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PubMed1999

Airway hyperresponsiveness and symptoms of asthma in a six-year follow-up study of childhood asthma.

BACKGROUND AND AIM: In an inception cohort study of 457 asthmatic children diagnosed at the age of 3 to 4 years, airway hyperresponsiveness (AHR) was assessed 6 years after first diagnosis in a subgroup of 84 children. Our objective was to associate the level of AHR with the symptomatic asthma status at follow-up. METHODS: Information on respiratory symptoms and medication use for the previous 6 years was obtained. Children with reported wheezing episodes during the previous year (n = 169) or for > or = 2 years at any time during the follow-up period (n = 85) were eligible for the challenge test. RESULTS: Among the 254 eligible children, 166 were randomly selected. The parents of 88 of them consented to have their child participate. At the time of assessment of AHR, 19 children (22%) were asymptomatic and 24 others (29%) had symptoms but did not use any medication. Forty-one children (49%) were symptomatic and required medication, including antiinflammatory preparations in 26 instances (31%). All but two children had significant AHR. There was no significant association between the level of AHR and graded symptomatic and medication score. Twenty-four of the 70 children (34%) with greatly enhanced AHR used no medication. CONCLUSIONS: This study shows that (1) almost all children first diagnosed with asthma 6 years ago and with persisting but not necessarily current symptoms of asthma have increased AHR, which satisfies a proposed epidemiologic definition of asthma; (2) AHR was present in 95% of the 20 currently asymptomatic children; and (3) one third of children with greatly enhanced AHR did not use any treatment.

Asthma↗

PubMed1999

The Chicago Asthma Consortium: a community coalition targeting reductions in asthma morbidity.

The problem of asthma in Chicago remains a complex one, and it is too early to know whether any programs and efforts have had a discernible effect, but the Chicago Asthma Consortium continues to expand its membership and to define its mission. The successes have come from harnessing the passion of the individual members to move the projects forward. As the focus of the consortium moves to addressing system-wide problems in asthma care and the delivery of that care, the consortium is undertaking the construction of a guide for future efforts. In this way, the consortium will fulfill its vision of creating a comprehensive, community-wide plan for the management of asthma, impacting on the unacceptable current levels of morbidity and mortality of the disease.

Asthma↗

PubMed1984

Classification of asthma based on clinical symptoms: asthma type in relation to patient age and age at onset of disease.

Seventy-one cases of bronchial asthma were classified into three types: bronchospasm, bronchospasm-hypersecretion and bronchiolar obstruction types. The characteristics of each type were studied in relation to patient age and age at onset of the disease. In the 71 subjects studied, the most frequent type was the bronchospasm type followed by the bronchospasm-hypersecretion type and bronchiolar obstruction type. Intractable asthma was most frequently observed in the bronchiolar obstruction type and least in the bronchospasm type. Most of the patients under 50 years of age showed the bronchospasm type. The bronchospasm-hypersecretion type was characteristically accompanied by blood eosinophilia when the patient age was under 50 years. In the bronchospasm-hypersecretion type, the incidence of intractable asthma was high in patients under 50 years of age, but not remarkable in those over 50. A large proportion of the patients over 50 years of age were of the bronchiolar obstruction type. There was no difference in the incidence of intractable asthma between the two groups classified by age at onset.

Adolescent↗

PubMed2004

Community violence and asthma morbidity: the Inner-City Asthma Study.

OBJECTIVES: We examined the association between exposure to violence and asthma among urban children. METHODS: We obtained reports from caretakers (n = 851) of violence, negative life events, unwanted memories (rumination), caretaker-perceived stress, and caretaker behaviors (keeping children indoors, smoking, and medication adherence). Outcomes included caretaker-reported wheezing, sleep disruption, interference with play because of asthma, and effects on the caretaker (nights caretaker lost sleep because of child's asthma). RESULTS: Increased exposure to violence predicted higher number of symptom days (P =.0008) and more nights that caretakers lost sleep (P =.02) in a graded fashion after control for socioeconomic status, housing deterioration, and negative life events. Control for stress and behaviors partially attenuated this gradient, although these variables had little effect on the association between the highest level of exposure to morbidity, which suggests there are other mechanisms. CONCLUSIONS: Mechanisms linking violence and asthma morbidity need to be further explored.

Arizona↗

PubMed2006

Is the childhood asthma questionnaire a good measure of health-related quality of life of asthmatic children in Asia?: validation among paediatric patients with asthma in Singapore.

BACKGROUND: Health-related quality of life (HR-QOL) is an important outcome in the treatment of chronic childhood diseases such as asthma. However, this measure is rarely used in young children in Asia because of the difficulty of obtaining valid, reliable instruments that are developmentally and culturally suitable. OBJECTIVES: To select, culturally adapt and validate a disease-specific HR-QOL questionnaire (Childhood Asthma Questionnaire [CAQ]-B) for asthmatic children aged 7-11 years in Singapore, and to understand the relationship between patient-reported HR-QOL domains and physician- or caregiver-rated severity. METHODS: A literature review was conducted to shortlist questionnaires based on pre-specified criteria. A pre-test was conducted to assess suitability and relevance of the questionnaires in Singapore. The selected questionnaire (CAQ-B) was then adapted to more closely reflect the local culture, climate, school system and terminology. Cross-sectional validation was conducted. All asthmatic patients aged 7-11 years attending the respiratory clinic in a paediatric hospital, and without co-morbidities that could significantly affect their HR-QOL, were invited to participate. Patients and their parents or caregivers were asked to complete the relevant sections of the questionnaire before their medical consultation. The child's severity of asthma was rated by the attending physician according to guidelines from the Singapore Ministry of Health. Correlations between the child-reported CAQ-B outcomes and clinical ratings of severity by both parents and physicians were investigated. Internal reliability was tested with Cronbach's alpha, and the overall questionnaire structure was explored using principal axis analysis with oblimin rotation and extraction for factors with Eigen values >1.0. RESULTS: The adapted CAQ-B was validated in 96 patients (40 girls and 56 boys) with a mean age of 8.7 +/- 1.1 years (range 7-11). Most children had no difficulty understanding and completing the questionnaire. The median time taken to complete a questionnaire was 10 minutes. Internal consistency of the various scales ranged from 0.29 to 0.76 (Cronbach's alpha) when items were analysed according to the UK or Australian scale structure. This increased to 0.57-0.76 after item reduction. Physician-rated severity only correlated significantly with the Active Quality of Living (AQOL) domain (r = -0.29, p = 0.02). However, parent/caregiver-rated severity correlated with three of four patient-reported domains: AQOL (r = -0.359, p = 0.001), Passive Quality Of Living (PQOL) [r = -0.271, p < 0.01] and severity (r = 0.367, p < 0.001). The AQOL domain was significantly correlated with the PQOL domain (r = 0.513, p = 0.005). CONCLUSIONS: The children and parents/caregivers in this study found CAQ-B to be a simple and acceptable questionnaire with some evidence of content validity. While two of the domains did not meet internal consistency standards expected of HR-QOL instruments for adults (Cronbach's alpha = 0.70), they were acceptable for children of this age. The patterns of correlation also suggest that parent/caregivers' perception of the severity of a young child's asthma may be a better indicator of a child's HR-QOL than clinical diagnosis of severity. However, further investigation is recommended to improve and validate the internal structure of the scale.

Adolescent↗

PubMed2006

Transcription factors in asthma: are transcription factors a new target for asthma therapy?

The essential features of persistent severe asthma include structural changes in the airway wall (remodelling). It is not known whether these are the sequelae of chronic inflammation or indeed its initiators. Several transcription factors have been implicated in the inflammatory process in asthma, including the glucocorticoid receptor (GR), NFkappaB, Activator Protein-1 (AP-1), Nuclear Factor of Activated T-cells (NF-AT), cyclic AMP Response Element Binding Protein and more recently, the CCAAT/Enhancer Binding Protein (C/EBP), Peroxisome Proliferator-activated Receptor (PPAR) and the bZIP transcription factor, Nrf2. Could a pathological de-regulation of one of these transcription factors explain the broad spectrum of asthma pathology and can their modulation lead to better symptom control? Although some of the transcription factors seem to be valid targets (NFkappaB, Nrf2 or STAT6) or tools (PPARgamma, -alpha and C/EBP-alpha) for new therapeutic approaches, since many transcription factors play a central role in tissue and organ homeostasis, a longterm general suppression or overexpression, would cause severe side effects in other organs. Cell type specific application of decoy or antisense oligonucleotides for NFkappaB, Nrf2 or STAT6, or specific agonists for PPARgamma and -alpha may help to control the inflammatory response in lung epithelial cells and infiltrated immune cells, but additional, unwanted, effects on other resident cells of the lung cannot be excluded and a beneficial effect over known anti-asthma drugs has first to be proven. In order to progress with such novel therapeutic strategies, the only option seems to be to link transcription factor inhibitors/activators to a cell type specific delivery system.

Animals↗

PubMed2000

Persistent asthma: patient characteristics, courses of asthma, and utility of salmeterol.

Applications of National Asthma and Education and Prevention Program (NAEPP) guidelines for the diagnosis and management of asthma may reduce the morbidity of this disorder. Medical records and questionnaires from a series of 177 outer-city adolescents and adults with persistent asthma were audited according to NAEPP guidelines and for utility of salmeterol (Serevent). Allergic sensitivity and exposure to indoor allergens house-dust mite (66% of patients), fungi (42%), cat (20%) and/or dog (14%) were of dominant importance to persistent asthma. Patients who continued salmeterol over 1 year had reduced severity of disease, improved forced expiratory flow at 25%-75% of vital capacity, and reduced usage of systemic, but not inhaled, corticosteroid.

Adolescent↗

PubMed1980

Asthma: The yoga perspective. Part I. The somatopsychic imbalance in asthma: towards a holistic therapy.

While the standard physiological and even certain psychological characteristics of asthmatic patients are well known, the current diagnostic and therapeutic approach to asthma remains inadequate, as it neglects certain interrelated somatopsychic factors vital to an optimal diagnostic-therapeutic programme. These include the role of skeletal muscle tension and posture, the role of the 'voluntary' respiratory musculature, especially the diaphragm, as well as anxiety, emotional suppression and excessive self-consciousness, all of which may be precipitants rather than the outcome of the onset of asthma. On the basis of these neglected factors and others, implications for an optimally effective therapy are discussed. The physical medicine or physiotherapeutic, as well as other recent therapeutic approaches, are reviewed and evaluated. It is concluded that all of these therapies are too "specific," and that a more holistic approach is necessary (which is provided in 'Asthma: The Yoga Perspective,' Part II-"Yoga Therapy in the Treatment of Asthma").

Asthma↗

PubMed1982

The battery of asthma illness behavior, I: independence from age of asthma onset.

The Battery of Asthma Illness Behavior was developed to assess the potential for psychomaintenance in chronic bronchial asthma. The present study demonstrates that the BAIB's success in predicting the perpetuation, exacerbation, and maintenance of asthma cannot be attributed to its merely reflecting one objective parameter of illness, i.e., age of asthma onset.

Adult↗

PubMed1991

Influence of antithyroidal therapy on asthma symptoms in the patients with both bronchial asthma and hyperthyroidism.

To investigate the possible influences of hyperthyroidism on the pathophysiology of bronchial asthma, we clinically observed the effect of antihyperthyroidal therapy on asthmatic symptoms in 7 patients who shared both disorders. In five cases, asthma symptoms were affected by the therapy. Asthma symptoms improved after normalization of thyroid function in two cases, but worsened after therapy for hyperthyroidism in three cases. There was no apparent correlation between the pathophysiology of the two diseases after therapy in the two other cases. These results showed that thyrotoxicosis does not uniformly affect the pathophysiology of asthma and emphasizes the need to follow asthmatic patients closely following treatment for hyperthyroidism.

Adult↗

PubMed1999

[Hospital admission for bronchial asthma: comparison between inpatient children and patients attending ambulatory asthma education].

BACKGROUND: Asthma bronchiale is a chronic disease with increasing prevalence, increasing numbers of hospital admissions, and a growing mortality rate. Training courses for patients could reduce the number of in-patients, but it is still not clear what leads to an increase in admissions and whether all children have equal access to the special training courses offered. METHODS: In order to settle these questions, 40 in-patients with asthma (clinical group) were compared with a training group of 80 children of the same age, who participated in an out-patients' training course for asthmatics held at Asthma-Zentrum Rhein-Main. During a retrospective examination clinical characteristics (therapy prior to admission, number of times of seeing a doctor before admission, number of days of absence from school) and socio-economic conditions (size of flat, level of education of parents, proportion of children from families of non-German origin), as well as environmental factors (parents' tobacco smoking) were determined. FINDINGS: As expected, significant disadvantages regarding clinical characteristics and socioeconomic data were recorded for the clinical group. Children in the clinical group less often got a regular prophylactic treatment before admission to hospital (43% vs. 80%). They were absent from school three times more often than children from the training group (6 days vs. 2 days); proportionally, their parents smoked twice as often (53% vs. 23%); frequently, the number of persons living in the flat exceeded the total number of rooms (43% vs. 23%), and only 61% had their own bedroom (vs. 81% in the training group). 40% of the children in the clinical group are from families of nationalities other than German vs. only 14% in the training group. Moreover, most parents of the children in the clinical group were undereducated or had no professional training at all, and rarely held university degrees. INTERPRETATION: The results show that the patients' profiles regarding therapy and socio-economic conditions differ substantially between in-patients and children from the training group at the Asthma-Zentrum. A major part of these patients in question had no access to or could not be reached by an ambulant training course for asthmatics. Especially socially and economically disadvantaged families, and families with little compliance must be informed more carefully and should be persuaded of the benefits of ambulant training courses for asthmatics.

Adolescent↗

PubMed1997

Randomized trial of zileuton in patients with moderate asthma: effect of reduced dosing frequency and amounts on pulmonary function and asthma symptoms. Zileuton Study Group.

This 6-month, randomized, multicenter study was designed to determine whether patients who had been treated with the leukotriene pathway inhibitor zileuton 600 mg four times daily (QID) for 2 months could be maintained at the same level of pulmonary function, symptom control, and beta-agonist use with less frequent dosing--first 600 or 800 mg three times daily (TID) and then twice daily (BID). A total of 278 patients with chronic asthma, ages 16 to 70, participated at 25 US centers. All had a 1-second forced expiratory volume (FEV1) of 35%-75%, reversible airway disease, and a nonsmoking history of 1 year. An 8-week open-label period (zileuton 600 mg QID) was followed by a 16-week double-blind period, in which patients who responded to the QID treatment were randomized to receive zileuton 600 or 800 mg TID for 8 weeks and then rerandomized to receive zileuton 600 or 800 mg BID for another 8 weeks. Primary outcomes were FEV1 and asthma symptom scores; secondary outcomes were peak expiratory flow rate, beta-agonist use, and asthma exacerbations requiring steroid rescue. Patients who showed improvements in lung function when treated with zileuton 600 mg QID demonstrated minimal decreases in FEV1 and comparable peak expiratory flow rates, symptom control, beta-agonist use, and systemic corticosteroid rescue when being treated with lower doses and/or less frequent doses of zileuton. Patients who demonstrate improved asthma control with zileuton 600 mg QID may be able to reduce their daily dosage and/or frequency while still maintaining the same level of symptom control.

Adolescent↗

PubMed1999

[Relationship between the clinical course of bronchial asthma from childhood to adulthood (deterioration/improvement), bronchial hyperreactivity and incidence of house dust mite allergens in households of persons treated for atopic bronchial asthma as children].

The aim of the study was to determine the impact of the exposition to house dust mite allergens or its lack on clinical state of asthma in young adults treated in their childhood for atopic bronchial asthma. The concentration of house mite allergen was studied with the method of Acarex test (detection of guanine--excretory product of house dust mites) in the flats of 55 persons treated for atopic asthma before adolescence. There was significant difference (p < 0.006) between the clinical course of asthma (improvement) in persons living in flats free of house dust mite allergens and those living in flats infested with mites. House dust mite allergens were present significantly more frequently in flats of persons with a low histamine threshold (19 of 20 examined flats) than in flats of persons with a high histamine threshold or without hyperreactivity to histamine (6 of 20 examined flats).

Adult↗

PubMedDate not supplied

Serum levels of eosinophilic cationic protein (ECP), myeloperoxidase (MPO), lipid peroxidation products, interleukin (IL)-5 and interferon (IFN)-gamma in children with bronchial asthma at acute asthma attack and remission.

We determined serum levels of myeloperoxidase (MPO), eosinophilic cationic protein (ECP), reactive oxygen species measured as thiobarbituric acid reactive substances (TBARS), interleukin (IL)-5, and interferon (IFN)-gamma in 14 asthmatic children during an asthma attack and remission. Twelve healthy children served as controls. In atopic asthmatics, asthma attack resulted insignificant elevations of ECP, MPO, and TBARS compared to remission. TBARS levels were also higher at remission compared to controls. However, there was a great deal of overlap in the values of asthmatics and controls. IL-5 and IFN-gamma were detectable at low levels and only in a few patients. These results provide further evidence for participation of eosinophils, neutrophils and reactive oxygen species in the pathogenesis of acute asthma, and suggest that their products may be used in monitoring asthma attack. Serum IL-5 and IFN-gamma levels are not appropriate for use in the follow-up of asthmatic children.

Acute Disease↗

PubMed1999

Comparison of different long-term asthma treatments in subjects with mild-to-moderate asthma.

In order to compare the efficacy of different asthma treatment in subjects with mild-to-moderate asthma, three groups of 11 patients were treated with nedocromil sodium (NS), beclomethasone dipropionate (BDP) and beclomethasone dipropionate plus salmeterol (BDP + S) in an open, randomized study. Symptom score, peak expiratory flow (PEF) maximal amplitude, forced expiratory volume in one second (FEV1), and methacholine reactivity were measured at the baseline and at intervals of 3 months up to 12 months. After 3 months, symptoms reduced significantly in all treatment groups, while PEF variability improved in BDP and BDP + S groups; FEV1 and bronchial responsiveness to methacholine were significantly improved in comparison with baseline value in the BDP + S group only. No significant difference was observed after 6 and 12 months of treatment in PEF variability, FEV1 or bronchial hyperreactivity in the NS group compared with baseline values, while a significant difference was observed in symptom score. BDP group showed a significant improvement in FEV1 and bronchial reactivity to methacholine after 6 and 12 months of treatment. In the BDP + S group, the improvement in symptoms and pulmonary function persisted until the end of the study. In conclusion, the combination of beclomethasone dipropionate and salmeterol improved pulmonary function and bronchial reactivity earlier than beclomethasone dipropionate alone, while nedocromil sodium improved symptoms but not pulmonary function. Assuming that bronchial reactivity could be an indirect measurement of airway inflammation, overtreatment of asthma in relationship with the classification of asthma severity of the International Guidelines could improve both airway inflammation and the prognosis of airway obstruction.

Adolescent↗

PubMed1975

Exercise-induced asthma in children with intrinsic and extrinsic asthma.

The significance of intrinsic asthma as a diagnosis has been questioned since, except for the lack of evidence of allergy, there is no pathophysiologic distinction from extrinsic asthma. Following a standardized exercise stress, allergic (extrinsic) asthmatics respond with more severe asthma than do nonallergic (intrinsic) asthmatics. The incidence of significant exercise-induced asthma is greater in a group of extrinsic asthmatics than in intrinsic asthmatics. Extrinsic asthmatics show increased airway sensitivity during a significant pollen season.

Adolescent↗

PubMed2002

Highlights from the annual scientific assembly: patient-centered approaches to asthma management: strategies for treatment and management of asthma.

Asthma is a chronic inflammatory disease in which the genetic predisposition to allergic disease is the strongest identifiable predisposing factor. (1) Optimal outpatient treatment of asthma includes identifying and minimizing exposure to asthma triggers, whether they Me allergens or irritants. When these triggers are not obvious, referral to an allergist may be appropriate to ideniify potential exacerbating factors. In addition, pulmonary consultation may be helpful in patients who do not have the typical features of asthma on chest radiograph or pulmonary function testing, or who are not responding well to standard therapy. The primary care physician is the most important component in the care of the asthmatic patient, however, managing acute exacerbations, determining long-term medical therapy, and providing preventive measures, such as yearly influenza vaccinations.

Anti-Asthmatic Agents↗

PubMed1992

[Pseudo-asthma and asthma with hypereosinophilia].

Despite of its high prevalence, asthma is not the sole cause of wheezing dyspnea: the obstruction of the principal airways, some diffuse bronchial diseases may present as pseudoasthma. The diagnosis of some behavioral dyspneas as well as functional laryngeal obstruction is sometimes highly difficult. The finding of a marked hypereosinophilia prompts the clinician to research a parasitic infection as a cause of pseudo-asthma, allergic bronchopulmonary aspergillosis complicating asthma, or an idiopathic hypereosinophilic disorder of which asthma is a component (as in Churg and Strauss syndrome).

Asthma↗