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PubMed2000

Caffeine for asthma.

BACKGROUND: Caffeine has a variety of pharmacological effects. It is chemically related to the drug theophylline which is used to treat asthma. Accordingly, interest has been expressed in its potential role as an asthma treatment. A number of studies have explored the effects of caffeine in asthma, this is the first review to systematically examine and summarise the evidence. OBJECTIVES: Caffeine is a weak bronchodilator and it also reduces respiratory muscle fatigue. It has been suggested that caffeine may reduce asthma symptoms. The objective of this review was to assess the effects of caffeine on lung function and identify whether there is a need to control for caffeine consumption prior to lung function testing. SEARCH STRATEGY: We searched the Cochrane Airways Group trials register and the reference lists of articles. We also contacted study authors. SELECTION CRITERIA: Randomised trials of oral caffeine compared to placebo in adults with asthma. DATA COLLECTION AND ANALYSIS: Trial quality assessment and data extraction were done independently by two reviewers. MAIN RESULTS: Six trials involving a total of 55 people were included. The studies were all of cross-over design and of high quality. In comparison with placebo, caffeine appears to improve lung function for up to two hours after consumption. Forced expiratory volume in one minute showed a small improvement up to two hours after caffeine use (standardised mean difference -0.73, 95% confidence interval -1.20 to -0.25). Mid-expiratory flow rates also showed a small improvement with caffeine and this was sustained up to four hours. REVIEWER'S CONCLUSIONS: Caffeine appears to improve airways function modestly in people with asthma for up to four hours. People may need to avoid caffeine for at least four hours prior to lung function testing.

Adult↗
PubMed2000

Long acting beta-agonists versus theophylline for maintenance treatment of asthma.

BACKGROUND: Theophylline and long acting beta2-agonists are bronchodilators used for the management of persistent asthma symptoms, especially nocturnal asthma. They represent different classes of drug with differing side-effect profiles. OBJECTIVES: To assess the comparative efficacy, safety and side-effects of long-acting beta-agonists and theophylline in the maintenance treatment of asthma. SEARCH STRATEGY: Randomised, controlled trials (RCTs) were identified using the Cochrane Airways Group register. The register was searched using the following terms: asthma and theophylline and long acting beta-agonist or formoterol or foradile or eformoterol or salmeterol or bambuterol or bitolterol. Titles and abstracts were then screened to identify potentially relevant studies. The bibliography of each RCT was searched for additional RCTs. Authors of identified RCTs were contacted for other relevant published and unpublished studies. SELECTION CRITERIA: All included studies were RCTs involving adults and children with clinical evidence of asthma. These studies must have compared oral sustained release and/or dose adjusted theophylline with an inhaled long-acting beta-agonist. DATA COLLECTION AND ANALYSIS: Potentially relevant trials, identified by screening titles and/or abstracts, were obtained. Two reviewers independently assessed full text versions of these trials to decided whether the trial should be included in the review, and assessed its methodological quality. Where there was disagreement between reviewers, this was resolved by consensus, or reference to a third party. Data were extracted by two independent reviewers. Inter-rater reliability was assessed by simple agreement. Study authors were contacted to clarify randomisation methods, provide missing data, verify the data extracted and identify unpublished studies. Relevant pharmaceutical manufacturers were also contacted. MAIN RESULTS: Six trials met the inclusion criteria. Five used salmeterol and one, biltoterol. They were of varying quality. There was a trend for salmeterol to improve FEV1 more than theophylline in three studies and salmeterol use was associated with more symptom free nights. Bitolterol, used in only one study, was reported to be less effective than theophylline. Subjects taking salmeterol experienced fewer adverse events than those using theophylline (Relative Risk 0.38; 95%Confidence Intervals 0.25, 0.57). Significant reductions were reported for central nervous system adverse events (Relative Risk 0.51; 95%Confidence Intervals 0.30, 0.88) and gastrointestinal adverse events (Relative Risk 0.32; 95%Confidence Intervals 0.17, 0.59). REVIEWER'S CONCLUSIONS: Salmeterol may be more effective than theophylline in reducing asthma symptoms including night waking and improving lung function. More adverse events occurred in subjects using theophylline when compared to salmeterol.

Adrenergic beta-Agonists↗
PubMed2000

Corticosteroids for acute severe asthma in hospitalised patients.

BACKGROUND: Corticosteroids are currently used routinely in the management of acute severe asthma. The optimal dose and route of administration continues to be debated. Some investigators have reported a greater benefit of higher doses of corticosteroids in the management of severe asthma, while others have not. OBJECTIVES: To determine whether higher doses of systemic corticosteroids (oral, intravenous or intramuscular) are more effective than lower doses in the management of patients with acute severe asthma requiring hospital admission. SEARCH STRATEGY: Randomised controlled trials were identified from the Cochrane Airways Group Asthma Register. In addition, primary authors and content experts were contacted to identify eligible studies. Bibliographies from included studies, known reviews and texts were also searched. SELECTION CRITERIA: Studies were selected for inclusion in the review if they met the following broad inclusion criteria: described as randomised controlled trials, included patients with acute severe asthma, compared different doses of corticosteroids (any route) in 2 or more treatment arms, and had a minimum period of follow up of 24 hours. Two reviewers independently assessed the studies for inclusion and disagreement was resolved by third party adjudication. DATA COLLECTION AND ANALYSIS: Data were extracted independently by two reviewers if the authors were unable to verify the validity of information. Missing data were obtained from authors or calculated from other data presented in the paper. The data were analysed as weighted mean differences (WMD) for primary pulmonary function outcomes using a fixed effects model. For the purposes of the review, three broad categories of corticosteroid dose (equivalent dose of methylprednisolone in 24 hours) were defined in advance: low dose (< or = 80 mg), medium dose (> 80 mg and < or = 360 mg) and high dose (> 360 mg). There were thus 3 main comparison groups: low versus medium dose, medium versus high dose and low versus high dose. MAIN RESULTS: Nine trials were included; a total of 344 adult patients have been studied (96 with low dose, 85 with medium dose and 163 with high dose corticosteroids). Only 6 trials provided sufficient data for the meta-analysis. There were no clinically or statistically significant differences detected in % predicted FEV1 among comparison groups after 24, 48 or 72 hours. At 48 hours, the weighted mean difference was -3.3% predicted (95% confidence interval -12.4 to + 5.8) for the low vs medium dose comparison, -1. 9% predicted (95% CI -8.1 to + 4.3) for the medium vs high dose comparison and + 0.5% predicted (95% CI - 7.8 to + 8.8) for the low vs high dose comparison. There appeared to be no significant differences in side effects or rates of respiratory failure among the varying doses of corticosteroids. REVIEWER'S CONCLUSIONS: No differences were identified among the different doses of corticosteroids in acute asthma requiring hospital admission. Low dose corticosteroids (< or = 80 mg/day of methylprednisolone or < or = 400 mg/day of hydrocortisone) appear to be adequate in the initial management of these adult patients. Higher doses do not appear to offer a therapeutic advantage.

Acute Disease↗
PubMed2001

Pneumococcal vaccine for asthma.

BACKGROUND: Infection with Streptococcus pneumoniae is an important cause of pneumonia and other serious illnesses, particularly amongst those with certain high-risk medical conditions such as asthma. Although pneumococcal vaccine is routinely advocated for people with asthma, there is uncertainty about the evidence base that underpins this recommendation. OBJECTIVES: To determine the efficacy of pneumococcal vaccine in reducing mortality or morbidity from pneumococcal disease in asthmatics. SEARCH STRATEGY: Randomised controlled trials were identified using the Cochrane Airways Group's register derived from MEDLINE, EMBASE, and CINAHL electronic databases and hand searched respiratory journals and meeting abstracts. SELECTION CRITERIA: Randomised controlled trials, with or without blinding, in which pneumococcal vaccine has been compared with placebo or no treatment in people with clinician diagnosed asthma. DATA COLLECTION AND ANALYSIS: Two reviewers independently reviewed all abstracts and full papers of all articles of potential relevance were retrieved. Methodological quality was rated using the Cochrane approach and the Jadad rating scale. Data extraction was performed by one reviewer and checked independently by a second. We planned to perform quantitative analyses of outcomes on an intention-to-treat basis, where possible. MAIN RESULTS: Of the three papers retrieved, only one satisfied the inclusion criteria and the methodological quality of this study was low (unblinded and inadequate allocation concealment). None of the data could be aggregated in a meta-analysis. Comparisons in a sub-set of 30 asthmatic children prone to recurrent episodes of otitis media, showed that pneumococcal vaccination decreased the incidence of acute asthma exacerbations from 10 to 7 (per child per year). REVIEWER'S CONCLUSIONS: This review found very limited evidence to support the routine use of pneumococcal vaccine in people with asthma. A randomised trial of vaccine efficacy in children and adults with asthma is needed.

Asthma↗
PubMed2006

Childhood asthma and extreme values of body mass index: the Harlem Children's Zone Asthma Initiative.

To examine the association between body mass index (BMI) percentile and asthma in children 2-11 years of age, we performed a cross-sectional analysis of 853 Black and Hispanic children from a community-based sample of 2- to 11-year olds with measured heights and weights screened for asthma by the Harlem Children's Zone Asthma Initiative. Current asthma was defined as parent/guardian-reported diagnosis of asthma and asthma-related symptoms or emergency care in the previous 12 months. Among girls, asthma prevalence increased approximately linearly with increasing body mass index (BMI) percentile, from a low of 12.0% among underweight girls (BMI </=5th percentile) to a high of 33.3% among girls at risk for overweight (BMI 85th-94th percentile). Among boys, asthma prevalence was associated in a U-shaped curve with the extremes of BMI percentile, that is, 36.4% among underweight boys, 19.1% among normal weight boys (BMI 6th-84th percentile), and 34.8% among overweight boys (>95th percentile). After adjusting for age, race/ethnicity, and household smoking, among girls, having asthma was associated with being at risk for overweight (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.4-5.0) and being overweight (OR, 2.1; 95% CI, 1.2-3.8) compared to normal weight; among boys, having asthma was associated both with overweight (OR, 2.4; 95% CI, 1.4-4.3) and with underweight (OR, 2.9; 95% CI, 1.1-7.7). Large, prospective studies that include very young children are needed to further explore the observed association between underweight and asthma among boys. Early interventions that concomitantly address asthma and weight gain are needed among pre-school and school-aged children.

Asthma↗
PubMed2003

Asthma control in the Asia-Pacific region: the Asthma Insights and Reality in Asia-Pacific Study.

BACKGROUND: Few data on asthma management are available for the Asia-Pacific region. OBJECTIVE: This study examined asthma symptoms, health care use, and management in the Asia-Pacific region. METHODS: We performed a cross-sectional survey, followed by administration of a questionnaire in a face-to-face setting in the respondents' homes in their language of choice. Urban centers in 8 areas were surveyed: China, Hong Kong, Korea, Malaysia, The Philippines, Singapore, Taiwan, and Vietnam. RESULTS: A population sample of 3207 respondents with physician-diagnosed asthma was identified by screening 108,360 households. Daytime asthma symptoms were reported by 51.4% of respondents, and 44.3% reported sleep disturbance caused by asthma in the preceding 4 weeks. At least 2 in every 5 respondents (43.6%) had been hospitalized, attended a hospital emergency department, or made unscheduled emergency visits to other health care facilities for treatment of asthma during the previous 12 months. Overall, 15.3% of respondents reported that they had required admission to the hospital for asthma treatment. Asthma severity correlated with the frequencies of hospitalizations and emergency visits for asthma in the past year. Even in those patients with severe persistent asthma, 34.3% regarded their disease as being well or completely controlled. Current use of an inhaled corticosteroid was reported by only 13.6% of respondents, and 56.3% used quick-relief bronchodilators. Absence from school and work in the past year was reported by 36.5% of children and 26.5% of adults. CONCLUSION: As reported for other regions, current levels of asthma control in the Asia-Pacific region fall markedly short of goals specified in international guidelines for asthma management.

Adrenal Cortex Hormones↗
PubMed2000

Nebulizer use in inner-city children with asthma: morbidity, medication use, and asthma management practices.

OBJECTIVE: To assess the frequency of nebulizer use, describe morbidity and patterns of medication administration, and examine the potential relationships between inhaled anti-inflammatory medication administration, asthma morbidity, and asthma management practices in children with asthma using a nebulizer compared with children with asthma not using a nebulizer. RESEARCH DESIGN: A cross-sectional, descriptive survey of previous events. SETTING: Elementary schools and participants' homes in Baltimore, Md, and Washington, DC. PARTICIPANTS: Six hundred eighty-six families of children aged 5 to 12 years with a diagnosis of at least mild, persistent asthma. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Asthma morbidity, health care utilization, pattern of asthma medication administration, nebulizer use, and asthma management data were collected by telephone survey administered to caregivers. Nebulizer use was defined as use at least 1 or more days per month during the last 6 months. Of 686 children identified, 231 (33%) reported current nebulizer use. Nebulizer users had significantly increased lifetime hospital admissions, hospitalizations, and emergency department visits in the last 6 months compared with nonnebulizer users. Inhaled corticosteroid administration was low for both groups (nonnebulizer users, 8%; nebulizer users, 15%). In the nebulizer users group, administration of inhaled anti-inflammatory medications was associated with increased asthma morbidity (increased hospitalizations, days and nights with symptoms, and oral steroid use). CONCLUSIONS: Nebulizer use by inner-city children with asthma is higher than anticipated but is not associated with reduced asthma morbidity. This group of high-risk children was undertreated with inhaled corticosteroids for long-term control of asthma despite reports of adequate monitoring by a primary care physician.

Administration, Inhalation↗
PubMed1997

Psychosocial characteristics of inner-city children with asthma: a description of the NCICAS psychosocial protocol. National Cooperative Inner-City Asthma Study.

Previous research has demonstrated a significant reciprocal relationship between psychosocial factors and asthma morbidity in children. The National Cooperative Inner-City Asthma Study investigated both asthma-specific and non-specific psychosocial variables, including asthma knowledge beliefs and management behavior, caregiver and child adjustment, life stress, and social support. This article presents these psychosocial characteristics in 1,528 4-9-year-old asthmatic urban children and their caretakers. Caretakers demonstrated considerable asthma knowledge, averaging 84% correct responses on the Asthma Information Quiz. However, respondents provided less than one helpful response for each hypothetical problem situation involving asthma care, and most respondents had more than one undesirable response, indicating a potentially dangerous or maladaptive action. Both adults and children reported multiple caretakers responsible for asthma management (adult report: average 3.4, including the child); in addition, children rated their responsibility for self-care significantly higher than did adults. Scores on the Child Behavior Checklist indicated increased problems compared to normative samples (57.3 vs. 50, respectively), and 35% of children met the criteria for problems of clinical severity. On the Brief Symptom Inventory, adults reported elevated levels of psychological distress (56.02 vs norm of 50); 50% of caretakers had symptoms of clinical severity. Caretakers also experienced an average of 8.13 undesirable life events in the 12 months preceding the baseline interview. These findings suggest that limited asthma problem-solving skills, multiple asthma managers, child and adult adjustment problems, and high levels of life stress are significant concerns for this group and may place the inner-city children in this study population at increased risk for problems related to adherence to asthma management regimens and for asthma morbidity.

Adult↗
PubMed2003

Asthma mortality in the Danish child population: risk factors and causes of asthma death.

Child death due to asthma is a rare and potentially preventable event. We investigated possible risk factors for death due to asthma in children and adolescents, as a step towards preventing or minimizing asthma death in this age group, and improving asthma management and care. We reviewed all 108 cases of asthma death in 1-19-year-olds in Denmark, 1973-1994. Copies of death certificates, hospital records, information from general practitioners, and autopsy records were obtained. The information was assessed with particular reference to: features and duration of asthma before death; severity of asthma; time and place of death; long-term and ongoing medical treatment; quality of medical care; circumstances of final illness; and medical treatment during the final episode of asthma. Age groups of 1-4 years, 5-14 years, and 15-19 years were analyzed separately and in aggregate. Death occurred predominantly in the 15-19-year age group. Generally, significantly more patients died in the summer. These patients were more atopic, had fewer asthma symptoms, and did not have regular asthma consultations. Nearly all patients had early-onset asthma. The 1-4-year age group was characterized by severe asthma. Major risk factors (all age groups) were: gradual deterioration during the last month; length of final attack (>3 hr); and delay in seeking medical help during the final attack. None of the children died during their first attack. Nonadherence was most frequent among the 15-19-year-olds. All asthmatic children and young adults should regularly receive medical care and assessment, even if they suffer only a few symptoms. This study underlines the need for ongoing education of the patient's family, the patient, and doctors on long-term management and management of acute attacks. Copies of clearly written individual plans for periods with increasing symptoms should be supplied to the patient/family and, where appropriate, to their general practitioners. The object of these measures is that the patient and parents/family learn to recognize the signs of deterioration and to act on them.

Administration, Inhalation↗
PubMed2000

Maternal asthma status alters relation of infant feeding to asthma in childhood.

The relation of infant feeding to childhood asthma is controversial. This study tested the hypothesis that maternal asthma alters the relation of breastfeeding to childhood asthma. Questionnaires were completed at age 6, 9 or 11 years by parents of 1043 children enrolled at birth. Active MD asthma was defined as a physician diagnosis of asthma plus asthma symptoms reported on one of the questionnaires. Duration of exclusive breastfeeding, categorized as never, < 4 months, or > or = 4 months, was based on prospective physician reports or questionnaires completed at 18 months. The relationship between breastfeeding and asthma differed by maternal asthma status. For children with maternal asthma, the percent developing active MD asthma increased significantly with longer duration of exclusive breastfeeding. Odds of developing asthma among these children were significantly elevated (OR: 5.7,CI: 2.8-11.5), after adjusting for confounders. This association of longer exclusive breastfeeding with increased risk of reported asthma among children with asthmatic mothers may be biologically based, or may reflect reporting biases.

Asthma↗
PubMed2004

Improving asthma symptom control in rural communities: the design of the Better Respiratory Education and Asthma Treatment in Hinton and Edson study.

METHODS: The prevalence of asthma in adults in the United States is approximately 7%, and 9% of asthma patients will require hospitalization each year. Many patients do not seek care, as they do not recognize overuse of beta-agonists as a risk factor for poorly controlled asthma. However, pharmacists are able to identify these patients through refill information on reliever medication prescriptions and potentially initiate community-management opportunities for these patients. DESIGN: The study is a randomized, controlled trial. Patients are randomized to intervention or usual care. STUDY POPULATION: Patients are high-risk asthma patients (defined as having an ER visit or hospitalization in the previous year, or using >2 canisters of short-acting beta-agonist in the previous 6 months). They are identified through community pharmacies. OBJECTIVES: The primary objective is to determine the effect of an education and referral intervention program initiated by community pharmacists, working with high-risk asthma patients, family physicians and respiratory therapists, on asthma control, as measured by the Asthma Control Questionnaire (ACQ). Secondary objectives include determining the effect of this program on ER visits/hospitalizations, inhaled corticosteroid use, courses of oral steroids and FEV(1). INTERVENTION: The intervention includes patient education, assessment and optimization of drug therapy, and physician referral as needed. Patients are referred to a respiratory therapist within 1 week of randomization for measurement of FEV(1) and reinforcement of education. Patients assigned to usual care receive written asthma information, referral to a respiratory therapist and usual pharmacy and physician care. UNIQUE ASPECTS: The design of the Better Respiratory Education and Asthma Treatment in Hinton and Edson (BREATHE) study is unique, given the multidisciplinary involvement, rural and community based, pharmacist initiated and targets specifically high risk patients. We believe that this study will show that management of asthma patients, involving the major role-players in their asthma care, will improve their asthma control.

Adolescent↗
PubMed2004

Efficacy, tolerability, and effect on asthma-related quality of life of formoterol bid via multidose dry powder inhaler and albuterol QID via metered dose inhaler in patients with persistent asthma: a multicenter, randomized, double-blind, double-dummy, placebo-controlled, parallel-group study.

BACKGROUND: Inhaled beta(2)-agonists are widely used in asthma treatment. The design limitations of pressurized metered dose inhalers (pMDIs) have prompted the development of dry powder inhalers (DPIs) for the delivery of asthma medications. OBJECTIVE: The goal of this study was to evaluate the efficacy, tolerability, and effect on asthma-related quality of life (QOL) of a long-acting beta(2)-adrenoreceptor agonist, formoterol, delivered via multidose DPI, compared with albuterol delivered via pMDI or placebo in adolescents and adults with persistent asthma. METHODS: This multicenter, randomized, double-blind, double-dummy, placebo-controlled, parallel-group study was conducted in outpatient clinics at 18 US centers. Adolescents and adults with persistent asthma received formoterol 10 pg BID via multidose DPI, albuterol 180 microg QID via pMDI, or placebo for 12 weeks. The primary efficacy variable was the 12-hour AUC of forced expiratory volume in 1 second (FEV(1)) after 12 weeks treatment. Secondary efficacy variables included asthma-related QOL, asthma symptom scores, rescue medication use, and other pulmonary function measures. RESULTS: A total of 239 patients (147 females, 92 males; age range, 13-85 years) with persistent asthma were enrolled (formoterol, n = 80; albuterol, n = 79; placebo, n = 80). Formoterol delivered via the multidose DPI resulted in clinically relevant and statistically significant increases in 12-hour AUC of FEV(1) after 12 weeks of treatment compared with albuterol pMDI and placebo (P < 0.019 and P < 0.001, respectively). Asthma-related QOL (total score) was significantly improved with formoterol treatment compared with placebo (P < 0.015). Nocturnal asthma symptom scores significantly improved with formoterol compared with albuterol and placebo (P < 0.001 and P < 0.003, respectively) and rescue medication use was significantly less with formoterol compared with albuterol and placebo (P < 0.004 and P < 0.002, respectively). Treatment with formoterol was well tolerated. CONCLUSIONS: In this study of adolescents and adults with persistent asthma, 12 weeks of treatment with formoterol 10 microg BID delivered via a multidose DPI provided significantly greater 24-hour bronchodilation compared with albuterol and placebo and resulted in significant improvements in asthma-related QOL compared with placebo. Formoterol was well tolerated in these patients.

Administration, Inhalation↗
PubMed2003

Asthma epidemiology: risk factors, case finding, and the role of asthma coalitions.

Asthma has no cure, and given that clinicians still do not understand what causes it in the first place, it is not preventable. With implementation of environmental control measures to minimize exposure to allergens and irritants, appropriate pharmacologic therapy, and patient and health care provider education, the disease can be managed successfully. Health care access and appropriate case management are essential components of any plan to address asthma as a public health problem. Asthma is now one of the most important diseases of childhood in developed countries. In the International Study of Asthma and Allergies in Childhood (ISAAC) study, the highest asthma prevalence was observed in westernized English-speaking countries (e.g., the United Kingdom, Australia, and New Zealand), with much lower prevalence rates in Eastern Europe, India, China, other countries in Asia, and Africa [18]. This observation has led to the belief that the rapid increases in asthma prevalence are more likely to be attributable to environmental than genetic factors. The rising prevalence in the United States and worldwide seems to be correlated with modern industrialization, suggesting that changes in the ambient environment may contribute to this increase in morbidity and mortality. Indoor factors that have been suggested to influence asthma pathogenesis include allergy to house dust mite and cockroaches, poor heating and ventilation, and exposure to cigarette smoke and other irritants. Scientific evaluation of the links between indoor and outdoor air pollution and asthma is incomplete, however. Much work remains to be done in defining the environmental factors that may cause asthma and that may trigger asthma exacerbations in individuals with the disease. Until then, clinicians must focus on developing a hard-hitting, comprehensive, interdisciplinary asthma program and work toward its successful and broad-based implementation. It is the only way to win the "war against asthma."

Adolescent↗
PubMed1999

Asthma and asthma-like disorders.

Bronchial asthma is defined as a chronic inflammatory disease resulting in a reversible and variable bronchial obstruction. For the clinical diagnosis of the disease there are some key indicators but as there is no 'gold standard' a correct diagnosis will sometimes not be obtained. Examples are patients in a symptom-free stage, current medication interfering with the methods used, patients with asthma-like symptoms reporting lack of effect of bronchodilators and patients who are unable to perform a forced expiration in an airway function test. The prevalence of asthma is reported to be 5-10%. The prevalence of asthma-like symptoms may be double this. The term 'asthma-like' has been used to an increasing extent during the last few years, which may indicate an increasing awareness of the fact that asthma-like symptoms are not always classical asthma. In this overview some disorders with asthma-like symptoms, especially in adults, are presented. The spectrum of differential diagnoses in a clinic may depend on which doctor/specialist the patient is consulting. In an asthma and allergy clinic it has been found that the most common differential diagnoses are chronic obstructive pulmonary disease (COPD), nonasthmatic cough and sensory hyper-reactivity (SHR), a disorder which is sometimes mixed up with asthma due to similar symptoms (heavy breathing, cough, increased secretion, difficulty in getting air etc.) and similar trigger factors (smoke, strong scents, exercise, cold air etc.). Recently it has been suggested that a capsaicin inhalation test may be an objective test for identifying patients with SHR. In asthma effective treatment is available today but in asthma-like disorders, such as SHR, no effective therapy is available, underlining the need of further research for understanding the pathophysiological mechanisms.

Asthma↗
PubMed2005

Asthma rescue and allergy medication use among asthmatic children with prior allergy prescriptions who initiated asthma controller therapy.

BACKGROUND: Asthma and allergic rhinitis are frequently comorbid conditions. Montelukast is effective in treating both diseases and may reduce total medication use among children with asthma and allergic rhinitis. OBJECTIVE: To determine the differences in respiratory and allergy medication use and costs, as proxies for control, in pediatric patients with asthma and allergy who initiated asthma controller therapy. METHODS: A 24-month, retrospective, pre-post cohort study using a pharmacy claims database of children (age < 16 years) with 2 or more consecutive asthma controller prescriptions and 1 or more allergy prescription (within 12 months before initial controller prescription). Children taking inhaled corticosteroids (ICSs) and montelukast were matched one to one based on age, days of prior allergic rhinitis therapy supply, duration of controller therapy, and propensity score. Differences in costs of rescue or acute asthma medications, prescription allergy medications, other respiratory medications, and the number of days of rescue or acute asthma medication use and allergy medication use were calculated. RESULTS: A total of 1,236 children were matched into ICS and montelukast groups (n = 618 each). Montelukast patients had a smaller cost increase overall compared with ICS patients (combined cost for rescue or acute asthma medications, allergy medications, and other respiratory medications: $5.55 vs $12.08, P < .001). Cost increase for rescue or acute asthma medications was significantly lower in the montelukast group ($0.94 vs $3.82, P = .003). The cost increase for allergy medications ($5.29 vs $10.06, P < .001) was also significantly lower in the montelukast group. Patients taking montelukast also had fewer days of therapy with asthma rescue medication and allergy medication compared with patients taking ICSs. CONCLUSIONS: Initiating therapy with montelukast was associated with better asthma and allergy control demonstrated via lower increase in use and costs of asthma rescue and allergy medications compared with initiating ICS therapy.

Acetates↗
PubMed2006

Survey of asthma care in Taiwan: a comparison of asthma specialists and general practitioners.

BACKGROUND: Asthma is a common disease in Taiwan. The promotion of quality care for asthmatic patients should focus not only on new treatment remedies but also on patient adherence to treatment and a continuous education program integrated into treatment plans. One reason for patients' poor response to treatment is the lack of asthma knowledge on the part of physicians in terms of attitudes toward treatment. OBJECTIVE: To investigate the current status of asthma treatment among asthma specialists and general practitioners and their relative acceptance of and adherence to treatment guidelines. METHODS: One thousand questionnaires were distributed to physicians throughout Taiwan using a randomized sampling procedure. The questionnaire asked about the use of different kinds of medications, including inhaled corticosteroids, to treat asthma; adherence to asthma treatment guidelines; the use of a peak flow meter for monitoring asthma status; and self-efficacy in the treatment of asthma. RESULTS: A total of 526 questionnaires were returned. Of these, 90.4% of specialists and 63.2% of general practitioners would follow the guidelines for patient care (P = .002). It was significant that 79.8% of specialists but only 41.9% of general practitioners would instruct patients to use a peak flow meter to monitor symptoms (P < .001). Asthma specialists also seemed to be significantly more competent than general practitioners regarding asthma knowledge, instruction of inhalation techniques, use of peak flow meters to monitor symptoms, and making an action plan. CONCLUSIONS: To minimize the knowledge gap between specialists and general practitioners regarding asthma treatment, recognized treatment guidelines need to be popularized or simplified. Furthermore, the continuing education of general practitioners in asthma knowledge and management skills is important.

Administration, Inhalation↗