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PubMed2006

Prevalence of symptoms of asthma, rhinitis, and atopic eczema among Brazilian children and adolescents identified by the International Study of Asthma and Allergies in Childhood (ISAAC) - Phase 3.

OBJECTIVES: To determine the prevalence of symptoms of asthma, rhinitis, and atopic eczema among schoolchildren aged 6 to 7 years and adolescents aged 13 to 14 years in 20 Brazilian cities by using the standardized ISAAC written questionnaire, and to assess the association of this prevalence with latitude, altitude and average annual temperature of collaborating centers. METHODS: Schoolchildren and adolescents from five Brazilian regions participated in the study, totaling 23,422 ISAAC questionnaires answered by schoolchildren's parents and 58,144 questionnaires answered by adolescents. The values for latitude, altitude and average annual temperature were obtained from the Brazilian Institute of Geography and Statistics. RESULTS: The mean prevalence rates among schoolchildren and adolescents were respectively 24.3 and 19.0% for active asthma; 12.6 and 14.6% for rhinoconjunctivitis; and 8.2 and 5.0% for atopic eczema. A significant negative association was observed between latitude and physician-diagnosed asthma among schoolchildren, severe asthma, physician-diagnosed asthma, eczema and atopic eczema among adolescents. No association with altitude was found. CONCLUSIONS: The prevalence of asthma, rhinitis and atopic eczema in Brazil varies considerably. Higher prevalence rates, especially of asthma and eczema, were found at centers located closer to the equator.

Adolescent↗
PubMed1978

"Asthma Alley": a space clustering study of asthma in Brooklyn, New York City.

A certain section of the borough of Brooklyn has sometimes been referred to as "Asthma Alley," expressing a feeling that this area in Brooklyn shows a markedly higher rate of asthma than adjacent areas. This study describes an epidemiologic method developed to determine whether the popular perception of spatial clustering of cases reflects reality. The spatial distribution of respiratory visits to the emergency room is taken as a reference against which clustering of asthma visits is compared, on the assumption that it is a good measure of the proportion of people in that area that make use of the emergency room facilities. From approximately 9,000 visits for asthma during the study period we were able to show that: (1) the differences in distribution of asthma cases among the health areas of Brooklyn are statistically significant; and (2) the health areas that show an excess of asthma visits lie along a belt east of the two hospitals and coincide with the popular impression of the location of "Asthma Alley."

Adult↗
PubMed1988

Living with Asthma. I. Genesis and development of a self-management program for childhood asthma.

This paper traces the roots of Living with Asthma, a self-management program for childhood asthma, from the Children's Asthma Research Institute and Hospital (CARIH), a residential treatment center in Denver, Colorado. The basic components of the program were developed and tested over the 40-year history of CARIH; the findings of an educational unit were added to this accumulated knowledge and expertise to complete the system. The program rests heavily on social learning theory, particularly two major tenets: 1) the concept of reciprocal determinism and 2) the learning/performance dichotomy. The crucial role of these concepts is described here, especially with respect to the design of the program and the selection of dependent variables. The remainder of this article describes the essentials of Living with Asthma, particularly the skills taught and performed by patients in a formal evaluation of the system. The design of the study, characteristics of patients enrolled in the program, and results obtained with the system are discussed. The program proved highly effective in significantly improving the knowledge of asthma in parents and their children, and in developing positive attitudes in both groups. It also produced significant reductions in the number of attacks experienced by the youngsters and improved their peak flow values. Participation in the program resulted in changes in morbidity indices of asthma, including significant reductions in school absenteeism and health-care costs incurred because of the disorder. These changes, it was concluded, reflected the result of the performance by patients of the self-management skills taught in Living with Asthma, coupled with the exceptional medical treatment they received.

Absenteeism↗
PubMed2005

Effect of asthma management education program on stress and compliance of patients with allergic asthma to house dust mite.

PURPOSE: This study was designed to examine the effect of asthma management education program applied to allergic asthma patients receiving immunotherapy due to house dust mite on their stress and compliance with health care regimens. METHODS: A quasi experimental design with non-equivalent control group and non-synchronized design was used. The subjects of this study were 61 patients who were receiving immunotherapy at intervals of a week after their symptoms were diagnosed as house dust mite allergic asthma at the pulmonary department of a university hospital in Seoul. They were divided into an experimental group of 29 patients who received asthma management education and a control group of 32 patients. The asthma management education program was composed of group education (once) and reinforcement education (three times) with environmental therapy and immunotherapy to house dust mite. RESULTS: Stress significantly decreased in the experimental group compared to that in the control group. Compliance with health care regimens significantly increased in the experimental group compared to that in the control group. CONCLUSIONS: The results suggested that the asthma management education program is effective for the management of stress and the improvement of compliance in patients with allergic asthma to house dust mite.

Adult↗
PubMed2006

Exasperations" of asthma: a qualitative study of patient language about worsening asthma.

OBJECTIVES: To identify expressions used by patients to describe worsening asthma; to examine the relevance of the word "exacerbation" to patients' experience; and to investigate whether their language is influenced by the severity of the episode and/or the target audience such as family members, friends and work colleagues. DESIGN AND SETTING: Qualitative study carried out from 1 January to 30 December 2004 among community volunteers to a research institute. Semistructured face-to-face interviews were used to elicit descriptions of episodes of worsening asthma, and further questioning was used to examine language used with family, employer and doctor. PARTICIPANTS: 25 people with asthma, aged 22-75 years. MAIN OUTCOME MEASURE: Themes identified by open coding about patient language for worsening asthma. RESULTS: 12 participants were not familiar with "exacerbation" and only three would use it themselves. "Attack" was the only specific term spontaneously volunteered (20 participants), but it was used for anything from mild to life-threatening episodes. Patients often downplayed the severity of worsening asthma to their families. Different language was used with employers, sometimes to justify sick leave and sometimes because of fear of perceived discrimination. When communicating with clinicians about worsening asthma, patients used symptom descriptors rather than specific terms. CONCLUSION: There are important differences in the language patients and clinicians use to describe worsening asthma, and the word "exacerbation" has poor utility for communication with patients.

Adult↗
PubMed2000

Segregation analysis of asthma: recessive major gene component for asthma in relation to history of atopic diseases.

Although asthma has a significant heritable component, the mode of inheritance remains controversial because of the complexity of the disease and the influence of environmental factors. Segregation analysis for asthma are performed with and without a history of atopic diseases (dermatitis and rhinitis) after adjusting for environmental factors. To investigate whether asthma may be inherited through a major gene with two alleles, the REGD program of the Statistical Analysis for Genetic Epidemiology (SAGE) package was conducted in 1,990 individuals from 227 families with at least one asthmatic child in a cross-sectional study of respiratory diseases in Southern Taiwan. Other covariates adjusted for included age, sex, current smoking, and environmental tobacco smoking. The hypothesis of Mendelian model and no parent-offspring transmission was rejected. However, when the variables of atopic disease and environmental factors were included in the model as covariates, the models for a two-allele gene with a recessive or codominant inheritance could not be rejected, and Akaike's Information Criterion was smaller (1,377. 13) for the recessive model than all of the other models tested, assuming a major gene with a population frequency of 0.56 +/- 0.04. However, Mendelian model without family effect was rejected. In conclusion, a history of asthma in parents is a strong risk factor for asthma in offspring. Under the assumptions of the applied segregation, at least one major gene exists that could be a gene involved also in allergy. However, the data suggest that a single locus gene explains a portion of asthma that is related to the history of atopic diseases. In addition, a polygenic/multifactorial (genetic and environmental factors) influence with a recessive component inheritance may be involved in the pathogenesis of asthma.

Adolescent↗
PubMed1975

Bronchial asthma in the Nigerian savanna region. A clinical and laboratory study of 106 patients with a review of the literature on asthma in the tropics.

One hundred and six asthma patients were studied in Zaria in the Nigerian savanna region. This group resembled hospital attenders in general in containing a disproportionately large number of immigrants from southern Nigeria and students undergoing higher education. Childhood asthma was rare. Asthma started after the age of 19 years in 69 per cent of patients. Twenty-seven per cent gave a history of rhinitis but none had had eczema. Twenty-two per cent gave a family history of asthma. Cutaneous hypersensitivity to house dust supported by a history of attacks being precipitated by dust was found in 41 per cent of patients. Asthma was worst in the rainy season in 45 per cent of patients. Mites were found in mattress dust samples; the mean count was 243 mites per g dust; Dermatophagoides farinae formed 86-6 per cent of the total mite population. The variability of airways obstruction averaged 50 per cent of maximum values for forced expiratory volume in the first second (FEV1) and peak expiratory flow (PEF). The median severity of airways obstruction measured as FEV1/VC per cent was four standard deviations below predicted normal. Eighty-seven per cent of patients were positive to prick skin tests with one or more allergens. The commonest reactions were to house dust (58 per cent), house dust mite (45 per cent) and Dermatophagoides farinae (44 per cent). Fifty-one per cent of a group of controls were also positive on skin testing but the pattern of responses was different from the asthmatic patients. This high proportion of reactors is explained by high allergen load. Serum IgE levels were lower in the asthmatics than in a group of healthy controls who showed the very high levels characteristic of some African populations. We suggest that the controls were protected from atopic disease by developing high blocking levels of non-specific IgE, perhaps in response to gut helminths. The clinical pattern of asthma in Zaria is compared with other countries in the tropical and temperate zones. The particular problems of treating asthma in developing tropical countries are discussed.

Adolescent↗
PubMed2001

Efficacy of omalizumab, an anti-immunoglobulin E antibody, in patients with allergic asthma at high risk of serious asthma-related morbidity and mortality.

AIM: Add-on therapy with omalizumab, an anti-immunoglobulin E antibody, is effective in improving disease control in patients with allergic asthma of varying severity. The aim of the present study was to determine the efficacy of omalizumab in a subgroup of patients at high risk of serious asthma-related morbidity and mortality. METHODS: A meta-analysis was performed of three randomised, double-blind, placebo-controlled studies (studies 1, 2 and 3) that enrolled 1412 patients with moderate or severe allergic asthma, all requiring daily treatment with inhaled corticosteroids (ICS). Omalizumab was administered subcutaneously every 2 or 4 weeks at a total 4-weekly dose of at least 0.016 mg/kg/IgE [IU/ml]. Each study consisted of a 16-week steroid-stable phase and a 12-16-week steroid-reduction phase, followed by a 24-week extension phase (studies 1 and 2 only). The primary outcome measure was the annualised rate of significant asthma exacerbation episodes (sAEEs) during the steroid-stable phase for the pooled subgroup of 254 high-risk patients (omalizumab, n = 135; placebo, n = 119). sAEEs were those requiring a doubling of baseline ICS dose (studies 1 and 2 only) or use of systemic steroids (all three studies). RESULTS: Overall, the number of patients with at least one sAEE during the steroid-stable phase was reduced from 35% (42/119) with placebo to 18% (24/135) with omalizumab. Mean sAEE rates were 1.56 and 0.69 per patient-year, respectively, a reduction of 56% with omalizumab (p = 0.007). Similar reductions in exacerbations in favour of omalizumab were observed for the whole study period and for all AEEs. In those with a history of hospitalisation in the last year, 6/49 (12%) on placebo vs. 2/44 (4.5%) on omalizumab were re-hospitalised during the study period. Patients treated with omalizumab also showed significantly greater improvements from baseline in PEFR (p = 0.026), overall AQoL (p = 0.042) and mean nocturnal (p = 0.007) and mean total (p = 0.011) asthma symptom scores compared with placebo. CONCLUSIONS: In patients at high risk of serious asthma-related morbidity and mortality, treatment with omalizumab offers the potential to halve the rate of asthma exacerbations and improve disease control.

Adolescent↗
PubMed2003

Individual cytokines contributing to asthma pathophysiology: valid targets for asthma therapy?

Asthma is a common, chronic inflammatory condition of the airways that leads to airway hyperresponsiveness, reversible narrowing of the airways, and airway wall remodeling. Cytokines are involved in various aspects of asthma pathophysiology, such as the polarization of T-helper (Th)2 cells, antigen presentation, immunoglobulin (Ig)E response, airway wall remodeling, and mast cell and eosinophil recruitment and activation. Th2-derived cytokines, such as interleukin (IL)-4, IL-5 and IL-13 contribute to many of these aspects. Inhibition of individual cytokines for asthma therapy has been, and continues to be investigated. Anti-IL-5 monoclonal antibodies did not demonstrate beneficial effects in asthma, with only partial inhibition of eosinophilia in the airway wall; soluble IL-4 receptor, which neutralizes the effects of IL-4, has provided modest improvements in moderate asthma. The anti-IgE monoclonal antibody approach has demonstrated the most benefit in allergic asthma, particularly in severe disease. Which individual cytokine target can be inhibited with beneficial effects comparable to or above that of current inhaled corticosteroids can only be discovered through clinical trials. Blocking the effects of more than one cytokine may be more successful, and greater therapeutic effects may be observed in particular categories of asthma.

Animals↗
PubMed2004

Application of asthma action plans to childhood asthma: national survey repeated.

AIMS: Define the way childhood asthma action plans are currently being used in New Zealand; determine New Zealand doctor's recommendations about the use of an increased dose of inhaled steroids in asthma action plans; and determine if there has been any change (during the last 7 years) in the way asthma action plans are used. METHODS: A postal survey was sent to all 297 paediatricians and paediatric registrars in New Zealand, and to a random sample of 500 general practitioners (GPs). The questions related to asthma action plan use, the inclusion of an increased dose of inhaled steroid in those plans, and details of the way doctor's adjusted inhaled steroid dose. Comparisons were made for selected questions between this survey and the same survey conducted in 1995. RESULTS: Valid responses were received from 179 (60%) paediatricians and paediatric registrars, and 233 (47%) GPs. 165 (70.8%) GPs and 137 (76.5%) paediatricians/paediatric registrars indicated that they used written action plans for children with asthma in their care. 184 (61.5%) respondents who used asthma action plans included a step involving an increase in the dose of inhaled steroid, compared to 83.6% in 1995 (p<0.001). GPs in 2002 were less likely to use action plans (p<0.001) and include a step with an increased dose of inhaled steroid (p=0.003) Paediatricians and paediatric registrars in 2002 were just as likely to use action plans (p=0.549), but less likely to include a step with an increased dose of inhaled steroid (p<0.001). GPs in 2002 were significantly more likely (than paediatricians and paediatric registrars) to include a step involving an increased dose of inhaled steroid (p<0.001) There has been a change in the practice of New Zealand GPs, paediatricians, and paediatric registrars--with a decreased tendency to double the dose of inhaled steroids in childhood action plans, thus suggesting doctors are cognisant of conclusions drawn by 'evidence-based medicine'. CONCLUSIONS: There has also been a decline in the proportion of asthmatic children receiving a written asthma action plan, and this is inconsistent with recommendations contained in consensus documents.

Administration, Inhalation↗
PubMedDate not supplied

A+ Asthma Rural Partnership coloring for health: an innovative rural asthma teaching strategy.

Asthma is the leading chronic illness in children, affecting about 4.8 million children in the United States. Recent reports indicate a lack of asthma educational resources for rural school health nurses to use in their practice. This article describes the development of the My Asthma Coloring Book educational tool for children and their families living in rural communities. My Asthma Coloring Book was developed to provide asthma information in a short-story format for children with asthma. The coloring book content is described, including its utilization as part of the A+ Asthma Rural Partnership research project funded by the National Institute of Nursing Research (R01NR05062-01).

Asthma↗
PubMedDate not supplied

Current epidemiology of asthma: emerging patterns of asthma.

Asthma is a chronic disease associated with substantial morbidity, mortality, and health care use. Between 1980 and 1994, the self-reported prevalence of asthma increased 75% among all race, sex, and age groups in every region of the United States. Although an estimated 14.6 million persons had asthma in the United States in 1996, more recent studies have suggested a plateauing of the prevalence of the disease. Because establishing the diagnosis of asthma and characterizing the features of the disease have long been difficult for both the clinician and the researcher, studies determining the frequency of asthma across different countries and over time, seeking clues to the etiology of the disease, and monitoring for untoward variations provide the clinician with additional resources to manage patients with asthma. The purpose of this article is to provide a brief overview of the current and emerging national and international trends in the epidemiology of asthma.

Asthma↗
PubMed2005

[Is guideline-defined asthma control achievable?--secondary publication. The Gaining Optimal Asthma ControL (GOAL) Study].

In this study, the percentage of patients with uncontrolled asthma who can achieve guideline-defined asthma control was assessed in 3,421 patients. Significantly more patients (71%) treated with salmeterol-fluticasone achieved asthma control than did patients receiving fluticasone alone (59%). The patients treated with salmeterol-fluticasone achieved asthma control more rapidly and at a lower dose of inhaled corticosteroid than did patients treated with fluticasone alone. Achievement of asthma control was associated with marked improvements in exacerbation rates and quality of life. Thus guideline-defined asthma control can be achieved in the majority of patients and should be the goal of asthma treatment.

Adrenal Cortex Hormones↗
PubMedDate not supplied

[Study of the obsesity and overweight as a risk factor for asthma and severity of the asthma in children of Valencia (Spain)].

BACKGROUND: Obesity and overweight have been described as factors associated with asthma. Our aim was to evaluate the role obesity plays on asthma in children. SCOPE AND SUBJECTs: A study carried out on children and teenagers between 8 and 15 years of age, chosen for a cluster-type random sampling from children who studied in 80 schools, which represents 30% of the schools in the city of Valencia. MATERIAL AND METHODS: The analysed data was organized into two groups, obese (from the Body Mass Index (Kg/m2)), showing children with a percentile over 85% of the measuring reference for the Spanish population) and non obese, when they did not fulfil this condition. The prevalence of the different parameters studied was calculated by an Interval of Confidence of 95%. The risk was calculated (Relative Risk) from those symptoms compatible with asthma among obese children compared to non obese children. RESULTS: No significant relative risk (RR) was seen for obesity with regards to asthma in those percentiles of obesity over 85. Otherwise, an increase in the relative risk (RR) regarding the severity of asthma was seen in relation to obesity, mainly in the 85th percentile (RR = 1.51 of suffering between 4-12 wheezing attacks and RR = 1.86 of suffering more than 12 attacks in obese children as opposed to non obese children). CONCLUSIONS: In this study, we did not identify a higher risk of asthma among obese children than among non obese children, although we did find there was a higher risk of severity of asthmatic symptoms. As far as the severity of the asthma is concerned, we saw a higher risk of wheezing and whistling attacks among obese children with the 85th and the 95th percentiles according to the Body Mass Index.

Adolescent↗
PubMed1989

[Clinical studies on steroid-dependent intractable asthma. Comparison between early and late onset of asthma].

The various components making for severe intractable asthma were clinically and allergo-immunologically studied in 90 patients with bronchial asthma, by comparison between early onset and late onset groups. 1. In the early onset asthma group, cases with low serum IgE levels showed a stronger tendency toward severe intractable asthma. 2. Late onset asthma cases with negative skin tests and negative specific IgE antibodies to house dust tended more often to be severe intractable cases. 3. There was no correlation between sensitization by specific antigens (house dust and Candida), especially Candida, and a tendency toward severe intractable asthma. 4. Severe intractable asthma might be caused by bronchospasm in cases under 30 years of age, by bronchospasm plus hypersecretion in cases between 31 and 40 years of age, and by bronchospasm plus bronchiolar obstruction in cases over 40 years of age.

Adolescent↗
PubMed1995

[Examination on aspirin-induced asthma and hypersensitivity to steroids--a questionnaire to 850 asthma on hypersensitivity to non-steroidal anti-inflammatory drugs and hypersensitivity to steroids].

We surveyed 850 patients with bronchial asthma and investigated such clinical features as the frequency of aspirin-induced asthma and hypersensitivity to steroids in the 457 available answers. We divided them into two groups, one was ASN: the asthmatics who had history of hypersensitivity to non-steroidal anti-inflammatory drugs, another was non-ASN: the asthmatics who had no history of hypersensitivity to non-steroidal anti-inflammatory drugs, and compared the two groups. The survey showed that the frequency of ASN was 12.0%. Its frequency rose with the severity of asthma to a level of 29.0% in severe cases. In ASN it was more frequent rates of female, infectious type, severe cases, and ASN had more frequent histories of oral use of steroids, use of ambulance, treatment in emergency rooms, and hospitalization than non-ASN. The serum IgE level was lower in ASN. The patients were 6 in ASN, none in non-ASN who had histories of hypersensitivity to steroids. They were 1.3% in all patients. 5 of 6 had past asthma attack progressived severely by rapid injection of succinate ester steroids and 2 of 6 had past by rapid injection of phosphoric acid ester steroids. In conclusion it was considered that we had to avoid rapid injection of steroids to aspirin-induced asthma and severe cases who were doubtful of aspirin-induced asthma in case of treatment of asthma attack.

Adult↗
PubMed1994

Prevalence of asthma and asthma-like symptoms in young adults living in three east Anglian towns.

BACKGROUND: The European Community respiratory health survey is examining the prevalence of asthma and risk factors for asthma. AIM: As part of this multinational survey, a study was undertaken to determine the prevalence of asthma and asthma-like symptoms in young adults living in Cambridge, Ipswich and Norwich using a postal questionnaire. METHOD: A previously validated symptom questionnaire was sent to 2500 men and 2500 women aged 20-44 years living in and registered with a general practitioner in each of the three towns. RESULTS: In total, approximately 9000 adults responded. The prevalence of symptoms suggestive of asthma was found to be similar in the three towns. Of respondents, 8% reported having been woken by an attack of shortness of breath at some time in the last 12 months, higher than previously reported. Five per cent reported having had an asthma attack. CONCLUSION: General practitioners wishing to examine asthma prevalence in their own practice population could use a similar methodology.

Adult↗
PubMed1994

Asthma knowledge in hospital patients with acute severe asthma.

OBJECTIVES: To assess patient knowledge about asthma management and to assess the risk of asthma-associated morbidity in patients admitted to hospital with acute severe asthma. SUBJECTS AND SETTING: Patients admitted to Fremantle Hospital with a primary diagnosis of acute severe asthma from July to September 1992. RESULTS: Bronchodilator therapy has been used for more than 12 months by all 25 previously diagnosed asthmatics, with 88% knowing that the drug was a bronchodilator. Corticosteroid therapy had been used by 84% of patients but only 52% of these knew that it was anti-inflammatory or "preventive" medication. Sixty per cent of patients did not recall seeing National Asthma Campaign advertisements. Twenty-three patients (88%) were classified as being at high risk of morbidity. CONCLUSIONS: The level of knowledge about asthma management in patients admitted to this hospital is poor. Most patients are at high risk of asthma-associated morbidity.

Acute Disease↗