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National school teachers' knowledge of asthma and its management.

Asthma is the most common chronic medical condition that school teachers may encounter among their pupils. However management of asthma in schools and the role school teachers adopt in this condition has only recently been explored. The aim of this study was to determine teachers' knowledge of asthma and its management. A postal questionnaire was circulated to 199 school teachers from 46 schools in Dublin City. A 74 per cent response rate was obtained. The number of children with asthma as identified by teachers was 7.8 per cent which suggests that asthma may be unrecognised in a number of pupils. Knowledge on signs and symptoms of asthma, provoking factors of asthma and the nature of the disease was generally satisfactory. However, knowledge on asthma medications, the purpose of inhalers and teachers' understanding of the treatment and management of asthma was considered poor. Knowledge on exercise-induced asthma was limited. There is a need to provide school teachers with education on asthma and its management. School policies on asthma also need to be developed with particular reference to action necessary in the event of an acute severe attack of asthma.

Adult↗
PubMed2003

Recent advances in the management of asthma using leukotriene modifiers.

Asthma is a chronic inflammatory disease of the airways that affects approximately 100 million people worldwide. In order to reduce symptoms, improve pulmonary function, and decrease morbidity, current treatment guidelines emphasize the importance of controlling the underlying inflammation in patients with asthma. Leukotrienes are leukocyte-generated lipid mediators that promote airway inflammation. Recognition of the importance of leukotrienes in the pathogenesis of asthma has led to the development of leukotriene modifiers, the first new class of drugs for the treatment of asthma to become available in 25 years. Controlled clinical trials with the four currently used leukotriene modifiers (montelukast, zafirlukast, and zileuton in the US and pranlukast in Japan) have established their efficacy in improving pulmonary function, reducing symptoms, decreasing night-time awakenings, and decreasing the need for rescue medications. They exert anti-inflammatory effects that attenuate cellular infiltration and bronchial hyperresponsiveness and complement the anti-inflammatory properties of inhaled corticosteroids. In patients with moderate and severe asthma, they permit tapering of the corticosteroid dose. In patients with exercise-induced asthma, leukotriene modifiers limit the decline in and quicken the recovery of pulmonary functions without the tolerance issues seen with chronic long-acting beta(2)-adrenoceptor agonist use. In patients with aspirin (acetylsalicylic acid)-induced asthma, they improve pulmonary function and shift the dose response curve to the right, reducing the patient's response to aspirin. In patients with seasonal allergic rhinitis, with or without concomitant asthma, they improve nasal, eye, and throat symptoms as well as quality of life. Leukotriene modifiers are generally safe and well tolerated with adverse effect profiles similar to that of placebo. The one safety issue raised with leukotriene modifiers, Churg-Strauss Syndrome, appears to be the unmasking of an already present syndrome that is manifested when the leukotriene modifiers permit corticosteroid doses to be reduced. Although current treatment guidelines recommend their use in patients with mild persistent asthma, these guidelines were developed just as leukotriene modifiers were coming to the market, before much of the clinical efficacy data were published. Because asthma is a heterogeneous disease, the different asthma phenotypes respond differently to therapies; consequently asthma therapy needs to be individualized. Leukotriene modifiers increase the therapeutic options for patients with asthma and, based on recent data, it is expected that future guidelines will describe expanded uses for these agents in clinical circumstances where these drugs are effective.

Acetates↗
PubMed1991

Bronchoalveolar lavage fluid mediator levels 5 minutes after allergen challenge in atopic subjects with asthma: relationship to the development of late asthmatic responses.

Inflammatory mediators have been implicated in the pathogenesis of human asthma and have been demonstrated to increase in bronchoalveolar lavage fluid during the time of the immediate asthmatic response (IAR) after allergen instillation in the lungs. However, the relationship of these mediators, measured early to the late asthmatic response (LAR), airway reactivity, and clinical asthma, is unknown. In the present study, we evaluated mediator levels in bronchoalveolar lavage fluid before and 5 minutes after allergen challenge from three subject groups: atopic subjects without asthma (N = 7), atopic subjects with asthma and without LAR [-) LAR) (N = 6), and atopic subjects with asthma and with LAR [+) LAR) (N = 6). Subjects with asthma were differentiated into subjects with and without LARs based on at least a 15% decrease in FEV1 between 3 to 8 hours postallergen inhalation. The mediators, prostaglandin D2 thromboxane B2 leukotriene C4 (LTC4), and histamine, were measured both before and after allergen instillation. Baseline prechallenge levels were similar, except in the case of LTC4. LTC4 was detectable at baseline significantly more frequently in the atopic subjects with asthma with and without LAR when these subjects were compared to the atopic subjects without asthma (nine of 12 detectable versus one of seven detectable). In all groups, significant increases in mediator levels were observed in the groups with asthma postallergen challenge, compared to the atopic subjects without asthma. Atopic subjects with asthma and without LAR had significantly higher levels of all four mediators after challenge than atopic subjects with asthma and with LAR and atopic subjects without asthma.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2004

The use of prostaglandin E2 in pregnant patients with asthma.

OBJECTIVE: Prostaglandin E(2) is a pharmacologic agent that is used commonly in obstetrics; however, its usage in patients with asthma is unclear. The study objective was to examine pregnant patients with asthma who received prostaglandin E(2). STUDY DESIGN: All pregnancies that were given prostaglandin E(2) suppositories and/or gel were recorded prospectively from January 1989 through December 2000. Those cases with a history of asthma or active asthma were analyzed for any clinical evidence of disease exacerbation after the administration of the agent. Clinical exacerbation was defined as any respiratory complaint that followed drug usage, the initiation of bronchodilator medications by patients currently not on therapy, or an increase in bronchodilator usage by patients with active disease. RESULTS: During the study period, 2513 patients received treatment with the cervical ripening gel, of whom 158 patients had a history of asthma or active asthma. Additionally, 536 patients were administered the 20-mg suppositories, of whom 31 patients had a history of asthma or active asthma. Thus, a total of 189 patients with a history of asthma or active asthma were exposed to prostaglandin E(2), and none of the patients had any evidence of a clinical exacerbation of the disease (0/189 cases; 95% CI, 0- 2%). CONCLUSION: Based on the 95% CI of these data, the maximum risk for the development of a clinical exacerbation of asthma, if exposed to the obstetric forms of prostaglandin E(2), is < or =2%. Although all drug usage in patients with asthma should be monitored carefully, this information would support the usage of prostaglandin E(2), if obstetrically indicated, in pregnant patients with asthma.

Administration, Intravaginal↗
PubMed2006

Identifying asthma exacerbations in a pediatric emergency department: a feasibility study.

BACKGROUND: Asthma is a common pediatric chronic disease and is estimated to account for more than 2million emergency department visits per year. Asthma guidelines have demonstrated improved outcomes, but remain underutilized due to several barriers. Computerized methods to automatically identify asthma exacerbations may be beneficial to initiate guideline recommended treatment, but have not been described. The goal of the study was to examine the accuracy of an algorithm to identify asthma patients at triage in real-time using only electronically available data. METHODS: During a 9-month period, the five most frequent presenting chief complaints for Emergency Department asthma patients aged 2-18 years were identified and accounted for >95% of asthma visits: wheezing, shortness of breath, fever, cough, and dyspnea. During a following 1-month period (November 2004), medical records of all patients with one of the five chief complaints were reviewed to establish a reference standard diagnosis. An asthma identification algorithm was developed that considered only data available in electronic format at the time of triage and included the presenting chief complaint, information from the computerized problem list (past medical history; current medications, such as beta-agonists, steroids, and other asthma medications), and ICD-9 billing codes from previous encounters. RESULTS: From 1835 Emergency Department visits, 368 visits (154 with asthma) had one of the five chief complaints and were included. A problem list was available in 203 (55.2%) and an ICD-9 code in 68 (18.5%) patients. Wheezing accounted for 56.5% of asthma visits, while fever was the most frequent chief complaint among all patients (43.8%). The asthma identification algorithm had a sensitivity of 44.8% (95% CI: 36.8-53.0%), a specificity of 91.6% (CI: 87.0-94.9%), a positive predictive value of 79.3% (CI: 69.3-87.3%) and a negative predictive value of 69.8% (CI: 64.0-75.1%). The positive and negative likelihood ratios were 5.3 (CI: 3.3-8.6) and 0.6 (CI: 0.5-0.7), respectively. CONCLUSION: The simple identification algorithm demonstrated good accuracy for identifying asthma episodes. The algorithm may represent a promising and feasible approach to create computerized reminders or automatic triggers that can facilitate the initiation of guideline-based asthma treatment in the Emergency Department.

Adolescent↗
PubMed2003

Asthma variability in patients previously treated with beta2-agonists alone.

BACKGROUND: According to national asthma guidelines, asthma severity can be classified as intermittent, mild, moderate, or severe on the basis of lung function, symptoms, nighttime awakenings, and exacerbations. Although it is widely believed that patients might not remain consistently in any given severity category over time, few studies have examined this directly. OBJECTIVE: We sought to assess the variability in disease severity-control among patients with persistent asthma who have not yet received an asthma maintenance treatment. METHODS: We performed an analysis of asthma severity-control over time in placebo-treated patients (n = 85) from 2 randomized, double-blind, 12-week clinical trials in patients with asthma previously receiving beta(2)-agonists alone. Asthma severity-control was assessed on the basis of morning percent predicted peak expiratory flow, albuterol use, and symptoms. RESULTS: At baseline, all patients met the criteria for moderate or severe persistent asthma (mean FEV(1) of 64% of predicted value or albuterol use and symptoms on 4.7 and 6.0 days per week, respectively). The mean percentage of treatment weeks that patients met all criteria for intermittent, mild, moderate, and severe asthma were 9%, 14%, 71%, and 6%, respectively. On the basis of morning peak expiratory flow, patients were classified as having intermittent-mild, moderate, or severe disease on 52%, 41%, and 7% of days, respectively. With regard to days per week with albuterol use or asthma symptoms, patients spent 59% and 45% of weeks, respectively, in the intermittent and mild categories. CONCLUSION: Asthma control cannot be adequately assessed in many patients by using discrete point-in-time assessments of lung function, short-acting beta-agonist use, or asthma symptoms. This might lead to underestimation of disease severity and contribute to inadequate therapy and, ultimately, asthma morbidity.

Adolescent↗
PubMed2004

Distinguishing severe asthma phenotypes: role of age at onset and eosinophilic inflammation.

BACKGROUND: Asthma is a heterogeneous process, yet little is understood regarding phenotypes. OBJECTIVE: To determine whether phenotypic differences exist between early-onset, severe asthma as compared with late-onset disease and whether the presence or absence of eosinophilia influences the phenotypes. METHODS: Cross-sectional analysis of integrated clinical, physiologic, and pathologic data collected from 80 subjects with severe asthma. Subjects were divided into those with asthma onset before age 12 years (n = 50) versus after age 12 (n = 30) and by the presence or absence of lung eosinophils. RESULTS: Subjects with early-onset, severe asthma had significantly more allergen sensitivity (skin test positivity, 98% vs 76%, P <.007) and more allergic symptoms (P values all <or=.02) than subjects with late-onset asthma. In contrast, subjects with late-onset asthma had lower lung function (P values =.05 to.07) than early-onset, despite a shorter (P <.0001) duration of illness. Both groups had a high degree of general asthma symptoms, but those with persistent eosinophils from either age at onset group had significantly more (multiple P values <.05). Similarly, the presence of eosinophils in either age at onset group was associated with the lowest lung function (P <or=.02). Although late-onset asthma was associated with the highest numbers of lung eosinophils (P <.007), only early-onset severe asthma was associated with a lymphocytic/mast cell inflammatory process. Finally, subjects with late-onset asthma without eosinophils had no subepithelial basement membrane thickening, suggesting a different pathologic process. CONCLUSIONS: Differentiating severe asthma by age at onset and presence or absence of eosinophils identifies phenotypes of asthma, which could benefit subsequent genetic and therapeutic studies.

Age of Onset↗
PubMed2005

Patterns of asthma control: a 3-year analysis of patient claims.

BACKGROUND: The goal of asthma therapy is to maintain consistent control. OBJECTIVE: We sought to examine the patterns of asthma control recorded over 3 years using administrative claims and resource utilization definition. METHODS: We performed a retrospective observational study with a nationally representative patient-level database containing pharmacy and medical claims. Patients with asthma (International Classification of Diseases, Ninth Revision-Clinical Modification code 493.xx), patients undergoing treatment with at least 1 asthma medication, and patients with 36 months of continuous claims coverage during the calendar years 1996 through 2002 were identified. A total of 63,324 patients were included in the study. Patients were classified as having controlled asthma in year 1 if they had less than 4 claims for a short-acting beta 2 -agonist, no claims for an OCS, and no asthma-related emergency department visits or hospitalizations. Patients were then followed over the next 8 quarters (2 years) to observe whether control was maintained. Control during a quarter was defined with the same criteria, except the reliever threshold was adjusted to 2 or more claims per quarter. RESULTS: Thirty-nine thousand ninety-five (57%) patients were defined as having controlled asthma during year 1. During the 2-year follow-up period, a range of 10% to 14% of these patients with controlled asthma met the criteria of uncontrolled asthma during any given quarter. Overall, 46,227 (73%) patients identified met the criteria for uncontrolled asthma at least once during the 3-year period. CONCLUSIONS: This study demonstrates that almost 75% of asthmatic patients experience an uncontrolled asthma episode 1 or more times over a 3-year period. Furthermore, we found that significant fluctuations in asthma control exist, even in patients with prior controlled asthma.

Adolescent↗
PubMed2005

Relationships among quality of life, severity, and control measures in asthma: an evaluation using factor analysis.

BACKGROUND: Validated psychometric tools measuring quality of life, asthma control, and asthma severity have been developed, but their relationships with each other and with other important patient-centered outcomes have not been rigorously assessed. OBJECTIVE: To use factor analysis to evaluate the relationships of these validated tools with each other and with other patient-centered outcomes. METHODS: Surveys were completed by a random sample of 2854 Health Maintenance Organization members age 18 to 56 years with persistent asthma. Surveys included demographic information; validated tools measuring generic (Short Form-12; SF-12) and asthma-specific (Juniper Mini Asthma Quality of Life Questionnaire; AQLQ) quality of life, asthma control (Asthma Therapy Assessment Questionnaire), and asthma symptom severity (Asthma Outcomes Monitoring System); self-described severity, control, and course over time; and history of acute exacerbations. RESULTS: Principal component analysis suggested a 5-factor model that accounted for approximately 59% of the variability. The most prominent rotated factor reflected asthma symptom frequency (19.4% of variability), was measured by the symptom subscale of the AQLQ, and was the only factor significantly related to the Asthma Therapy Assessment Questionnaire, Asthma Outcomes Monitoring System, or the self-reported assessments of severity, control, or course. Other factors included symptom bother (12.1% of variability), reflected by the environment and emotion AQLQ subscales; activity limitation (13.9% of variability), reflected by the activity AQLQ subscale and the SF-12 physical component scale; mental health (8.3% of variability), reflected by the SF-12 mental component scale; and acute exacerbations (5.0% of variability), not measured by any of the validated scales. CONCLUSION: Distinct components of patient-reported asthma health status can be identified by factor analysis. Distinct constructs of severity versus control cannot be identified by the use of these tools alone.

Adolescent↗
PubMed2007

Excessive body weight is associated with additional loss of quality of life in children with asthma.

BACKGROUND: Asthma and excessive body weight frequently coexist, whereas the exact relationship between the 2 diseases is unknown. OBJECTIVE: To study whether asthma combined with excessive body weight has a greater effect on quality of life in children than the separate effects of asthma or excessive body weight alone. METHODS: In a cross-sectional design, 1758 school children (age 7-10 years) participated: 4 study groups were composed of children with asthma and with/without excessive body weight, and healthy controls with/without excessive body weight. Diagnosis of asthma was defined by either a doctor's diagnosis or by core questions of the International Study of Asthma and Allergies in Childhood questionnaire in combination with either reversible airway obstruction or bronchial hyperresponsiveness. Excessive body weight was defined by using international cutoff points for body mass index. Quality of life was evaluated by the Pediatric Asthma Quality of Life Questionnaire. RESULTS: For all domains of quality of life, children with both asthma and excessive body weight had lower scores than children with either asthma alone or excessive body weight alone. Compared with healthy controls, the score was 25% lower in children with asthma and excessive body weight, 14% lower in children with asthma and normal weight, and only 1% lower in overweight controls. CONCLUSION: Excessive body weight is associated with an additional decrease in quality of life in children with asthma. CLINICAL IMPLICATIONS: Clinicians should be aware of the interaction between asthma and excessive body weight and the effect on quality of life and should give extra attention to children with both conditions.

Asthma↗
PubMed2004

Low levels of immunoglobulin A in children with intrinsic asthma: a possible protection against atopy.

Immunoglobulin A and G (IgA, IgG) serum concentrations were detected in children with nonallergic/intrinsic (36 children) or allergic/extrinsic asthma (43 children) and in age-matching control children (40 children). Asthmatic children with allergic asthma had lower IgA (1.36+/-0.54 g/L) and higher IgG (10.48+/-2.77 g/L) levels than the age-matching control children group (1.63+/-0.69 vs. 9.01+/-2.32 g/L). Children with nonallergic/intrinsic asthma had lower IgA (1.03+/-0.41 g/L) ( p = 0.004) and IgG (8.38+/-1.93 g/L) (p = 0.001) levels than the allergic/extrinsic asthma group (1.36+/-0.54 vs. 10.48+/-2.77 g/L). Low IgA levels were found in children with nonallergic/intrinsic asthma and high IgG levels were found in those children with allergic/extrinsic childhood asthma. The hypothesis is that the increased incidence of asthma in the population may be caused by a decrease in childhood infections (hygiene hypothesis). Frequent infections in early life boost the immune system, stimulating Th1-type response in young children and reducing the risk of atopic diseases. Our hypothesis is that low IgA (and/or IgG) levels in our patients might be responsible for infection development among those children with nonallergic/intrinsic asthma. These infections stimulate the normal development of immune system in young children, reducing risk of atopy, so that those children do not get allergic/extrinsic childhood asthma. Intrinsic childhood asthma=nonallergic (nonatopic) childhood asthma. Extrinsic childhood asthma=allergic (atopic) childhood asthma.

Adolescent↗
PubMed2006

Measuring asthma quality in primary care: can we develop better measures?

OBJECTIVE: Asthma is common and commonly under-treated. Currently quality indicators often do not provide specific directions for areas of improvement. This work lays the foundation for a quality improvement initiative that provides practice-specific feedback related directly to clinical activities completed for individual patients with asthma. METHODS: Medical record review using a group of quality assessment elements developed from previous medical record review studies of asthma care and the NAEPP asthma care guidelines. RESULTS: For 500 school children ages 5-18 yr who made one or more asthma visits in the year of interest, the frequency of daytime asthma symptoms were recorded in 54% of patients' medical records at any time during a one-year period, while nighttime symptom frequency was recorded in 33%. Only 12% of medical records recorded any information on missed work, school or activity days. Nine percent recorded information or acknowledged any asthma "triggers". Asthma severity level was documented in only an additional 4% of the children's records. Most medical records documented prescribed asthma medications and dosages (85%) but few recorded the medications or dosages the patients were actually taking. CONCLUSIONS: Many medical records do not include the basic clinical information required to assess asthma severity, adherence to asthma therapy or the response to therapy. This lack of information makes implementation of asthma care guidelines impossible. Therefore, these measures may be useful baseline quality indicators to begin the process of improving asthma care.

Adolescent↗
PubMed2006

Recent asthma exacerbations: a key predictor of future exacerbations.

OBJECTIVE: The objective of this analysis was to investigate whether patients with severe or difficult-to-treat asthma who experienced recent severe asthma exacerbations are at increased risk of future asthma exacerbations. METHODS: We conducted a 1.5-year prospective analysis of 2780 patients 12 > or =years of age from The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens study. Severe exacerbations were defined as either an asthma-related emergency department visit or night of hospitalization in the 3 months prior to study visit; a secondary analysis assessed prior steroid bursts as an independent predictor and outcome. Potential confounding was assessed by statistical adjustment for demographic and clinical factors, as well as asthma severity and asthma control. RESULTS: Compared with patients without a recent severe exacerbation, patients with a recent exacerbation were at increased risk of future exacerbation (odds ratio=6.33; 95% CI 4.57, 8.76), even after adjustment for demographics and clinical factors (odds ratio=3.77; 95% CI 2.62, 5.43), asthma severity (physician-assessed: odds ratio=5.62; 95% CI 4.03, 7.83), National Asthma Education and Prevention Program (odds ratio=5.07; 95% CI 3.62, 7.11), Global Initiative for Asthma (odds ratio=5.32; 95% CI 3.80, 7.47), and asthma control (odds ratio=3.90; 95% CI 2.77, 5.50). CONCLUSION: This analysis suggests that recent severe asthma exacerbations are a strong independent factor predicting future exacerbations and, as such, should be considered as part of the clinical assessment of patients with severe or difficult-to-treat asthma.

Adolescent↗
PubMed1998

Association of being overweight with greater asthma symptoms in inner city black and Hispanic children.

OBJECTIVE: To determine whether the weight status of inner city black and Hispanic children with asthma differs from that of their peers and to assess whether overweight asthmatic children experience greater asthma symptoms. STUDY DESIGN: A cross-sectional study in an ambulatory chest clinic of an inner city medical center. METHODS: We studied black and Hispanic children aged 2 to 18 years (n = 209) with the single diagnosis of asthma. The peer control subjects consisted of a sample of black and Hispanic children aged 6 to 13 years (n = 1017), enrolled in the New York City schools. Asthma symptoms, the number of asthma medications prescribed, and peak expiratory flow rate (PEFR) measurements were used to classify asthma severity and relate to body mass index (BMI). Bivariate categorical analysis and chi 2 tests were performed to examine the relationship between high BMI and the individual measures of asthma severity. RESULTS: The prevalence of overweight was significantly higher in children with moderate to severe asthma than in their peers. The risk of overweight based on a BMI in the 85th percentile or greater was significantly associated with the following measures of asthma severity: (1) the number of school days missed per year; (2) a PEFR less than or equal to 60% of the predicted PEFR; and (3) the number of asthma medications prescribed. CONCLUSIONS: The prevalence of overweight was significantly higher in children with moderate to severe asthma than in their peers, and being overweight was associated with significantly more severe asthma symptoms. Further studies in overweight asthmatic children are needed, including the effect of weight loss on lung function and other markers of asthma severity.

Adolescent↗
PubMed2003

Identifying the child in need of asthma therapy.

Based on the results of the long-term CAMP clinical trial in childhood asthma, the benefits of continuous long-term use of inhaled glucocorticoid on asthma control are clear. Studies are in progress to evaluate whether early intervention with inhaled glucocorticoids can alter the natural history of asthma. Indicators are now being defined to identify the patient at risk for persistent asthma and thus to identify candidates for early intervention. Given the right medication and the patient profile, it may be possible to induce remission or even a cure. Patients with severe asthma have low pulmonary function that is difficult to improve, however. It will be important to recognize patients at risk for severe asthma and to intervene more effectively to prevent asthma progression. None of these advances will be possible without a comprehensive approach to asthma care including the ready access to health care. Although it seems that the rise in asthma mortality and morbidity has reached a plateau, there are significant racial and ethic disparities in asthma health care use and mortality. The goal should now be to strive for a reduction in asthma morbidity and mortality. A high proportion of asthma morbidity among inner-city children may be related to nonadherence; therefore targeting management approaches to improve adherence could prove effective in reducing morbidity. Recommendations have been made to integrate available resources in the United States to improve overall asthma outcomes for children.

Anti-Asthmatic Agents↗
PubMed1997

Allergic rhinitis and asthma: how important is the link?

Dysfunction of the upper and lower airways frequently coexist, and they appear to share key elements of pathogenesis. Data from epidemiologic studies indicate that nasal symptoms are experienced by as many as 78% of patients with asthma and that asthma is experienced by as many as 38% of patients with allergic rhinitis. Studies also have identified a temporal relation between the onset of rhinitis and asthma, with rhinitis frequently preceding the development of asthma. Patients with allergic rhinitis and no clinical evidence of asthma commonly exhibit nonspecific bronchial hyperresponsiveness. The observation that management of allergic rhinitis also relieves symptoms of asthma has heightened interest in the link between these diseases. Intranasal corticosteroids can prevent increases in nonspecific bronchial reactivity and asthma symptoms associated with seasonal pollen exposure. Similarly, among patients with perennial rhinitis, daily asthma symptoms, exercise-induced bronchospasm, and bronchial responsiveness to methacholine are reduced after administration of intranasal corticosteroids. Antihistamines, with or without decongestants, reduce seasonal rhinitis symptoms, asthma symptoms, and objective measurements of pulmonary function among patients with rhinitis and asthma. The mechanisms that connect upper and lower airway dysfunction are under investigation. They include a nasal-bronchial reflex, mouth breathing caused by nasal obstruction, and pulmonary aspiration of nasal contents. Nasal allergen challenge results in increases in lower airway reactivity within 30 minutes, suggesting a neural reflex. Improvements in asthma associated with increased nasal breathing may be the result of superior humidification, warming of inspired air, and decreased inhalation of airborne allergens. Postnasal drainage of inflammatory cells during sleep also may affect lower airway responsiveness. A link between allergic rhinitis and asthma is evident from epidemiologic, pathophysiologic, and clinical studies. Future research, however, is needed to determine whether nasal therapy can alter the natural history of asthma.

Administration, Intranasal↗
PubMed1999

Occupational asthma in Europe and other industrialised areas: a population-based study. European Community Respiratory Health Survey Study Group.

BACKGROUND: There are no large population-based studies on occupational asthma, and few estimates of the proportion of asthma attributed to occupation, even though asthma is the most common occupational respiratory disorder in industrialised countries. METHODS: We assessed data on 15,637 people aged 20-44, randomly selected from the general population of 26 areas in 12 industrialised countries. Asthma was assessed by methacholine challenge test and by questionnaire data on respiratory symptoms and use of medication. Occupation was defined by job-titles and a job exposure matrix was constructed. FINDINGS: Highest risk of asthma, defined as bronchial hyperresponsiveness and reported asthma symptoms or medication, was shown for farmers (odds ratio 2.62 [95% CI 1.29-5.35]), painters (2.34 [1.04-5.28]), plastic workers (2.20 [0.59-8.29]), cleaners (1.97 [1.33-2.92]), spray painters (1.96 [0.72-5.34]), and agricultural workers (1.79 [1.02-3.16]). Similar risks were shown for asthma defined as reported asthma symptoms or medication. The most consistent results across countries were shown for farmers and cleaners. Excess asthma risk was associated with high exposure to biological dusts, mineral dusts, and gases and fumes. The proportion of asthma among young adults attributed to occupation was 5%-10%. INTERPRETATION: The prevalence of occupational asthma in women and in specific occupations has been underestimated. Given a mean prevalence of asthma of about 5%, about 0.2%-0.5% of young adults become asthmatics or have their asthma exacerbated because of their occupations.

Adult↗
PubMed2001

Use of changes in symptoms to predict changes in lung function in assessing the response to asthma therapy.

BACKGROUND: The majority of adult patients with asthma are managed by primary care providers. Although there is no generally accepted gold standard for the assessment of asthma severity in general practice, treatment decisions and modifications to therapy are strongly influenced by patients' symptoms and history of asthma medication use. OBJECTIVES: The primary goal of this study was to determine whether there is a correlation between changes in asthma symptoms during treatment and changes in lung function, as measured by peak expiratory flow (PEF). A secondary goal was to compare the relative efficacy (in terms of improvement in asthma symptoms and lung function) of 3 commonly used asthma treatments: inhaled fluticasone propionate, inhaled salmeterol xinafoate, and oral zafirlukast. METHODS: This was a retrospective comparison employing regression analyses of asthma symptom and lung function data from 2890 male and female adolescent and adult patients with persistent asthma who were enrolled in 8 randomized, double-blind, double-dummy, parallel-group studies. Data on patients' self-rated symptoms, PEF, supplemental albuterol use, nighttime awakenings, and frequency of asthma exacerbations were used to ascertain whether there was a correlation between changes in asthma symptoms and changes in pulmonary function, and to compare treatment effects. RESULTS: Changes in patients' ratings of asthma symptoms after treatment with study medications showed a strong correlation with changes in lung function. Similarly, changes in lung function were strongly correlated with changes in supplemental beta-agonist use and quality of life. In addition, fluticasone or salmeterol treatment resulted in significantly greater increases in mean morning PEF (P < 0.001), significantly greater decreases in symptom scores (P < or = 0.004), significantly fewer nights with awakenings due to symptoms (P < or = 0.017), and significantly greater reductions in supplemental beta-agonist use (P < 0.001) compared with zafirlukast treatment or placebo. Patients treated with fluticasone or salmeterol also experienced significantly lower rates of asthma exacerbation (3%) during treatment than did those receiving zafirlukast (7%) or placebo (12%) (P < 0.001 and P = 0.015, fluticasone and salmeterol, respectively). CONCLUSION: These findings support the validity of primary care practitioners' basing asthma-management decisions on patients' symptoms.

Adolescent↗