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PubMed1995

Asthma self-management programs can reduce the need for hospital-based asthma care.

UNLABELLED: Mortality from asthma and its complications is increasing as is the expense associated with treating this disease. We hypothesized that an asthma-education program, already in place, had reduced hospitalizations (HOS) and emergency-department (ED) visits for asthmatic patients who participated. METHODS: We compared asthmatic patients' ED visits and HOS for the 12-month periods immediately before and after treatment in our center. METHODS: All patients received physician-directed medical management based upon the National Asthma Education Panel recommendations. One group (PART, n = 13) received instruction in self-management using the peak-flow meter (PFM) and an action plan (AP) to adjust medication dosages in response to changing post-bronchodilator peak-flow meter readings. Average cost for this intervention was $820 (2 visits, each with 60-90 minutes of instruction). The other group (FULL, n = 13), in addition to receiving a PFM and AP, completed a multidisciplinary education program stressing trigger identification and avoidance, environmental control, proactive adjustment of anti-inflammatory agents, and stress management. Average cost for this intervention was $1,700 (multidisciplinary evaluations and 12 hours of instruction). Those who did not enter the education program did so by choice or circumstance (ie, transportation problems, inability to commit the required time for the program, insurance denial). RESULTS: Of the 13 PART-group subjects, 8 experienced all 31 ED and/or HOS in the year prior to our program. Four of 13 accounted for the 15 ED and/or HOS after discharge from the program (50% improvement, p < 0.05). Of the 14 patients in the FULL group, 7 accounted for 25 ED and/or HOS prior to the program. There were no ED and/or HOS after the program (100% improvement, p < 0.05). CONCLUSION: Based on this sample, it is evident that both PART and FULL programs can significantly impact the frequency with which hospital-based asthma care is required and thus reduce the overall cost of caring for patients with asthma.

Asthma↗
PubMedDate not supplied

Incidence and significance of precipitating antibodies in occupational and non-occupational extrinsic non-atopic (type III) asthma (bronchial asthma with precipitins).

Precipitating antibodies against different organic enviromental dusts were studied in 37 patients with suggestive symptoms of nonatopic bronchial asthma, comparatively with a group of 4 patients with atopic asthma and with a group of asymptomatic subjects, exposed to the same organic dusts as the majority of patients. Precipitins were found present in over 75% of the sera from patients with infectious type non-atopic asthma and were associated with positive semidelayed type skin tests as well as with positive bronchial provocation tests a few hours after antigen inhalation. No precipitins were found in the sera from patients with atopic asthma. Precipitating antibodies were also found but in lower percentages (30%) and at lower titers, in clinically asymptomatic subjects who were occupationally exposed to the respective antigens. It was demonstrated that the presence of precipitins in the sera of patients with bronchial asthma is a valuable diagnostic element which confirms the clinical and anamnestic data. The pathogenic role of precipitins is not yet clear. It might be related to the amount of these precipitins in the serum.

Antigens↗
PubMed2002

Understanding patient perceptions of asthma: results of the Asthma Control and Expectations (ACE) survey.

In spite of support among UK healthcare professionals for asthma guidelines, studies continue to show that many patients fail to reach the suggested management goals. Patient expectations and poor communication may be factors in this failure. This survey assessed patients' asthma control, expectations in respect of asthma and communication with healthcare professionals. A structured questionnaire, designed for self-completion, was developed and distributed to asthma patients at participating pharmacies. A total of 1031 questionnaires were returned. Most of the respondents, even among those feeling well, reported lifestyle restrictions because of asthma. These restrictions were not generally discussed with healthcare professionals. One-third did not perceive the benefits of inhaled corticosteroids. Low expectation may be a major contributor to the poor control seen in this survey. The failure to discuss lifestyle restrictions and symptom levels with healthcare professionals gives little scope for recommendation of appropriate and adequate treatment. Improved communication between healthcare professionals and patients may help such understanding and raise patient expectations.

Adolescent↗
PubMed2002

[Teenagers with asthma. A qualitative survey among teenagers with asthma of their expectations and attitudes when it comes to offered health care services].

INTRODUCTION: We wanted to examine the factors that were of importance for the hospital outpatient treatment of teenagers with asthma. MATERIAL AND METHODS: A total of 89 teenagers received a postal questionnaire and an invitation to participate in a focus group interview on outpatient asthma follow-up. RESULTS: Only 16 answered the questionnaire and 7 participated in the interview. The importance of personal contact was stressed and the teenagers expected much from the personnel aiming to help them. In a questionnaire follow-up of initial non-responders, 82% still had asthma and 75% of these received asthma medication. DISCUSSION: The low participation rate and the high expectations explain why teenagers with asthma constitute a group of patients with less than optimal results of treatment.

Adolescent↗
PubMed2003

The new asthma guidelines: a patient-centred approach to asthma.

Asthma is chronic disabling condition that causes high levels of morbidity and mortality. New asthma guidelines provide evidence to guide clinical decisions about asthma management and advocate self-management programmes that involve the use of written personalized asthma action plan. Nurses have a vital role to play in improving outcomes for people with asthma.

Asthma↗
PubMed1992

National Asthma Education Program Expert Panel report: guidelines for the diagnosis and management of asthma.

1. Asthma, a chronic lung disease that affects 10 million Americans, is receiving increased attention as a public health problem due to increased occurrence and number of reported deaths. 2. This article presents an overview of the National Asthma Education Program Expert Panel guidelines, specifically addressing the definition and pathophysiology of asthma, effective management and control of asthma, and special considerations in asthma management. 3. Implications of the Expert Panel guidelines for occupational health nurses are addressed.

Asthma↗
PubMed1989

[The effect of climatic and meteorologic factors on bronchial hyperreactivity and the course of bronchial asthma diseases and their potential significance in asthma prevention: hypotheses, methodologic approaches and initial results].

Bronchial hyperresponsiveness (BHR) as the main condition for the development of asthma may be modulated either by intrinsic or by extrinsic stimuli as well as by climatic and meteorologic factors. Proinflammatory mediators in combination with alterations of airway mucosa induce or amplify BHR. Upper airway viral infections, exposure to allergens in atopic subjects, chronic hyperplastic changes of the upper airways, airway irritants and analgesics are supposed to be the most likely asthma triggers in predisposed children and adults. There is the suggestion that BHR can be improved not only by treatment with steroidal and nonsteroidal antiinflammatory drugs but also by maritime climatotherapy. The latter could be the result not only of the reduction of inhalative irritants, e.g. of allergen concentration, but also by the involvement or more complex mechanisms. Possible theoretic approaches and hypotheses regarding the mode of action of maritime climatic cures are discussed. First preliminary results obtained in a mediterranean region have demonstrated a negative impact of metereologic events like passages of cold weather fronts or increase of wind velocity on the course of asthma disease. An improvement of BHR assessed by histamine challenge test has been observed at the end of climatotherapy in the Baltic sea area. Prospective studies about asthma prevention in subjects at risk with BHR and atopy that have been starting should contribute to the evaluation of the therapeutic effects and the prognostic importance of maritime climatotherapy for getting exact scientific indications for climatotherapy in patients with bronchial asthma.

Adult↗
PubMedDate not supplied

Status asthmaticus, severe acute asthma or severe exacerbation of asthma.

"Status Asthmaticus" is an old term which has been defined in many different ways. Two distinctive features are usually used to identify "Status Asthmaticus": severity and lack of response to bronchodilators. However, the latter condition is not always observed and thus the term "Status Asthmaticus" basically implies severity. "Severe acute asthma" is a new term which has replaced "Status Asthmaticus". Nevertheless, a severe attack of asthma may occur suddenly or can take place after days or weeks of a progressive deterioration. A "Status Asthmaticus" can be "acute" or "subacute" according to the rate of deterioration; therefore the term "Severe acute asthma" is misleading. Since the term "Status Asthmaticus" essentially implies severity, severe attacks would be better described as "Severe exacerbation of asthma" (SEA). Classification of the SEA into two types (acute and subacute), could help to reveal the etiology of the attack and might also be relevant to the management of the patient. For instance an acute SEA can be seen in brittle asthma and in patients with aspirin intolerance. On the other hand, patients with the subacute form are refractory to bronchodilators and must be treated with corticosteroids.

Acute Disease↗
PubMed1993

Diagnosis and management of asthma: a brief review of two asthma expert panel reports.

During the past decade, asthma morbidity and mortality have increased noticeably. Although the reasons for the increase are not clear, the prevalence of asthma has been reported to be increasing not only in the United States but also in other countries throughout the world, including the United Kingdom, New Zealand, and Australia. Asthma mortality rates and morbidity trends are increasing despite what appears to be major scientific advances in our understanding of asthma and in the face of a multitude of new therapeutic modalities. This article presents a brief overview of the pathogenesis and diagnosis of asthma, and highlights the major management recommendations of two expert panel reports.

Algorithms↗
PubMed1997

Does participation in distance learning and audit improve the care of patients with acute asthma attacks? The General Practitioners in Asthma Group.

OBJECTIVE: To test whether general practitioners who completed an audit cycle encompassing a data recording exercise, distance learning programme and personalized feedback changed their management of patients with acute asthma attacks. DESIGN, SETTING AND SUBJECTS: Practice and patient details from two national correspondence surveys of the management of acute asthma attacks in the United Kingdom in 1991-92 and 1992-93 were compared. Main outcome measures were use of nebulised bronchodilators, systemic steroids during an asthma attack, and increased use of prophylactic therapy after attacks. RESULTS: Ninety-one general practitioners completed an audit cycle and reported data on 782 patients with asthma attacks in 1991-92 and 669 in 1992-93. There were no significant changes in practice resources during this time. Management changed in line with recommended guidelines and audit feedback suggestions leading to more use of nebulised bronchodilators [272 (35%) before, 268 (40%) after, Odds Ratio (OR) 0.80, 95% Confidence Intervals (CI) 0.64-0.99], systemic steroids [563 (72%) before, 506 (76%) after, OR 0.83, CI 0.65-1.06], and 'step-up' in preventative therapy [402 (51%) before, 382 (57%) after, OR 0.79, CI 0.64-0.98]. CONCLUSION: General Practitioners who completed an audit cycle showed changes in the management of acute asthma attacks in line with guidelines which may have been caused by participation in distance learning and clinical audit. However, general practitioners motivated to change clinical management may be similarly motivated to take part in audit. Audit may be the catalyst for change rather than the cause of change.

Acute Disease↗
PubMed1976

A multifactorial study of patients with asthma. Part 2: air pollution, animal dander and asthma symptoms.

As part of a multifactorial computer-assisted study of patients with asthma, the relationship between air pollution, animal dander and asthma symptoms was evaluated. No association was found between four major air pollutants (carbon monoxide, ozone, nitrogen oxides and sulfur dioxide) and asthma symptoms. Patients who owned cats and dogs reported more severe asthma symptoms (p less than .01) than patients who did not own cats and dogs. The evaluations completed to date indicate that daily exposure to cats and dogs accounts for more of the asthma symptoms differences between patients than daily exposure to air pollutants.

Adolescent↗
PubMed1998

Diagnosis and management of rhinitis: complete guidelines of the Joint Task Force on Practice Parameters in Allergy, Asthma and Immunology. American Academy of Allergy, Asthma, and Immunology.

This document contains complete guidelines for diagnosis and management of rhinitis developed by the Joint Task Force on Practice Parameters in Allergy, Asthma and Immunology, representing the American Academy of Allergy, Asthma and Immunology, the American College of Allergy, Asthma and Immunology and the Joint Council on Allergy, Asthma and Immunology. The guidelines are comprehensive and begin with statements on clinical characteristics and diagnosis of different forms of rhinitis (allergic, non-allergic, occupational rhinitis, hormonal rhinitis [pregnancy and hypothyroidism], drug-induced rhinitis, rhinitis from food ingestion), and other conditions that may be confused with rhinitis. Recommendations on patient evaluation discuss appropriate use of history, physical examination, and diagnostic testing, as well as unproven or inappropriate techniques that should not be used. Parameters on management include use of environmental control measures, pharmacologic therapy including recently introduced therapies and allergen immunotherapy. Because of the risks to patients and society from sedation and performance impairment caused by first generation antihistamines, second generation antihistamines that reduce or eliminate these side effects should usually be considered before first generation antihistamines for the treatment of allergic rhinitis. The document emphasizes the importance of rhinitis management for comorbid conditions (asthma, sinusitis, otitis media). Guidelines are also presented on special considerations in patients subsets (children, the elderly, pregnancy, athletes and patients with rhinitis medicamentosa); and when consultation with an allergist-immunologist should be considered.

Diagnosis, Differential↗
PubMed2004

Performance of a novel clinical score, the Pediatric Asthma Severity Score (PASS), in the evaluation of acute asthma.

OBJECTIVES: To evaluate the reliability, validity, and responsiveness of a new clinical asthma score, the Pediatric Asthma Severity Score (PASS), in children aged 1 through 18 years in an acute clinical setting. METHODS: This was a prospective cohort study of children treated for acute asthma at two urban pediatric emergency departments (EDs). A total of 852 patients were enrolled at one site and 369 at the second site. Clinical findings were assessed at the start of the ED visit, after one hour of treatment, and at the time of disposition. Peak expiratory flow rate (PEFR) (for patients aged 6 years and older) and pulse oximetry were also measured. RESULTS: Composite scores including three, four, or five clinical findings were evaluated, and the three-item score (wheezing, prolonged expiration, and work of breathing) was selected as the PASS. Interobserver reliability for the PASS was good to excellent (kappa = 0.72 to 0.83). There was a significant correlation between PASS and PEFR (r = 0.27 to 0.37) and pulse oximetry (r = 0.29 to 0.41) at various time points. The PASS was able to discriminate between those patients who did and did not require hospitalization, with area under the receiver operating characteristic curve of 0.82. Finally, the PASS was shown to be responsive, with a 48% relative increase in score from start to end of treatment and an overall effect size of 0.62, indicating a moderate to large effect. CONCLUSIONS: This clinical score, the PASS, based on three clinical findings, is a reliable and valid measure of asthma severity in children and shows both discriminative and responsive properties. The PASS may be a useful tool to assess acute asthma severity for clinical and research purposes.

Adolescent↗
PubMed2000

Inhaled vs oral steroids for adults with chronic asthma.

OBJECTIVES: To determine therapeutically equivalent doses of inhaled versus oral steroids for adults with chronic asthma. SEARCH STRATEGY: The Cochrane Airways Group trials register was searched using the terms: (drug delivery systems OR ((nebuli* OR inhal* OR MDI) AND oral*)) AND ( steroid* OR corticosteroid* OR glucocorticoid* OR beclomethasone OR betamethasone OR fluticasone OR cortisone OR dexamethasone OR hydrocortisone OR prednisolone OR prednisone OR triamcinolone). SELECTION CRITERIA: Randomised controlled trials were selected of at least 4 weeks duration and included patients over the age of 15 years with chronic asthma. Trials compared inhaled steroids and oral prednisolone or prednisone; where the maximum dose for inhaled steroids was 2000 mcg/day and prednisolone 60 mg (on alternate days). DATA COLLECTION AND ANALYSIS: Two independent reviewers screened 1285 titles and abstracts from the electronic search, bibliography searches and other contacts. Of these, 10 trials met previously defined inclusion criteria. Two reviewers independently extracted study characteristics, and outcome measures. MAIN RESULTS: All trials were small and no data could be pooled. Carry-over effects were present in at least one cross-over trial. Data from six trials produced the same pattern, in which prednisolone 7.5-12 mg/day appeared to be as effective as inhaled steroid 300-2000 mcg/day. In two trials, inhaled steroid 300-400 mcg/day was more effective than prednisolone 5 mg/day. All doses of inhaled steroid appeared to be more effective than alternate day doses of prednisolone up to 60 mg on alternate days. Side-effect data were reported too variably to permit comparisons. A 30% incidence was reported in one study in patients receiving prednisolone 5 mg/day, none were reported in patients on inhaled steroids. REVIEWER'S CONCLUSIONS: A daily dose of prednisolone 7.5-10 mg/day appears to be equivalent to moderate-high dose inhaled corticosteroids. Side-effects may be present on low doses, so if there is no alternative to oral steroids, the lowest effective dose should be prescribed.

Administration, Inhalation↗
PubMed2006

Long-term comparison of 3 controller regimens for mild-moderate persistent childhood asthma: the Pediatric Asthma Controller Trial.

BACKGROUND: More evidence is needed on which to base recommendations for treatment of mild-moderate persistent asthma in school-aged children. OBJECTIVE: The Pediatric Asthma Controller Trial (PACT) compared the effectiveness of 3 regimens in achieving asthma control. METHODS: A total of 285 children (ages 6-14 years) with mild-moderate persistent asthma on the basis of symptoms, and with FEV(1) >or= 80% predicted and methacholine FEV(1) PC(20) or= 80% predicted, confirming current guideline recommendations.

Acetates↗
PubMed1981

Ketotifen in atopic asthma and exercise-induced asthma.

The efficacy of ketotifen, a tricyclic benzocycloheptathiophene derivative, was assessed in an outpatient clinical trial and in a group of 12 asthmatic subjects with exercise-induced asthma. Subjects in the outpatient trial had mild asthma and consisted of two groups: a group of 24 atopic asthmatics with at least one positive skin test reaction and with an associated history of bronchial reactivity to at least one allergen; and a group of eight asthmatics with one or more positive skin prick tests but not bronchial reactivity to an allergen. Both groups took four weeks medication of ketotifen 1 mg bd and placebo in a randomised double-blind crossover study. There was no difference between ketotifen and placebo for any measurement made during the study and consequently no evidence of drug efficacy. The exercise study followed a standardised protocol and each subject took in random double-blind order, placebo, 1 mg, 2 mg, and 4 mg ketotifen two hours before exercise. There was no difference in the mean decreases in lung function from pre-exercise baseline values after three doses of ketotifen than with placebo. Drug levels suggested ketotifen was well absorbed. It would appear that if given for a period of only four weeks ketotifen had no beneficial effects in the management of mild asthma, and that a single dose before exercise does not modify exercise-induced asthma.

Adolescent↗
PubMed1999

Sensitivity and specificity of asthma definitions and symptoms used in a survey of childhood asthma.

We compared the ability of definitions/symptoms of asthma to identify urban, elementary schoolchildren with physician-diagnosed asthma and bronchial hyperresponsiveness (BHR) post-exercise challenge. Definitions of asthma from the literature were compared, including American Thoracic Society (ATS) and British Medical Research Council (BMRC) definitions. Modified ATS had the highest sensitivity (77%), whereas BMRC had the highest specificity (99%). The most sensitive symptom was "wheeze with cold" (89%). The most specific symptoms were "medication required," and "breathing normal between attacks" (95%). Definitions and symptoms were poor predictors of BHR. Researchers can use these estimates in selecting and defining specific populations of children with asthma.

Asthma↗