The paediatric asthma management plan: a guide for nursing children with asthma. National Asthma Campaign of the Thoracic Society of Australia and New Zealand.
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Asthma↗
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Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
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[Studies on the mechanism of developing bronchial asthma due to Candida albicans. 5. A comparative study of the mechanisms producing bronchial asthma among Candida, other molds and house dust-induced asthma].
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Allergens↗
Serum enzymes in patients with asthma and emphysema. 3. The prognosis of asthma patients with elevated blood enzyme values in connection with their asthma.
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Aged↗
[Asthma is asthma, is asthma...].
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Administration, Inhalation↗
How asthma friendly is your school? National Heart, Lung, and Blood Institute. National Asthma Education and Prevention Program. School Asthma Education Subcommittee.
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Adolescent↗
Poor perceptions and expectations of asthma control: results of the International Control of Asthma Symptoms (ICAS) survey of patients and general practitioners.
AIMS: To assess current levels of asthma control and to identify barriers to optimal asthma management. METHODS: A survey was conducted of 802 asthma patients (via computer-aided telephone interviewing) and 809 general practitioners (GPs; via the internet) from the UK, Italy, France, Germany, Spain, Canada and Australia. RESULTS: Over three-quarters (82%) of patients surveyed reported an absence of asthma control, with the vast majority (80%) experiencing subsequent lifestyle restrictions. Although most (58%) GPs questioned believed that total asthma control was possible, half (52%) agreed that their patients were not achieving best possible asthma control. CONCLUSIONS: Action is required to encourage patients to view their asthma more seriously and to be more proactive in reporting symptoms to their GP. These actions, coupled with greater prompting of patients by GPs about their asthma, should help to optimize asthma management.
Journal Article↗
A population-based prescription study of asthma drugs during pregnancy: changing the intensity of asthma therapy and perinatal outcomes.
BACKGROUND: Among the goals of gestational asthma, therapy is optimisation of pulmonary function. According to the US Food and Drug Administration, no asthma drugs can be considered 'safe' during pregnancy. Fear of adverse fetal effects may thus lead to restrictive use of asthma drugs during pregnancy, and no population-based studies concerning gestational asthma therapy exist. OBJECTIVES: To examine whether asthma drugs or changing intensity of asthma therapy during pregnancy was associated with deviations from expected values of gestational age, birth weight, length at birth, or malformations. METHODS: The Birth Registry was used to identify all 15,756 primiparous women who gave birth in the County of North Jutland between 1991 and 1996. According to the North Jutland Prescription Database, 303 of these women received prescriptions for asthma drugs during pregnancy. Women who did not purchase any prescription drugs during pregnancy constituted the reference group. CONCLUSION: Women who received prescriptions for asthma drugs during pregnancy gave birth to infants with birth weight and length at birth within the expected limits. Reducing intensity of asthma treatment during pregnancy was associated with lower birth weight and length at birth. This may indicate that pregnant women chose to discontinue therapy although their disease severity justifies continuation of treatment. However, analyses did not take into account important clinical variables, and results could also be due to confounding factors or chance.
Adult↗
Inhaled beta-agonists for asthma in mechanically ventilated patients.
BACKGROUND: A small number of patients with acute severe asthma require intubation and positive pressure ventilation. The beneficial effects of inhaled bronchodilators on acute asthma in spontaneously breathing subjects are well established, but there remain important questions regarding inhaled beta2-agonists, for patients who are intubated and receiving ventilation. OBJECTIVES: To determine the effects of inhaled beta-agonists on asthmatic patients who require intubation and mechanical ventilation. SEARCH STRATEGY: Randomised controlled trials were sought from the Cochrane Airways Group Asthma Register. Primary authors and content experts were contacted to identify eligible studies and bibliographies from known reviews and texts were searched. SELECTION CRITERIA: Randomised, controlled clinical trials involving adult patients with acute asthma, who were intubated and supported with positive pressure ventilation. Studies were to be included if patients were treated with beta2-adrenergic agonist agents and there was a comparator group treated with either placebo, no medication, or 'standard' treatment. DATA COLLECTION AND ANALYSIS: Two reviewers independently examined all identified articles. The full text of any potentially relevant article was reviewed independently by two reviewers. MAIN RESULTS: The search yielded 152 abstracts. Of these, four articles were identified as potential trials. None of the four trials met the inclusion criteria for the review. REVIEWER'S CONCLUSIONS: There are no data from randomised controlled trials to provide evidence for or against current practices regarding the use of inhaled beta2-agonists in asthmatic subjects who are intubated and ventilated.
Acute Disease↗
Severe asthma: lessons from the Severe Asthma Research Program.
Severe asthma affects only a small percentage of the asthma population. However, these patients remain poorly understood and difficult to treat. Because the numbers are relatively small (10% or less of the asthma population), a network approach with shared protocols, samples, and data provides a unique opportunity to recruit the numbers of subjects necessary to perform adequately powered studies. The Severe Asthma Network (Severe Asthma Research Program) was established by the National Heart, Lung, and Blood Institute in 2001 to advance collectively the study of severe asthma to determine factors that differentiated these patients or subjects from those with milder asthma. Nearly 800 subjects have been recruited in less than 4 years to begin to address these differences. Future studies will specifically evaluate the role of inflammatory/oxidative processes, infection, genetics, and the distal lung in the pathogenesis of severe asthma.
Asthma↗
Sex differences among adults presenting to the emergency department with acute asthma. Multicenter Asthma Research Collaboration Investigators.
BACKGROUND: Asthma is an increasing problem worldwide, particularly among women. Sex differences in acute asthma presentation, management, or outcome would have important medical and economic implications. OBJECTIVE: To compare emergency department (ED) visits for acute asthma among women vs men. METHODS: We performed a prospective cohort study as part of the Multicenter Asthma Research Collaboration. Patients in the ED, aged 18 to 54 years, who presented with acute asthma underwent a structured interview in the ED and another by telephone 2 weeks later. The study was performed at 36 EDs in 18 states. Pregnant women with asthma were excluded (n=53). RESULTS: Of 1228 patients, 64.3% were women. Women did not differ significantly from men by age or education level, but women were more likely to be insured, have a primary care provider, and use inhaled corticosteroids. Women had a higher mean+/-SD peak expiratory flow rate than men, both early (expressed as percent predicted) (53%+/-21% vs 41%+/-18%; P<.001) and late (77%+/-24% vs 65%+/-21%; P<.001) in the ED stay. Despite this, women were more likely to be admitted to a hospital (multivariate odds ratio, 2.2; 95% confidence interval; 1.3-4.0) than men. At 2-week follow-up, women had not experienced more relapse events (odds ratio, 1.1) but were 1.5 times more likely to report an ongoing exacerbation (95% confidence interval; 1.0-2.4). CONCLUSIONS: Of adults who presented to the ED with acute asthma, women were almost twice as common as men. Although men received less outpatient care and had worse pulmonary function, women were more likely to be admitted to the hospital and to report an ongoing exacerbation at follow-up. Further studies are needed to better understand the complex relationship between sex and acute asthma.
Acute Disease↗
Prevalence of asthma among Qatari schoolchildren: International Study of Asthma and Allergies in Childhood, Qatar.
The aim of the present study is to determine the prevalence of asthma and allergic diseases among schoolchildren aged 6-14 years in the State of Qatar, based on a questionnaire designed by the International Study of Asthma and Allergy in Childhood (ISAAC). A cross-sectional study of 3,283 school children living in both urban and rural areas (average age, 9.03 +/- 1.99 years; 52.3% boys and 47.7% girls) was conducted between February 2003-February 2004. The population sample had a high prevalence of diagnosed asthma (19.8%), allergic rhinitis (30.5%), eczema (22.5%), and chest infection (11.9%). The frequency of asthma, allergic rhinitis, and eczema among parents reflected the same pattern as seen in their children. Overall, males had more asthma, allergic rhinitis, and chest infections than females. In general, the prevalence rate of asthma and allergic rhinitis decreased with age. The prevalence rate of asthma was significantly higher in mothers (11.8%) than in fathers (9.0%), but the frequency of allergic rhinitis symptoms was comparable (mothers, 18.5%; fathers, 17.5%). The prevalence rate of asthma (19.8%) in Qatari schoolchildren is very close to that in the neighboring Gulf country, Oman (20.7%), and higher than in some developing countries. Genetic factors related to the high rates of consanguinity may play an important role in the high prevalence rates noted in the Qatari population, but changes in lifestyle and environmental factors cannot be discounted as possible causes of the high prevalence noted in this study.
Adolescent↗
Eosinophils, T-lymphocytes, mast cells, neutrophils, and macrophages in bronchial biopsy specimens from atopic subjects with asthma: comparison with biopsy specimens from atopic subjects without asthma and normal control subjects and relationship to bronchial hyperresponsiveness.
Bronchial biopsy specimens were obtained by fiberoptic bronchoscopy from 21 atopic subjects with asthma, 10 atopic subjects without asthma, and 12 normal healthy control subjects. With immunohistochemical techniques and a panel of monoclonal antibodies, inflammatory cells were identified and counted in the bronchial mucosa. The mean number of leukocytes (CD45+) and T-lymphocytes (CD3+, CD4+, and CD8+) at two airway levels in the subjects with asthma tended to be higher than in the other groups, but this difference did not achieve statistical significance. Similarly, there were no significant differences in the numbers of mucosal-type or connective tissue-type mast cells, elastase-positive neutrophils, or Leu-M3+ cells in the airway mucosa of subjects with asthma compared with atopic subjects without asthma and healthy control subjects. In contrast, significantly more interleukin-2 receptor-positive (CD25+) cells and "activated" (EG2+) eosinophils (EOSs) were present in the airways of subjects with asthma at both proximal and subsegmental biopsy sites. When the relationships between numbers of T-lymphocytes, activated (CD25+) cells, and EOSs were analyzed, there were positive correlations between CD3 and EG2, between CD3 and CD25, and between CD25 and EG2 positive cells in the airways of subjects with asthma. Furthermore, the ratio of EG2+ to CD45+ cells correlated with the provocative concentration of methacholine that caused a 20% decrease of FEV1 in hyperresponsive subjects. Although these associations do not prove a causal relationship, the results support the hypothesis that activated (CD25) T-lymphocytes release products which regulate recruitment of EOSs into the airway wall. In addition, our findings suggest that, in the large airways at least, asthma is not associated with hyperplasia of either mucosal-type or connective tissue-type mast cell.
Adult↗
Relationships among numbers of bronchoalveolar lavage cells expressing messenger ribonucleic acid for cytokines, asthma symptoms, and airway methacholine responsiveness in atopic asthma.
BACKGROUND: We recently demonstrated that T lymphocytes in bronchoalveolar lavage (BAL) fluid from atopic asthmatic patients were activated and expressed increased cytokine messenger ribonucleic acid (mRNA) for "TH2-type" cytokines, particularly IL-4 and IL-5, when compared with those in normal control subjects. This pattern of cytokines may determine the nature of the cellular infiltrate in the bronchial mucosa in asthma and hence the bronchial hyperresponsive (BHR) and symptoms that characterize this condition. METHODS: To examine the association between these cytokines and clinical measures of asthma severity we have extended our studies of BAL cells from subjects with atopic asthma. Numbers of BAL cells with positive in situ hybridization signals for IL-2, IL-3, IL-4, IL-5, granulocyte macrophage colony-stimulating factor (GM-CSF), and interferon-gamma were counted on cytocentrifuge preparations. Results were compared between patients with symptomatic (n = 19) and asymptomatic asthma (n = 10), and associations were sought with airway methacholine responsiveness, resting airway caliber, and asthma symptom scores. RESULTS: There were increased proportions of cells positive for IL-3 (p < 0.05), IL-4 (p < 0.005), IL-5 (p < 0.005), and GM-CSF (p < 0.005) mRNA in BAL fluid from patients with symptomatic asthma when compared with that from subjects free of symptoms, but no difference between the groups in numbers of cells expressing IL-2 and interferon-gamma mRNA. There were significant associations among numbers of cells expressing mRNA for IL-4, IL-5, and GM-CSF, and airflow restriction, BHR, and Aas asthma score. CONCLUSIONS: These findings support the hypothesis that cytokines contribute to airway events that determine asthma symptoms and BHR.
Adult↗
Short-term and long-term asthma control in patients with mild persistent asthma receiving montelukast or fluticasone: a randomized controlled trial.
PURPOSE: To determine whether montelukast is as effective as fluticasone in controlling mild persistent asthma as determined by rescue-free days. SUBJECTS AND METHODS: Participants aged 15 to 85 years with mild persistent asthma (n = 400) were randomized to oral montelukast (10 mg once nightly) or inhaled fluticasone (88 mug twice daily) in a year-long, parallel-group, multicenter study with a 12-week, double-blind period, followed by a 36-week, open-label period. RESULTS: The mean percentage of rescue-free days was similar between treatments after 12 weeks (fluticasone: 74.9%, montelukast: 73.1%; difference = 1.8%, 95% confidence interval [CI]: -3.2% to 6.8%) but not during the open-label period (fluticasone: 77.3%, montelukast: 71.1%; difference = 6.2%, 95% CI: 0.8% to 11.7%). Although both fluticasone and montelukast significantly improved symptoms, quality of life, and symptom-free days during both treatment periods, greater improvements occurred with fluticasone in lung function during both periods and in asthma control during open-label treatment. Post hoc analyses revealed a difference in rescue-free days favoring fluticasone in participants in the quartiles for lowest lung function and greatest albuterol use at baseline. CONCLUSION: In patients with mild persistent asthma, rescue-free days and most asthma control measures improved similarly with fluticasone or montelukast over the short term, but with prolonged open-label treatment, asthma control improved more with fluticasone. Improved asthma control with fluticasone appeared to occur in those with decreased lung function and greater albuterol use at baseline. In the remaining patients, the two treatments appeared to be comparable. These results suggest that classification criteria for mild persistent asthma may need to be re-evaluated.
Acetates↗
Aspirin sensitivity and severity of asthma: evidence for irreversible airway obstruction in patients with severe or difficult-to-treat asthma.
BACKGROUND: Patients with aspirin sensitivity experience hyperplastic sinusitis and nasal polyposis. We speculated that similar mechanisms could be acting in the lower airway and that these individuals would demonstrate more severe asthma and irreversible loss of lung function. OBJECTIVE: We sought to investigate the role of aspirin-exacerbated respiratory disease (AERD) as a risk factor for the development of irreversible airway obstruction. METHODS: The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens (TENOR) study is a multicenter observational study of subjects with severe or difficult-to-treat asthma. Data were compared between subjects who reported asthma exacerbation after aspirin ingestion and those who did not. The primary measure of bronchodilator-resistant obstruction (possible remodeling) was the maximally achieved postbronchodilator spirometry averaged over the 3-year duration of the study. RESULTS: Adult subjects (>/=18 years) with AERD (n = 459) were compared with subjects with non-aspirin-sensitive asthma (n = 2848). Subjects with AERD had significantly lower mean postbronchodilator percent predicted FEV(1) compared with subjects with non-aspirin-sensitive asthma (75.3% vs 79.9%, P < .001). Differences in spirometry between the 2 cohorts persisted after controlling for potential confounding variables. In addition, subjects with AERD were more likely to have severe asthma by means of physician assessment (66% vs 49%, P < .001), to have been intubated (20% vs 11%, P < .001), to have a steroid burst in the previous 3 months (56% vs 46%, P < .001), and to have required high-dose inhaled corticosteroids (34% vs 26%, P < .001). CONCLUSIONS: These data suggest that aspirin sensitivity is associated with increased asthma severity and possible remodeling of both the upper and lower airways.
Adolescent↗
Effect of asthma intervention on children with undiagnosed asthma.
OBJECTIVE: To measure the effect of an asthma intervention on the functional status and morbidity of children with undiagnosed asthma. STUDY DESIGN: Data from a randomized trial were used to compare outcomes at baseline and follow-up for children with undiagnosed and diagnosed asthma. We studied 510 symptomatic children with diagnosed asthma (diagnosed) and 299 children with symptoms but no diagnosis (undiagnosed). Baseline functioning and morbidity were similar for undiagnosed and diagnosed patients classified as moderate-severe. RESULTS: There were fewer undiagnosed reported allergies, seasonal symptoms, and other respiratory diagnoses (all P < 0.01). Among the moderate-severe, functional status, for example, symptom-days ( P = .02), symptom-nights ( P < .01), and days of restricted activity ( P < .01), was significantly reduced at follow-up for the undiagnosed in the intervention group but not for undiagnosed control subjects. Findings were similar for children with diagnosed asthma. CONCLUSIONS: Children with undiagnosed asthma were generally nonatopic, although some had symptoms at a level comparable to children with a diagnosis. The intervention successfully improved functional status for children with undiagnosed asthma as well as for children with diagnosed asthma. These results can be applied to ongoing discussions related to case detection.
Absenteeism↗
What lies behind relief and worsening of asthma symptoms? A register-based study of adults with asthma and other chronic obstructive pulmonary diseases in Finland.
AIMS: To examine how subjects with relief or worsening of asthma symptoms differ in terms of gender, age, severity and duration of asthma, comorbidity, and difficulties with medication and daily life. METHODS: A postal inquiry among a sample of 6000 adults with clinically diagnosed asthma and/or other chronic obstructive pulmonary diseases. RESULTS: Relief of asthma symptoms over a 12-month period was associated with a recent asthma diagnosis, within five years, in both sexes. Lack of current smoking and lack of problems in using anti-asthmatic treatment were associated with a positive outcome in men, and mild asthma and living alone associated with a positive outcome in women. Severe and moderate asthma predicted worse symptoms in both sexes, as did other obstructive pulmonary diseases, living alone, and medication problems amongst men. CONCLUSIONS: Patients with asthma should be cared for comprehensively, requiring consideration of both clinical and psychosocial factors that can modify the course of the disease.
Adolescent↗
Effects of anti-asthma therapy on dyspnea perception in acute asthma patients.
Blunted perception of dyspnea may predispose patients to fatal asthma attacks. To examine whether this impaired perception of dyspnea in patients with acute asthma could be corrected by anti-asthma therapy, the medical records of 104 consecutive asthma patients who had been hospitalized as a result of asthma attacks were analyzed retrospectively. During the course of treatment with conventional asthma medications, the forced expiratory volume in 1s (FEV1) and the Borg scale-based dyspnea perception scores during breathing through an inspiratory muscle trainer were measured at least twice. The baseline Borg score measured just before discharge was significantly lower than from that measured initially, regardless of improvement in FEV1. In contrast, the Borg score at the highest resistance (HR; 3.12+/-0.26 vs. 5.03+/-0.53; P<0.01) and the HR-induced DeltaBorg score (1.68+/-0.20 vs. 4.47+/-0.54, P<0.001) were increased significantly in the Poor Perceivers (Borg score 5 at HR and HR-induced DeltaBorg score 3). Patient age (r=0.363, P<0.001), blood eosinophil counts (r=-0.285, P<0.01), and serum total IgE levels (r=-0.213, P<0.05), but not FEV1, were significantly related to the effect of the treatment on the HR-induced DeltaBorg scores. These findings suggest that anti-asthma treatments decrease dyspnea even without a concomitant improvement in lung function and correct the impaired perception of inspiratory resistive load in acute asthma, and that age and allergy influence the effect of treatment on impaired perception.
Acute Disease↗