through 8 related to asthma) was applied to 13,604 children aged 6-7 years from six Brazilian cities: Porto Alegre (South, N = 2,976), Curitiba (South, N = 1,664), São Paulo (Southeast, N = 3,005), Uberlândia (Southeast, N = 3,002), Itabira (Southeast, N = 1,551) and Recife (Northeast, N = 1,406). At the age of 13-14 years the WQ was applied to 20,554 schoolchildren living in Porto Alegre (South, N = 3,198), Curitiba (South, N = 3,008), São Paulo (Southeast, N = 3,008), Uberlândia (Southeast, N = 3,001), Itabira (Southeast, N = 2,134), Salvador (Northeast, N = 3,119) and Recife (Northeast, N = 3,086). The parents of the younger children answered the WQ, whereas the adolescents answered the questionnaire themselves. The response rates were 72% and 93% for the 6-7-year-old children and for the 13-14-year-old children, respectively. There was a slight predominance of male children in the population studied. In the group of 6-7-year-olds, the prevalence of physician diagnosed asthma was 7.3% for boys and 4.9% for girls: in the group of 13-14-year-olds the rates were 9.8% and 10.2%, respectively. Asthma severity was similar for both age groups, and wheezing following exercise was more frequent among the adolescents. In keeping with studies from other parts of the world, comparison between reported symptoms and diagnosed asthma revealed a significantly lower frequency of diagnosed asthma, suggesting that in the study population, asthma is underdiagnosed.

Adolescent↗
PubMed1995

[The European Asthma Study. The prevalence of asthma-related symptoms in 5 Spanish areas. The Spanish Group of the European Asthma Study].

BACKGROUND: The European Study of Asthma was designed to study the variability of the prevalence of asthma in Europe. The aim of the present paper was to report the results obtained on the participation and prevalence of symptoms related to asthma in 5 Spanish areas: Albacete, Barcelona, Galdakao, Huelva and Oviedo. METHODS: A sample population of 16,884 individuals between 20-44 years of age was studied with a questionnaire adapted from the International Union Against Tuberculosis and Lung Disease. RESULTS: Response was obtained from 14,269 (84.5%) individuals. The frequency of symptoms related to asthma over the last year varied widely from area to area. Night attacks of shortness of breath varied from 3.6% to 11.6%; asthma attacks from 1.4% to 3.4%; medication for asthma from 1.2 to 5.6%. The global frequency of these symptoms in men and women respectively was 4.9% and 5.0% in Galdakao, 6.3% and 6.6% in Barcelona, 9.4% and 9.3% in Oviedo, 10.7% and 9.1% in Albacete and 14.3% and 14.9% in Huelva. With regard to the remaining symptoms, night attacks of coughing and wheezing were of note because of their high prevalence ranging, according to areas, from 24.6% and 36.0% and 13.3% and 33.7%, respectively. CONCLUSIONS: This is the first providing population data on the prevalence of symptoms related to asthma in adults in Spain. The global prevalence of symptoms varied from 4.9% to 14.3% in men and 5.0% to 14.9% in women. Although posterior analysis based on atopy data and bronchial hyperreactivity will allow better interpretation of these prevalence rates, they suggest that asthma is a frequent disease in individuals from 20 to 44 years of age in Spain.

Adult↗
PubMed1990

Alpha- and beta-adrenergic-receptor systems in bronchial asthma and in subjects without asthma: reduced mononuclear cell beta-receptors in bronchial asthma.

We assessed the adrenergic-receptor system in individuals with bronchial hyperreactivity, beta-Adrenergic receptors on mononuclear cell membranes, alpha-adrenergic receptors on platelet membranes, and the cAMP response in these cell types to different stimuli, including platelet-activating factor (PAF), were determined. Studies were assessed in 10 subjects with mild asthma, six methacholine-sensitive subjects without asthma, and 10 normal subjects. The density and affinity of beta-receptors and alpha-receptors were determined by Scatchard analysis. Our findings were that (1) subjects with asthma had a significantly lower density of beta-receptors compared to normal subjects, (2) subjects with asthma had a significantly lower cAMP response to isoproterenol stimulation compared to the two other groups, (3) in subjects without asthma. PAF decreased the basal cAMP level and significantly inhibited the response to isoproterenol stimulation, (4) there was no difference in density and affinity of platelet alpha-receptors or in platelet cAMP responses to stimulation by alpha-agonists among these three groups, and (5) neither cAMP response or beta-receptor density on mononuclear cells were significantly correlated with pulmonary-function tests (FEV/FVC times 100), sensitivity to methacholine, or cold-air inhalation. These results suggest that patients with asthma may have a lower isoproterenol cAMP response and decreased density of beta-adrenergic receptors on mononuclear cells in the absence of beta-agonist therapy. It is speculated that release of PAF and other mediators secondary to allergen exposure, even in the absence of overt attacks of asthma, may inhibit the response to endogenous or exogenous beta-adrenergic agonists.

Adolescent↗
PubMed1994

Clinical features of adult-relapse asthma in comparison with those of child-onset asthma and adult-onset asthma.

Clinical features of adult-relapse asthma (group B, n = 15) were compared with those of child-onset asthma (group A, n = 18) and adult-onset asthma (group C, n = 34) in terms of allergic component and bronchial hypersensitivity. The percentage of patients with high levels of serum IgE (> 300 U/ml) in groups A, B, and C was 83%, 73%, and 50%, respectively, and the percentage of patients with positive IgE RAST for house dust was 87.5%, 78.6%, and 46.7%, and that for mite was 93.3%, 92.9%, and 58.6% in groups A, B, and C, respectively. The histamine concentration of PC20 for the bronchial hypersensitivity test in groups A, B, and C was 196 micrograms/ml, 500 micrograms/ml, and 724 micrograms/ml, respectively. Thus, the adult-relapse asthma was closer to the child-onset asthma type in allergic state and closer to the adult-onset asthma type in bronchial hypersensitivity state. The classification employed here seemed to provide some merits in delineating the features of adulthood asthma.

Administration, Inhalation↗
PubMed1993

[Occupational asthma: an experimental asthma. Apropos of isocyanate-induced asthma].

Isocyanate-induced occupational asthma is a model of experimental asthma related to the environment. Many of its features are identical with those of allergic asthma by sensitization to air-borne allergens. Exposure to isocyanate before the first symptoms of asthma varies from a few weeks to several years. The prevalence of isocyanate-induced asthma has been estimated at 5 to 25%. Atopy is found in less than 30% of the cases. A significant increase of HRBNS can be demonstrated in most patients, but it may be absent. It may also fluctuate with the working periods or after a bronchial provocation test with isocyanate. Elimination of this compound reduces the HRBNS level in only one quarter of the cases. Delayed or biphasic reactions are frequent: 30 to 60% depending of the authors. An early diagnosis followed by total elimination may result in complete cure, but more than 50% of the patients remain symptomatic and with HRBNS. An IgE-dependent mechanism can be demonstrated in about 20% of the cases. The course of isocyanate-induced asthma is interesting in that the same phenomena are probably observed in chronic asthma resulting from repeated exposures to environmental allergens.

Asthma↗
PubMed1999

Development of a survey of asthma knowledge, attitudes, and perceptions: the Chicago Community Asthma Survey. Chicago Asthma Surveillance Initiative Project Team.

Little is known about the general public's perception of the diagnosis of asthma and the impact of asthma on individuals, their families, and their communities. In addition, there appear to be no published survey instruments specifically designed to gain insights into how the general public perceives asthma. The purpose of this paper is to describe the development of such an instrument, the Chicago Community Asthma Survey (CCAS)-32. Development began with two qualitative steps. First, a review of the published literature guided the initial instrument construction (Step 1). Content domains were chosen based on clinical input and the Health Belief Model. Most items were derived from existing instruments. To assess content validity, cognitive interviews and expert reviews were conducted (Step 2). Items were added, modified, and deleted based on the information gathered at each of these steps. In the next step, item performance measurement (Step 3), testing of two samples provided quantitative data to further inform item reduction. Items with uniform correct responses or responses lacking in variability were excluded. The result of this three-step process was a 32-item survey of asthma knowledge, attitudes and perceptions, the CCAS-32. The introduction to the survey was subsequently modified to minimize respondent bias (Step 4). In conclusion, the CCAS-32 was constructed with input from experts in asthma and individuals from the Chicago area. The items in the CCAS-32 appear to have both face validity and acceptable performance characteristics.

Adolescent↗
PubMed2000

Asthma on the job: work-related factors in new-onset asthma and in exacerbations of pre-existing asthma.

Occupational asthma (OA) can be defined as variable airways narrowing causally related to exposure in the working environment to airborne dusts, gases, vapours or fumes. There are many agents in the work-place that can induce asthma or cause substantial deterioration in pre-existing asthma. It has been estimated that 5-15% of adult-onset asthma can be attributed to occupational exposures. Hence adult patients, especially those with new-onset asthma, must be investigated with regard to occupational risk factors for disease. The prognosis for OA is improved if the causal exposure is controlled either by controlling the exposure at the workplace or by moving the patient out of the workplace.

Acrylates↗
PubMed2002

Impact of montelukast on symptoms in mild-to-moderate persistent asthma and exercise-induced asthma: results of the ASTHMA survey. Adding Singulair Treatment to Handle symptoms in Mild to moderate Asthmatics.

A nation-wide survey was undertaken in Belgium among general practitioners (GPs) to evaluate the impact of the leukotriene receptor antagonist (LTRA) montelukast on the control of asthma symptoms, after at least 4 weeks of treatment. Patients from 6 years of age were eligible if they were suffering from mild-to-moderate persistent asthma which was still symptomatic despite inhaled corticosteroids (ICS) treatment, or from exercise-induced asthma. Patient general satisfaction was evaluated by recording the willingness to continue the treatment. A total of 1360 GPs took part in the study and more than 11000 patients were included in the survey. Of the included patients, 85% were receiving inhaled corticosteroids, 60% of whom were also on long-acting beta2-agonists (LABA). However, despite the use of daily controller medication, 92% of the patients still reported limitation of activities, 49% difficulties with sleep and 45% early morning awakening due to asthma. Moreover, 78% of the patients used rescue medication more than twice a week. At the end of the survey, 90% of the patients expressed their willingness to continue montelukast therapy. Of the patients having symptoms at the start of the study, 87% reported amelioration in sleep while on montelukast therapy, 80% less frequent early morning awakening, 85% better ability to perform daily activities and 77% decreased need for rescue medication.

Acetates↗
PubMed1998

The validity and reliability of an asthma knowledge questionnaire used in the evaluation of a group asthma education self-management program for adults with asthma.

This paper reports aspects of the validity and reliability of an asthma general knowledge questionnaire for adults (AGKQA), developed as one of the outcome measures for a randomized controlled effectiveness trial of an asthma education program for adults with asthma. It also illustrates how study data can provide a valuable, generally neglected opportunity to assess the validity and reliability of a measure where resources are not available for the extensive investigation of these properties prior to administration of the measure in a study. The AGKQA was demonstrated to have good content and face validity. Construct validity assessed using the principal components method for factor analysis suggested the scale was unidimensional. Criterion-related validity, assessed using the contrasted groups method, demonstrated a significant difference (p < 0.0001) in total score and for 68% of item responses for the adults with and without direct experience of asthma. The Kuder-Richardson 20 reliability coefficient for internal consistency calculated using responses at baseline, immediately, and 12 months post-intervention were, respectively, 0.56, 0.80, and 0.75, indicating excellent reliability. The AGKQA is an acceptably valid and reliable measure for the assessment of program content mastery that it was designed to test.

Adolescent↗
PubMed2000

Use of "preventer" medications and written asthma management plans among adults with asthma in New South Wales. NSW Health Department Asthma Data Working Group.

OBJECTIVES: (1) To measure the extent of use of preventer medications (ie, inhaled corticosteroids or cromones) and possession of written asthma management plans (AMPs) among people with asthma in New South Wales in 1997. (2) To assess factors associated with underuse of preventer medications and AMPs. DESIGN AND SETTING: A cross-sectional survey by computer-assisted telephone interviews of a stratified random sample of the adult population of New South Wales, Australia. PARTICIPANTS: People aged 16 to 54 years with asthma diagnosed by a doctor and causing symptoms or requiring treatment in the preceding year (n = 1,372). RESULTS: Although 55.2% of survey participants had used preventer medications in the preceding year, only 27.8% had used them regularly. Only 34.7% had a written AMP. Preventer medications were judged to be indicated for 54% of the study population, but only 42.5% of this group had used them regularly (43.1% had a written AMP). Younger adults were less likely to use preventer medications regularly, but there was no difference in use of preventer medications by sex, urban/rural residence, or manner of purchasing reliever medications (either on prescription or "over the counter"). Past smokers used preventers more commonly than current smokers, with never smokers having an intermediate prevalence of regular preventer use. Age, sex, urban/rural residence, and manner of purchasing reliever medications were not related to the possession of an AMP. CONCLUSION: Despite the trend towards increased use of preventer medications and written AMPs during the 1990s, undertreated asthma remains a major public health problem in Australia.

Adolescent↗
PubMed1993

Asthma in pregnancy. National Asthma Education Program Working Group on Asthma and Pregnancy. National Institutes of Health, National Heart, Lung and Blood Institute.

This manuscript is a summary of a comprehensive report dealing with asthma and pregnancy issued by the working group on Asthma and Pregnancy, National Institutes of Health (NIH), National Heart, Lung, and Blood Institute. The report was developed by a panel of obstetricians, pharmacologists, internists, allergists, and pulmonologists, who met over an 18-month period under the auspices of the NIH. Undertreatment of pregnant asthmatics, partially because of unfounded fears of adverse pharmacologic effects on the developing fetus, remains the major problem in the management of asthma during pregnancy in the United States. The four key components of asthma management during pregnancy are: 1) objective assessment of maternal lung function and fetal well-being, 2) avoidance or control of environmental precipitating factors, 3) pharmacologic therapy, and 4) patient education.

Asthma↗