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PubMed2004

Prevalence of wheeze and self-reported asthma and asthma care in an urban and rural area of Tanzania and Cameroon.

We investigated the prevalence of wheeze, self-reported asthma, and asthma care via four cross-sectional surveys among adults and children (5-15 years) in urban and rural populations from Tanzania and Cameroon. Age-standardized prevalence of current wheeze (in the previous year) was 2.2% to 5.0% in adults and 1.9% to 5.2% in children in Tanzania, and 1.3% to 2.5% (adults) and 0.8% to 5.4% (children) in Cameroon. There were no consistent patterns of urban:rural prevalence. Peak flow rates varied with age, peaking at 25-34 years, and were higher in urban areas (age adjusted difference 22-70 L/min) and in the Tanzania populations. Awareness (83%-86% versus 52%-58%) and treatment (43%-71% versus 30%-44%) of asthma was higher among those with current wheeze in rural areas. Use of inhaled drugs, particularly steroids, was rare. Diagnosis by traditional healers (15%) and use of traditional remedies (62% of those recalling any treatment) were common only among self-reported asthmatic patients in rural Cameroon. Asthma is an importantclinical condition in sub-Saharan Africa. There were major gaps in clinical care, particularly in urban areas. Sustainable methods for delivering accessible and effective asthma care in sub-Saharan Africa are required.

Adolescent↗
PubMed2005

Cognitive-behavioral treatment combined with asthma education for adults with asthma and coexisting panic disorder.

This study tested the efficacy of a nurse-administered 8-week group treatment program for adults with asthma suffering from coexisting panic disorder. The program consisted of cognitive behavioral treatment (CBT) for panic disorder combined with asthma education (AE). Forty-eight women with a confirmed diagnosis of asthma and panic disorder were randomly allocated to a treatment condition (n=25) and a wait-list control condition (n=23). Twenty-five participants--15 in the treatment group and 10 in the wait-list control group--completed treatment. Repeated measures ANOVA procedures were used to compare the groups on panic and asthma outcomes at posttreatment and 6-month follow-up. The results demonstrate that the CBT-AE program is capable of producing substantial and durable antipanic and antianxiety treatment effects and led to substantial but nonsustained improvement in morning peak-flow expiratory rate and asthma-related quality of life. Implications of these findings for this clinical population are addressed.

Adolescent↗
PubMed2006

Computer-based decision support for pediatric asthma management: description and feasibility of the Stop Asthma Clinical System.

Clinical guidelines can assist in the management of asthma. Decision support systems (DSSs) can enhance adherence to clinical guidelines but tend not to provide clinicians with cues for behavioral change strategies to promote patient self-management. The Stop Asthma Clinical System (SACS) is a DSS designed for this purpose. To assess feasibility, seven clinicians used SACS to guide well visits with 26 predominantly persistent pediatric asthma patients. Data were collected via survey and in-depth semi-structured interviews. SACS improved assessment of asthma severity and control, classification of and intervention in medicine and environmental trigger management problems, and development of an action plan (all p < 0.05). Clinician-patient communication was enhanced. The primary challenge was that SACS increased clinic visit time. SACS can enhance clinician behavior to improve patient asthma self-management, but more studies are indicated to mitigate temporal constraints and evaluate impact on clinician and patient communication and behavior as well as clinical outcomes.

Algorithms↗
PubMed1996

Total serum IgE is associated with asthma independently of specific IgE levels. The Spanish Group of the European Study of Asthma.

In this study we aimed to assess whether the association between asthma (defined by symptoms and bronchial responsiveness) and total immunoglobulin E (IgE) levels was independent of specific IgE levels to common aeroallergens. A general population-based sample, supplemented with symptomatic individuals, comprising 1,916 young adults, aged 20-44 years, from five areas of Spain, performed a face-to-face respiratory questionnaire, and spirometry, and had total and specific serum IgE levels to mites, pets and moulds recorded. In 1,626 of the subjects, a dose-response methacholine challenge test was completed. Subjects reporting current attacks of asthma showed an association with total IgE (odds ratio (OR) for IgE > 100 kU.L-1 = 4.73, 95% confidence intervals (95% CI) = 2.01-11.12, adjusted for specific IgE, sex, age, smoking, forced expiratory volume in one second (FEV1), and area), which did not vary by bronchial responsiveness. The association between total IgE and asthma also occurred among those with negative specific IgE antibodies (OR 18.0; 95% CI 13.9-120). Individuals with current wheezing and bronchial responsiveness without attacks of asthma also showed an adjusted association with total IgE (OR 4.96; 95% CI 2.32-10.6), which remained for persons without specific IgE (OR 5.86; 95% CI 2.18-1.7). These findings reinforce previous evidence that asthma is associated with increased levels of total IgE, even in subjects negative for specific IgE to common aeroallergens.

Adult↗
PubMed2006

Smoking, respiratory symptoms and likely asthma in young people: evidence from postal questionnaire surveys in the Wythenshawe Community Asthma Project (WYCAP).

BACKGROUND: Although it is recognised that smoking is a major risk factor for subjects with chronic obstructive pulmonary disease and is associated with respiratory symptoms, there is less agreement concerning the relationship between asthma and smoking. This study aims to examine the relationship between cigarette smoking and asthma prevalence. METHOD: Data were used from two postal questionnaire surveys (1999 and 2001) in two general practice populations, using a respiratory questionnaire based on the ECRHQ and a generic quality of life questionnaire (EQ-5D). Only subjects less than 45 years old were included in the survey. An empirical definition of likely asthma was used based on respiratory questionnaire responses. Smoking was examined according to three categories, current smoker, ex smoker and never smoker. RESULTS: Almost 3500 subjects were included in the analyses. Current smokers had a higher prevalence of likely asthma compared to never smokers, odds ratio (OR) 1.59 (95% confidence interval (CI) 1.24 to 2.04). and also compared to ex smokers OR 1.79 (CI 1.25 to 2.56), but there was no difference between ex smokers and never smokers (OR 1.00 (0.75-1.35)). Current smoking was also positively associated with all symptoms but not with a history of hayfever/eczema. CONCLUSION: Although the positive association found between current smoking and obstructive airways disease is likely to be due to the effect of cigarettes on asthma, it could reflect an association with early COPD (GOLD stages 0 or 1). Smoking cessation has a beneficial effect on the prevalence of respiratory symptoms and is therefore of paramount importance among these young adults.

Adolescent↗
PubMed2006

Adequacy of medical chart review to characterize emergency care for asthma: findings from the Illinois Emergency Department Asthma Collaborative.

OBJECTIVES: To assess the intermethod reliability of medical chart review compared with directly observed care in patients presenting to emergency departments (EDs) for asthma care. METHODS: ED care practices for persons with asthma were evaluated by comparing chart review with trained observers. Fifty-one patients from five EDs participating in the Illinois Emergency Department Asthma Collaborative were studied. Practices in assessment, treatment, education, and referral were measured. Eighteen elements of care were assessed. Concordance between chart and observation was measured by using the kappa statistic. RESULTS: Of 51 subjects studied, nine were children. Kappa values varied depending on content. Kappa values ranged from 0.22 to 0.91 for items reflecting asthma assessment. Good concordances (kappa = 0.50 to 0.82) were found for items reflecting treatment practices. The lowest concordances were for items assessing educational activities (kappa = 0.04 to 0.34). Referral practices had fair to moderate concordances (kappa = 0.21 to 0.45). CONCLUSIONS: Intermethod reliability of medical chart review and directly observed care varied depending on the element of care being measured. The use of chart review to measure quality of ED-based asthma care may only be appropriate for a limited number of care processes that are reliably and validly captured from chart review.

Adolescent↗
PubMed2002

Home and allergic characteristics of children with asthma in seven U.S. urban communities and design of an environmental intervention: the Inner-City Asthma Study.

Most published environmental remediation interventions have been directed at single allergens and have employed demanding strategies; few have been performed in the homes of inner-city children disproportionately burdened by asthma. Our objective was a) to describe the allergen sensitivities, environmental tobacco smoke (ETS) exposure, and home environmental characteristics of a national sample of inner-city children with moderate to severe asthma and b) to develop and implement a multifaceted, home-based comprehensive intervention to reduce home allergens and ETS, tailored to the specific sensitization and exposure profiles of those children. Allergen skin testing and a home evaluation were performed to determine the presence of ETS and factors known to be associated with increased indoor allergen levels. Based on published remediation techniques, a home environmental intervention, organized into modules, each addressing one of five specific allergen groups or ETS, was designed. Of 994 allergic children from seven U.S. urban communities, 937 successfully completed baseline interviews and home allergen surveys and were enrolled. More than 50% of children had positive skin tests to three or more allergen groups. Cockroaches were reported in 58% of homes, wall-to-wall carpeting in the child's bedroom in 55%, a smoker in 48%, mice or rats in 40%, and furry pets in 28%. More than 60% of enrolled families received four or more modules, and between 94% and 98% of all modules were completed. We conclude that most inner-city children with moderate to severe asthma are sensitized to multiple indoor allergens and that environmental factors known to be associated with asthma severity are commonly present in their homes. The intervention developed for the Inner-City Asthma Study employs accepted methods to address an array of allergens and ETS exposure while ensuring that the intervention is tailored to the specific sensitization profiles and home characteristics of these children.

Adult↗
PubMed1993

The application of an asthma severity index in patients with potentially fatal asthma.

The asthma severity index (ASI) is proposed as a tool to monitor the course of patients with increased risk of asthma-related morbidity and mortality. The ASI is a weighted summary of the diagnostic features of potentially fatal asthma (PFA). Fifteen patients with PFA were evaluated with ASIs calculated for the intervals 1 year prior to and 1 year following management by our allergy-immunology service. In each patient, a reduction was noted in the ASI following management, which corresponded to a reduction in asthma events. The ASI will have utility in the evaluation of chronic asthma treatment and in patient education.

Adolescent↗
PubMed2003

Budesonide and formoterol in a single inhaler improves asthma control compared with increasing the dose of corticosteroid in adults with mild-to-moderate asthma.

BACKGROUND: We evaluated the efficacy and safety of low-dose budesonide/formoterol, 80 micro g/4.5 micro g, bid in a single inhaler (Symbicort Turbuhaler; AstraZeneca; Lund, Sweden) compared with an increased dose of budesonide, 200 micro g bid, in adult patients with mild-to-moderate asthma not fully controlled on low doses of inhaled corticosteroid alone. METHODS: All patients received budesonide, 100 micro g bid, during a 2-week run-in period. At the end of the run-in phase, 467 patients with a mean FEV(1) of 82% predicted received 12 weeks of treatment with budesonide/formoterol in a single inhaler or budesonide alone in a higher dose. Patients kept daily records of their morning and evening peak expiratory flow (PEF), nighttime and daytime symptom scores, and use of reliever medication. RESULTS: The increase in mean morning PEF-the primary efficacy measure-was significantly higher for budesonide/formoterol compared with budesonide alone (16.5 L/min vs 7.3 L/min, p = 0.002). Similarly, evening PEF was significantly greater in the budesonide/formoterol group (p < 0.001). In addition, the percentage of symptom-free days and asthma-control days (p = 0.007 and p = 0.002, respectively) were significantly improved in the budesonide/formoterol group. Budesonide/formoterol decreased the relative risk of an asthma exacerbation by 26% (p = 0.02) compared with budesonide alone. Adverse events were comparable between the two treatment groups. CONCLUSION: This study shows that in adult patients whose mild-to-moderate asthma is not fully controlled on low doses of inhaled corticosteroids, single-inhaler therapy with budesonide and formoterol provides greater improvements in asthma control than increasing the maintenance dose of inhaled corticosteroid.

Administration, Inhalation↗
PubMed2004

Asthma inhalers in schools: rights of students with asthma to a free appropriate education.

Students who possess and self-administer their asthma medications can prevent or reduce the severity of asthma episodes. In many states, laws or policies allow students to possess and self-administer asthma medications at school. In the absence of a state or local law or policy allowing public school students to possess inhalers and self-medicate to treat asthma, 3 federal statutes may require public schools to permit the carrying of such medications by students: the Individuals With Disabilities Education Act, Section 504 of the Rehabilitation Act of 1973, and Title II of the Americans with Disabilities Act. Local policies and procedures can be based on these federal laws to ensure that students with asthma can take their medicines as needed.

Asthma↗
PubMedDate not supplied

Symposium on asthma disease management: the role of the asthma expert: a view from Mexico.

In Mexico, no effort has been made to estimate a nationwide prevalence rate of asthma. However, in the last 10 years several local studies have been carried out that analyze the same age cohort that have similar methodological features, enabling us to have a reference from which to look at childhood asthma prevalence in Mexico. Applying statistical analysis to all the surveys, we obtained a prevalence rate of childhood asthma of 11.85% with a confidence interval of 11.32% and 12.38%. We have data that let us know that the prevalence of asthma in México is increasing as in other countries. The comportment of asthma medication is changing very slowly, at least in the commercial market.

Allergy and Immunology↗
PubMed1994

Consistency of diagnostic criteria for asthma from Laënnec (1819) to the National Asthma Education Program (1991).

Interpretation of longitudinal trends in asthma incidence, prevalence, and mortality must assume consistency in the diagnostic criteria used by clinicians. This review samples the textbook and clinical literature on clinical recognition and diagnosis of asthma from Laënnec (1819) to the National Asthma Education Program (1991), which introduced as a standard for clinical care a set of diagnostic criteria based on laboratory confirmation. There is great consistency among authors in descriptions of the cardinal diagnostic criteria of asthma as episodic dyspnea punctuating periods of normal breathing, generally associated with expiratory wheezing and prolonged expiration. In contrast, there is much greater variation in the formal definitions or explanations of the presumed pathophysiology of the disorder. It is much more difficult to document the actual diagnostic criteria used by practicing clinicians in the past, but these findings indicate a high degree of consistency over 172 years in what was taught and was considered acceptable practice. The literature on asthma contains several medical classics, a few gems of insight, and some unusual authors; some of these are noted in the discussion, as is the strong tradition of reciprocity in American and British medicine.

Asthma↗
PubMed1995

Do both paternal and maternal smoking influence the prevalence of childhood asthma? A study into the prevalence of asthma in children and the effects of parental smoking.

Asthma is one of the commonest of chronic illnesses affecting children. Parental smoking has been considered to have an effect on this. In an attempt to clarify the relationship between parental smoking and the prevalence of childhood asthma we interviewed parents of 97.5% of the children aged 3-11 years registered with a large urban British general practice. We found a lifetime prevalence of asthma of 19.6%, 23.2% of boys and 15.9% of girls. Asthma was more common, 37.6%, in children who also had eczema. Parental smoking appeared to increase the prevalence of asthma. This was more marked when both parents smoked.

Absenteeism↗
PubMed2004

Mild persistent asthma. Traits, treatment set it apart from mild intermittent asthma.

Mild persistent asthma has greater airway hyperresponsiveness than mild intermittent asthma and may also have more persistent respiratory symptoms and more severe consequences. By other measures, the two conditions are not always easy to differentiate. Nevertheless, primary care physicians need to be able to recognize and treat mild persistent asthma in order to reduce the number of severe exacerbations, and even fatalities, that can occur if it is not properly managed. In this article, Dr Lim discusses how to differentiate mild persistent asthma from mild intermittent asthma and explores the best options for pharmacologic treatment.

Administration, Inhalation↗
PubMed1999

Severe exacerbation of asthma: a new side effect of interferon-alpha in patients with asthma and chronic hepatitis C.

Interferon-alpha is used by physicians to treat numerous common medical disorders; however, therapy is often limited by side effects. Pulmonary complications, such as interstitial pneumonitis and bronchiolitis obliterans organizing pneumonia, have been described in patients receiving interferon-alpha therapy. Exacerbation of asthma induced by subcutaneous administration of interferon-alpha has not been previously reported. We describe two patients with mild asthma in whom treatment with interferon-alpha for chronic hepatitis C resulted in exacerbation of the underlying asthma. The severe asthmatic symptoms resolved promptly after use of interferon-alpha was discontinued and corticosteroid therapy was initiated. Repeated treatment with interferon-alpha several months later resulted in a rapid, more severe exacerbation of asthma in both patients. Patients undergoing therapy with interferon-alpha, especially those with chronic asthma, should be monitored closely for pulmonary symptoms. If these symptoms develop, patients should be instructed to discontinue use of interferon-alpha and seek medical attention immediately.

Acute Disease↗
PubMed2002

The asthma files: evaluation of a multimedia package for children's asthma education.

Children's knowledge of asthma triggers and the impact on children's knowledge of using 'The Asthma Files', an interactive, educational computer program, were evaluated in this pilot study. Thirty-one children aged between seven and 14 years and diagnosed with asthma were recruited to the study. Ten boys participated in evaluating the triggers section and a questionnaire was used to determine their feelings about the program and retention of information. Children enjoyed using the package and knowledge about asthma triggers increased significantly. 'The Asthma Files' shows promise as an additional tool to augment existing education.

Adolescent↗
PubMedDate not supplied

International Study of Asthma and Allergies in Childhood (ISAAC) written questionnaire: validation of the asthma component among Brazilian children.

Written questionnaires have been widely used in epidemiological studies of asthma. However, when translated to another language, they must be validated. The International Study of Asthma and Allergies in Childhood (ISAAC) written questionnaire had been previously validated by a comprehensive study, but this had not been done in Brazil. Our objective was to validate the asthma component of the ISAAC self-applicable written questionnaire following its translation to Portuguese. A group of 10 pediatricians and 10 pediatric allergists graded the questions from 0 to 2, and established a maximum score for each question. The questionnaire was answered by parents or guardians of asthmatic children, aged 6 to 7 years old (n = 26) and of nonasthmatic control children of the same age (n = 26); and by asthmatic (n = 33) and nonasthmatic (n = 33) adolescents, aged 13 to 14 years. Half of these individuals responded to the same questionnaire after 2 to 4 weeks. This second response allowed the evaluation of the reproducibility of the ISAAC questionnaire. The maximum global score possible was 14, and cut-off levels of 5 and 6 were found for the groups of 6 to 7 and 13 to 14 year olds, respectively. There was significant agreement between the adolescents' responses to the questionnaire and those from their parents or guardians (74.3%); however, significant discordance was observed for individual questions including "wheezing with exercise." In both age periods the questionnaire was significantly reproducible (Kappa test) (6 to 7 year olds Kw = 1; 13 to 14 year olds Kw = 0.89). In conclusion, the asthma component of the ISAAC written questionnaire was proven to be reproducible, adequate and able to differentiate between asthmatics and controls. Adolescents answered the questionnaire appropriately, however the results suggest that adolescents' parents or guardians underestimate asthma symptoms which interfere little with the adolescent's daily activities.

Adolescent↗
PubMed1999

[The prevalence of asthma-related symptoms in 13-14-year-old children from 9 Spanish populations. The Spanish Group of the ISAAC Study (International Study of Asthma and Allergies in Childhood)].

BACKGROUND: Asthma is one of the more prevalent diseases in childhood. Geographical differences have been found but it is unknown if they are true or are a consequence of the different methods used in the study of asthma. POPULATION AND METHODS: In 9 Spanish populations: Almería, Barcelona, Bilbao, Bahía de Cádiz, Cartagena, Castellón, Pamplona, Valencia and Valladolid, 27,407 children aged 13-14 years were interviewed using the asthma written and video questionnaires of the ISAAC protocol. Comparisons among geographical areas were performed using a cluster analysis and a Poisson regression model adjusting by gender. RESULTS: The prevalence of resting wheezing using the video questionnaire was higher in males than in females (15.4% versus 12.6%) for wheezing ever. In the last year the prevalence of wheezing was 7.8% in males versus 7.0% in females. The analysis shows a group of centers with low prevalence of asthma symptoms: Valladolid, Almería, Castellón and Pamplona. Nevertheless there are also centers with higher prevalences as Bilbao, Barcelona and Bahía de Cádiz. CONCLUSIONS: Prevalence of asthma and asthmatic symptoms is high in Spanish children aged 13-14 years. There are true geographical differences in Spain, being Valladolid, Almería, Castellón and Pamplona the areas with lowest prevalence.

Adolescent↗