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PubMed1999

Use of inhaled medications and urgent care services. Study of Canadian asthma patients.

OBJECTIVE: To determine asthma patients' patterns of disease and knowledge of asthma. DESIGN: Telephone survey of patients with diagnosed asthma. SETTING: Residences in 10 Canadian provinces. PARTICIPANTS: Patients with asthma diagnosed by a doctor: 829 men and women with a mean age of 38 +/- 7 years. MAIN OUTCOME MEASURES: Classes of asthma medications, patterns of use, frequency and severity of asthma symptoms use of emergency departments and urgent medical services, participation in asthma education programs, presence of environmental triggers, and knowledge of asthma pathophysiology and treatment. RESULTS: Four hundred fifty-six patients (55%) reported daily symptoms of asthma; 431 patients (52%) used inhaled beta 2-agonists daily. Only 340 patients (41%) used inhaled corticosteroids (IC), and many used them irregularly. A total of 579 (72%) respondents reported no unscheduled visits to a family physician for worsening asthma, but one third of patients had been to an emergency department for uncontrolled asthma in the last 5 years, and most of these visits had occurred during the last year. As to knowledge, 406 patients (49%) disagreed with the statement that asthma is a lifelong condition that cannot be cured. Among IC users, only 101 (30%) knew that IC reduced airway inflammation; among beta 2-agonist users, only 33% agreed that beta 2-agonists opened the bronchial tubes. Two hundred forty patients (29%) reported being current cigarette smokers, and 381 (46%) reported having pets at home. CONCLUSIONS: Daily symptoms and daily use of beta 2-agonists are common among Canadian asthma patients, and this is in excess of what is considered acceptable by current asthma care guidelines. Underuse of IC, inadequate knowledge of asthma symptoms and treatments, and failure to avoid asthma triggers were common in the population studied.

Administration, Inhalation↗
PubMed2000

Guideline for the management of chronic asthma in children--2000 update. Allergy Society of South Africa Working Group.

OBJECTIVE: To increase awareness of asthma and diagnose asthma early in children. To make recommendations regarding management of chronic childhood asthma in a country with diverse cultural, socio-economic and educational characteristics. The guideline should be used by health professionals involved in the treatment of asthma at all levels of care. OPTIONS: Various management options were considered. Ideal treatment includes use of the new generation inhaled corticosteroids (fluticasone, budesonide), housedust mite intervention for asthma control using impermeable covers for pillows and mattresses, and if needed use of inhaled long-acting beta 2 agonists (LABAs) and leukotriene receptor antagonists (LRAs). Alternative therapeutic approaches for situations where resources are limited include simple housedust mite control measures (e.g. airing mattresses and bedding), avoidance of exposure to passive smoking, use of lower doses of beclomethasone than recommended by other guideline documents and/or sustained-release (SR) theophylline as preventer treatment and use of plastic bottles as cheap spacer devices. OUTCOMES: The main potential outcomes considered were: to reduce morbidity and mortality by correct diagnosis of asthma, to achieve the best quality of life for the child with asthma, to minimise side-effects from medication and to prevent development of permanently abnormal lung function. EVIDENCE: Current international guideline documents for diagnosis and management of childhood asthma were evaluated. Clinical studies before 1998 pertaining to the various aspects of management of childhood asthma were reviewed, including controlled studies on the use of inhaled corticosteroids in children with asthma, randomised controlled trials on the use of LRAs and two studies evaluating the efficacy of LABAs. Current data on the anti-inflammatory effects of SR theophylline were also reviewed as well as a randomised controlled trial on the benefits of SR theophylline as adjunct treatment in childhood asthma. The benefit of simple spacer devices, based on well-conducted local studies (published in an international peer-reviewed journal) was also considered. VALUES: The South African Childhood Asthma Working Group (SACAWG) committee members, appointed by the Allergy Society of South Africa (ALLSA), were selected to represent the interests of health professionals involved in the care of childhood asthma and to co-opt other colleagues with expertise relevant to the guideline. The committee was divided into six task groups headed by a chairperson--each task group had to review critically the previous SACAWG guideline (for deficiencies and obstacles to implementation), review current trends in asthma management (evidence-based where available) and submit proposals and recommendations to their respective chairperson. The chairperson then compiled a report for discussion by the SACAWG executive committee. The executive group convened a meeting to discuss the recommendations and obtain consensus. An editorial board was appointed to compile the final report. Cultural factors, patient preferences, cost, availability and education were considered important. BENEFITS, HARMS AND COSTS: Proper treatment should enable most children with asthma to lead normal or near-normal lives. The guideline could be implementable at all levels of care. The risk of systemic effects due to inhaled corticosteroids should be minimised in children with mild to moderate persistent asthma (risk of systemic effects is more likely at daily beclomethasone doses exceeding 400 micrograms or the equivalent dose of other inhaled corticosteroids). Promotion of simple environmental control measures and use of inhaled beclomethasone and/or SR theophylline should make treatment more widely available and more affordable and improve adherence to treatment. Alternative cheap plastic bottle spacer devices will increase availability and assist with overcoming the problem of incorrect inha

Adrenal Cortex Hormones↗
PubMed2002

Prognostic factors of severe asthma in Puerto Rico.

Asthma in Puerto Rico is a serious Public Health Problem. This study extends our cross-sectional self-reported asthma prevalence survey of 3,000 volunteers. The purpose of the present study was to analyze the importance of known prognostic factors of asthma severity among 486 self-reported participants. Patients with more than one visit to the emergency room in the previous 12 months due to asthma exacerbations were classified as cases of "severe asthma", and those asthmatic patients who did not visit emergency rooms were classified as "non-severe asthmatic subjects". Severe cases and non-severe asthmatic subjects were compared regarding age, sex, family history of asthma, presence of household pets, and in the previous 12 months: history of hospitalization due to asthma, respiratory infections, tobacco smoking, exposure to passive smoking, and avoidance of passive smoking. Crude and logistic regression adjusted odds ratio was used as a measure of association between each prognostic factor, and the outcome namely severe asthma, while adjusting for all confounders simultaneously. The results clearly showed that previous hospitalizations due to asthma (OR = 7.3, p < 0.0001) and frequent of respiratory infection (OR = 2.5, p = 0.0003) were prognostic factors associated with increased asthma severity. A statistically significant, two percent less likelihood to have severe asthma for each year of age was found. Weak associations were found between asthma severity and male gender, family history of asthma, passive smoking, and presence of household pets. Avoidance of environmental tobacco exposure (passive smoking) was found to be an important and statistically significant protective factor associated with a 47% less likelihood for severe asthma. In conclusion, appropriate management of patients with history of hospitalization due to asthma is very important. The correct management of respiratory infection in asthmatic patients may result in a reduction of up to 60 percent of the odds of having asthma severe enough to require emergency treatment, and may reduced by 86.3 percent hospitalizations.

Adolescent↗
PubMedDate not supplied

Rural elementary school teachers' intent to manage children with asthma symptoms.

A study of 212 rural elementary school teachers sought to determine the relationships among the variables of their general knowledge about asthma, attitude toward asthma, self-efficacy in helping children with asthma manage their asthma, and social support for initial management of children's asthma with the teachers' intent to manage children who present with signs and symptoms of asthma in the classroom. The situational variables of number of years teaching experience, number of children with asthma that teachers have had in their classroom during their teaching profession, and whether or not the teacher had asthma or knew of someone with asthma also were explored in relation to intent to manage asthma. Results indicate that although teachers had a favorable attitude toward asthma and were tolerant of students with asthma, their knowledge about asthma was low. Because asthma can be life-threatening, it is essential to assist those involved in monitoring and managing children with asthma to provide timely, appropriate care. In this way, the goal of having a child with asthma live as normal a life as possible, including all school activities, can be realized.

Asthma↗
PubMed2004

A community-based asthma management program: effects on resource utilization and quality of life.

OBJECTIVE: The Waianae Coast Comprehensive Health Center (WCCHC) developed an integrated community-based asthma management program in an effort to reduce inappropriate medical utilization and improve quality of life in their pediatric asthma population. METHODS: Over a period of three years, eighty-eight children with asthma participated in the community-based asthma management program. During this time, an automated asthma tracking system was developed, the WCCHC established a standard system of care based on the National Asthma Education and Prevention Program Expert Panel Report Guidelines for the Diagnosis and Management of Asthma (NAEPP Asthma Guidelines) adapted for cultural sensitivity, and a coordinated team care approach was implemented in the asthma management program. RESULTS: During the pilot study, forty children participated in the program. Among these forty individuals, there was a significant decrease in both per capita expenditures and asthma related visits after community health worker (CHW) intervention. Average per capita charges decreased from dollar 735 to dollar 181, Emergency Department (ED) visits decreased from 60 to 10, and the overall asthma related visits decreased from 1.5 to 0.25 per person after the initial CHW encounter. These results were replicated during the 2000-2001 intervention period where average per capita charges decreased from dollar 310 to dollar 129 and ED encounters dropped from 32 to 10 after the first CHW encounter. In addition, the number of high utilizers-defined as those presenting to the ED two or more times for asthma-related diagnoses- sharply decreased from 176 in 1998 to only 16 in 2001. Quality of life improved, with 72% fewer nighttime and 96% fewer daytime symptoms reported after CHW intervention during the pilot study. During the year 2000, symptoms during exercise and asthma related doctor visits decreased 59% and 67% respectively after CHW intervention. CONCLUSION: The community-based asthma management program demonstrated success in improving utilization patterns and reducing asthma-related expense among program participants. Improvement was also noted in quality of life as expressed through frequency and time of asthma symptoms. Other health care institutions may also be positively impacted by developing multidisciplinary team implemented, culturally-adapted, and scientifically-based disease management programs.

Asthma↗
PubMed2006

[Correlation of reticular basement membrane thickness and airway wall remolding in asthma patients].

OBJECTIVE: To investigate the correlation between the reticular basement membrane thickness and the airway wall remolding in asthma patients. METHODS: Lung tissues were obtained from 5 patients who died from asthma, 3 males and 2 females, aged 45 +/- 16 (fatal asthma group), 5 asthmatics who died of diseases unrelated to asthma, 3 males and 2 females, aged 47 +/- 13, (non-fatal asthma group), and 5 dead patients without asthma, 3 males and 2 females, aged 24 +/- 14 (control group) to select 41, 38, and 43 transverse sections of tracheae respectively. The samples of tracheae were divided into cartilaginous and membranous airways by light microscopy (x100). The thickness of reticular basement membrane and the dimensions of the airway wall, including the smooth muscle area, submucosal gland area, inner and outer wall areas, and lumen area were measured. The correlations of reticular basement membrane thickness with the airway changes were analyzed. RESULTS: The reticular basement membrane was significantly thicker in both cartilaginous and membranous airways in the fatal and non-fatal asthma groups than in the control group (all P < 0.05). The submucosal gland area of the fatal asthma group was significantly larger than those of the non-fatal asthma group and control group (both P < 0.05). The inner wall area of the cartilaginous airway of the fatal asthma group was significantly larger than that of the non-fatal asthma group (P < 0.05); however, the inner wall area of the membranous airway of the fatal asthma group was not significantly different from that of the non-fatal asthma group. The outer wall areas of cartilaginous and membranous airways of the fatal asthma group were both significantly larger than those of the other 2 groups (all P < 0.05). There was no significant difference in the lumen areas of cartilaginous and membranous airways between the fatal and non-fatal asthma groups. The reticular basement membrane thickness was correlated with the smooth muscle area (P < 0.05), submucosal gland area (P < 0.05), and inner wall area (P < 0.01) of the corresponding bronchi in regard to the cartilaginous airway; and was correlated with the smooth muscle area (P < 0.05) and inner wall area (P < 0.01) of the corresponding bronchi in regard to the membranous airway, but was not correlated with the airway size, lumen area, and outer wall area in regard to the 2 kinds of airways. CONCLUSION: The reticular basement membrane thickness of central airway reflects the airway remolding of the central airway and the changes of smooth muscle and inner wall of the peripheral airway. It is worthwhile to do end bronchial biopsy to measure the reticular basement membrane thickness so as to assess the pathology of the airway and to conduct long-term follow-up among the asthma patients.

Adolescent↗
PubMed1995

Infectious asthma: a reemerging clinical entity?

BACKGROUND: In the primary care setting, patients often report that their asthma began after an acute respiratory infection such as bronchitis, pneumonia, or an influenza-like illness ("infectious asthma"). Preceding respiratory illnesses such as bronchitis and pneumonia are also epidemiologic correlates of asthma in both children and adults. These associations suggest the possibility that respiratory infection is involved in the initiation of asthma in addition to the already acknowledged role of infection in asthma exacerbations. The purpose of this study was to investigate whether a history of infectious asthma influenced clinical and pulmonary function characteristics of patients with chronic asthma. METHODS: Conducted in a community-based primary care practice, this is a clinical descriptive study of 92 middle-class patients who had a mean age of 37.7 years (standard deviation 15.4 years), a clinical diagnosis of chronic asthma, and baseline pulmonary function test results available for analysis. RESULTS: There was sufficient history available to classify asthma as infectious in 41 (45%) of 92 patients. Patients with infectious asthma reported a much shorter duration of asthma symptoms than did patients with atopic, occupational, and exercise-induced asthma (5.6 vs 13.3 years, P = .001). Nevertheless, patients with infectious asthma had significantly worse percentages of predicted FEV1 and FEF25%-75%, both before and after bronchodilator therapy. CONCLUSIONS: Infectious asthma was common in this primary care setting. Compared with patients with other asthma syndromes, those with infectious asthma had worse pulmonary function despite a shorter duration of symptomatic disease. Further studies of the cause and prognosis of this clinical entity are warranted.

Adult↗
PubMed1995

Goals of asthma therapy.

OBJECTIVE: The purpose of this article is to facilitate the management of patients with asthma. The article will discuss the components of optimal care and asthma therapy. DATA SOURCES: References are limited to the English language. Also included are descriptions of experiences based on the clinical practice of the author. STUDY SELECTION: Papers were selected on the basis of their timeliness, explanation of important findings related to clinical practice, and the treatment of asthma. RESULTS: Effective asthma management requires understanding of asthma pathophysiology and how and when to provide asthma treatment, which includes specific, symptomatic, and adjunctive therapies. Optimal care entails a thorough knowledge of the goals of asthma therapy, including preventing asthma symptoms, maintaining nearly normal pulmonary function and activity levels, preventing asthmatic exacerbations, and avoiding adverse effects from asthma medications. For patients with an allergic component to their disease, allergen avoidance and immunotherapy can cure or at least significantly improve a patient's asthma. Using an "Asthma Action Plan," patients can be instructed on how to prevent symptoms of asthma from occurring and how to maintain normal or nearly normal pulmonary function by monitoring their pulmonary function "zone," based on daily peak flow meter results. At the present time, asthma is treated inadequately in the United States, but the situation can be improved primarily through education. CONCLUSIONS: The goals of asthma therapy are achievable in the US if several objectives are met: physicians are taught asthma pathophysiology; patients are educated about the prevention and treatment of asthma; the importance of an evaluation by an allergist is recognized; and patients are provided access to good medical care.

Asthma↗
PubMed1995

US asthma mortality: 1941 to 1989.

BACKGROUND: Asthma mortality in the United States has nearly doubled in the past 10 years. An examination of long-term trends in United States asthma mortality places the current mortality rates in a historical perspective, identifies high-risk groups for interventions, and may provide clues to the etiology of asthma mortality. METHODS: Asthma deaths for the population aged 5 to 34 years were abstracted from United States vital statistics reports for the period 1941 through 1989. Race-specific and sex-specific mortality rates were age-adjusted to the 1989 estimate of the US population. RESULTS: Among the population aged 5 to 34 years, three distinct periods of asthma mortality were observed: 1941 to 1964, 1965 to 1977, and 1978 to 1989. From 1941 through 1964, nonwhites exhibited a gradual increase in asthma mortality rates; in contrast, whites showed no change in mortality rates. From 1965 through 1977, a marked decline in mortality rates was observed among both nonwhites and whites. From 1978 through 1989, asthma mortality increased with a near doubling in the mortality rates in both nonwhites and whites. Overall, nonwhites had mortality rates 4 times those of whites, with nonwhite males aged 15 to 34 at the greatest risk of death due to asthma. Age and sex differences in asthma mortality are also apparent. The population aged 15 to 34 years generally had mortality rates greater than the population aged less than 15 years. For the population aged 5 to 14 years, regardless of calendar year, females had lower mortality rates than males. Among the population aged 15 to 34 years, females experienced twice the mortality rates of males prior to 1965; however, by the 1980s this relationship no longer existed. CONCLUSIONS: The asthma mortality rate for nonwhites was 4-fold higher than for whites, although the reported prevalence of asthma is less than 2-fold greater. The population aged 15 to 34 years had higher mortality rates than the population aged 5 to 14 years despite exhibiting a lower prevalence of asthma. There are also gender differences in asthma mortality. These differences may be attributable to differences in asthma severity, or differences in disease management or reflect actual differences in mortality. These findings suggest that the search for clues to understand the increase in asthma mortality from 1978 to 1989 should include an attempt to understand why asthma mortality declined in the preceding decade from 1967 to 1977 as these may not be completely unrelated trends.

Adolescent↗
PubMed1997

[An investigation of the clinical utility of serum interleukin-5 measurements in bronchial asthma patients].

Bronchial asthma has been identified as a chronic inflammatory airway disorder associated with cell infiltration (mainly eosinophils) and airway epithelial cell detachment caused by the activation of infiltrated cells. Interleukin-5 (IL-5), a cytokine closely related to the production and activation of eosinophils, has been shown to induce the proliferation and differentiation of eosinophils, prolong their survival, and to enhance the functions of mature eosinophils. We monitored clinically the changes in serum IL-5 concentrations in patients with bronchial asthma both during and after asthma attacks. The relationship serum IL-5 concentrations and the type and severity of bronchial asthma, as well as eosinophil counts in sputum, was investigated. We also measured changes in IL-5 concentrations during steroid therapy. IL-5 concentrations were significantly decreased during asthma attacks and after their relief (p < 0.001). An analysis of blood samples taken from 55 patients suffering asthma attacks showed that serum IL-5 concentrations were significantly higher in non-atopy-type asthma than in atopy-type asthma (p < 0.05). Serum IL-5 levels are highest in severe asthma, followed by moderate asthma (p < 0.001) and mild asthma (p < 0.001). Serum IL-5 concentrations during asthma attacks and eosinophil counts in sputum were closely correlated (r = 0.85). Serum IL-5 concentrations were below the limit of determination and decrease the number of eosinophils in sputum was noted in 15 patients whose asthma was well-controlled by the long-term inhalation of beclometasone. Serum IL-5 concentrations did not decrease below the limit of determination (even during attack-free periods) in patients whose disease could not be well controlled by 6-month inhalation therapy with beclometasone. In patients with major and moderate bronchial asthma attacks, serum IL-5 concentrations decreased as symptoms improved over time following the i.v. infusion of steroids, suggesting that steroids are effective in inhibiting the production of IL-5. Measurement serum IL-5 concentrations could be clinically useful in the determination of the pathology (e.g., severity) of bronchial asthma could serve as an index for the degree of control of asthma, and may be useful in determining the disease's long-term prognosis.

Adult↗
PubMed2005

Asthma and depression: a pragmatic review of the literature and recommendations for future research.

BACKGROUND: Although the association between asthma and psychosocial factors has long been recognised, it is only in the last decade that the impact of coexisting asthma and depression has become the focus of considerable research interest. However, the findings so far have been confusing and often contradictory. This paper sets out a methodical review and appraisal of the literature to date, including suggestions for future research. METHOD: PubMed and PsycINFO databases were used to search for English-language articles relating to asthma and depression research. The resulting articles were then reviewed and summarised, creating a report that was used to develop research recommendations. RESULTS: The main findings from this review included: (a) results are mixed as to whether persons with asthma are more likely to be depressed than those without asthma; (b) asthma and depression may have an 'additive' adverse effect on the normal asthma-related quality of life reductions; (c) subjective measures of asthma severity may be more strongly related to depression than objective measures; (d) specific asthma symptoms appear to be linked to depression; (e) sadness and depression can produce respiratory effects consistent with asthma exacerbations; (f) depression appears to be negatively related to asthma treatment compliance; (g) corticosteroid use in asthma treatment has been associated with depression, though it is unclear how common this problem is in real life; (h) interventions that address the physical, psychological, and social consequences of asthma are likely to lead to the most successful treatment outcomes; (i) treating the depression of individuals with asthma is likely to minimise the negative effects of the coexistence; and (j) a number of common methodological problems were observed in the literature. RECOMMENDATIONS: There is a large amount of research yet to be undertaken to clarify issues around asthma and depression, with the overdue next step being to design integrated treatment approaches, and carry out large-scale prospective studies to determine the impact of using such approaches to treat individuals with depression and asthma. Such studies will be the only way in which some fundamental questions about the development and coexistence of these two conditions will be answered.

Journal Article↗
PubMedDate not supplied

National Athletic Trainers' Association position statement: management of asthma in athletes.

OBJECTIVE: To present guidelines for the recognition, prophylaxis, and management of asthma that lead to improvement in the quality of care certified athletic trainers and other heath care providers can offer to athletes with asthma, especially exercise-induced asthma. BACKGROUND: Many athletes have difficulty breathing during or after athletic events and practices. Although a wide variety of conditions can predispose an athlete to breathing difficulties, the most common cause is undiagnosed or uncontrolled asthma. At least 15% to 25% of athletes may have signs and symptoms suggestive of asthma, including exercise-induced asthma. Athletic trainers are in a unique position to recognize breathing difficulties caused by undiagnosed or uncontrolled asthma, particularly when asthma follows exercise. Once the diagnosis of asthma is made, the athletic trainer should play a pivotal role in supervising therapies to prevent and control asthma symptoms. It is also important for the athletic trainer to recognize when asthma is not the underlying cause for respiratory difficulties, so that the athlete can be evaluated and treated properly. RECOMMENDATIONS: The recommendations contained in this position statement describe a structured approach for the diagnosis and management of asthma in an exercising population. Athletic trainers should be educated to recognize asthma symptoms in order to identify patients who might benefit from better management and should understand the management of asthma, especially exercise-induced asthma, to participate as active members of the asthma care team.

Journal Article↗
PubMed2005

Asthma control in adults in Asia-Pacific.

OBJECTIVE: The Asthma Insights and Reality in Asia-Pacific (AIRIAP) survey collected detailed information on asthma severity and management in the urban centres of eight areas of the Asia-Pacific region. This study compared asthma morbidity and management practices in these areas. METHODOLOGY: Following recruitment, face-to-face interviews were completed with 2323 adults with diagnosed asthma, who had current symptoms or were using asthma medication. Comparisons between areas were made for asthma severity, asthma burden and management practices. RESULTS Asthma severity varied significantly between areas (P < 0.01), with Vietnam and mainland China reporting the most cases with severe, persistent symptoms. Severity of asthma was significantly associated with advancing age and a lower level of education in a multivariate analysis (P < 0.001). The total use of acute healthcare for asthma was significantly associated with increased asthma severity. Work absence due to asthma was highest in the Philippines (46.6%) and lowest in South Korea (7.5%). The use of inhaled corticosteroids was associated with age in a non-linear manner. There was significant variation among countries in usage of inhaled corticosteroids, from 1.3% in South Korea to 29.0% in Taiwan (P < 0.00001). A peak flow meter was owned by a total of 7.7% of respondents, and overall, 17.9% of adults had a written action plan for asthma management. CONCLUSIONS: Within the Asia-Pacific region, asthma in adults differs significantly in disease severity, management and treatment according to area of residence. International recommendations on the management of asthma are generally not being followed.

Adolescent↗
PubMed2003

Lower bronchodilator responsiveness in Puerto Rican than in Mexican subjects with asthma.

In the United States, Puerto Ricans and Mexicans have the highest and lowest asthma prevalence, morbidity, and mortality, respectively. To determine whether ethnicity-specific differences in therapeutic response, clinical response, and/or genetic factors contribute to differences in asthma outcomes, we compared asthma-related clinical characteristics among 684 Mexican and Puerto Rican individuals with asthma recruited from San Francisco, New York City, Puerto Rico, and Mexico City. Puerto Ricans with asthma had reduced lung function, greater morbidity, and longer asthma duration than did Mexicans with asthma. Bronchodilator responsiveness, measured as percentage change from baseline FEV1, was significantly lower among Puerto Ricans with asthma than among Mexicans with asthma. Puerto Ricans with asthma had on average 7.3% (95% confidence interval [CI], 4.6 to 9.9; p < 0.001) lower bronchodilator reversibility in FEV1, higher risk of an emergency department visit in the previous year (odds ratio, 2.63; 95% CI, 1.6 to 4.3; p < 0.001), and of previous hospitalization for asthma (odds ratio, 1.94; 95% CI, 1.2 to 3.2; p = 0.009) than Mexicans. Subgroup analysis corroborated that Puerto Ricans with asthma had more severe disease than did Mexicans on the basis of lung function measurements, responsiveness to beta2-adrenergic agonists, and health care use. We conclude that Puerto Ricans with asthma respond less to albuterol than do Mexicans with asthma. These findings underscore the need for additional research on racial/ethnic differences in asthma morbidity and response to therapy.

Asthma↗
PubMed1998

Reported difficulties in access to quality care for children with asthma in the inner city.

OBJECTIVE: To characterize perceived access and barriers to quality health care for asthma among the caregivers of children in the inner city. DESIGN: Multicenter, cross-sectional survey. SETTING: Eight sites in 7 major metropolitan US inner cities. PARTICIPANTS: A systematic sample of children with asthma, aged 4 to 9 years, and their caregivers who resided in census tracts in which at least 30% of the households were below the 1990 federal poverty guidelines, recruited from 25 primary care clinics and 13 emergency departments (EDs) from November 1, 1992, through October 31, 1993. RESULTS: Of the 1528 children enrolled, 1376 had physician-diagnosed asthma and form the basis of this report. This group was further divided into 284 children (20.6%) who met all recruitment criteria for severe asthma and 207 (15.0%) with mild asthma who met none. Of parents in the total sample, 95.6% reported a usual place for short-term asthma care for their child; 75.4% used the ED. Children with severe asthma were significantly more likely to use the ED than those with mild asthma (84.3% vs 63.0%; P<.01). A usual place for follow-up asthma care was reported by 96.7% of subjects. There were no differences in access or type of facility used by asthma severity. More than half the study group reported difficulty in accessing care for acute asthma attacks and for follow-up care with no differences by asthma severity. Among those with severe asthma, 47.5% used inhaled steroids or cromolyn, 52.8% used a spacer device if they had been prescribed a metered dose inhaler, and 21.2% of children older than 6 years were prescribed a peak flowmeter. Patients with mild asthma were significantly less likely to report use of all 3 items (steroids or cromolyn, 1.4%; spacer device, 15.4%; and peak flowmeter, 3.1%, respectively; P<.01). CONCLUSION: Although access to asthma care among children in US inner cities appears adequate as determined by the traditional measure of reporting a regular source of care, barriers are frequently reported, as are deficiencies in the quality of medical care.

Anti-Asthmatic Agents↗
PubMed2002

Providers underestimate symptom severity among urban children with asthma.

BACKGROUND: Guidelines recommend that children with mild persistent to severe persistent asthma receive maintenance anti-inflammatory medications. However, providers may not be aware of the severity of their patients' symptoms. The underestimation of severity may contribute to poor adherence to asthma care guidelines. OBJECTIVES: To describe the use of preventive medications among a group of urban children with mild persistent to severe persistent asthma and to evaluate the degree to which their health care providers are aware of their asthma severity. DESIGN: Children (ages 4-6 years) from urban schools in Rochester, NY, were eligible if their parents reported mild persistent to severe persistent asthma symptoms. Each child's health care provider was asked to assess the child's asthma severity and use of medications based both on their knowledge of the child and review of the medical record. Parent and provider assessments were compared. Bivariate and regression analyses were used to identify factors associated with concordant classifications of asthma severity. RESULTS: Ninety children with parent-defined mild persistent to severe persistent asthma participated (64% boys, 67% black, 73% receiving Medicaid). Only 40% of the children were described accurately by their providers as having mild persistent to severe persistent asthma, and only 50% of the total had been prescribed maintenance medications. Thirty-six percent of families reported that their child used maintenance medications daily. In contrast, most of the children who were classified by their provider as having mild persistent to severe persistent asthma were prescribed a maintenance medication (83%), and 58% used them daily. Sociodemographic characteristics and asthma severity were not associated with provider accuracy. CONCLUSIONS: Most children in this study were not accurately classified by their providers as having mild persistent to severe persistent asthma and had not been prescribed maintenance medications. When providers were aware of their patient's asthma symptoms, most of the children were prescribed maintenance medications. Attempts to improve adherence to asthma guidelines should take into consideration provider underestimations of asthma severity.

Anti-Asthmatic Agents↗
PubMed2004

Asthma among homeless children: undercounting and undertreating the underserved.

BACKGROUND: In the United States, children of color, children who live in urban medically underserved communities, and children whose families have limited economic resources have excessively high rates of asthma. The identification of high-risk subgroups of underserved children is crucial for understanding the determinants and scope of the childhood asthma epidemic and for developing successful interventions. OBJECTIVE: To determine the population prevalence of asthma among homeless children. DESIGN: Cross-sectional study. SETTING: Three family shelters in New York City. PARTICIPANTS: A total of 740 children whose families entered 3 family shelters from June 30, 1998, to September 18, 1999. MAIN OUTCOME MEASURES: Prior physician asthma diagnosis, current asthma symptoms using National Asthma Education and Prevention Program symptom criteria, current medications, and emergency department use in the past year. RESULTS: Of the children, 26.9% had a prior physician diagnosis of asthma. In addition, 12.9% of the children without a prior physician diagnosis of asthma reported symptoms consistent with moderate or severe persistent asthma. Overall, 39.8% of homeless children in New York City are likely to have asthma. Few children with persistent asthma received any anti-inflammatory treatment. Almost 50% (48.6%) of children with severe persistent asthma had at least 1 emergency department visit in the past year; 24.8% of children with symptoms of mild intermittent asthma had at least 1 visit. CONCLUSIONS: The prevalence of asthma among a random sample of homeless children in New York City is likely to be 39.8%-more than 6 times the national rate for children. Asthma in homeless children is also likely to be severe and substantially undertreated.

Adolescent↗
PubMed2001

Relationship between bronchial hyperresponsiveness and development of asthma in children with chronic cough.

To evaluate the relationship between bronchial hyperresponsiveness (BHR) and the development of asthma in children with chronic cough, we performed methacholine inhalation challenges and transcutaneous oxygen pressure (tcPO2) measurements in 92 children with chronic cough aged from 1-13 years (55 boys and 37 girls; mean, 5.3 years) and followed them for > or = 10 years. Forty-four age-matched children with asthma (24 males and 20 females; mean, 6.5 years) and 44 age-matched children without cough or asthma served as controls (18 males and 26 females; mean, 4.6 years). Consecutive doubling doses of methacholine were inhaled until a 10% decrease in tcPO2 from baseline was observed. The cumulative dose of methacholine at the inflection point of the tcPO2 record (Dmin-PO2) was considered to represent hyperresponsiveness to inhaled methacholine. After 10 years or more of follow-up, 60 of the 92 subjects with cough answered our questionnaire, and 27/60 had been diagnosed with asthma. There was a statistical difference in Dmin-PO2 between the children who presented with chronic cough originally and who developed asthma (asthma-developed group) and those who did not develop asthma (asthma-free group). There was no difference in the value of Dmin-PO2 between the asthma-developed group and the asthma group, or between the asthma-free group and the age-matched control group. Among the children with chronic cough, there was no difference in Dmin-PO2 between girls and boys, either in the asthma-developed group or in the asthma-group. We conclude that 45% of the children with a chronic cough in early life developed asthma, and that BHR in children with chronic cough during the childhood period is a strong risk factor for the development of asthma.

Administration, Inhalation↗