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PubMed2006

Delivering tailored asthma family education in a pediatric emergency department setting: a pilot study.

OBJECTIVE: Many children are brought to the pediatric emergency department (ED) with acute asthma symptoms. Emergency asthma care is costly, and many ED visits may be preventable. Families often do not have written asthma action plans and lack asthma self-management skills. This study tests a tailored self-management intervention delivered in the ED for families of children with asthma. The primary hypotheses were that the intervention group would have greater confidence to manage asthma 14 days postintervention and more well-asthma visits and fewer urgent care/ED visits at 9 and 12 months. METHODS: This randomized intervention/usual-care study was part of a larger ED asthma surveillance project in 4 urban pediatric ED sites. Asthma educators used a computer-based resource to tailor the intervention messages and provide a customized asthma action plan and educational summary. Children with acute asthma were enrolled during an ED visit, and follow-up telephone interviews were conducted during the next 9 months. The ED clinician classified the child's acute and chronic severity. RESULTS: To date, 464 subjects aged 1 to 18 years have been enrolled. The ED clinicians reported that 46% had intermittent and 54% had persistent chronic severity with 51% having mild acute severity episodes. The confidence level to prevent asthma episodes and keep them from getting worse was significantly higher in the intervention group at 14 days postintervention. More subjects in the intervention group reported well-asthma visits by 9 months. Return ED visits were significantly lower in the intervention group in those with intermittent asthma. Twelve-month follow-up is in process. CONCLUSIONS: The tailored ED self-management intervention demonstrates significant effects on caregiver self-confidence and well-visit follow-up. Additional evaluation is needed to determine what impact this intervention has long-term.

Adolescent↗
PubMed2006

The influence of variation in type and pattern of symptoms on assessment in pediatric asthma.

OBJECTIVE: We conducted a national, population-based survey to examine the asthma-related health burden of US children. METHODS: A telephone-based survey was conducted in 2004 of children 4 to 18 years of age with current asthma in the United States. In 41,433 households screened, 1089 children reported current asthma; 801 interviews were completed by parents of children aged 4 to 15 years and by children themselves aged 16 to 18 years. The survey included questions about symptoms, perceived level of control, activity limitations, health care use, medicines, disease management, and knowledge. Global asthma symptom burden, derived from the National Asthma Education and Prevention Program guidelines, was composed of 3 components: short-term symptom burden (4-week recall), long-term symptom burden (past year), and functional impact (activity limitation). RESULTS: The majority of children were classified with mild intermittent disease on the basis of recent daytime symptoms alone (80%); yet, when report of nighttime symptoms was included, the proportion of children classified as having mild intermittent symptoms decreased (74%). When asthma burden was assessed on the basis of the global symptom burden construct, only a minority (13%) of individuals was classified as having an asthma symptom burden consistent with mild intermittent disease; the majority (62%) was classified as having moderate/severe disease. In addition, the impact of asthma on the daily activities is substantial; avoiding exertion (47%) and staying inside (34%) are common approaches to improve control of asthma symptoms. CONCLUSIONS: The goals of therapy for asthma, based on the National Asthma Education and Prevention Program guidelines, have not been achieved for the majority of children. In addition, parents and children overestimate the child's asthma control and commonly restrict activities to control asthma symptoms. Deficiencies in the control of asthma may be related to the underestimation of the burden of disease.

Adolescent↗
PubMed2003

Estradiol in premenstrual asthma: a double-blind, randomized, placebo-controlled, crossover study.

STUDY OBJECTIVES: To characterize asthma symptoms and pulmonary function throughout two menstrual cycles, with and without exogenous estradiol administration, in women with premenstrual asthma, and to determine the effect of estradiol administration on asthma symptoms, pulmonary function, quality of life, and biomarkers of airway inflammation. DESIGN: Double-blind, randomized, placebo-controlled, crossover study. SETTING: Respiratory clinic and clinical research center. SUBJECTS: Twelve women with documented premenstrual asthma (> or = 20% premenstrual worsening of asthma symptoms and/or of peak expiratory flow [PEF] during a 1-month screening phase). INTERVENTION: Each woman received either estradiol 2 mg or placebo orally between cycle days 23 and 28 (i.e., premenstrually, or before the onset of menses) in the first cycle and then crossed over to the other arm in the second cycle. Throughout both cycles, the women recorded daily morning and evening PEF readings and asthma symptoms. MEASUREMENTS AND MAIN RESULTS: Spirometry testing and measurement of serum estradiol and biomarkers of airway inflammation were performed on days 8 (follicular phase), 22 (luteal phase), and 28 (premenstrually) of both the estradiol and placebo cycles. During the two premenstrual visits, the Asthma Quality of Life Questionnaire was administered. No notable differences were observed between the estradiol and placebo cycles in daily PEF recordings or composite asthma symptoms scores. The area under the curve (AUC) for the composite asthma symptoms versus time profile was numerically, but not statistically, lower (denoting less severe symptoms) during the estradiol cycle than during the placebo cycle. Likewise, no significant difference in AUC values for morning PEF or evening PEF was found between the estradiol cycle and the placebo cycle. Despite differences (p<0.05) in day-28 estradiol concentrations for estradiol and placebo cycles, no significant differences were found in forced expiratory volume in 1 second, serum endothelin-1, serum and urine eosinophil protein X, urine leukotriene E4, or quality-of-life scores. CONCLUSION: Exogenously administered estradiol did not have a significant effect in women with premenstrual asthma whose asthma was classified predominantly as mild and under excellent control. As in the case of premenstrual syndrome, the placebo effect may be prominent in premenstrual asthma. Further trials, involving women with more severe asthma under poorer control, are warranted to discern underlying mechanisms for the worsening of asthma in relation to menstruation.

Adult↗
PubMedDate not supplied

Co-existence of asthma and allergic rhinitis: a 23-year follow-up study of college students.

The purpose of this study is to examine the co-existence of asthma and allergic rhinitis among former college students who were diagnosed with these diseases either before or after their freshman year. A total of 738 former Brown University students (69% males and 31% females) who were evaluated and underwent skin testing during their freshman year completed a 23-year follow-up questionnaire inquiring of their history of allergies and asthma. The mean age of the participants at the time of the follow-up study was 40 years. In this group, the cumulative incidence of asthma was 11.3% (84/738), hay fever was 41.5% (306/738), and nonseasonal allergic rhinitis was 14.0% (103/738). The cumulative incidence of allergic rhinitis (hay fever) and/or nonseasonal allergic rhinitis (was 45.8% (338/738). Among the 84 individuals with a cumulative incidence of asthma, 63 (75.0%) had a history of hay fever, 27 (32.1%) had a history of nonseasonal allergic rhinitis, and 72 (85.7%) had a history of allergic rhinitis. Among the 306 participants with a cumulative incidence of hay fever, 63 (20.6%) had a history of asthma. Twenty-seven (26.2%) of the 103 individuals with a history of nonseasonal allergic rhinitis had a cumulative incidence of asthma. Among the 338 individuals with a cumulative incidence of allergic rhinitis 72 (21.3%) had a history of asthma. Among the participants with a history of both asthma and hay fever, 44.8% developed hay fever first, 34.5% developed asthma first, and 20.7% developed both diseases at the same time. Among the individuals with a history of asthma and nonseasonal allergic rhinitis, 38.5% developed nonseasonal allergic rhinitis first, 30.8% developed asthma first, and 30.8% developed both diseases at the same time. This study further demonstrates the frequent co-existence of asthma and allergic rhinitis. Among asthmatics, allergic rhinitis occurred in 85.7%. Only 14.3% of asthmatics did not have allergic rhinitis. Among individuals with allergic rhinitis, asthma occurred in 21.3%. Also, allergic rhinitis often precedes or occurs at the same time as asthma.

Adult↗
PubMed1993

A comparison of patient attitudes toward asthma self-management among acute and preventive care settings.

This study characterizes the attitudes regarding asthma and asthma care of low-income, African-American adults who receive care from acute care settings. As a point of reference, their attitudes and knowledge were compared with those of a group of patients receiving asthma care from a private setting that stresses preventive asthma self-management. Patients were assessed regarding attitudes toward (1) routine asthma self-care and decisions as to when to self-treat versus seek asthma care, (2) administration of asthma medications, (3) satisfaction with acute-care services, and (4) the desire for asthma education. Asthma morbidity, sociodemographic characteristics, awareness of environmental triggers, and daily stressors were also assessed. Responses of adults receiving most of their asthma care from acute care settings suggest the same pattern of failure to treat asthma regularly and delay in seeking care as implicated in asthma deaths among children. Emphasis on self-treatment of asthma symptoms, not preventive self-management, was apparent among the attitudes of the acute care patients. Lack of regular care, delay of treatment, and reliance on self-treatment via over-the-counter medications was noted. Implications of these findings for the development of asthma education programs are addressed.

Adult↗
PubMed1999

Adherence to asthma guidelines in general practices.

Adherence to asthma practice guidelines is low. Improved compliance could potentially improve care of patients with asthma. The purpose of this study was to determine if patients managed in a general practice with an associated asthma clinic are more likely to use asthma medications according to clinical practice guidelines than patients managed in the general surgery of the practice. A cross-sectional study of adult asthmatics, aged 18-55 years, was conducted in six British general practices. Prescription data on all asthma medication was collected for a 6-month period. Information on asthma clinic attendance, age, sex, employment status, other medical illness, and how patients used their inhaled beta2-agonist was collected through questionnaire. The prescription data for asthma medication and patient use of inhaled beta2-agonist were compared to the British Thoracic Society's (BTS) Guidelines for Management of Asthma in Adults to determine if the patient's asthma medication regimen was appropriate. There was no significant association found between appropriate asthma medication and asthma clinic attendance or other patient characteristics. Adherence to the BTS guidelines was low. Fifty-eight percent of the asthma patients used asthma medication regimens that were not consistent with the BTS guidelines published 1 year earlier. Adherence to the BTS guidelines was low regardless of patient characteristics, including asthma clinic attendance, age, sex, employment status, other medical illness, or individual practice. These findings underscore the need to document the utility of clinical practice guidelines which may improve physician compliance.

Adrenergic beta-Agonists↗
PubMed1999

Adult-onset asthma and occupational exposures.

OBJECTIVES: This study examined certain occupational exposures and the risk for adult-onset asthma. METHODS: A nested case-referent study of adult-onset asthma was performed on a random population sample (N=15813), aged 21 to 51 years. Cases for the study included 2 groups: subjects reporting "physician-diagnosed" asthma (N=251) and a broader "asthma" group (N=362). The "asthma" group consisted of subjects with "physician-diagnosed" asthma (N=251) and subjects reporting asthma-like symptoms without having "physician-diagnosed" asthma (N=111). The referents (N=2044) were randomly selected from the whole population sample. The case-referent sample was investigated with a comprehensive questionnaire about occupational exposures, asthma, respiratory symptoms, smoking, and atopy. Odds ratios were calculated with stratification for gender, year of diagnosis, and birth year. RESULTS: The highest odds ratio for "physician-diagnosed" asthma was associated with exposure to flour dust [odds ratio (OR) 2.8, 95% confidence interval (95% CI) 1.5-5.2] and the occupational handling of resin-based paints (isocyanates) (OR 3.0, 95% CI 1.6-5.9). Exposure to welding fumes, textile dust, and work with glues containing acrylates was also associated with an increased odds ratio for "physician-diagnosed" asthma. Including persons with asthma-like symptoms (ie, the asthma group) showed similar results. CONCLUSION: This population-based case-referent study from Sweden indicates that occupational exposure to acrylate-based compounds and welding fumes is associated with increased risk for adult-onset asthma.

Adult↗
PubMed1999

Comparison of patients with asthma managed in general practice and in a hospital clinic.

OBJECTIVES: To compare knowledge and attitudes about asthma, self-management skills and impact of asthma on quality of life between patients managed in general practice (GP) and in a hospital clinic. DESIGN: Cross-sectional survey with six months' follow-up. PATIENTS AND SETTING: 105 adults with asthma: 61 from the Alfred Hospital Asthma and Allergy Clinic, Melbourne, and 44 from nearby general practices, in 1994-1995. MAIN OUTCOME MEASURES: Patient sociodemographic and clinical characteristics; patient knowledge, attitudes and beliefs about asthma; self-management skills; and impact of asthma on quality of life. RESULTS: GP patients were more educated (P = 0.04) and more likely to smoke (P = 0.04) and to have mild asthma (P = 0.04) than hospital patients; they were less likely to use theophylline (P = 0.006) and to have exercise limitation (P = 0.03), and had fewer previous hospital admissions (P = 0.01). Impact of asthma on quality of life was greater in the hospital group than in the GP group. At baseline, the GP group were less likely to have written asthma action plans (P = 0.018), and were less able to manage rapid onset attacks than the hospital group (P = 0.02). More subjects in the hospital group than the GP group felt their asthma was severe (P = 0.02) and were optimistic about their asthma improving (P = 0.03). GP patients increased their knowledge about asthma significantly (P = 0.002) over six months. CONCLUSIONS: Patients with asthma managed in general practice and in hospital differ in clinical parameters, quality of life and attitudes to asthma. Future educational initiatives should take such differences into account.

Adult↗
PubMed1996

Ambulatory care visits for asthma: United States, 1993-94.

OBJECTIVE: This report describes ambulatory visits for asthma in the United States across three ambulatory care settings. The primary focus is on visits to office-based physicians. METHODS: The data sources include the National Ambulatory Medical Care Survey (NAMCS), a national probability survey of visits to office-based physicians in the United States, and the National Hospital Ambulatory Medical Care Survey (NHAMCS), a national probability survey of visits to hospital emergency and outpatient departments in the United States. Most estimates presented are annual averages for the 2-year period, 1993-94. Visits for asthma are defined as those for which asthma was the first-listed diagnosis. A trend analysis compares office visit data collected in 1993-94 to data in the 1980-81 NAMCS. RESULTS: There was an average annual estimate of 13.7 million ambulatory care visits for asthma in 1993-94, an annual rate of 53.4 visits per 1,000 persons. Four-fifth of ambulatory care utilization for asthma was conducted in physician offices. Relative utilization of office-based physicians was less for adolescent and black patients. The office visit rate for asthma increased 50 percent between 1980-81 and 1993-94. During 1993-94, use of office visits for asthma averaged 43 visits per 1,000 persons of 11 million office visits per year. The office visit rate in the Northeast was almost 2.5 times that in the South, although the prevalence of asthma was similar among regions. There were 5.8 return asthma visits for every new problem encounter. More than 40 percent of asthma visits had one or two comorbidities, mostly other respiratory conditions. Spirometry was used in 28 percent of asthma visits by new patients. Bronchodilators and anti-inflammatory agents were the most common medications prescribed. The use of corticosteroids and beta2-adrenergic agonists, either alone or in combination, increased substantially since 1980-81. The rate of utilization of methylxanthines decreased 61 percent between 1980-81 and 1993-94. CONCLUSIONS: The patient populations receiving care for asthma vary depending on the ambulatory care setting. Patients relying on hospital outpatient care for chronic asthma conditions may receive differential treatment and have different outcomes compared with patients of office-based physicians. For office-based ambulatory care, visits for asthma have increased substantially since 1980. Medication is the primary method of treatment with an increasing use of anti-inflammatory agents. The preferred bronchodilator has changed from methylxanthines to beta2-adrenergic agonists.

Adolescent↗
PubMed2000

Factors associated with severe asthma.

OBJECTIVE: To study the role of various factors associated with development and severity of bronchial asthma in children between 5-15 years of age. SETTING: Tertiary Care Medical College Hospital. METHODS: A case control study was carried out during May 96 to April 98. Sixty children each suffering from mild (chronic) and severe asthma (chronic) and 60 controls were enrolled to study the association of various risk factors with development of asthma and for severe disease. RESULTS: On univariate analysis factors associated with significant risk for development of asthma included family history of asthma (p = 0.003), lack of exclusive breastfeeding (p = 0.05), past history of bronchiolitis (p = 0.02), associated allergic rhinitis (p = 0.04) and atopic dermatitis (p = 0.01). For development of severe asthma, associated factors were early onset of symptoms (p = 0.01), family history of asthma in grandparents (p = 0.04) and more than 10 cigarettes per day smoked by any family member. No significant effect of air pollution, overcrowding, pets and passive smoking were found on either development of asthma or it's severity. On multivariate analysis only age of onset below 48 months was associated with severe asthma (OR 2.13, 95% CI 1.00-4.54). Exclusive breastfeeding for more than 4 months was the most protective factor for development of asthma (OR 0.25, 95% CI 0.08-0.70). A strong association between development of asthma and past history of bronchiolitis or tuberculosis (OR 5.26, 95% CI 1.7-16.20) and presence of associated atopic dermatitis or rhinitis (OR 7.5, 95% CI 1.64-34.48) was observed. CONCLUSION: History of associated allergic diseases and past history of bronchiolitis were significantly associated with development of asthma. Exclusive breastfeeding for first 4 months of life was protective. The most significant factor associated with severe asthma was onset of illness before 48 months of age. There was no significant effect of air pollution, over crowding, pets at home or passive smoking on severity of asthma

Adolescent↗
PubMed2002

[Epidemiological survey on bronchial asthma in Henan province].

OBJECTIVE: To survey asthma prevalence, correlation factors for prevention, treatment, and for policy decision of asthma control. METHODS: Done with TB epidemiological survey synchronously, sampling by stratified-cluster-random method. 43 points were selected and distributed in all 18 prefectures in Henan province. Sampling population was 75 134, and 65 033 (97.0%) were investigated actually. RESULTS: In this survey, 682 asthma patients were found. The total prevalence rate was 1.05%, the rate for children was 1.71%, and that for adult was 0.82%; the rates for male and female were 1.16%, 0.94% respectively. The ratio of male to female was 1.23:1. When asthmatic chronic bronchitis cases were regarded as asthma cases and included in total asthma cases, the overall prevalence rate of asthma would increase up to 1.73%, raised by 65%. The higher prevalence were in 0 approximately 3 years old age group (4.48%) and >/= 65 years old age group (1.43%), the lowest prevalence was in 15 approximately 24 years old age group (0.36%). For 90% of asthmatic children, the initiative age of asthma was before 7 years old, and for 1/3 adult patient, it was in childhood. The prevalence of asthma in rural area was higher than that of urban area. Cold air, common cold, stimulation of smoking and cooking, and room dust were the 4 main inducing factors. Seasonal attack of asthma accounted for 67.2%, and that in winter and spring was 65.4%. 60.6% of asthma cases showed history of allergic diseases including allergic rhinitis, dermatitis, and drug allergy; 34.3% asthma family history. CONCLUSIONS: The rate of prevalence and inducing factors of asthma in Henan province were gained in this survey. The results may basically reflect the present status and be provided for asthma control as reference. According to the prevalence, asthma cases would be up to 0.98 approximately 1.6 million in whole Henan province and more attention should be paid to this situation.

Adolescent↗
PubMed2002

Asthma disease management: a provider's perspective.

Asthma is a highly prevalent problem in Singapore, with an increasing societal and economic burden. However, asthma is also an eminently treatable condition, with evidence that integrated education-treatment efforts directed at important patient sub-groups can be cost-effective. What is important is a comprehensive and integrated asthma management programme, aimed at reducing the burden of asthma at all levels of the healthcare system, with the long-term goal of improving asthma care cost-effectively. This refers to asthma disease management. Asthma disease management should focus on identifying deficiencies in asthma management across the population diagnosed with the condition and establish a partnership between the patient, provider and the healthcare system to improve the overall quality of asthma care. The framework for implementing such a programme bridges key concepts and programmes that are already in place in the various institutions. These include patient and physician education, the use of clinical practice guidelines, clinical pathways, outcomes management, quality improvement processes, information technology, case management and existing asthma shared-care programmes and resources. In order to significantly reduce asthma morbidity, an integrated approach is required, involving individuals providing asthma care at various levels of care delivery. There is also a need to co-ordinate the efforts of such individuals and institutions involved so that there is good horizontal and vertical integration of care. The disease management approach described is intended to raise the overall standard of asthma care across a spectrum of patients with asthma.

Asthma↗
PubMed2002

Parental asthma knowledge.

UNLABELLED: Asthma knowledge an important components of asthma education. OBJECTIVE: To determine the levels of asthma knowledge in parents of asthmatic children and factors that may influence it. METHODS: This is a prospective study done between March 1998 and July 1998. Sixty-seven parents were interviewed using the 31 item asthma knowledge questionnaire that had been validated and translated. The children' asthma severity was classified. The questionnaire includes bio-data of children and parents, types of medication and dosages duration of asthma, exposure to cigarette smoke, acute asthma admissions, and parent's economic status. RESULTS: The mean score for asthma knowledge was 15.5. The total score was 31. Asthma knowledge was significantly higher in parents whose children were using steroids [p = 0.03, CI (-3.58, -0.02)]. It correlated significantly with steroid dosage (r = 0.29, p = 0.02), and was significantly higher in parents of higher economic status. Parent's asthma knowledge had no association with children's asthma status, age of the child or parents, exposure to cigarette smoke, frequency of admission or asthma duration. CONCLUSION: The low asthma knowledge level indicates the need to increase the effort in educating parents. The main indicator for higher knowledge was steroid usage and dosage. Higher asthma knowledge in the high-income group was probably related to levels of education.

Adolescent↗
PubMedDate not supplied

Plasma kallikrein amidolytic activity in bronchial asthma.

We have investigated plasma kallikrein amidolytic activity in the following groups of patients: 1. Normal control group of blood donors. 2. Extrinsic pollen-activated bronchial asthma patients, during periods of symptomatology and at a later time after the spring. 3. Subjects with atopic bronchial asthma in acute phase when admitted to our hospital's emergency room and later when clinically recovered. 4. Subjects with extrinsic bronchial asthma, sensitive to Dermatophagoides pteronyssinus and Dermatophagoides farinae with FEV1 < 80%. 5. Subjects with extrinsic bronchial asthma, sensitive to Dermatophagoides pteronissinus and Dermatophagoides farinae in a state of clinical rest. After 9 minutes of activation, the following results were found, with a significance of p < 0.01: There are significant differences between the normal group and those that we consider the active groups, asthma FEV1 < 80%, pollen-sensitive asthma in springtime and acute asthma. No significant differences exist between the normal group and inactive groups, inactive asthma, pollen-sensitive asthma out of springtime and acute asthma inactive. Significant differences exist in active groups (acute asthma and pollen-sensitive asthma in springtime) when they become inactive (acute asthma inactive and pollen-sensitive asthma out of springtime). The active groups have a higher plasma kallikrein amidolytic activity than both the inactive and control groups.

Acute Disease↗
PubMed2004

Evidence-based asthma management.

In 2002 the National Asthma Education and Prevention Program published evidence-based guidelines for the diagnosis and management of asthma, but there are some unresolved asthma-management issues that need further research. For asthmatic children inhaled corticosteroids are more beneficial than as-needed use of beta(2) agonists, long-acting beta(2) agonists, theophylline, cromolyn sodium, nedocromil, or any combination of those. Leukotriene modifiers are an alternative but not a preferred treatment; they should be considered if the medication needs to be administered orally rather than via inhalation. Cromolyn sodium and nedocromil are effective long-term asthma-control medications, but they are not as effective as inhaled corticosteroids. There is insufficient evidence to determine whether cromolyn benefits maintenance of childhood asthma. Cromolyn sodium and nedocromil are alternatives, but not preferred treatments for mild persistent asthma. Cromolyn may be useful as a preventive therapy prior to exertion or unavoidable exposure to allergens. Regular inhalation of corticosteroids controls asthma significantly better than as-needed beta(2) agonists. No studies have examined the long-term impact of regular inhaled corticosteroids on lung function in children <or= 5 years old. As monotherapy, inhaled corticosteroids are more effective than long-acting beta(2) agonists. The asthma-control benefit of inhaled corticosteroids decidedly outweighs the risks from inhaled corticosteroids. There is no high-level evidence that low-to-medium-dose inhaled corticosteroids have ocular toxicity or important effects on hypothalamic-pituitary-adrenal function in children. Antibiotic therapy has no role in asthma management unless there is a bacterial comorbidity, but further research is needed on the relationship between sinusitis and asthma exacerbation. The asthma care plan should include a written asthma action plan for the patient, but there is inadequate evidence as to whether the asthma action plan should be based on symptoms or on peak flow monitoring. There is low-level evidence that helium-oxygen mixture (heliox) may be of benefit in the first hour of an acute asthma attack but less advantageous after that first hour. Metered-dose inhalers are no more or less effective, overall, than other aerosol-delivery devices for the delivery of beta(2) agonists or inhaled corticosteroids, so the least expensive delivery method should be chosen.

Administration, Inhalation↗
PubMed2005

Current treatment options for asthma in adults.

Asthma is a common disorder with an increasing prevalence in the developed world. It is a serious health problem affecting health care costs, lost productivity, and death. Unfortunately, uncontrolled asthma is common and often unrecognized by physicians; of equal concern, uncontrolled asthma is accepted by asthmatic patients as they are uneducated as to what to expect from asthma therapy. Many learn to live with the limitations of daily activity and to overuse their rescue inhalers and yet when asked by their physicians, ''How's your asthma?'' the answer is ''okay''. The pursuit of more revealing questions regarding frequency in the use of rescue medications, nocturnal symptoms, activity limitations, and compliance with controller medications may be then overlooked. To achieve the goal of normal life on as few medications as possible will start with a well-educated patient. Understanding intermittent from persistent asthma and then tailoring the best regimen for each patient is imperative. The treatment options and the advances in the understanding of the pathophysiology of asthma in the past 3 decades have been remarkable. There are increasing resources for both physicians and patients available to facilitate a better understanding of asthma management and the several treatment options. Currently established guidelines are an excellent starting point for initiating therapy for intermittent and mild, moderate, and severe persistent asthma. The short-acting beta 2 agonists are first-line therapy for intermittent asthma, exercise-induced asthma, and acute exacerbations. Long-acting Beta 2 agonists, cromolyn and nedocromil, and leukotriene modifiers may also be used for exercise. Systemic corticosteroids may be needed for acute exacerbations. The treatment of choice for persistent asthma is ICS and, depending on the severity, add-on therapy with long-acting beta 2 agonists, theophylline, and leukotriene modifiers are next. Lastly, omalizumab, anti-IgE therapy, will make an important place for its use in certain persistent moderate and severe asthma. This will be particularly true if the cost of the medication is reduced in the future. Asthma control, morbidity, and mortality will improve with a careful and comprehensive medical regimen using the current multiple treatment options.

Adult↗
PubMed2005

Asthma and tobacco: double trouble for Wisconsin adolescents.

BACKGROUND: Environmental tobacco smoke (ETS) exposure has been identified as a cause of asthma and a trigger of asthma attacks in children. We examined the relation of demographic and tobacco-related risk factors to both lifetime asthma diagnosis and the asthma attack rate among Wisconsin adolescents. The impact of asthma on adolescent school absenteeism was also examined. METHODS: Data used were from the 2004 Wisconsin Youth Tobacco Survey (n=3125), which was administered in a sample of Wisconsin public middle and high schools. Multivariable logistic regression was used to examine risk factors simultaneously. RESULTS: Self-reported lifetime asthma prevalence was 19% among Wisconsin adolescents. Thirty-five percent of adolescents with asthma reported having an asthma attack in the past 12 months. Living with a smoker was a significant predictor of lifetime asthma diagnosis and, among adolescents with asthma, daily ETS exposure was associated with a 2-fold increased risk of having an asthma attack. Being diagnosed with asthma did not deter adolescents from smoking and was a significant predictor of school absenteeism. CONCLUSIONS: Asthma is an important health problem for Wisconsin adolescents. Tobacco-related risk factors contribute to the burden of the disease. Interventions to reduce smoking and ETS exposure targeted to adolescents and their guardians are needed. Better asthma control among adolescents could reduce school absenteeism.

Adolescent↗
PubMedDate not supplied

Asthma control and management: a patient's perspective.

Irish asthma guidelines, published in 2000, are based on the Global Initiative for Asthma (GINA) international asthma management guidelines and provide recommendations for optimal asthma management and control. Using the same methodology as employed in the Asthma Insights and Reality in Europe (AIRE) survey, which assessed whether specific goals of asthma management based on GINA were being realised, 400 patients with current asthma in Ireland were interviewed in the Asthma Insights and Reality in Ireland (AIRI) survey to determine their healthcare utilisation, symptom severity, activity limitations and level of asthma control. Of those surveyed, acute services were utilised by a significant number of respondents. Over the previous year, 27% had either an emergency visit to the hospital or their general practitioner (GP) and 7% were hospitalised for asthma. In terms of asthma control, 19% experienced sleep disturbance at least once a week, 29% missed work or school and 37% of respondents experienced symptoms during physical activity over the previous 4-week period. Based on these findings, the level of asthma control and asthma management in Ireland falls short of recommended national and international asthma guidelines.

Adolescent↗