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PubMed2002

Efficacy of budesonide in inhaled corticosteroid-naive patients and patients with mild persistent asthma.

BACKGROUND: Patients with mild intermittent or mild persistent asthma represent 70% of asthma sufferers. Inhaled corticosteroids (ICSs) are the mainstay of treatment for persistent asthma, although many of the early clinical studies of these drugs included only patients with moderate to severe asthma. OBJECTIVE: This article reviews the literature on the efficacy of budesonide in the treatment of mild persistent asthma, including newly diagnosed ICS-naive patients. METHODS: Published data were identified by a MEDLINE search of the English-language literature from 1992 to 2002 using the terms budesonide plus efficacy or safety, both with and without the termsfluticasone or beclomethasone. An AstraZeneca reference database was also used to identify publications from the same period. Controlled, randomized studies that included patients with mild persistent asthma and early-treatment intervention were selected for inclusion. RESULTS: Inhaled budesonide has been used for almost 20 years in the treatment and control of moderate to severe asthma. Studies involving patients with mild persistent asthma have demonstrated significant improvements in peak expiratory flow (PEF) rates (P < 0.01) and forced expiratory volume in I second (P < 0.016) values for adult, adolescent, and pediatric patients treated with budesonide compared with placebo. Budesonide therapy is effective when given once or twice daily via dry powder inhaler or nebulizer, even at a low starting dose (200 microg/d). No significant adverse events have been reported with budesonide within the dose range used to treat mild persistent asthma (200 to 400 microg/d). Significant improvements in PEF rates (P < 0.01) and significant reductions in the risk of exacerbations and the number of days with poorly controlled asthma have been reported for ICS-naive patients treated with budesonide compared with placebo (both P < 0.001). In the primary care setting, mild persistent asthma may be undertreated. Patients with mild persistent asthma benefit significantly from early treatment with budesonide (P < 0.05). CONCLUSIONS: Budesonide is effective and well tolerated in the treatment of mild persistent asthma in adults and children, including many patients whose primary care physicians do not think they require daily ICS treatment.

Administration, Inhalation↗
PubMed2003

Family history as a predictor of asthma risk.

Asthma, one of the most important chronic diseases of children, disproportionately affects minority and low-income children. Many environmental risk factors for asthma have been identified, including animal, mite, and other allergens; cigarette smoke; and air pollutants. Genetics also play an important causative role, as indicated by familial aggregation and the identification of candidate genes and chromosomal regions linked to asthma risk. Using a positive family history of asthma to identify children at increased risk could provide a basis for targeted prevention efforts, aimed at reducing exposure to environmental risk factors. To assess the predictive value of family history as an indicator of risk for childhood asthma, we reviewed population-based studies that evaluated family history of asthma and atopic disease in children with asthma. Our search identified 33 studies from all geographic regions of the world for review. The studies varied in definitions of positive family history and asthma phenotype and used study populations with asthma prevalence ranging from 2% to 26%. Nevertheless, family history of asthma in one or more first-degree relatives was consistently identified as a risk factor for asthma. In ten studies, sensitivity and predictive value of a positive family history of asthma could be calculated: sensitivity ranged from 4% to 43%, positive predictive value from 11% to 37%, and negative predictive value from 86% to 97%. Although a positive family history predicts an increased risk of asthma, it identifies a minority of children at risk. Positive family history may have utility in targeting some individual prevention efforts, but the low positive predictive value limits its value as a means to direct environmental remediation efforts.

Adolescent↗
PubMed2004

Oral corticosteroid-sparing effects of inhaled corticosteroids in the treatment of persistent and acute asthma.

OBJECTIVE: To review the efficacy and safety of inhaled corticosteroids (ICSs) when used to reduce daily oral corticosteroid (OCS) requirements in patients with severe persistent asthma and periodic requirements in patients with acute asthma exacerbations. DATA SOURCES: Clinical studies of the OCS-sparing effects of ICSs were located by searching MEDLINE databases from 1966 onward using the terms oral, steroid, and asthma in combination with the generic names for each marketed ICS. STUDY SELECTION: Studies reporting on the use of ICSs to reduce OCS requirements in patients with persistent and acute asthma are included. RESULTS: Clinical study results consistently show that ICSs significantly improve asthma control and reduce OCS requirements among adults, children, and infants with persistent asthma. A dose reduction or complete discontinuation of use of OCSs is possible in most patients without loss of asthma control. ICSs also can control asthma during acute asthma exacerbations and reduce the need for short courses of OCSs. With many ICSs, the reductions in OCS use are accompanied by recovery of hypothalamic-pituitary-adrenal axis function, indicating that the safety of asthma therapy is improved when OCS requirements are decreased with ICSs. Of the available ICSs that may reduce OCS needs, budesonide appears to be the most intensively studied. CONCLUSIONS: ICSs can reduce OCS requirements in adults and children with persistent asthma and during acute asthma exacerbations. The reduced systemic corticosteroid activity associated with ICS treatment improves the overall safety of asthma therapy.

Administration, Inhalation↗
PubMed2004

Aspirin intolerance and allergy to house dust mites: important factors associated with development of severe asthma.

BACKGROUND: Although the occurrence of bronchial asthma is still increasing, the possible factors associated with the development of severe asthma have not been completely determined. OBJECTIVE: To measure the incidence of severe asthma and its determinants in outpatients. Aspirin intolerance, house dust mite (HDM) allergy, male sex, age older than 65 years, and duration of asthma exceeding 10 years were investigated as factors potentially related to the severity of asthma. METHODS: The study population included 598 women and 408 men, mean age of 44.59 years (SD +/- 16.45 years), randomly chosen from patients with asthma under follow-up surveillance in an outpatient clinic. Their medical histories were reviewed; spirometry and skin prick tests were performed. RESULTS: The asthma was diagnosed as intermittent in 35.39%, persistently mild in 33.40%, moderate in 23.76%, and severe in 7.45% of the study cohort. In the patients with atopy, HDM allergy was a significant factor associated with the development of severe asthma [odds ratio (OR) = 5.65]. Of the 1,006 patients, 341 (33.90%) had had asthma for at least 10 years, which was a significant factor in the overall study group (OR = 3.64). We found 95 cases (9.44% of the study group) of aspirin intolerance, including 23 of the 75 patients with severe asthma (30.67%; OR = 5.44). Logistic regression analysis showed that aspirin intolerance was most closely associated with severe asthma (beta = 5.79; P < .001). CONCLUSIONS: The data from this study show that aspirin intolerance, HDM allergy, and asthma duration exceeding 10 years are major factors associated with severe asthma in outpatients.

Adolescent↗
PubMed2003

Outcome results of a school-based screening program for undertreated asthma.

BACKGROUND: Undertreatment of asthma is associated with significant potentially preventable morbidity, including frequent school absences. Guideline dissemination and clinician education have met with variable success. School-based identification of children with potentially undertreated asthma may provide an alternative strategy for improving asthma management in children. OBJECTIVE: To evaluate the effectiveness of school-based identification of potentially undertreated asthma. METHODS: A controlled trial of school-based identification of children with known but symptomatic asthma using mailed parent surveys, letters recommending medical follow-up, and medical record review to evaluate changes in asthma treatment after referral. RESULTS: Most parents (79.9%, n = 5,116 respondents) responded to the survey and 19.4% (n = 994) of children were reported to have a physician diagnosis of asthma or reactive airway disease. Letters of referral were sent to 489 children with parent-reported asthma who were identified as having potentially undertreated asthma. Approximately one-third (31.2%, n = 153) of these children had physician visits, and 92 (18.8% of all referred) had documented medication changes. In addition, there were 20 new physician diagnoses in this group of children. In the control group of 604 children with asthma, there were significantly fewer children with asthma-related visits (131, 21.7%, P = 0.0004) and children with medication changes (74, 12.3%, P = 0.002) in a comparable 6-month window. CONCLUSIONS: School-based screening or case identification increased the number of physician asthma-related visits and changes in asthma therapy.

Adolescent↗
PubMed2002

Health-related quality of life and future health care utilization for asthma.

BACKGROUND: Although health-related quality of life (HRQL) has been increasingly used as an outcome in asthma, its utility for identifying patients at risk for adverse asthma outcomes has not been established. OBJECTIVE: In a prospective cohort study, to evaluate the longitudinal impact of HRQL on future health care utilization and cost among adults with asthma, accounting for known risk factors for utilization. METHODS: A stratified random sample of 3,482 adult Northern CA Kaiser Permanente members with asthma was selected using computerized utilization databases and a screening survey item. Subjects completed a mail survey that included measures of generic (SF-12) and asthma-specific HRQL (ITG-Asthma Short Form battery). During the 12 months after survey completion, computerized utilization and cost data were ascertained. RESULTS: Better baseline asthma-specific HRQL was associated with a decreased risk of asthma-related emergency department visit or hospitalization during longitudinal followup (odds ratio per 10-point score increment 0.84; 95% confidence interval [CI] 0.74 to 0.95), controlling for demographic and clinical factors. Better baseline generic physical HRQL was associated with a decreased risk of future all-cause hospitalization (odds ratio 0.68; 95% CI 0.60 to 0.77). More favorable asthma-specific HRQL scores were also related to decreased asthma-related health care costs during the ensuing year (-0.086 log-dollars per 10-point score increment; 95% CI -0.11 to -0.06). Better generic physical HRQL scores were associated with lower total costs (-0.24 log-dollars; 95% CI -0.32 to -0.17). CONCLUSIONS: In a large cohort of adult health maintenance organization members with asthma, asthma-specific HRQL was associated with future asthma-related utilization and cost.

Adolescent↗
PubMed2001

The rising prevalence of asthma in young Melbourne adults is associated with improvement in treatment.

BACKGROUND: Asthma is a common source of morbidity and is now recognized as a national health priority in Australia. Although a number of epidemiologic studies have been conducted in Australia to determine the prevalence of asthma in adults, it is unclear whether the prevalence is changing. OBJECTIVES: To determine the prevalence in 1998 of self-reported asthma and respiratory symptoms among young adults and changes in prevalence between 1990 and 1999. METHODS: Cross-sectional postal survey to 4,455 young adults (aged 20 to 44 years) randomly selected from the electoral rolls of the inner southeastern suburbs of metropolitan Melbourne. The survey instrument was the validated European Community Respiratory Health Survey screening questionnaire, which gathered data on self-reported respiratory symptoms, including whether asthma had been diagnosed. Identically worded questions from similar surveys conducted in 1990, 1992, and 1999 were used to compare changes in prevalence. RESULTS: A response rate of 72% was achieved in 1998 after three mailings and telephone followup. Forty-two percent reported nasal allergies, 26% wheezed within the past 12 months, and 20% ever had asthma. The prevalence of doctor-diagnosed asthma was 18%, whereas 10% reported using asthma medications within the past 12 months. Nine percent of respondents reported an asthma attack within the past 12 months. The prevalence of having ever had asthma, doctor-diagnosed asthma, and using asthma medications had increased significantly since 1990. However, the prevalence of respiratory symptoms did not significantly change over this time. CONCLUSIONS: The prevalence of asthma is likely to be rising, but the symptoms of asthma are being better managed in young Melbourne adults.

Adult↗
PubMed1997

Prevalence of asthma and wheezing in public schoolchildren: association with maternal smoking during pregnancy.

BACKGROUND: Asthma is the most common chronic disease in childhood. The prevalence of asthma is especially high in inner city children. The occurrence of asthma may be associated with many environmental factors, including involuntary exposure to maternal smoking. OBJECTIVES: This study reports prevalence of asthma and wheezing in a sample of public school students in Chicago and examines the association between maternal smoking during pregnancy and childhood asthma. METHODS: A total of 705 fifth grade students from 13 public schools participated in the study. A slightly modified International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was administered in classrooms to assess students' wheezing and asthma prevalence. RESULTS: Overall, 34.5% of children reported ever wheezing, 28.9% reported wheezing in the past year, 21.1% reported exercise-related wheezing in the past year, 23.6% reported physician-diagnosed asthma, 16.1% reported taking asthma or wheezing medication in the past 2 weeks, and 15.2% reported visiting emergency rooms for treatment of asthma in the past year. After adjusting for confounding variables in a logistic model, maternal smoking during pregnancy was significantly associated with children's asthma (adjusted odds ratio = 1.9; 95% confidence interval: 1.1 to 3.5). CONCLUSIONS: This study reports high prevalence of asthma and wheezing among the students and suggests that maternal smoking during pregnancy may increase the risk of asthma in children.

Asthma↗
PubMed1998

Clinical differences among women with and without self-reported perimenstrual asthma.

BACKGROUND: Studies suggesting that 30% to 40% of asthmatic women report significant perimenstrual (late luteal phase) exacerbations of asthma are primarily retrospective, rely on subjective findings and do not demonstrate a consistent association between asthma and the menstrual cycle. OBJECTIVE: In this exploratory analysis, women with and without self-reported perimenstrual exacerbations of asthma (PMA) were examined prospectively to determine the association between asthma and the menstrual cycle and to characterize associated clinical factors. METHODS: Thirty-two adult asthmatic women with regular menstrual periods recorded daily asthma symptoms, medication use, and peak expiratory flow rate (PEFR) over six consecutive menstrual cycles, and underwent spirometry and methacholine bronchoprovocation during the luteal and follicular phases of 2 cycles. RESULTS: Nine of 32 subjects (28.2%) reported PMA. Daily means of rescue medication use and AM peak flow computed for each perimenstrual day demonstrated significant non-parallelism of group profiles; subjects with PMA had increasing inhaled short acting beta 2-agonist use and decreasing AM peak flow rates during the perimenstrual interval. Luteal-follicular phase differences in FEV1 or methacholine bronchoprovocation between the groups were not detected. Subjects with PMA were older (P=.007), had longer duration of asthma (P=.039), and increased baseline asthma severity (P=.076) compared with subjects without PMA. CONCLUSION: The findings of this study suggest that women with self-reported perimenstrual asthma demonstrate perimenstrual differences in rescue bronchodilator use and AM peak flow and appear to constitute a distinct subset of women with asthma who are older, have longer duration of asthma, and increased severity of asthma compared with women without self-reported perimenstrual asthma. These factors identify women who require close monitoring of their asthma during their menstrual cycles.

Adolescent↗
PubMed1996

Incidence and prevalence of physician-diagnosed asthma in a suburban population of young adults.

BACKGROUND: Asthma is a common chronic disease of both children and adults, but there have been few reports of the incidence of asthma in well defined adult populations. OBJECTIVE: To determine the incidence and prevalence of asthma in a population of young adults living in suburban Detroit. METHODS: As part of a study of the development of allergic disease in children, the parents of 841 study children, from a defined, well characterized population, were questioned about their personal histories of allergic disease, including asthma, during the mother's pregnancy. The children have been followed from birth until 4 years of age. When the child became 4, the parents were again questioned about allergic disease. Those reporting asthma when the child was 4 but not prior to the child's birth, were recontacted to confirm that they had been diagnosed by a physician as having asthma in the 4-year interval. Because of prior reports concerning racial differences in the prevalence of asthma and the small number of non-white mothers in the study population, calculations of asthma prevalence and incidence were limited to the 760 mothers, who described themselves and their baby's father as white. RESULTS: The parents studied were young adults mean age 28.7 [(standard deviation (SD) 4.5 years] and 31.0 (SD 5.0) years, of mothers and fathers, respectively. These parents were relatively well educated with 30.7% of mothers and 43.5% of fathers having college degrees. The initial prevalence of a previous physician diagnosis of asthma was 7.5% [95% confidence interval (95% CI) = 5.7-9.6] in the mothers and 6.9% (95% CI = 5.2-9.0) in the fathers, yielding a total prevalence of 7.2% (95% CI = 5.9-8.7) in these 1484 adults. Five hundred thirty-three mothers and 498 fathers (total = 1031), who did not report asthma during the mothers' pregnancies, were available for questioning when the children were 4 years old. The average yearly incidence of asthma was 5.2 (95% CI = 2.6-9.2) per 1000 in the mothers and 1.5 (95% CI = 0.3-4.4) per 1000 in the fathers (P = .058), with an overall incidence of 3.4 (95% CI = 1.8-5.7) per 1000. The average yearly incidence was 5.3/1000 in those < 30 years old and 1.5/1000 in those > or = 30 years of age (P = .056). CONCLUSIONS: We conclude that the incidence of asthma in this population of relatively young, well educated, white adults is approximately 3.4 per 1000 per year and that newly diagnosed asthma was more common in women and in those < 30 years of age.

Adolescent↗
PubMed1999

Clinical outcomes of steroid-insensitive asthma.

BACKGROUND: Steroid insensitivity increasingly is being recognized in patients with severe, chronic asthma. Virtually no data exist regarding the clinical outcomes of steroid insensitive (SI) asthma despite clear expectations of poorer longitudinal course for this condition. METHODS: We obtained 2-year follow-up data from 34 pediatric patients who had been evaluated for steroid insensitivity at a national asthma referral center. Outcomes evaluated included current oral glucocorticoid (GC) dose; number of GC bursts, emergency room visits, and hospitalizations for asthma in the prior 12 months; Asthma Functional Severity; Pediatric Asthma Quality of Life; and Pediatric Asthma Caregiver's Quality of Life. RESULTS: At follow-up, patients with SI asthma and their caregiving parent both reported poorer quality of life (QOL) compared with those with steroid sensitive (SS) asthma (adolescent: 4.6 +/- 0.4 versus 5.6 +/- 0.3; P < .05; caregiver: 5.1 +/- 0.4 versus 6.2 +/- 0.2; P < .05). Steroid-insensitive patients showed no significant difference in GC dose, number of GC bursts, emergency room visits or hospitalizations, or Asthma Functional Severity compared with SS patients. CONCLUSIONS: Steroid insensitivity was associated with significantly poorer QOL at 2-year follow-up. Steroid insensitive patients did not show poorer clinical outcomes compared with SS patients as assessed by current steroid requirements and health care utilization. Overall, the observed pattern of results suggests that SI asthma may be a worse form of asthma because a more fixed pattern of lung obstruction has developed. Further longitudinal study of the clinical and cellular outcomes of SI asthma is needed to more fully characterize the types and magnitude of risks associated with SI status.

Adolescent↗
PubMed2003

Resource costs for asthma-related care among pediatric patients in managed care.

BACKGROUND: In 1998, the economic burden of asthma in the United States was estimated to be 12.7 billion dollars. Yet few studies have examined the relationship between the total costs of asthma-related care and measures of asthma morbidity. Understanding the relationship between total costs of asthma-related care and morbidity can assist in designing the most cost-effective asthma care strategies to improve patient outcomes and minimize total costs. OBJECTIVE: To investigate correlates of asthma costs for children with mild-to-moderate persistent asthma and, specifically, to characterize how closely the percentage of predicted forced expiratory volume in 1 second (FEV1) and symptom days were correlated with costs of illness. METHODS: A total of 638 parents and children with mild-to-moderate persistent asthma in 4 managed care delivery systems in 3 different US geographic regions were enrolled. Symptom burden and annual resource utilization were determined from reports of physician visits, hospitalizations, emergency department visits, medication use, and parental missed workdays. Spirometry was conducted on children who were 5 years and older. To characterize the relationship between symptom days and the percentage of predicted FEV1 with costs, we specified a multivariate regression model. RESULTS: The median total annual asthma-related cost for the group was 564 dollars (interquartile range [IQR], 131 dollars-1602 dollars). Indirect costs represented 54.6% of total costs. Medicines accounted for 52.6% of direct costs. The mean percentage of predicted FEV1 was 101.6% (range, 39.3%-183.5%; IQR, 91.6%-111.3%), with 91.4% of patients with a percentage of predicted FEV1 of more than 80%. Based on multivariate modeling, increasing asthma severity, use of peak expiratory flow rate meters, younger age, low-income status and nonwhite race, and longer duration of asthma were significantly associated with increasing cost. Symptom days (P < 0.001) predicted annual costs better than percentage of predicted FEV1 (P < 0.16) in this group of children. CONCLUSIONS: For the large number of children with mild-to-moderate persistent asthma and normal or near-normal lung function, symptom days are predictive of health care costs. For these insured children receiving care from 3 large managed care providers, low-income status and nonwhite race were the strongest correlates for increased asthma-related costs.

Age Factors↗
PubMed2004

Something old, something new: indoor endotoxin, allergens and asthma.

Endotoxin and allergen exposure have been explored in the context of asthma for more than a century. Building upon a pyramid of knowledge are recent observations that provide new insights to the effect of these exposures on the development of asthma. Some of these studies challenge some previously held concepts of the role of these exposures in asthma inception. Indoor allergens are well established as the basis of inflammation in sensitised asthmatics, contributing to disease severity. Then does greater exposure to indoor allergens cause allergen sensitisation and asthma as well? While risk of sensitisation to house dust mites generally increases with higher levels of exposure, this does not seem to hold for cats, where higher levels of cat allergen exposure are associated with less sensitisation. Indeed, several recent studies suggest that early childhood exposure to animals, as indoor pets or in farming stables, are associated with a lower prevalence of asthma, hay fever, and inhalant allergen sensitisation. Endotoxin in asthma provides a similar paradox. Endotoxin is a potent immune-stimulatory component of the bacterial cell wall of all gram-negative bacteria. As such, endotoxin is ubiquitous in our environment. Endotoxin exposure has been well demonstrated to underlie "Monday Asthma" or byssinosis in cotton workers, and has since emerged as a frequent cause of asthma-like symptoms in a wide range of occupational settings. Asthmatics are particularly sensitive to inhaled endotoxin, and inhalation induces both immediate and sustained airflow obstruction. The paradox of endotoxin exposure is that higher levels of exposure in early life might mitigate the development of allergy and persistent asthma. With endotoxin exposure being significantly higher in homes with animals and in farming households, where allergy and asthma are less likely to develop, endotoxin and other microbial exposures in early life may keep allergen sensitisation and asthma from developing by promoting Th1-type immune development. These observations, consistent with the "Hygiene Hypothesis" of allergy and asthma, are an encouraging glimpse of the potential for early immune modulatory approaches to asthma therapy and prevention.

Air Pollution, Indoor↗
PubMed1977

Nasal polyps, nasal polypectomy, asthma, and aspirin sensitivity. Their association in 445 cases of nasal polyps.

In a retrospective study of 445 patients with nasal polyps, 95 (21 per cent) had asthma. Forty-two (44 per cent) of the patients with asthma had been skin tested and 27 (60 per cent) had positive reactions. Nasal polyps were twice as common in men as women, though a woman with nasal polyps was twice as likely to have asthma as a man. The average age of onset of polyps was 39 years and of asthma was 38 years. No significant difference was found in the age of onset of polyps or asthma in various groups of patients. Two per cent of all the patients in the series had nasal polyps, asthma and hypersensitivity to aspirin (the ASA triad). Ten per cent of those with polyps and asthma were hypersensitive to aspirin and thus had the full triad. Overall, 6 per cent of all the patients in the series were recorded as being allergic to aspirin. Asthma developed more commonly before polypectomy than after in the ratio of 2.5:1. Around 1 per cent of first polypectomies and 0.5 per cent of all polypectomies were followed by the development of asthma within a few months. The onset of asthma was found to occur most frequently just before or just after the first polypectomy. Those who developed asthma after polypectomy had significantly more polypectomies than both non-asthmatics and those whose asthma preceded their polyps. Though it is possible polypectomy may on rare occasions precipitate asthma, it is felt that it does not cause it.

Adolescent↗
PubMed2001

Asthma in relation to personality traits, life satisfaction, and stress: a prospective study among 11,000 adults.

BACKGROUND: While patients' personality has been thought to affect allergic diseases, the association of asthma and psychological factors is still debated. Stress is believed to predispose to asthma, but no clear evidence of causality has been found. We have studied the role of psychological factors in prevalent as well as in incident asthma cases among the adult population. METHODS: A total of 11540 adults initially aged 18-45 years responded to three questionnaires in 1975, 1981, and 1990, respectively. The association of psychological factors (including extroversion and neuroticism scales, subjective stress, and life satisfaction) and prevalent asthma was studied, as well as the predisposing effect of these factors on the risk of adult onset asthma. Logistic regression was used for risk calculations. RESULTS: Low life satisfaction was associated with asthma prevalence (age- and sex-adjusted OR=2.27: 1.04-4.93 for prevalent asthma among those with low life satisfaction compared to those with high life satisfaction), as was neuroticism (age and sex-adjusted OR=1.78:1.12-2.84 for those with a high neuroticism score compared to those with a low score). A high extroversion score was significantly associated with the risk of adult onset asthma among women (age-adjusted OR=2.72: 1.44-5.12 for new asthma among those with high score compared to those with a low extroversion score). CONCLUSION: No specific personality type is associated with adult onset asthma, but there is a significant sex difference in the effect of psychological factors in asthma risk. A high extroversion score is a strong predictor of incident asthma among women. Prevalent asthma decreases life satisfaction and is associated with a high neuroticism score.

Adult↗
PubMed2001

Trichophyton sensitivity in allergic and nonallergic asthma.

BACKGROUND: Although the role of inhaled fungi in inducing asthma has been repeatedly confirmed, there are few reports about the association of asthma with dermatophyte sensitivity and the causal role of Trichophyton allergy in asthma. The objective was to investigate the presence of Trichophyton sensitivity among patients with allergic and nonallergic asthma in combination with tinea, and to compare the situation with several control groups in order to evaluate the factors determining Trichophyton sensitivity. METHODS: A total of 86 subjects (55 female, 31 male) with a mean age of 38.6 +/- 11.1 years were included in the study. The patients were divided into five groups: 1) nonallergic asthma plus tinea (n = 19) 2) allergic asthma plus tinea (n = 15) 3) asthma without tinea (n = 22) 4) tinea without asthma (n = 17) 5) healthy controls (n = 13). Skin tests with standardized extracts of T. rubrum and specific IgE measurements were performed in all subjects. All patients were also subjected to microscopic evaluation and fungal culture for dermatophyte infection. RESULTS: The skin test positivity rate to Trichophyton extract of groups 1 (63.1%), 2 (46.7%), and 4 (47.1%) was higher than that in groups 3 (4.4%) and 5 (7.7%) (P < 0.05). Although not significant, the rates of sensitivity to T. rubrum (63.1%) and of severe asthma (31.6%) were higher in the group with nonallergic asthma with tinea (group 1) than in other groups. Among 51 patients in whom direct microscopic evaluation revealed dermatophyte infection, 60.8% had positive fungal cultures for T. rubrum (58.1%), T. mentagrophytes (35.5%), and Candida (6.4%). CONCLUSION: According to our data, the presence of fungal infection seems to be an important determinant in hypersensitivity to Trichophyton whether or not the subject is asthmatic and/or allergic. Since a greater proportion of patients with nonallergic asthma--in whom the rate of severe asthma was also higher - showed positive skin tests to Trichophyton extracts in this study, we believe that patients with severe, intrinsic asthma should be examined for signs of fungal infection and tested to determine immediate hypersensitivity to dermatophyte antigens.

Adult↗
PubMed2000

Prevalence of asthma in 13-14 yr-old schoolchildren across Israel.

There is evidence that the incidence and severity of asthma are increasing worldwide, but there are limited data on asthma in Israel. The aim of this study was to investigate the prevalence and severity of asthma and asthma symptoms in 13-14 yr-old schoolchildren in Israel. The self-completed questionnaire used was a modified version of that developed by the International Study of Asthma and Allergies in Childhood (ISAAC), and was administered to a national sample of 12,918 children. The prevalence of asthma ever, wheezing ever and wheezing in the last 12 months were 13.7, 23.8 and 17.9% respectively. Significantly higher rates of a history of asthma and asthma symptoms were observed in Jews compared with Arabs. Although asthma ever was more prevalent in males than in females, asthma symptoms were significantly more common in females. The type of area of residence had no effect on the prevalence of wheezing. The ethnic differences in the prevalence of asthma persisted after controlling for sex, district of residence and level of urbanization. The prevalence of both asthma and asthma symptoms in Israel are slightly above the mean reported from 10 other countries in Europe and the Far-East.

Adolescent↗
PubMed2000

Body weight characteristics of subjects on asthma medication.

OBJECTIVE: Weight gain is a frequently documented side effect after long-term anti-inflammatory treatment with systemic corticosteroid drugs in patients with asthma. In recent years new types of inhaled corticosteroids have been introduced, which act locally and are more rapidly bio-transformed. Even such corticosteroids may have a detectable, clinically relevant systemic side effect on weight. The aim of this study is to investigate if there is any relationship between body weight and asthma medication. DESIGN: The relationship between asthma medication and body weight was analysed in two combined randomized samples of the adult Swedish population 16-60 y of age (n = 17,912). Multivariate logistic regression analyses were carried out to obtain estimates for (1) body mass index (BMI) indicating 'obesity' (BMI > 29.9 kg/m2) in men and women controlling for self-reported asthma medication, and (2) self-reported asthma medication controlling for BMI. In both cases we furthermore controlled for interview period, age, Swedish region, smoking habits, physical activities and level of education. RESULTS: We found no significantly higher odds for obesity in men (OR = 1.21 (0.55-2.64) or women (OR = 1.97 (0.89-4.38) on asthma medication compared to men and women with pharmacologically untreated asthma even after adjustment for smoking habits, physical activities, level of education and other related co-variables. However, we found significant positive associations between obesity and interview period, age and former smoking and inverse significant relationships with the degree of physical activity. We also found significantly higher adjusted odds for asthma, indicated by self-reported asthma medication, in women (OR = 2.74 (1.91-3.91)) but not in men (OR = 1.57 (0.96-2.56)) with BMI indicating 'obesity'. CONCLUSION: There is no strong evidence to suggest that modern pharmacological asthma treatment may contribute much to the development of obesity in either men or women on asthma medication. Adjustment for smoking habits, physical activities, level of education and other related co-variables have minor effects on these relationships. Obesity may still be an independent risk factor for asthma since we observed significantly higher odds for self-reported asthma medication in women and an almost significant relationship in men even after control for BMI and other related co-variables.

Adolescent↗