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PubMed1997

Airways obstruction in patients with long-term asthma consistent with 'irreversible asthma'.

OBJECTIVE: To describe a series of eight patients with long-term asthma and pulmonary function consistent with "end-stage," irreversible obstruction. DESIGN: Retrospective descriptive analysis of patients with severe asthma. SETTING: A university-based allergy-immunology service with a large population of corticosteroid-dependent patients with asthma. PATIENTS: Eight patients with long-standing asthma and apparently irreversible airways obstruction despite long-term oral and inhaled corticosteroid therapy. MEASUREMENTS: Pulmonary function data, radiographic studies including chest radiograph and high-resolution CT of the chest, and serologic analysis to rule out allergic bronchopulmonary aspergillosis and alpha1-antitrypsin deficiency had been performed as indicated, and these results were obtained through chart review. RESULTS: The age of the patients ranged from 41 to 58 years, with a mean duration of asthma of 39 years (SD = 12.4 years). No patient had evidence of any other pulmonary disease process. The mean duration of daily or alternate-day oral corticosteroid treatment was 15.8 years (SD=11.8 years). Despite intensive pharmacotherapy, all patients had an FEV1 57% (42+/-12%) with marked small airways disease as reflected in the forced expiratory flow between 25% and 75% of the FVC. Three of the eight patients demonstrated an accelerated decline in FEV1 despite continuous systemic corticosteroids. CONCLUSIONS: We have described a series of eight patients with long-standing asthma who demonstrate irreversible airways obstruction despite long-term systemic and inhaled corticosteroids. The term "end-stage asthma" or irreversible asthma might be applied to these patients in whom fixed obstruction has occurred in the absence of other pulmonary diseases.

Adult↗
PubMed2003

Who gets diagnosed with asthma? Frequent wheeze among adolescents with and without a diagnosis of asthma.

OBJECTIVE: 1). To describe the factors associated with not receiving an asthma diagnosis among children with frequent wheezing symptoms and 2). to determine risk factors for frequent wheezing in the population. METHODS: The North Carolina School Asthma Survey provided self-reported questionnaire data on respiratory health from 122 829 children ages 12 to 18 years enrolled in 499 public middle schools in North Carolina during the 1999-2000 school year. Questions from the International Survey of Allergies and Asthma in Childhood were used to estimate the prevalence of asthma and wheezing-related illness and associated factors. RESULTS: Factors independently associated with undiagnosed frequent wheezing versus asymptomatic children included female gender (odds ratio [OR]: 1.45; 95% confidence interval [CI]: 1.35-1.54), current smoking (OR: 2.60; 95% CI: 2.43-2.79), exposure to household smoke (OR: 1.59; 95% CI: 1.50-1.70), low socioeconomic status (OR: 1.52; 95% CI: 1.42-1.63), and African American (OR: 1.25; 95% CI: 1.15-1.34), Native American (OR: 1.35; 95% CI: 1.11-1.62), and Mexican American (OR: 1.32; 95% CI: 1.17-1.48) race/ethnicity. Urban residence showed a weak negative association (OR: 0.91; 95% CI: 0.85-0.96). A similar pattern of results was observed for analyses comparing odds of undiagnosed frequent wheeze versus diagnosed asthmatics. Report of allergies was less likely in frequent wheezers (70%) compared with diagnosed asthmatics (86%), but much higher than in asymptomatic children (36%). Thirty-three percent of children with undiagnosed frequent wheezing reported 1 or more physician visits in the last year for wheezing or breathing problems compared with 71% of children with diagnosed asthma, and 4% in asymptomatic children. The prevalence of any inhaler use in the past 12 months was 12% for undiagnosed frequent wheezers versus 78% for diagnosed asthmatics. The proportion of undiagnosed frequent wheezers with fair or poor self-rated health (23%) was slightly higher than diagnosed asthmatics (20%) and much higher than asymptomatic children (4%). CONCLUSIONS: In one of the largest adolescent asthma surveys ever reported in the United States, undiagnosed frequent wheezing was independently associated with female gender, current smoking, exposure to household smoke, low socioeconomic status, allergies, and African American, Native American, and Mexican American race/ethnicity. Children with undiagnosed frequent wheezing were not receiving adequate health care for their asthma-like illness. Clinicians who treat adolescents should consider asking adolescents specifically about wheezing. This information may assist primary care physicians in identifying children with undiagnosed asthma in need of treatment.

Adolescent↗
PubMed2004

Community organization to reduce the need for acute care for asthma among African American children in low-income neighborhoods: the Neighborhood Asthma Coalition.

BACKGROUND: Low-income African Americans exhibit disproportionate prevalences, morbidity rates, and mortality rates for asthma. OBJECTIVE: To determine whether a community-based intervention, the Neighborhood Asthma Coalition (NAC), conducted through a well-established neighborhood organization in St. Louis could improve awareness of asthma, change attitudes about its care, improve asthma management practices, and reduce the need for acute care for asthma. METHODS: The NAC included educational programs for parents and children, promotional activities, and individualized support provided by trained neighborhood residents. African American children, 5 to 14 years of age, with at least 1 incident of acute care (emergency department visit or hospitalization) within the previous year were enrolled from 8 zip code areas with low-income residents and high proportions of Medicaid-eligible children, ie, 4 NAC neighborhoods and 4 comparable control neighborhoods. Evaluations included quarterly telephone interviews to assess asthma attitudes and management and sites of care. Audits of acute care sites covered 12 months before initiation of the NAC through 3 years of the program. RESULTS: A total of 371 patients were contacted and determined to be eligible for the study, and 345 agreed to participate, representing a recruitment rate of 93%. Of those, 15 withdrew and 24 were lost to follow-up monitoring after the initial contact. In addition, 57 were excluded from analysis because of relocation or for other reasons. Utilization data to determine rates of acute care (emergency department visits and hospitalizations) were collected for 249 patients (100 NAC subjects and 149 control subjects). Acute care rates decreased for both the NAC and control groups from the year before intervention to the last year of intervention, with no significant differences between the NAC and control groups. Participation in NAC programming affected the acute care outcome; the NAC-low participation and control groups did not differ but the NAC-high participation group differed significantly from the pooled control and NAC-low participation groups in reductions in acute care rates. Both contacts with NAC staff members and attendance at educational events were associated with changes toward stronger views that asthma can be managed (partial correlation = .27 and partial correlation = .24, respectively). Structural equation modeling demonstrated that participation in the NAC was associated with positive changes on the Index of Asthma Attitudes scale and lower rates of acute care. Social isolation was associated with greater participation in the program and thus reduced care rates. CONCLUSIONS: The NAC reached its intended audience, including those who were socially isolated, brought about changes in management practices, and was associated with promising reductions in acute care rates among active participants in the program.

Acute Disease↗
PubMedDate not supplied

The effect of endoscopic sinus surgery on asthma: management of patients with chronic rhinosinusitis, nasal polyposis, and asthma.

We attempted to determine the efficacy of endoscopic sinus surgery in adult patients with asthma and chronic rhinosinusitis or nasal polyposis. Fifty asthmatic patients from 17 to 74 years of age with a history of either chronic rhinosinusitis or nasal polyposis were examined. Sinonasal disease was confirmed endoscopically and with computerized tomography, and all had failed aggressive medical management of their sinonasal disease before undergoing endoscopic sinus surgery performed by the same surgeon in all cases. The following were compared for 12 months: preoperative and postoperative overall asthma control, peak flow measurements, asthma medication requirements, including the use of oral steroids, and hospitalizations for asthma. Twenty patients felt that their asthma control had improved postoperatively. Twenty per cent used less steroid inhaler, and 28% less bronchodilator inhaler. Of those 23 patients measuring peak flows, seven achieved higher levels and seven noted fewer dips and swings. Significant reductions in oral steroid requirements (p < 0.001) and hospitalization for asthma (p < 0.025) were also recorded postoperatively. Irrespective of whether the patient had chronic rhinosinusitis or nasal polyposis, both groups improved postoperatively. The commonest symptoms experienced by the group as whole and by the nasal polyposis patients were hyposmia and nasal obstruction. Postnasal discharge and headache were more important in the chronic rhinosinusitis group. Mean visual analog scores improved for all symptoms; in particular for nasal obstruction and sense of smell. Aggressive management of sinonasal pathology can improve asthma status. No major differences were recorded for outcomes when comparing patients with chronic rhinosinusitis or nasal polyposis; in particular there was no evidence for a worsening of asthma after nasal polypectomy.

Administration, Oral↗
PubMedDate not supplied

An attempted prospective testing of an asthma severity index and a quality of life survey for 1 year in ambulatory patients with asthma.

It has been recommended that allergist-immunologists use quality of life (QOL) surveys to document their "added value" in patient care. There are little cross-sectional or prospective data regarding longer term follow-up of patients using QOL assessments and none associated with prospective use of an asthma severity index (ASI). Our objective was to identify clinical and psychological correlates of adverse asthma outcomes as assessed using the ASI survey. A 12 item QOL and a nine item ASI survey, spirometry, and history and physical were obtained from patients initially and then every 3 months for a year. The ASI was calculated as follows: one point for each emergency treatment of asthma if not in status asthmaticus, three points for each hospitalization for status asthmaticus, and six points for each intensive care admission or intubation. Patients were 56 adults between ages 18 and 45 with asthma enrolled between May 1994 and February 1996 with the intention to be reassessed quarterly for a year. At enrollment the 56 patients had ASI scores for the previous 12 months ranging from zero to 30. The patient with an ASI of 30 did not return after the initial visit. Of the 13 patients who completed the study, 12 patients had a zero ASI score over a 12-month period; one patient who had an initial score of 26 finished with a score of one. There were no deaths throughout the follow-up period. Of the 43 patients who did not complete the study only six (13.9%) cited local managed care or primary care physician as taking over their care. Initial ASI scores were dichotomized (zero versus greater-than-zero) due to skewness. The forced expiratory volume in one second (FEV1), % predicted FEV1 and peak flow were not related significantly to the dichotomized ASI score. The strongest univariate predictor was the self-assessment of asthma burden using a 78 mm visual analog scale. A two variable model included a query about bodily pain in the last 4 weeks and a self-assessment of general health. The dropout rate was high but only 13.9% of such patients reported that managed care or primary care physicians were responsible. A two variable model was a strong predictor of asthma severity. The single best predictor of asthma severity was a visual analog scale based on the question "How do you think your asthma is?"

Adolescent↗
PubMedDate not supplied

Identification of asthma risk factors in Mexico City in an International Study of Asthma and Allergy in Childhood survey.

The International Study of Asthma and Allergy in Childhood (ISAAC) has assessed the prevalence of asthma, as well as the factors related to the disease in different countries. The aim of this study was to identify asthma risks factors in Mexico City. Data were obtained from questionnaires of children participating in a phase 3b ISAAC survey. Two thousand ninety-eight boys and 2008 girls were recruited in the 6- to 7-year-old group and 3243 boy and 3333 girls were recruited in the 13- to 14-year-old group. Logistic regression was used to determine the asthma risks factors. In the logistic regression for cumulative and current asthma prevalence, the variables allergic rhinitis and atopic dermatitis were the most important risk factors with the highest odds ratios (OR > 1.5; p < 0.05). The use of antibiotics and paracetamol in the first 12 months of life were related to cumulative asthma in both genders in the 6- to 7-year-old group. Contact of pregnant mother with farm animals was positively related with cumulative asthma in boys in the 6- to 7-year-old group. The main factors associated with the cumulative and current prevalence of asthma in both age groups were atopic dermatitis and allergic rhinitis. Future interventions for the prevention and early diagnosis and treatment could be focused in the natural history of the atopic march.

Adolescent↗
PubMed1997

The association of nocturnal asthma with asthma severity.

The objective of this study is to assess nocturnal asthma as a marker for poor control of asthma. Cross-sectional study of asthmatic patients was conducted in six general practices in East Anglia, England. Subjects were 240 asthma patients, between the ages of 20 and 54 years, from the above general practices. A continuous asthma severity score (range 6-26), consisting of the summation of ordinal responses to questions regarding asthma symptoms during the last 6 months, was used for analysis. The crude association between nocturnal asthma and severity score was statistically highly significant. Regression analysis suggests that, after controlling for possible confounding variables, there remains a strong association between nocturnal asthma (NA) and severity, which is modified by self-report of current consultation for "nervous/emotional trouble" (current NT). In the absence of current NT, NA raises the severity score by 5.3 (95% CI 4.5, 6.2), whereas in the presence of current NT, NA raises the severity score by 8.2 (95% CI 4.8, 11.6). NA appears promising as a marker for poorly controlled asthma. Confirmation of the association found in this study by objective measures of severity would strengthen the utility of NA as a marker.

Adult↗
PubMed1998

Features that distinguish those who die from asthma from community controls with asthma.

To evaluate risk factors for asthma mortality, an unmatched case-control study was undertaken in the Canadian prairie provinces of Alberta, Saskatchewan, and Manitoba. Those between the ages of 5 and 50 (inclusive) who died from an acute exacerbation of asthma were compared to a control group of people with asthma from the same geographical areas who were contacted using random-digit dialing. Because no deaths occurred among residents less than 15 years old, this analysis was limited to cases and controls between 15 and 50 years old. Of the 38 deaths that occurred between November 1992 and October 1995, data were obtained from next of kin for 35 (92.1%). Of the 210 potential controls that were identified, 142 returned completed questionnaires (67.6%). Cases were more likely than controls to have asthma reported to be severe, to have experienced nocturnal symptoms, to have had cardiopulmonary resuscitation (CPR)/intubation, and to have had more healthcare utilization in the previous year. Medication use was also more common among cases compared to controls. Specific asthma triggers were reported more often for cases than controls; weather changes, excitement, depression, and stress showed the greatest case control differences. Although a number of very strong risk factors for death from asthma were identified, death from asthma is so rare in this age group that it is not possible to label an individual as "likely" to die from asthma. Nonetheless, patients, caregivers, and health professionals should be aware of indicators that would suggest greater risk.

Adolescent↗
PubMed1993

[Characteristics of clinical asthma types in elderly patients with bronchial asthma].

Asthma was classified into four types, Ia-1 (bronchospasm with 0-49 ml/day of expectoration), Ia-2 (with 5-99 ml/day), Ib (over 100 ml/day) and II (bronchiolar obstruction), according to clinical symptoms. Characteristics of airway responses in each clinical asthma type were compared between 25 elderly (mean age, 65.2 years) and 30 younger subjects (mean age, 44.9 years) with bronchial asthma, by observing ventilatory function and cellular composition in bronchoalveolar lavage (BAL) fluid. 1. In patients with types 1a-2 and Ib, the %V25 value was significantly lower in the elderly subjects than in the younger subjects. 2. Comparing the values of ventilatory parameters of type Ia-1 cases with other asthma types, %V25 value was lower in other asthma types than in type Ia-1 in the elderly. All ventilatory parameters examined were generally lower in type II cases than in other asthma types in the elderly, but this difference was not significant. In contract, in the younger subjects, the values of %MMF, %V50 and %V25 were significantly lower in type II cases than in other asthma types. 3. The proportion of neutrophils in bronchoalveolar lavage (BAL) fluid was higher in the younger patients with type II than in the elderly patients with the same type, although there was no significant difference between older and younger subjects. The proportion of BAL eosinophils in patients with type Ib was significantly higher in younger subjects than in elderly subjects. These results indicate that airway responses which are characteristic of each asthma type are stronger in younger patients than in elderly patients.

Aged↗
PubMed2000

Validity of symptom and clinical measures of asthma severity for primary outpatient assessment of adult asthma.

BACKGROUND: Symptom and pulmonary function measures of asthma severity are used for severity classification in practice guidelines. However, there is limited methodological evidence in support of their validity and utility. AIM: To validate initial symptom and forced expiratory volume (FEV1) measures of asthma severity with the subsequent risks of exacerbations resulting in emergency room (ER) visits, hospitalisation, and sickness absence from work. In addition, symptom-based measures of change in asthma severity were also evaluated against the concurrent risks of asthma exacerbations. METHOD: A cohort of 361 adult asthmatic patients in general outpatient clinics was studied. At initial interview, frequencies of asthmatic symptoms and nocturnal exacerbations, FEV1, and a severity score combining these measures, were recorded. At re-interview in the third year, the frequencies of asthma exacerbations resulting in ER visits, hospitalisation, and sickness absence, and a self-assessed global measure of change in severity and serially-assessed change in symptom frequencies, were measured. RESULTS: All individual symptom and FEV1 measures were strongly related to the subsequent risks of ER visits, hospitalisation, and sick absence. A severity score of more than 3 (moderate to severe asthma) and self-assessed change in asthma severity were most strongly and significantly associated with greatly increased risks of all outcomes. Individual symptoms and FEV1 measures alone did not show high sensitivities, but the severity score combining these measures gave much more satisfactory validity. Perhaps not surprisingly, self-assessed change in asthma appeared to give the most satisfactory validity. CONCLUSION: These results support the validity and clinical utility of a simple clinical score based on symptom and FEV1 measures, and self-assessed measure of change in severity, for risk classification in contemporary clinical practice guidelines.

Adult↗
PubMed1999

Canadian Asthma Consensus Report, 1999. Canadian Asthma Consensus Group.

OBJECTIVES: To provide physicians with current guidelines for the diagnosis and optimal management of asthma in children and adults, including pregnant women and the elderly, in office, emergency department, hospital and clinic settings. OPTIONS: The consensus group considered the roles of education, avoidance of provocative environmental and other factors, diverse pharmacotherapies, delivery devices and emergency and in-hospital management of asthma. OUTCOMES: Provision of the best control of asthma by confirmation of the diagnosis using objective measures, rapid achievement and maintenance of control and regular follow-up. EVIDENCE: The key diagnostic and therapeutic recommendations are based on the 1995 Canadian guidelines and a critical review of the literature by small groups before a full meeting of the consensus group. Recommendations are graded according to 5 levels of evidence. Differences of opinion were resolved by consensus following discussion. VALUES: Respirologists, immunoallergists, pediatricians and emergency and family physicians gave prime consideration to the achievement and maintenance of optimal control of asthma through avoidance of environmental inciters, education of patients and the lowest effective regime of pharmacotherapy to reduce morbidity and mortality. BENEFITS, HARMS AND COSTS: Adherence to the guidelines should be accompanied by significant reduction in patients' symptoms, reduced morbidity and mortality, fewer emergency and hospital admissions, fewer adverse side-effects from medications, better quality of life for patients and reduced costs. RECOMMENDATIONS: Recommendations are included in each section of the report. In summary, after a diagnosis of asthma is made based on clinical evaluation, including demonstration of variable airflow obstruction, and contributing factors are identified, a treatment plan is established to obtain and maintain optimal asthma control. The main components of treatment are patient education, environmental control, pharmacotherapy tailored to the individual and regular follow-up. VALIDATION: The recommendations were distributed to the members of the Canadian Thoracic Society Asthma and Standards Committees, as well as members of the board of the Canadian Thoracic Society. In addition, collaborating groups representing the Canadian Association of Emergency Physicians, the Canadian College of Family Physicians, the Canadian Paediatric Society and the Canadian Society of Allergy and Immunology were asked to validate the recommendations. The recommendations were discussed at regional meetings throughout Canada. They were also compared with the recommendations of other similar groups in other countries. DISSEMINATION AND IMPLEMENTATION: An implementation committee has established a strategy for disseminating these guidelines to physicians, other health professionals and patients and for developing tools and means that will help integrate the recommendations into current asthma care. The plan is outlined in this report.

Adolescent↗
PubMed2000

Anti-inflammatory therapy reduces total costs of asthma care compared with bronchodilation: the Asthma Outcomes Registry.

BACKGROUND: Current consensus guidelines recommend reliance on anti-inflammatory drugs to treat asthma, reserving theophylline and other long-acting bronchodilators as adjuncts for patients whose symptoms are not well controlled with anti-inflammatory therapy. The effect of such recommendations on total costs of asthma care has not yet been examined, however. OBJECTIVE: To explore the relation between choice of maintenance therapy with anti-inflammatory agents vs long-acting bronchodilators and annual costs of asthma care using data from the Asthma Outcomes Registry. METHODS: Patients 16 years and older were selected from the Asthma Outcomes Registry cohort if they had received either anti-inflammatories (inhaled corticosteroids or cromones) or long-acting bronchodilators (theophylline, salmeterol, oral beta-agonists, or ipratropium bromide), but not both, for at least 1 year before study entry. Oral corticosteroid-dependent patients, those with other chronic lung disease, and those with incomplete cost data during the 365 days before and after their enrollment in the Asthma Outcomes Registry (baseline and follow-up years) were excluded. The effect of anti-inflammatory vs bronchodilator therapy was assessed by comparing the change (follow-up minus baseline) in total costs of asthma care. RESULTS: A total of 314 patients met criteria for study inclusion (237 treated with anti-inflammatories and 77 treated with bronchodilators). Median costs during the baseline year were similar in the anti-inflammatory and bronchodilator groups ($341 and $335, respectively). In the follow-up year, the median change in cost in the anti-inflammatory group was a decline of $93 compared with an increase of $76 in the bronchodilator group (P < .0001). This treatment effect was consistent across subgroups defined by age and amount of medication consumed. CONCLUSIONS: These findings add support to current guidelines recommending reliance on anti-inflammatory therapy to control asthma. The emergence of new therapeutic agents to control inflammation may continue to reduce the costs of treating this important disease.

Adolescent↗
PubMed2000

Asthma education: how much does it improve knowledge of childhood asthma amongst medical students and paramedics?

The objective of this study was to measure the knowledge of childhood asthma among medical students and paramedics. A previously validated questionnaire about childhood asthma was completed by 281 of 314, third and fifth year medical students at Universiti Kebangsaan Malaysia, Kuala Lumpur. Their knowledge of asthma was assessed during the first and last weeks of their paediatric rotation. A similar questionnaire was completed by 23 of 60 paramedics from various medical disciplines in Hospital Kuala Lumpur. They had attended a two-day seminar on respiratory diseases and their knowledge was assessed prior to and six weeks after the seminar. On the initial assessment the mean score for the final year medical students was 24.5, third year medical students 20.9 and paramedics 18.3. After intervention their mean scores increased significantly to 26.3 (p < 0.0001), 24.6 (p < 0.0001) and 21.3 (p < 0.0001). After intervention, the final year medical students improved significantly in all questions except in the management of acute asthma. Post intervention, third year medical students showed a significant increase in knowledge pertaining to symptomatology, pathophysiology, trigger factors and prophylactic drugs used in asthma management. Although the knowledge of paramedics improved post intervention, they had major deficiencies in knowledge about pathophysiology, trigger factors, preventive and acute asthma therapy, side effects of asthma treatment as well as clinical scenarios. Improvement after intervention was only seen in six of the 31 questions. This study demonstrated an increase in knowledge about childhood asthma among medical students and paramedics after a short intervention.

Adult↗
PubMed2001

Epidemiology of asthma in children. Who gets asthma and why?

BACKGROUND: Asthma is a common disease in childhood which results in a substantial burden of illness in Australia. This is manifest by distressing symptoms, impact on quality of life and role performance and health service utilisation. OBJECTIVE: This article reviews the current literature on the epidemiology of asthma in children. It particularly focuses on the prevalence, trends in prevalence, risk factors and causes of asthma. The emphasis is on common questions that parents of children with asthma would like answered by their general practitioners. DISCUSSION: We know something about some of the risk factors for asthma and a little about the mechanisms for the development of asthma. Despite the paucity of knowledge about the causes of asthma, some positive steps can be taken to prevent it. Allergic or asthmatic parents, whose children have a high risk of developing asthma, can be advised to avoid smoking during pregnancy and avoid environmental tobacco smoke exposure after the child is born, to undertake house dust mite control strategies, to breastfeed their babies for at least three months and subsequently to provide their child with a nutritious, balanced diet.

Asthma↗
PubMed2001

Occurrence and causes of occupational asthma in South Africa--results from SORDSA's Occupational Asthma Registry, 1997-1999.

OBJECTIVE: To present results for the first 3 years of the occupational asthma registry of the Surveillance of Work-related and Occupational Respiratory Diseases in South Africa (SORDSA) programme, ending December 1999. DESIGN: Surveillance was accomplished by collecting voluntary reports of occupational asthma cases from pulmonologists, occupational medicine practitioners and occupational health nurses. SETTING: Medical and occupational health referral centres in the nine provinces of South Africa. SUBJECTS: Patients diagnosed with new-onset occupational asthma with latency or irritant-induced asthma, reported to SORDSA during 1997-1999. OUTCOME MEASURES: Frequencies of cases, causative agents, industries causing exposure and diagnostic methods. Average annual incidence rates by province and by occupation. RESULTS: During this period 324 cases of occupational asthma were reported. The average annual incidence rate of occupational asthma was estimated in the three best-reporting provinces, namely Gauteng, KwaZulu-Natal and the Western Cape, as 17.5 per million employed people annually. This rate was highest in the Western Cape (25.1 per million). Semi-skilled operators had the highest incidence rate of 68.7 per million annually in the three provinces. Isocyanates and latex were the most common agents. Low molecular weight causative agents predominated (68.8%) over high molecular weight agents. Health care was the most frequently reported workplace for occupational asthma (OA) development. Serial peak flow testing was the method most often used for diagnosis. One-fifth of the cases were still occupationally exposed to the causative agent at time of diagnosis. CONCLUSION: Despite underreporting, SORDSA's estimate of the occupational asthma incidence rate was similar to that of the UK. SORDSA has also demonstrated that surveillance programmes in a developing country can provide useful information on which to base prevention activities.

Asthma↗
PubMed2001

Impact of an asthma carepath on the management of acute asthma exacerbations.

INTRODUCTION: Clinical pathways are being developed to standardise the management of acute asthma with the aim of improving asthma care. We evaluated the impact of an asthma carepath (CP), developed and instituted at a large community-based teaching hospital. MATERIALS AND METHODS: Case records of consecutive asthma cases were reviewed after the implementation of a new asthma CP (November 1999 to March 2000). Data from July to October 1998 were used as historical control data [pre-carepath (pre-CP)]. Data collected included patient demographics, investigations performed, treatment prescribed, use of peak expiratory flow rate (PEFR) monitoring, length of stay (LOS) and asthma relapse rates. RESULTS: One hundred and eighteen consecutive cases treated according to CP were compared with 67 pre-CP controls. There was no significant difference between the two groups with regard to LOS, use of PEFR monitoring, use of systemic steroids in hospital or asthma relapse after discharge (P > 0.05). A significant decrease in sputum tests (34.3% pre-CP versus 18.6% CP, P = 0.017) and use of antibiotics (62.7% pre-CP versus 30.4% CP, P < 0.001) was observed for patients on CP. The proportion of patients who had their salbutamol reviewed (49.3% pre-CP versus 73.7% CP, P = 0.001) and oxygen reviewed (25.8% pre-CP versus 73.8% CP, P = 0.004) was also significantly higher for cases on CP. CONCLUSION: Although the asthma CP did not significantly reduce LOS or early relapse, it was associated with a significant reduction of the use of sputum tests and antibiotics. Review of salbutamol and oxygen as treatment was also more likely.

Adult↗
PubMed1999

Self-reported asthma in adults and proxy-reported asthma in children--Washington, 1997-1998.

Increased awareness of asthma as a public health problem reflects recent increases in asthma prevalence, asthma-related visits to hospital emergency departments, and asthma-related mortality. To assess the prevalence of asthma in Washington, the Washington State Department of Health added survey items on asthma to its 1997 and 1998 Behavioral Risk Factor Surveillance System (BRFSS) survey. This report summarizes the results of those surveys, which indicate that persons with asthma reported significantly lower health status than other respondents and that a substantial proportion of households with children reported having a child with asthma.

Adult↗
PubMed2003

[Asthma management in adult emergency departments in Israel in comparison to asthma guidelines].

BACKGROUND: Asthma management is in focus all over the world. It is constantly updated, including aspects of Emergency Department (ED) care, on the basis of global and national evidence-based clinical guidelines. Despite the existence of these guidelines, the management of asthma, including management in the ED, is lagging behind. AIM: This study strives to evaluate various aspects of asthma management in the EDs in Israel. METHOD: A questionnaire was sent to each Head or Deputy Head of all the adult EDs in Israel. The questionnaires were collected within 16 days in December 2000. Ninety-six percent of all adult EDs in Israel responded. The mean response of each ED to all the questions was 99.5%. RESULTS: Oximetry on admission is performed for every patient in a third of the EDs although an oximeter is available in every ED. Measurements of airway obstruction severity by PEFRm or FEV1 in more than 50% of patients before hospital admission or discharge is only conducted in 9% of the EDs and in 52% of them it is not measured at all. Inhalation of a short beta-agonist combined with anticholinergic is performed in 84% of EDs. Corticosteroids are given to more than 80% of the arriving patients in only 54% of EDs and on discharge it is continued in all or almost all patients in 63% of EDs. A written time interval for the next medical visit after discharge from ED is not specified in 50% of EDs. In contrast to these findings, there is almost complete accordance among EDs (88%) that asthma management in the ED should follow formal guidelines and that common guidelines for asthma management should be adopted by all EDs in Israel (71%). CONCLUSIONS: The discrepancies between the existing clinical guidelines for asthma management in the ED and its actual use on the one hand, and the agreement among EDs on the importance of the guidelines on the other hand, are raising the necessity for common guidelines for asthma management in the EDs in Israel. Perhaps, more importantly, it highlights the urgent need for new effective and creative ways to implement asthma guidelines into routine ED practice.

Adult↗