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PubMed2005

A population-based study of asthma, quality of life, and occupation among elderly Hispanic and non-Hispanic whites: a cross-sectional investigation.

BACKGROUND: The U.S. population is aging and is expected to double by the year 2030. The current study evaluated the prevalence of asthma and its correlates in the elderly Hispanic and non-Hispanic white population. METHODS: Data from a sample of 3021 Hispanics and non-Hispanic White subjects, 65 years and older, interviewed as part of an ongoing cross-sectional study of the elderly in west Texas, were analyzed. The outcome variable was categorized into: no asthma (reference category), current asthma, and probable asthma. Polytomous logistic regression analysis was used to assess the relationship between the outcome variable and various socio-demographic measures, self-rated health, asthma symptoms, quality of life measures (SF-12), and various occupations. RESULTS: The estimated prevalence of current asthma and probable asthma were 6.3% (95%CI: 5.3-7.2) and 9.0% (95%CI: 7.8-10.1) respectively. The majority of subjects with current asthma (Mean SF-12 score 35.8, 95%CI: 34.2-37.4) or probable asthma (35.3, 34.0-36.6) had significantly worse physical health-related quality of life as compared to subjects without asthma (42.6, 42.1-43.1). In multiple logistic regression analyses, women had a 1.64 times greater odds of current asthma (95%CI: 1.12-2.38) as compared to men. Hay fever was a strong predictor of both current and probable asthma. The odds of current asthma were 1.78 times (95%CI: 1.24-2.55) greater among past smokers; whereas the odds of probable asthma were 2.73 times (95%CI: 1.77-4.21) greater among current smokers as compared to non-smokers. Similarly fair/poor self rated health and complaints of severe pain were independently associated with current and probable asthma. The odds of current and probable asthma were almost two fold greater for obesity. When stratified by gender, the odds were significantly greater among females (p-value for interaction term = 0.038). The odds of current asthma were significantly greater for farm-related occupations (adjusted OR = 2.09, 95%CI: 1.00-4.39); whereas the odds were significantly lower among those who reported teaching as their longest held occupation (adjusted OR = 0.36, 95%CI = 0.18-0.74). CONCLUSION: This study found that asthma is a common medical condition in the elderly and it significantly impacts quality of life and general health status. Results support adopting an integrated approach in identifying and controlling asthma in this population.

Aged↗
PubMed2004

Predictive value of a cross-cultural asthma case-detection tool in an elementary school population.

OBJECTIVE: Bronchial asthma, which affects approximately 5 million US children, is vastly underdiagnosed and treated, particularly among minorities and those of low socioeconomic status. Because current methods of detecting those at greatest risk of asthma in a multicultural setting appear inadequate, we assessed the validity and reliability of a new asthma questionnaire across 3 dominant cultures in Orange County, California (white, Hispanic, and Vietnamese). METHODS: Children in grades 1, 3, and 5 and their families, in 3 different schools representative of these major ethnic groups, were randomly selected to participate in the validation process. Two schools with low socioeconomic status and dominant Hispanic or Vietnamese minorities were designated inner-city schools, whereas the third school was a suburban school with predominately white students. Participants completed a 7-question, 11-element questionnaire in their primary language, followed by an asthma evaluation (history, physical examination, and spirometry) by an asthma specialist (who was blinded with respect to the results of the questionnaire), at their respective schools. The physician then made a determination regarding the presence and severity (according to National Institutes of Health guidelines) of asthma. Several weeks later, the entire student body was asked to complete the questionnaire at home and return it to school for analysis. Validation of each item was evaluated for sensitivity, specificity, and positive and negative predictive values, and application of univariate analyses provided an estimated probability of an asthma diagnosis by the asthma specialist. A "best-fit" algorithm was determined with all 11 elements, if possible, and an abbreviated algorithm that selected the fewest-question combination that yielded the best asthma predictability was established. Reliability was established with the percent agreement between the 2 questionnaires and the kappa statistic. RESULTS: Of the 401 children/families who participated in the validation analysis, 45% were Hispanic, 22% white, 19% Vietnamese, and 15% other. The overall prevalence of asthma specialist-diagnosed asthma was 28%, with 65% of cases being graded as intermittent and 35% as persistent. Sixty-two percent of the children had not been previously diagnosed with asthma. There were no significant differences among cultures in sensitivity or specificity for any of the individual questions or the complete or abbreviated algorithms. The abbreviated algorithm with 3 questions, ie, question 1 (asthma in the past 2 years), question 4 (cough, chest tightness, trouble breathing, or wheezing with exercise), and question 6 (same symptoms in the morning or day in the past 4 weeks) yielded comparable sensitivity and specificity for the complete algorithm in all groups. The abbreviated algorithm had >86% predictability in detecting children with persistent asthma and 56% predictability in detecting children with intermittent asthma. Reliability was also excellent, with percent agreement usually > 80% and kappa values of >.70. CONCLUSIONS: This asthma detection tool has been shown to be suitable for detecting persistent asthma in a multicultural inner-city population, as well as in a suburban setting. An abbreviated algorithm with 3 questions and >80% predictability in detecting persistent asthma seems ideal for evaluating large numbers of school-aged children. The school setting is an excellent site for identifying children with asthma. Although there is concern that subjects detected in the school setting might not have access to ongoing medical care, case detection is an important first step that could lead to earlier diagnosis and treatment. Reducing the barriers to good care in inner-city environments is the next step.

Algorithms↗
PubMed2004

Asthma in Wisconsin adults: a persistent problem for patients and providers.

Asthma is a chronic lung condition that requires active provider and patient management to prevent chronic symptoms and exacerbations. Data from the 2002 Wisconsin Behavioral Risk Factor Survey were used to determine asthma prevalence and characterize asthma symptom severity, control, and management among Wisconsin adults. About 8.5% or an estimated 345,000 adults in Wisconsin reported currently having asthma. Most adults with asthma (66%) have symptoms consistent with intermittent asthma. Over 80% of Wisconsin adults with asthma reported experiencing asthma symptoms in the past 30 days and 14% reported going to the emergency department for asthma in the past 12 months. The National Asthma Education and Prevention Program Management and Diagnosis Guidelines are considered the standard of quality for asthma care. Asthma management in Wisconsin falls short of meeting these guidelines. Classifying the severity of asthma, scheduling routine follow-up care, recommending measures to control asthma triggers, and treating or preventing comorbid conditions are key asthma management clinical activities. Increased clinical management coupled with improved patient self-management is needed to reduce the burden of asthma in Wisconsin. The Wisconsin Asthma Plan, released by the Wisconsin Asthma Coalition, provides concrete steps for improving provider and patient asthma management.

Adolescent↗
PubMed1994

An estimate of the prevalence of asthma and wheezing among inner-city children.

OBJECTIVE: To estimate the prevalence of asthma and wheezing unassociated with a diagnosis of asthma among inner-city children. DESIGN: Cross-sectional survey of a sample of Bronx households. METHODS: Random digit dialing telephone survey using parental report. SETTING: Bronx County, NY. PARTICIPANTS: 662 self-designated heads-of-household who reported for all children 0 through 17 years of age living in their households. MEASUREMENTS: Questions from the Child Health Supplement to the 1988 National Health Interview Survey and the International Union Against Tuberculosis and Lung Disease Bronchial Symptoms Questionnaire were used to estimate the prevalence of asthma and wheezing-related illness. RESULTS: Information was gathered on 1285 children. Of this sample, 184 (14.3%) were reported to have ever had asthma (cumulative prevalence) and 111 (8.6%) were reported to have asthma in the last 12 months (period prevalence). The asthma period prevalence rate among Bronx children was twice the United States rate (4.3%). Among children 0 through 11 years of age, the prevalence rate was similar for boys and girls, although among children 12 through 17 years of age, asthma was significantly more prevalent among boys. Fifty-four children (4.2%) were reported to have had wheezing in the past 12 months unassociated with a diagnosis of asthma (wheeze only). The cumulative, but not the period, prevalence rate of asthma differed significantly by income and race/ethnicity. The cumulative prevalence was significantly higher among Hispanics and children from the lowest income families. The prevalence of wheeze only (no reported history of asthma) was higher among whites (6.4%) and blacks (5.8%) than Hispanics (2.9%) (P < .1). The reported number of wheezing attacks and the average number of nights per week that sleep was disturbed by wheezing during the past year were similar for those with asthma and those with wheeze only, although severe attacks (wheezing severe enough to limit speech) were significantly more likely among those reported to have asthma (P < .001). The total asthma prevalence (period prevalence of asthma plus wheeze only) was 12.8% and was quite consistent across subgroups. CONCLUSIONS: These data suggest that the prevalence of asthma among inner-city children may be substantially higher than the rates for this group estimated from national survey data. Some proportion of the wheeze only group may represent undiagnosed, and thereby undertreated, asthma. Public health efforts directed at reducing asthma morbidity and mortality need to address the possibility that asthma prevalence is higher within inner cities and that a large number of children with asthma may be inadequately diagnosed and treated.

Adolescent↗
PubMed2004

The Living & Breathing Study: a study of patients' views of asthma and its treatment.

AIM: To evaluate patient understanding of their asthma and determine patient preferences regarding the delivery of asthma care and treatment. METHODS: Adults with asthma receiving treatment for mild to moderate asthma were recruited to a two-part study: a qualitative phase using a semi-structured interview schedule followed by a quantitative phase based on a structured interview schedule. All interviews were undertaken face-to-face. SETTING AND SUBJECTS: A random sample of 40 patients with mild to moderate asthma from seven areas of the UK took part in the qualitative phase of the study. In the quantitative phase, 517 patients on treatment for mild to moderate asthma were interviewed in person by market researchers. This population was achieved using a quota sampling approach that also achieved a representative demographic profile. Initial contact was made in door-to-door calls. Interviews took place in 64 locations across the UK. RESULTS: Ninety-one percent (n=468) of respondents felt their asthma was under control, yet two-thirds (n=339) experienced symptoms at least 2-3 times a week. Only 24% (n=123) felt their asthma could improve over time, and 71% (n=366) received no advice from healthcare professionals on how their asthma might change in the future. Fourteen percent (n=74) of respondents had no ongoing contact with any healthcare professional regarding their asthma. Fifty-eight percent (n=301) were very satisfied with their asthma care, but this dropped to 33% (n=173) when respondents were shown asthma guidelines regarding what to expect from treatment. Sixty-two percent (n=318) of respondents said their asthma varied at different times of the day, and 86% (n=444) stated that their asthma varied at different times of the year. Eighty percent (n=414) of respondents had never been provided with a written, personal asthma action plan recommending changes patients could make themselves to prescribed treatment according to symptom severity, though 68% (n=353) said they would feel comfortable following such a plan. CONCLUSIONS: Most patients have low expectations of what can be achieved by asthma management and do not realise their condition can be improved. Many are resigned to the effects of poor asthma control until made aware that guidelines indicate this can be better. Given that many are receptive to the notion of written, personal asthma action plans, the implementation of these, supported by appropriate education, could help patients achieve improved asthma control.

Journal Article↗
PubMed2003

Health consequences for children with undiagnosed asthma-like symptoms.

BACKGROUND: A growing body of evidence indicates that there are a substantial number of children who report asthma-like symptoms and are not diagnosed with asthma. However, there is little information on the health consequences of asthma-like symptoms for children with these symptoms and no asthma diagnosis. OBJECTIVE: To assess the prevalence and health consequences (school absences, sleep disturbances, activity limitations, physician visits, emergency department visits, and hospitalizations) of asthma-like symptoms among children with and without physician diagnosis. STUDY DESIGN: We surveyed 122 829 children aged 12 to 14 years in 499 North Carolina public middle schools. A standardized questionnaire (International Study of Asthma and Allergies in Childhood [ISAAC]) containing video scenes of adolescents experiencing asthma-like symptoms was adapted to include questions on health consequences. RESULTS: Seventeen percent (n = 21 184) reported current asthma-like symptoms with no diagnosis of asthma (during the last 12 months.) Eleven percent (n = 13 619) of the children reported physician-diagnosed asthma with current asthma-like symptoms. Of the children with asthma-like symptoms and no diagnosis of asthma, 20% missed a half day or more of school per month because of wheeze, 25% had limited activities because of wheeze once or more per month, and 32% had sleep disturbances because of wheeze in the last 4 weeks. Seven percent of children with current asthma-like symptoms but no diagnosis reported 1 or more emergency department visits for asthma-like symptoms, and 5% reported wheeze-related hospitalizations in the last year. Of children with physician-diagnosed asthma, almost half (47%) reported missing a half day or more of school in the last month. Thirty percent of physician-diagnosed children reported 1 or more emergency department visits in the last year for asthma-like symptoms. CONCLUSIONS: The health consequences of asthma-like symptoms in children with no diagnosis are substantial; these children are essentially untreated. Better detection of this disease group by the medical community has the potential to improve health consequences for these children.

Absenteeism↗
PubMed1999

Preliminary report of mortality among workers compensated for work-related asthma.

BACKGROUND: Although fatalities due to asthma have been reported among subjects with occupational asthma (OA) associated with re-exposure, groups of subjects with work-related asthma have not been systematically followed up for mortality. During a review of compensation claims for asthma in Ontario, we identified 3 respiratory deaths among subjects previously compensated for OA for whom their surviving spouses received death benefits. This suspected "cluster" prompted us to undertake an investigation to examine mortality pattern among workers compensated for work-related asthma. METHODS: Subjects receiving compensation for OA or aggravation of asthma (AA) between 1980 and 1993, and a comparison sample of workers with claims for musculoskeletal injuries during the same period were identified from the Ontario Workers' Compensation Board. We also identified another comparison group of non-compensated asthmatic patients seen at a hospital clinic during the same period. The files of those with work-related asthma were reviewed to determine if OA or AA was adequately documented. Mortality was ascertained by linkage with the Mortality Database at the Ontario Cancer Registry through 1996. We compared the mortality of the three groups with that expected in the general population of Ontario using SMRs, and directly by proportional-hazards regression. RESULTS: The study included 3,070 subjects: 1,112 with work-related OA/AA with adequate documentation, 1,556 with work-related injuries, and 402 patients with non-work-related asthma. Of the 66 deaths identified, only 2 deaths were due to asthma, both in the work-related asthma group: one from the index cluster and one not previously identified. A second index death was coded as dying from COPD not elsewhere classified (ICD9 496), while the third index death also died of asthma but there was not sufficient information documenting OA to include the subject in the analyses. As compared with the general population, there were fewer deaths than expected from most causes, except for deaths among the work-related asthma claimants and the nonwork-related asthma patients from respiratory diseases (SMRs 1.3 and 5.9, respectively; 0.5 among injury claimants), all chronic obstructive lung disease (ICD9 490-496; SMRs 2.3 and 7.7, respectively), and asthma (SMRs 18.2 and 0, respectively). In direct comparison of the work-related asthma claimants with the injury claimants, the risk of death appeared elevated from respiratory disease (RR 2.6) and ischemic heart disease (IHD) (RR 2.8) but the confidence intervals included unity. CONCLUSIONS: This preliminary report raises the possibility that serious outcomes, including excess deaths from respiratory disease, in particular asthma, may occur among those with work-related asthma even in the absence of re-exposure. However, the findings are inconclusive given that the number of deaths was small and we identified only one new asthma death in addition to the index cluster. We also observed for the first time that deaths due to circulatory disease, particularly IHD, may also be increased among such workers; this needs to be confirmed elsewhere.

Adult↗
PubMed2003

Psychiatric factors in asthma: implications for diagnosis and therapy.

Emotional factors are an obstacle in the diagnosis and management of asthma. This review discusses three problem patterns: negative emotions in relatively normal patients with asthma; patients presenting possible functional symptoms and; patients presenting asthma in conjunction with psychiatric deviations. Negative emotions influence the symptoms and management of asthma, even in relatively normal patients. Psychogenic symptoms appear normal, but culminate in functional symptoms in a minority of patients. Diagnosing and treating asthma in patients with comorbid asthma and psychiatric symptoms is very difficult. On the one hand, treating asthma may often be just treating the emotions. On the other hand, negative emotions make the treatment of asthma guesswork. Physicians should estimate emotional influences in their patients' symptoms for an optimal evaluation of medication efficacy. Assessment and analysis of emotional factors surrounding exacerbations seems essential, e.g. emotional precipitants of asthma and asthma-evoked negative emotions. Moreover, patients should be informed about stress-induced breathlessness and the consequences of overuse of bronchodilators. When patients present with atypical symptoms, or do not properly respond to asthma medication, functional symptoms should be suspected. Psychiatric analysis may often lead to the conclusion that symptoms have a functional basis. In patients with comorbid asthma and anxiety disorders, asthma should be the focus for treatment since difficult-to-control asthma often causes anxiety problems in the first place. Moreover, panic-like symptoms in asthma are often related to sudden onset asthma exacerbations. However, in patients with comorbid asthma and depression, depression should become the focus of treatment. The reason is that optimal treatment of depressive asthmatics is probably impossible. Special issues include specific problems with children, compliance problems, and physicians' dilemmas regarding the simultaneous treatment of asthma and psychiatric symptoms.

Anti-Asthmatic Agents↗
PubMed2006

Effects of a leukotriene receptor antagonist on exhaled leukotriene E4 and prostanoids in children with asthma.

BACKGROUND: Leukotriene (LT) E(4) and 8-isoprostane concentrations are elevated in exhaled breath condensate in children with asthma. The effects of leukotriene receptor antagonists (LTRAs) on exhaled leukotriene and prostanoids in children with asthma are unknown. OBJECTIVE: (1) To study the effect of montelukast, a LTRA, on exhaled LTE(4), 8-isoprostane, and prostaglandin E(2) in children with asthma and atopic children; (2) to measure exhaled nitric oxide. METHODS: An open-label study with oral montelukast (5 mg once daily for 4 weeks) was undertaken in 17 atopic children with asthma and 16 atopic children without asthma. RESULTS: Pretreatment exhaled LTE(4) (P < .0001) and 8-isoprostane (P < .0001) values were higher in atopic children with asthma than in atopic children without asthma. In atopic children with asthma, montelukast reduced exhaled LTE(4) by 33% (P < .001), and this reduction was correlated with pretreatment LTE(4) values (r = -0.90; P = .0001). Posttreatment exhaled LTE(4) levels in children with asthma were higher than pretreatment LTE(4) values in atopic children without asthma (P < .004). Montelukast had no effect on exhaled LTE(4) in atopic children without asthma (P = .74), or on exhaled 8-isoprostane (atopic children with asthma, P = .94; atopic children without asthma, P = .55) and PGE(2) (atopic children with asthma, P = .56; atopic children without asthma, P = .93) in both groups. In atopic children with asthma, exhaled nitric oxide concentrations were reduced by 27% (P < .05) after montelukast. CONCLUSION: Leukotriene receptor antagonists decrease exhaled LTE(4) in atopic children with asthma. This reduction is dependent on baseline exhaled LTE(4) values. CLINICAL IMPLICATIONS: Measurement of exhaled LTE(4) might help identify children with asthma most likely to benefit from LTRAs.

Acetates↗
PubMed1996

Prevalence of possible undiagnosed asthma and associated morbidity among urban schoolchildren.

OBJECTIVE: The extent to which urban children endure the symptoms and consequences of asthma without a physician diagnosis has not been well studied. Our objective was to obtain an estimate of the prevalence of possible undiagnosed asthma in a population of urban schoolchildren. DESIGN AND METHODS: A population-based cross-sectional study was conducted in urban schoolchildren, grades 3 to 5. Undiagnosed asthma was defined as caretaker report of symptoms and/or bronchial hyperresponsiveness, defined as a 15% or greater drop in baseline forced expiratory volume in 1 second, after exercise challenge. RESULTS: A total of 230 children (61% of those eligible) participated in the study. Forty children (17.4%; 95% Confidence interval (CI) = 12.5% to 22.3%) had reports of a physician diagnosis of asthma. Of these, 33 (14.3%; (95% CI = 9.8% to 18.9%) reported wheezing in the past 12 months. Among the remaining 189 eligible children, 11 (5.8%; 95% CI = 2.5% to 9.2%) met study criteria for undiagnosed asthma based on bronchial hyperresponsiveness (BHR). Another 16 (8.5%; 95% CI = 4.5% to 12.4%) met study criteria for undiagnosed asthma through modified American Thoracic Society symptom criteria. Overall, 27 children (27/189; 14.3%) fulfilled criteria for undiagnosed asthma. Children identified as having undiagnosed asthma were compared with children who had no BHR and no symptoms and who did not report a physician diagnosis of asthma (children without asthma). Children with BHR were more likely to have a report of allergies and eczema than children without asthma, odds ratios (OR) = 8.5 (95% CI = 2.4 to 30.7) and 6.4 (95% CI = 1.1 to 38.1), respectively. Children meeting symptom criteria were more likely to have a report of allergies, OR = 6.2 (95% CI = 2.0 to 19.1), and bronchitis, OR = 6.7 (95% CI = 2.0 to 22.4), and were also more likely to report sleep disruption, OR = 7.1 (95% CI = 2.3 to 21.8) and missed physical education classes, OR = 15.0 (95% CI = 4.8 to 46.7), compared with children without asthma. CONCLUSIONS: We estimated a prevalence of 14.3% for possible undiagnosed asthma among urban schoolchildren, grades 3 to 5, through caretaker report of symptoms or BHR postexercise challenge. Children with undiagnosed asthma reported more atopic disease than children without asthma. In addition, children meeting symptom criteria for asthma reported more bronchitis, sleep disruption, and missed physical education classes than did those without asthma. These results suggest that rates of undiagnosed asthma may be high in this predominantly black school-age population.

Asthma↗
PubMed1999

Prevalence and burden of illness for asthma and related symptoms among kindergartners in Chicago public schools.

BACKGROUND: Asthma mortality rates in poor communities of Chicago are among the highest in the country. Possible explanations include increased asthma prevalence, increased severity, and suboptimal health care. OBJECTIVE: To estimate the prevalence of asthma and asthma-related symptoms among inner-city kindergarten children, and to characterize their burden of illness, asthma-related health care access, and pharmacologic treatment. METHODS: Cross-sectional survey of parents of kindergartners was conducted in 11 randomly selected Chicago elementary schools. A self-administered 16-item questionnaire was given to parents of kindergartners. Parents who reported doctor-diagnosed asthma or at least one of several key asthma-related symptoms were then interviewed with a supplemental questionnaire examining asthma-related health care and medication use. RESULTS: Based on data from 638 children [mean age 5.7 (SD = 0.6) years], the prevalence of diagnosed asthma was 10.8%. Sixteen percent of the respondents reported that their child had wheezed in the past year. The prevalence of asthma-related symptoms unassociated with a diagnosis of asthma was 30.1%. The children with diagnosed asthma had evidence of a high burden of illness: over 40% were reported to have had sleep disturbance due to wheezing > or =1 to 2 nights/week and 86.6% reported acute care visits for respiratory symptoms in the past year. Self-reported access to medical care was high. Over 40% of the children with doctor diagnosed asthma were reported to have used a beta2-agonist in the preceding 2 weeks, and 12.2% used an inhaled anti-inflammatory. CONCLUSIONS: These data suggest that asthma prevalence in school-aged children in inner-city communities may be higher than US estimates. The burden of illness experienced by these children is substantial. Also, a large proportion of children were reported to have respiratory symptoms consistent with asthma, and no asthma diagnosis, suggesting possible undiagnosed asthma. While measures of health care access appear to indicate that the majority of children with asthma experience no identified barriers to health care, there is evidence to suggest undertreatment.

Administration, Inhalation↗
PubMed1999

Asthma, atopy and Chlamydia pneumoniae antibodies in adults.

BACKGROUND: Factors involved in the development of inflammation and asthma in nonatopic subjects have remained largely obscure, although there is some evidence to suggest that certain infections may play a role. OBJECTIVE: We investigated the association between serological evidence of Chlamydia pneumoniae infection and asthma in adults, and the possible modifying effect of the patients' atopic status on this association. METHODS: Four hundred and thirty consecutive patients who attended the hospital between 1992 and 1993 with symptoms suggestive of asthma, rhinitis or allergy were enrolled. Diagnostic procedures including lung function measurements and skin-prick tests were performed in all patients. The patients with established asthma (n = 332) were divided into those with recent asthma (n = 224, onset 1985 onward) and longstanding asthma (n = 108, onset before 1985). The controls (n = 98) comprised all subjects who did not meet the criteria of asthma. Serum immunoglobulin (Ig)G, IgA and IgM antibodies to C. pneumoniae were measured by the microimmunofluorescence test. RESULTS: In women, the prevalences of elevated IgG (a titre of >/= 128) and IgA (>/= 32) antibody levels and the age-adjusted geometric mean titres (GMT) of IgG and IgA antibodies were invariably highest among subjects with nonatopic longstanding asthma. Elevated IgG titres in women occurred in 11% of controls, in 28% of nonatopic recent onset asthmatics, and in 43% of asthmatics with nonatopic longstanding disease; for men the respective figures were 33, 50 and 64%. Logistic regression analysis controlling for age, sex and smoking showed that asthma was significantly associated with elevated IgG antibody levels to C. pneumoniae (odds ratio 3.3, 1.6-6.8 for longstanding asthma, 2.3, 1. 2-4.4 for recent asthma, and among women only 4.2, 1.6-10.9 for longstanding asthma, and 3.0, 1.3-7.2 for recent asthma). When the atopics and nonatopics were analysed separately, an even stronger relationship in the nonatopics was obtained for longstanding asthma (6.0,2.1-17.1). In contrast, the relationship between atopic asthma, either recent or longstanding, and elevated IgG titres was not significant, indicating that asthma per se does not predispose to C. pneumoniae infection. CONCLUSIONS: Asthma was significantly associated with elevated IgG antibody levels to C. pneumoniae, and this association was strongest for nonatopic longstanding asthma.

Adult↗
PubMed2003

Association between outpatient follow-up and pediatric emergency department asthma visits.

BACKGROUND: The National Heart, Lung, and Blood Institute (NHLBI) guidelines recommend that patients receive a follow-up outpatient asthma visit after being discharged from an emergency department (ED) for asthma. OBJECTIVE: To measure the frequency of follow-up outpatient asthma visits and its association with repeat ED asthma visit. DESIGN: We conducted a retrospective cohort study of children with asthma using claims data from a university-based managed care organization from January 1998 to October 2000. We performed a multivariate survival analysis using Cox proportional hazards model to determine the effect of follow-up outpatient asthma visits on the likelihood of a repeat ED asthma visit, after controlling for severity of illness, patient age, gender, insurance, and the specialty of the primary care provider. RESULTS: A total of 561 children had 780 ED asthma visits. Of these, 103 (17%) had a repeat ED asthma visit within 1 year. Almost two-thirds of children (66%) did not receive outpatient follow-up for asthma within 30 days of an ED asthma visit. Outpatient asthma visits within 30 days of an ED asthma visit are associated with an increased likelihood (relative risk = 1.80; 95% confidence interval 1.19, 2.72) for repeat ED asthma visits within 1 year. CONCLUSIONS: Most patients do not have outpatient follow-up after an ED asthma visit. However, those patients that present for outpatient follow-up have an increased likelihood for repeat ED asthma visits. For the primary care provider, these outpatient follow-up visits signal an increased risk that a patient will return to the ED for asthma and are a key opportunity to prevent future ED asthma visits.

Adolescent↗
PubMed2005

Characterization of a population of monozygotic twins with asthma.

BACKGROUND: Asthma is a complex inflammatory lung disease that results from allergic and nonallergic environmental exposures in genetically susceptible individuals. The interrelationship and impact of environmental and genetic determinants on the development of asthma is still unclear. Monozygotic twins (MZT) have been considered a potentially useful population to investigate the role of genetic and environmental factors on asthma because of their identical genetic background, similar childhood environmental exposures, and expected high concordance rate for asthma. METHODS: A detailed questionnaire designed to obtain demographic information, medical history/severity of asthma, and environmental exposures was distributed to 43 pairs of MZT pairs where one or both probands had a history of asthma. All twin pairs were clinically evaluated for atopy by skin testing. Asthma was assessed by questionnaire, baseline spirometry, disease severity, airway reactivity, and medication scores. RESULTS: Based on a history of physician-diagnosed asthma, disease severity, airway reactivity, and medication scores, 22 MZT pairs were identified as concordant (C) for asthma while 21 MZT pairs were discordant (D) for asthma. Those MZT-C for asthma were on average older and more often female. Adjusted odds ratios for age and gender revealed that MZT-C for asthma had a 2.3 greater likelihood of childhood tobacco exposure and a 1.8 greater likelihood of early exposure to a pet compared to MZT-D pairs. In addition, MZT-C for asthma had a 2.4 greater likelihood of being full term vs. premature at birth. None of these odds ratios were statistically significant due to a small sample size. However, a trend for a greater likelihood of earlier environmental exposures was observed for MZT-C asthma pairs. Among MZT-D probands, a history of asthma in one proband was supported by a lower FEV1 and higher airway reactivity, disease severity, asthma symptom, and medication scores compared to the nonasthma proband. There was significant intrapair heterogeneity among MZT-C and MZT-D probands in their positive skin test responses to specific aeroallergens. CONCLUSION: Cross-sectional evaluation of larger MZT populations where one or both proband has asthma with a long-term prospective follow-up may be a feasible way for identifying the impact of environmental determinants as independent risk factors for the development of asthma.

Adolescent↗
PubMed1995

Asthma knowledge, attitudes, and quality of life in adolescents.

Adolescents with asthma, their peers, and their teachers were studied in order to establish the level of knowledge concerning asthma and its management, their attitudes towards asthma, and the degree quality of life impairment due to asthma. A community survey was conducted among year 8 high school students (n = 4161) and their teachers (n = 1104). There was a good response rate to the questionnaires from students (93%) and teachers (61%). Twenty three per cent of students had asthma and this caused mild to moderate quality of life impairment, particularly with strenuous exercise. Asthma was provoked by passive smoke exposure in 30% of asthmatic students and up to 51% of students avoided situations because of asthma triggers. Asthma knowledge was low in teachers (mean score 14.90 out of a possible 31), students without asthma (11.25) and students with asthma (14.50). Specific knowledge on the prevention and treatment of exercise induced asthma was poor. There was a moderate degree of tolerance towards asthma among all three groups. Most considered internal locus of control as important, although students without asthma also considered chance to be a determinant of outcomes for people with asthma. Asthma is a common cause of quality of life impairment among year 8 high school students. Although specific knowledge on asthma is low, students and teachers hold favourable attitudes towards asthma. There are opportunities to intervene and improve asthma management among adolescents.

Adolescent↗
PubMed1995

Incidence of asthma in Swedish teenagers: relation to sex and smoking habits.

BACKGROUND: The prevalence of asthma and the use of asthma drugs is increasing worldwide. Studies of the incidence of asthma are few but are of interest in finding factors associated with onset of the disease. A study was performed to estimate the incidence of asthma and its relation to sex and to tobacco smoking between the ages of 16 and 19 years, and to compare the incidence of asthma with the proportion of individuals receiving a prescription of an asthma drug for the first time during one year. METHODS: A questionnaire was sent in 1990 to all 3627 individuals born in 1974 living in the county of Jämtland and Gästrikland, the southern part of the county of Gävleborg in central Sweden. Individuals reporting airways disease or obstructive symptoms were investigated with a further interview and lung function tests. The cross sectional questionnaire study was repeated in 1993. The incidence of asthma was calculated in the 2308 individuals who answered the questionnaire in both surveys and who were found not to have asthma in 1990. RESULTS: The yearly incidence of asthma defined from self reported disease, physician diagnosed asthma, drug use, or asthma associated symptoms was between 0.8% and 1.3%, depending on the criteria used. All criteria used resulted in a higher incidence in female subjects. Female sex was a risk factor for asthma when standardised for smoking, and smoking was also a risk factor for asthma when standardised for sex to all but two of the criteria used. In all the criteria the increased risk of asthma combined with smoking was greater in female subjects. CONCLUSION: The yearly incidence of asthma was about 1% between the ages of 16 and 19 years. Smoking and female sex were found to be risk factors for asthma. The incidence of asthma was close to the incidence of new drug use for asthma.

Adolescent↗
PubMed2004

Identifying children with persistent asthma from health care administrative records.

BACKGROUND: Investigation into the origins of asthma is contingent on definitions of asthma, which can differentiate asthma from transient wheezing syndromes in children. OBJECTIVES: This research was undertaken to develop a definition for asthma derived from health care administrative records, which would identify children with persistent asthma. PATIENTS AND METHODS: Using population-based, health care administrative data, children with possible asthma were identified as having one or more physician visits or hospitalizations for asthma or bronchitis diagnoses from January 1995 to December 1995, or, in the absence of asthma-like diagnoses, one or more prescriptions for asthma prophylaxis drugs or ketotifen concomitant with a beta-agonist, or two or more prescriptions for beta-agonists. RESULTS: The likelihood of persistent asthma, defined as repeated health care and prescription use for asthma from 1996 to 1998, was assessed for various asthma markers and risk factors in 29,198 children with possible asthma. Children with asthma prescription drugs or asthma health care use not limited to the winter season were three to six times more likely than children without these characteristics to have persistent asthma. The likelihood of persistent asthma was elevated to a substantial degree in the presence of both of these markers. CONCLUSIONS: The inclusion of these measures in a diagnosis-based definition improves the ability to identify persistent asthma in children.

Adolescent↗
PubMed1994

Inflammation in nocturnal asthma?

At present there is some indirect evidence for increased nocturnal inflammation in patients suffering from nocturnal asthma: 1. Circulating eosinophil numbers and activation, as reflected by increased levels of ECP and EDN and low-density eosinophils, are increased at night. 2. Circulating histamine levels are increased at night. 3. Hyperresponsiveness to AMP at night is increased compared with hyperresponsiveness to methacholine. However, most results of various studies point to nocturnal asthma's being an expression of more severe asthma: 1. Both AMP and propranolol responsiveness, indirect measures of airway hyperresponsiveness, are lower both at 4:00 A.M. and 4:00 P.M. in asthmatics with nocturnal asthma than those without nocturnal asthma. 2. Patients with nocturnal asthma have higher circulating numbers of eosinophils at both 4:00 A.M. and 4:00 P.M. than those without nocturnal asthma, and eosinophil survival is not different at these times. 3. Patients with nocturnal asthma have higher PGD2 levels in BAL both at 4:00 A.M. and 4:00 P.M. than those without nocturnal asthma, but show no significant difference between levels at these two times. 4. Two studies have shown no difference in BAL eosinophil numbers and activation parameters at night in nocturnal asthma. 5. Histamine levels in BAL fluid are comparable day and night in patients with and without nocturnal asthma. 6. Inflammatory mediators in BAL are higher in asthmatic patients than in normal subjects, but are not different between patients with and without nocturnal asthma. Thus, patients with nocturnal asthmatic symptoms show an overall increased burden of mediators released from mast cells and other inflammatory cells. In conclusion, we feel that the term "nocturnal asthma" is misleading, in that it does not describe a unique entity in certain patients with asthma. We prefer, in view of the previous arguments, to consider nocturnal asthma a mere expression of more severe asthma. Thus we suggest the term "nocturnal asthma" be changed to "asthma with nocturnal symptoms."

Asthma↗