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PubMed1998

Prevalence of bronchial hyperresponsiveness to 4.5% saline and its relation to asthma and allergy symptoms in Austrian children.

The prevalence of asthma in school children has been reported to have increased, with wide variations between countries. To allow comparison of prevalence data, objective markers of asthma should be measured. Therefore, we assessed the prevalence of bronchial hyperresponsiveness (BHR) to hypertonic saline and its relation to asthma and allergy symptoms in 507 Austrian school children, aged 12-15 yrs in a cross-sectional, community based survey. These children were selected from 3,371 children who had answered a self-administered written questionnaire on asthma, hay fever, eczema and environmental factors. The prevalence of BHR to hypertonic saline was 14% and the majority (70%) of the children had mild BHR. The prevalence of wheeze in the last 12 months was 12% and of a diagnostic label of asthma was 6%. Fifty three per cent of the children with symptoms in the last 12 months and a diagnostic label of asthma had BHR, and 33% of those with symptoms in the last 12 months regardless of a diagnostic label of asthma showed a positive response to hypertonic saline. Atopic dermatitis, a diagnostic label of asthma, night cough apart from colds, wheeze in the past 12 months (but not "former wheeze") and male gender were significantly associated with increased response to 4.5% saline in the final logistic regression model. These results show that the prevalence of asthma symptoms in the last 12 months and the prevalence of bronchial hyperresponsiveness to hypertonic saline are twice that of a diagnosis of asthma and that asthma might be underdiagnosed in the present population. The response to hypertonic saline is most strongly associated with current asthma and allergy symptoms. A combination of a "diagnostic label of asthma" and "asthma symptoms in the last 12 months" might best reflect "current asthma" in epidemiological studies in this population.

Adolescent↗
PubMedDate not supplied

The Asheville Project: long-term clinical, humanistic, and economic outcomes of a community-based medication therapy management program for asthma.

OBJECTIVE: To assess clinical, humanistic, and economic outcomes of a community-based medication therapy management (MTM) program for 207 adult patients with asthma over 5 years. DESIGN: Quasi-experimental, longitudinal pre-post study. SETTING: 12 pharmacy locations in Asheville, N.C. PATIENTS/OTHER PARTICIPANTS: Patients with asthma covered by two self-insured health plans; professional educator at Mission Hospitals; 18 certificate-trained community and hospital pharmacists. INTERVENTIONS: Education by a certified asthma educator; regular long-term follow-up by pharmacists (reimbursed for MTM by health plans) using scheduled consultations, monitoring, and recommendations to physicians. MAIN OUTCOME MEASURES: Changes in forced expiratory volume in 1 second (FEV1), asthma severity, symptom frequency, the degree to which asthma affected people's lives, presence of an asthma action plan, asthma-related emergency department/hospital events, and changes in asthma-related costs over time. RESULTS: All objective and subjective measures of asthma control improved and were sustained for as long as 5 years. FEV1 and severity classification improved significantly. The proportion of patients with asthma action plans increased from 63% to 99%. Patients with emergency department visits decreased from 9.9% to 1.3%, and hospitalizations from 4.0% to 1.9%. Spending on asthma medications increased; however, asthma-related medical claims decreased and total asthma-related costs were significantly lower than the projections based on the study population's historical trends. Direct cost savings averaged 725 dollars/patient/year, and indirect cost savings were estimated to be 1230 dollars/patient/year. Indirect costs due to missed/nonproductive workdays decreased from 10.8 days/year to 2.6 days/year. Patients were six times less likely to have an emergency department/hospitalization event after program interventions. CONCLUSION: Patients with asthma who received education and long-term medication therapy management services achieved and maintained significant improvements and had significantly decreased overall asthma-related costs despite increased medication costs that resulted from increased use.

Absenteeism↗
PubMedDate not supplied

School readiness among urban children with asthma.

BACKGROUND: Children with chronic illnesses, including asthma, are at risk for school problems. Developmental problems, however, may begin before school entry, and the developmental status of preschool children with asthma has not been evaluated. OBJECTIVE: To test the hypothesis that urban preschool children with asthma have lower parent-reported developmental scores compared with children without asthma. METHODS: A comprehensive survey of children beginning kindergarten in 1998 in the urban school system in Rochester, NY, collected parent reports of demographic, medical, and developmental data. We compared children with asthma with and without limitation of activity to children without asthma for motor, language, socioemotional, and school readiness skills and the need for extra help with learning. Linear and logistic regression were used to determine associations between asthma and developmental outcomes. RESULTS: Among the 1058 children in this sample, 9% had asthma, including 5% with asthma with limitation of activity. After adjustment for multiple potential confounding variables, the children with asthma with limitation had lower scores on school readiness skills compared with children without asthma (2.0 vs 2.5, P <.001). Further, the parents of children with asthma with limitation were substantially more likely (P <.05) to describe them as needing extra help with learning (74% vs 56%; odds ratio, 3.2; 95% confidence interval, 1.5--7.8). CONCLUSIONS: Urban preschool children with significant asthma had poorer parent-reported school readiness skills and a greater need for extra help with learning compared with children without asthma. This finding suggests that developmental problems for children with asthma may begin before school entry.

Asthma↗
PubMed1998

The spectrum of irritant-induced asthma: sudden and not-so-sudden onset and the role of allergy.

A retrospective investigation of 86 asthmatic subjects defined clinical features of irritant-induced asthma and assessed the contributory role of an allergic predisposition. Three categories of asthma were evaluated: (1) occupational asthma due to a sensitizer (11 subjects, 13%); (2) irritant-induced asthma (54 persons, 63%); and (3) not occupational/environmental exposure-related asthma (21 subjects, 24%). Two distinct clinical presentations of irritant-induced asthma emerged: the first was sudden onset (29 subjects) and the second was not so sudden in onset (25 subjects). Sudden-onset, irritant-induced asthma was analogous to the reactive airways dysfunction syndrome. Clinical manifestations began immediately or within a few hours (always within 24 h) following an accidental, brief, and massive exposure. In contrast, for the not-so-sudden-onset asthma subjects, the causative irritant exposure was not brief, usually not massive, continued for > 24 h, and the initiation of asthma took longer to evolve. Eighty-eight percent of individuals with not-so-sudden irritant-induced asthma displayed an atopy/allergy status (p < 0.01). Some of the atopy/allergy subjects with presumed new-onset asthma were found to have suffered preexisting asthma that had been clinically quiescent for at least 1 year before the triggering exposure (16 persons). We conclude that preexisting allergic/atopy and/or preexisting asthma were significant contributors to the pathogenesis of not-so-sudden, irritant-induced asthma and emphasizes a critical interaction between environmental and host factors in the pathogenesis of asthma.

Acute Disease↗
PubMed2003

Internet-enabled interactive multimedia asthma education program: a randomized trial.

OBJECTIVE: To determine whether health outcomes of children who have asthma can be improved through the use of an Internet-enabled interactive multimedia asthma education program. METHODS: Two hundred twenty-eight children with asthma visiting a pediatric pulmonary clinic were randomly assigned to control and intervention groups. Children and caregivers in both groups received traditional patient education based on the National Asthma Education and Prevention Program. Intervention group participants received additional self-management education through the Interactive Multimedia Program for Asthma Control and Tracking. Pediatric Asthma Care Knowledge Survey, Pediatric Asthma Caregiver's Quality of Life Questionnaire, asthma symptom history, spirometry, and health services utilization data were collected at the initial visit and at 3 and 12 months. RESULTS: Interactive Multimedia Program for Asthma Control and Tracking significantly increased asthma knowledge of children and caregivers, decreased asthma symptom days (81 vs 51 per year), and decreased number of emergency department visits (1.93 vs 0.62 per year) among the intervention group participants. The intervention group children were also using a significantly lower average daily dose of inhaled corticosteroids (434 vs 754 micro g [beclomethasone equivalents]) at visit 3. Asthma knowledge of all 7- to 17-year-old children correlated with fewer urgent physician visits (r = 0.37) and less frequent use of quick-relief medicines (r = 0.30). CONCLUSIONS: Supplementing conventional asthma care with interactive multimedia education can significantly improve asthma knowledge and reduce the burden of childhood asthma.

Adolescent↗
PubMed2006

Recurrent wheeze in early childhood and asthma among children at risk for atopy.

OBJECTIVES: Little is known about the natural history of wheezing disorders among children at risk for atopy. We examined the relation between early wheeze and asthma at 7 years of age among children with parental history of asthma or allergies followed from birth. METHODS: Information on wheeze was collected bimonthly from birth to age 24 months and every 6 months thereafter. Recurrent early wheeze was defined as > or =2 reports of wheezing in the first 3 years of life. Frequent early wheeze was defined as > or =2 reports of wheezing per year in the first 3 years of life. At 7 years of age, asthma was defined as physician-diagnosed asthma and wheezing in the previous year. RESULTS: Of the 440 participating children, 223 (50.7%) had > or =1 report of wheeze before 3 years old, 111 (26.0%) had recurrent early wheeze, and 12 (2.7%) had frequent early wheeze. Whereas only 31 (13.9%) of 223 children with > or =1 report of wheeze developed asthma at 7 years of age, 24 (21.6%) of 111 children with recurrent early wheeze developed asthma at 7 years of age. Among the 12 children with frequent early wheeze, 6 (50%) had asthma at 7 years of age. After adjustment for other covariates, recurrent early wheeze in children at risk for atopy was associated with a fourfold increase in the odds of asthma at 7 years of age, and frequent early wheeze was associated with an approximately 12-fold increase in the odds of asthma at 7 years of age. Most (94%) of the children without frequent early wheeze did not develop asthma at 7 years of age. CONCLUSIONS: The absence of recurrent early wheeze indicates a very low risk of asthma at school age among children with parental history of asthma or allergies. Early identification of children who will develop asthma at school age is difficult, even in children at risk for atopy. However, children with parental history of asthma or allergies who have frequent early wheeze, in particular, are at greatly increased risk of asthma and merit close clinical follow-up.

Asthma↗
PubMedDate not supplied

Unmet needs in the treatment of allergic asthma: potential role of novel biologic therapies.

OBJECTIVE: To provide a review of the current status of the treatment of asthma and introduce new and developing forms of therapy by means of a review of published literature on asthma and publications on new and emerging therapies. Increased public awareness of asthma, improved patient and provider education, implementation of national treatment guidelines, and availability of safe and effective therapies have combined to provide an effective response to the increase in asthma prevalence. However, the number of persons with poorly controlled asthma and asthma-related complications remains unacceptably high. This is particularly true for the relatively small cohort of patients with moderateto- severe asthma that is poorly controlled with inhaled corticosteroids and other standard-of-care medications. Consequently, these patients often experience frequent exacerbations, leading to a disproportionate consumption of asthma health care resources and a poor quality of life. The National Committee on Quality Assurance suggests that the negative impact of asthma can be minimized if health care providers implement aggressive asthma management programs that include patient education and appropriate medications. Newer therapies such as injectable anti-IgE may provide a benefit for many patients. SUMMARY: Currently available asthma medications have been proven to be generally safe and effective for most asthma patients. However, the subset of patients with difficult-to-treat asthma who experience frequent exacerbations requiring emergency department visits or hospitalizations may benefit from novel therapies designed to target specific mechanisms underlying airway inflammation. CONCLUSIONS: New therapies may help in the treatment of patients whose asthma is not controlled. These include anti-immunoglobulin E (IgE) antibodies, cytokine modulators, and DNA vaccinations. Future research will determine if these targeted biologic therapies are a cost-effective means to improve the clinical and economic outcomes of asthma management.

Antibodies, Monoclonal↗
PubMed1993

The cost of asthma: can it be reduced?

Asthma is a major public health problem in developed countries, where it consumes a large and increasing share of scarce health resources. Ideally, medical management should be both optimal in terms of improving the patient's quality of life, and cost-effective for society. At present, there is very little information relating to costs and economic efficiency of current asthma management. Although the true total cost of asthma is unknown, current estimates suggest it is high. The main value of recent total cost estimates is that they identify the most expensive areas of asthma costs, and ideally, formal cost-effectiveness analyses should be concentrated on these areas. Asthma is still under- or inappropriately diagnosed, and undertreated. Several national and international consensus plans for the optimal management of asthma in children and adults have been published. If these inadequacies in asthma management were corrected, using current treatment recommendations, the overall cost of asthma from both the community and patient perspective should fall. The situation requires increased use of preventative medications {sodium cromoglycate (cromolyn sodium) or inhaled corticosteroids}, more widespread use of written crisis plans, more proactive medical consultations (rather than reactive or urgent consultations), further expansion of asthma education programmes, and further education of medical practitioners about the optimum management of both long term asthma and the acute exacerbation of asthma in the patient's home, the doctor's office, the hospital emergency room and the hospital inpatient setting. The increased costs associated with these measures would be more than offset by reduced expenditure on bronchodilator drugs, less widespread use of nebulisers at home and in hospitals, reduced antibiotic usage, reduced need for expensive emergency medical care and particularly reduced utilisation of hospital resources. To ensure that resources are being directed into the most cost-effective areas of asthma care, clinical trials of asthma should include utilisation of healthcare resources as an outcome measure, and estimates of the costs of the treatment under study. In addition, since the intangible cost (quality of life) is one of the most important effects of treatment from the patient's perspective, this should be more widely used as an outcome measure in clinical trials. Ultimately, prevention of asthma is the long term goal. If the hypothesis that sensitisation to house dust mite in early infancy is a major contributor to the subsequent development of asthma, then prevention may require drastic and expensive changes to current housing.

Adrenal Cortex Hormones↗
PubMed1998

The effectiveness of one-on-one nurse education on the outcomes of high-risk adult and pediatric patients with asthma.

The effects of an asthma self-management program on asthma outcomes were evaluated in adult and pediatric patients with asthma who were considered at high risk (i.e., those who were not in control of their disease as determined by resource utilization, medication use, or lack of use). The program consisted of one-on-one nurse-to-patient ("nurse champion") education and subsequent assessment of asthma outcomes using the Asthma Quality Assessment System (AQAS) questionnaire, which measured asthma severity, patient quality of life, asthma awareness and knowledge, confidence in managing asthma, use of peak flow meters, asthma symptoms, medication use, lost work or school days, and affect of asthma. Over the course of six months, nurse champions educated 201 patients from four managed care plans and collected data at baseline and during four follow-up sessions. Adult patients and pediatric patient caregivers reported significant improvements in quality of life, and clinical and process measures. Significant increases in asthma knowledge were observed immediately after patient education, including greater than 89% increase in the proportion of patients who reported that they know "a lot" about the "things that cause asthma symptoms." Significant decreases were also found in work or school days missed, urgent care utilization, and hospital admission rates. Appropriate preventive care visits increased by more than 40%. These results indicate that the nurse champion program was associated with an improvement in asthma outcomes in high-risk adult and pediatric patients and warrant further evaluation in controlled studies. Incorporating one-on-one education programs into asthma management is an effective and rapid means of improving asthma outcomes.

Absenteeism↗
PubMed2001

Asthma in Pacificans in New Zealand and in the South Pacific.

Asthma morbidity is a major public health problem in New Zealand. While considerable research has been done on asthma prevalence and access to asthma care among European and Maori, currently available information on the prevalence and severity of asthma in Pacific people in New Zealand is sparse. Furthermore, there have been only a few surveys on asthma prevalence in Pacific countries and these have used a variety of methodologies. We have therefore reviewed research on asthma prevalence and access to asthma health care in New Zealand and the Pacific nations, which had included information on Pacific people. The available evidence indicates several key features of asthma in Pacific people. In New Zealand, asthma prevalence in Pacific children is similar to, or lower than, that in non-Polynesian children, whereas in adults the prevalence is higher in both Pacific and Maori people. Asthma is more severe in Pacific people and Maori with a higher frequency of hospitalizations. The available evidence also indicates that the greater severity, and the greater adult prevalence, in Pacific people may be partly or wholly due to problems of access to culturally appropriate asthma health care and asthma education. However, this is an area that needs further research. There is some evidence that prevalence of asthma may be higher in Pacific children in New Zealand than in the Pacific, however little else is known about the prevalence patterns of asthma throughout the Pacific. Systematic standardised prevalence studies, including participation in Phase III of the ISAAC study, would clearly be of value in assessing the patterns and extent of asthma morbidity throughout the Pacific.

Adolescent↗
PubMed2004

Prevalence of and major risk factors for adult bronchial asthma in Taipei City.

BACKGROUND AND PURPOSE: The prevalence of bronchial asthma has been on the rise worldwide, but the prevalence of adult asthma in Taiwan has not been reported. The objective of this study was to determine the current 1-year and lifetime asthma prevalence rates, and to identify major risk factors for adult asthma in Taiwan. METHODS: A cluster sampling was conducted in 1999, where 21 clusters and 4549 adults (age > or = 18 years) were selected randomly. Face-to-face interviews were conducted with a total of 2076 adults (45.6%; men/women, 987/1089) using a questionnaire designed to assess asthma and asthma-like symptoms adapted from the American Thoracic Society with minor modifications to include information about current asthma status. RESULTS: The results showed that 50 cases had a previous diagnosis of asthma and 94 had been classified as probably having asthma with intermittently audible wheezing. The lifetime prevalence rate of asthma in adults in Taipei City was 7.8%. Seventy three out of 144 patients had asthmatic symptoms or wheezing in the past 12 months. The 1-year prevalence of asthma was 4.1%. A multiple logistic regression model showed the odds ratio (95% confidence interval) of a history of maternal asthma to be 5.8 (2.77 to 12.18), that of allergic rhinitis to be 3.2 (2.03 to 5.16), that of paternal asthma to be 2.2 (0.91 to 5.21), that of older age (> or = 50 years) to be 2.0 (1.25 to 3.19), and that of smoking habit to be 1.7 (1.02 to 2.72). CONCLUSIONS: The lifetime prevalence rate of adult bronchial asthma in Taipei City was 7.8% and related to both genetic and environmental factors, which included maternal or paternal history of asthma, history of allergic rhinitis, older age (> or = 50 years), and smoking habits.

Adolescent↗
PubMed2004

[Prevalence of gastroesophageal reflux disease in patients with bronchial asthma].

The aim of this study was to determine the prevalence of gastroesophageal reflux disease (GERD) in patient with asthma, its relation to the severity of asthma, BMI (body mass index) and method of treatment. Two hundred eight patients with asthma were included in the study. All patients were carefully studied for asthma severity and surveyed using questionnaire specific for diagnosis of GERD also BMI was determined. Among the asthmatics 22.1% had chronic severe asthma, 43.3% had chronic moderate asthma and 34.6% had chronic mild asthma. GERD was present in 86.9% of patients with severe asthma (p<0.001 as compared to moderate and mild asthma), 62.2% of patients with moderate asthma and 48.6% of patients with mild asthma. BMI was significantly higher in patients with severe asthma and reached 28+/-5.3 kg/m2. GERD was present in all patients with severe asthma and BMI above 30 kg/m2. 72.5%, 17.85% and 8.6% of patients with severe, moderate and mild asthma respectively, experienced symptoms of GERD after ingestion of theophylline and oral steroids. The study demonstrated a greater prevalence of GERD symptoms in severe asthma and related GERD to BMI and treatment with theophylline and systemic steroids.

Adult↗
PubMedDate not supplied

The asthma belief survey: development and testing.

Accurate evaluation of asthma self-efficacy is essential to the effective management of asthma. This article describes the development and testing of the Asthma Belief Survey (ABS). The instrument is a 15-item tool that uses a 5-point self-report scale to measure asthma self-efficacy in relation to daily asthma maintenance and an asthma crisis. This instrument was tested with a sample of 79 African American school children, who attended eight inner-city elementary schools. The mean age of the sample was 11.05 years with a range of 8 to 14 years. The majority of students had been diagnosed with asthma prior to the age of 5 years. The Asthma Belief Survey demonstrated good psychometric properties: good Cronbach's alpha reliability coefficient (.83), coherence as a single scale measuring children's self-efficacy in treating their own asthma, and significant relationships with scales of asthma knowledge (r = .51, p < .000) and asthma self-care practices (r = .52, p < .001). The Asthma Belief Survey has sound reliability and validity evidence to support its use to measure a child's asthma self-management self-efficacy. The practitioner can use this instrument to assess a child's self-efficacy in the areas of asthma health maintenance and avoidance of asthma episodes.

Adolescent↗
PubMed2005

[Characteristics of the airway inflammation and the relationship to interleukin-17 in severe asthma].

OBJECTIVE: To investigate the characteristics of airway inflammation in severe asthma and the association with interleukin-17 (IL-17). METHODS: Sixteen patients with mild persistent asthma, 14 patients with moderate persistent asthma and 18 patients with severe persistent asthma, as well as 15 normal control subjects, were included in this study. At baseline, asthma symptom score was recorded, and lung function was measured. Induced sputum was obtained and processed for cell differential and the supernatant was assayed for the concentrations of IL-17 and IL-8 by sandwich enzyme-linked immunosorbent assay (ELISA), eosinophil cationic protein (ECP) by the immuno-CAP system, and neutrophil myeloperoxidase (MPO) by a colorimetric method, and the values were normalized to the protein content. Then 15 mild to moderate and 15 severe asthmatic patients received inhaled corticosteroid (Pulmicort, Astra-Zeneca) therapy for 4 weeks, and the above measurements were repeated. RESULTS: The percentage of sputum eosinophils and the level of ECP were significantly increased in mild [0.0670 +/- 0.0740, (155 +/- 91) x 10(-6) g/g protein], moderate [0.0830 +/- 0.0440, (180 +/- 83) x 10(-6) g/g protein] and severe [0.1240 +/- 0.1430, (191 +/- 87) x 10(-6) g/g protein] asthmatic patients, as compared to the normal controls [0.0000 +/- 0.0010, (44 +/- 25) x 10(-6) g/g protein, P < 0.01)]; but there was no significant difference among mild, moderate and severe asthma (P > 0.05). On the contrary, the percentage of sputum neutrophils was significantly increased in patients with severe asthma (0.589 +/- 0.203) as compared to patients with mild (0.455 +/- 0.154) and moderate (0.449 +/- 0.194) asthma and normal controls (0.313 +/- 0.134, P < 0.01). The level of MPO was also increased in severe asthma [(31 +/- 10 ) U/g protein] as compared to mild [(12 +/- 4) U/g protein] and moderate [(22 +/- 7) U/g protein] asthma and normal controls [(10 +/- 4) U/g protein, P < 0.01]. The sputum level of IL-17 in severe, moderate asthma [(264 +/- 137) x 10(-9) g/g protein, (172 +/- 65) x 10(-9) g/g protein] was significantly higher than those in mild asthma [(126 +/- 52) x 10(-9) g/g protein] and normal controls [(56 +/- 20) x 10(-9) g/g protein, P < 0.01]. As compared to the normal controls [(83 +/- 36) x 10(-9) g/g protein], the level of IL-8 in severe asthma [(531 +/- 321) x 10(-9) g/g protein] was significantly increased (P < 0.01), and those in mild [(410 +/- 181) x 10(-9) g/g protein] and moderate [(438 +/- 148) x 10(-9) g/g protein] asthma were also increased, although the difference was not statistically significant (P > 0.05). The level of IL-17 was correlated positively with IL-8, neutrophils and MPO (r = 0.525, 0.349, 0.602, all P < 0.01). After steroid therapy, the percentage of eosinophils, the levels of ECP, MPO, IL-17 and IL-8 decreased significantly in all patients combined, but the percentage of neutrophils remained unchanged (P > 0.05) and still significantly higher in severe asthmatic patients (0.642 +/- 0.157) as compared to mild and moderate asthmatic patients (0.394 +/- 0.147, P < 0.01). CONCLUSIONS: Airway neutrophilia is a feature of severe asthma. The IL-17/IL-8 pathway may be involved in the initial neutrophil influx into the airways.

Adult↗
PubMed2006

Risk factors and characteristics of early-onset asthma in Taiwanese children.

BACKGROUND AND PURPOSE: Early-onset asthma has been reported to be associated with a family history of allergy and exposure to environmental factors. This study was designed to evaluate the relationship between age of onset of asthma and genetic and environmental factors with asthma severity in Taiwanese children. METHODS: A group of 352 children with asthma (220 males and 132 females), ranging in age from 5 to 15 years, were enrolled in this study. The subjects were divided into 2 groups: early-onset asthma (up to and including age 3) and late-onset asthma. General characteristics including family history of allergies and exposure to domestic pets and tobacco smoke were recorded. The subjects underwent pulmonary function testing and analysis of serum immunoglobulin E (IgE), eosinophil counts, and specific IgE for common allergens. RESULTS: Early-onset asthma was present in 149 subjects and late-onset asthma in 203. Family history of allergies included a sibling with asthma or urticaria predisposed to early-onset asthma (asthma, p=0.034; urticaria, p=0.024). Food and milk allergen sensitization were more common in early-onset asthma (food allergens, p=0.025; milk, p=0.034). Children with early-onset asthma had higher eosinophil counts (p=0.041). However, there was no correlation between age at onset and pulmonary function testing, the levels of total IgE and IgE specific for Dermatophagoides pteronyssinus or Dermatophagoides farinae. CONCLUSIONS: A history of asthma or urticaria in a sibling is a risk factor for early-onset asthma. A greater prevalence of food allergen sensitization and high eosinophil counts are characteristic of early-onset disease.

Adolescent↗
PubMed1997

Accuracy of asthma treatment in schoolchildren in NSW, Australia.

Insufficient use of anti-inflammatory drugs, such as inhaled corticosteroids and cromoglycate, may contribute to the disease burden associated with asthma. Conversely, aggressive treatment of mild disease may result in avoidable costs and/or adverse drug effects. The aim of this study was to determine the relationship between asthma severity and inhaled corticosteroid/cromoglycate use in a large (n=4,909) random sample of children, aged 8-11 yrs, in NSW, Australia. Asthma and its treatment were assessed by questionnaire responses. Asthma, defined as diagnosis plus current wheeze, was present in 901 children (18% of the sample), of whom 225 (5%) had moderate asthma, defined as asthma plus additional symptoms (sleep disturbance), utilization (hospital, casualty), or disability (reduced activity, school absence). Use of inhaled corticosteroid/cromoglycate was reported by 636 children (13% of the sample). Determinants of use included: asthma diagnosis, current wheeze, and troublesome dry nocturnal cough. There was also a strong relationship between anti-inflammatory treatment and a multicomponent asthma severity score constructed for each child. Inhaled corticosteroids and/or cromoglycate were used by 56% of the children with asthma (24% daily) and by 76% of children with moderate asthma (42% daily). Undertreatment, defined as less than daily inhaled corticosteroids/cromoglycate in moderate asthma, was identified in 130 children (14% of those with asthma or 3% of the sample). Conversely, apparently aggressive treatment, defined as inhaled corticosteroid/cromoglycate use in children with persistent minimal symptoms (asthma severity score of less than 3) was identified in 101 children (2% of the sample). Although there were significant differences between regions in the choice of anti-inflammatory drugs and in the prevalence both of undertreatment and apparently aggressive treatment, there was no clear relationship to regional utilization of emergency and hospital services for asthma. Nevertheless, the frequency of undertreatment suggests an opportunity to reduce asthma morbidity by more consistent application of current therapeutic guidelines.

Administration, Inhalation↗
PubMed1997

Specialty differences in the management of asthma. A cross-sectional assessment of allergists' patients and generalists' patients in a large HMO.

OBJECTIVE: To examine the differences in medical management and quality of life between patients with asthma who receive their primary asthma care from allergists and those who receive their care from generalists in a large health maintenance organization (HMO). METHODS: We conducted a cross-sectional study of patients with asthma in a large HMO (Kaiser Permanente, Northwest Region, Portland, Ore). Participants were 392 individuals aged 15 through 55 years with physician-diagnosed asthma, taking antiasthma medications, reporting current asthma symptoms, and receiving asthma care from an allergist or from a generalist. Primary outcomes include characteristics of asthma, health care utilization, and quality of life. RESULTS: Patients cared for by allergists tended to have more severe asthma than those cared for by generalists (P < .01). The allergists' patients tended to be older (38.6 +/- 9.6 years vs 35.7 +/- 12.6 years, P < .01), more atopic (91% vs 78%, P < .01), and more likely to report perennial (rather than seasonal) asthma (26% vs 36%, P < .04) than the generalists' patients. Patients receiving their primary asthma care from an allergist were considerably more likely than generalists' patients to report using inhaled anti-inflammatory agents (P < .01), oral steroids (P < .01), and regular (daily) breathing medications to control their asthma (P < .01). Allergists' patients were more likely to have asthma exacerbations treated in a clinic setting rather than an emergency department (P < .01). Furthermore, allergists' patients reported significantly improved quality of life as measured by several dimensions of the SF-36 scale (physical functioning, role emotional, bodily pain, and general health; P < .05). CONCLUSIONS: These findings suggest that specialist care of asthma is of benefit for patients with asthma in a large HMO. Specifically, the allergists' patients conformed more closely to national asthma management guidelines and reported better quality of life than did the generalists' patients.

Adolescent↗
PubMedDate not supplied

The Australian National Asthma Campaign: effects of public education activities based on mass media.

INTRODUCTION: The National Asthma Campaign (NAC) was formed in 1990 as a coalition of the key professional organizations concerned with asthma and its management in Australia. It has conducted multifaceted educational activities targeting health care professionals, people with asthma, and the general public. Between November 1991 and March 1993, an educational mass media campaign was developed to inform people about new approaches to preventive asthma therapy and how people with symptoms of asthma should talk to their doctor or pharmacist about new management and monitoring strategies. Evaluation was based on McGuire's communication/persuasion model for assessing the impact of mass media campaigns. METHODS: Four serial cross-sectional population surveys of persons over the age of 18 years were conducted in four major Australian cities using structured telephone interviews. Information was sought on asthma campaign awareness and knowledge or use of appropriate asthma management practices. RESULTS: There was an increasing trend in awareness of asthma messages in the media and of appropriate message recall across the two-year period. Knowledge about the need to use preventive therapy for asthma improved significantly. Among those with asthma there was a significant upward trend in the proportion who discussed asthma with their doctor or pharmacist and who used peak flow meters and written asthma management plans. CONCLUSIONS: The net impact of the NAC and other activities has been an increase in awareness about asthma in Australia. These campaigns relied on the relatively nonselective medium of television to raise awareness and to start to change attitudes to asthma. The challenge is to build on these trends to further reduce morbidity and mortality due to asthma.

Adult↗