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PubMed1992

[Proposal of a new classification of adult bronchial asthma--child onset asthma, adult onset asthma and adult relapse asthma. Project Team for Research into Adult Bronchial Asthma in Japan].

The first nationwide research into adult bronchial asthma in Japan proposed a new classification of adult asthma. Adult asthma was categorized into child onset asthma, adult onset asthma and adult relapse asthma. The frequency of child onset asthma, adult onset asthma and adult relapse asthma in adult asthma was 11.2%, 77.3% and 3.7%, respectively. The frequency of child onset asthma decreased markedly in the older age group. On the other hand, the frequency of adult onset asthma increased, and reached more than 90%, in the older age group. The frequency of the following factors: atopic asthma, complications with other atopic diseases, mild asthma, male patients, experience of mechanical ventilation, visits to night clinics and oxygen therapy on acute attack, was significantly higher in the child onset asthma group than in the adult onset asthma group. The frequency of infectious type, aspirin intolerance, steroid dependent asthma, severe asthma and regular medication was significantly higher in the adult onset asthma group. Adult relapse asthma seemed to fall between these two groups. Based on the above observations, we proposed a new classification of adult asthma which includes child onset asthma, adult onset asthma and adult relapse asthma.

Asthma↗
PubMed1998

Algorithm for the diagnosis and management of asthma: a practice parameter update: Joint Task Force on Practice Parameters, representing the American Academy of Allergy, Asthma and Immunology, the American College of Allergy, Asthma and Immunology, and the Joint Council of Allergy, Asthma and Immunology.

This algorithm on the diagnosis and treatment of asthma is intended to complement and update the previously published Practice Parameters for the Diagnosis and Treatment of Asthma. Both documents were developed by the Joint Task Force on Practice Parameters, representing the AAAAI, ACAAI, and the JCAAI. The authors of this asthma algorithm have attempted to include all the elements essential for the diagnosis and care of patients with asthma. Every effort was made to keep the algorithm clear and concise, yet thorough and complete (Fig 1). Each component of the algorithm is elaborated further in a brief annotation. For further discussion, the reader is referred to the more extensive Practice Parameters for the Diagnosis and Treatment of Asthma.

Acute Disease↗
PubMed2000

Dietary marine fatty acids (fish oil) for asthma.

BACKGROUND: Epidemiological studies suggest that a diet high in marine fatty acids (fish oil) may have beneficial effects on inflammatory conditions such as rheumatoid arthritis and possibly asthma. OBJECTIVES: 1. To determine the effect of marine n-3 fatty acid (fish oil) supplementation in asthma. 2. To determine the effect of a diet high in fish oil in asthma. SEARCH STRATEGY: The Cochrane Airways Review Group register was search using the terms: marine fatty acids OR diet OR nutrition OR fish oil OR eicosapentaenoic acid OR EPA. Bibliographies of retrieved trials were searched and fish oil manufacturers contacted. SELECTION CRITERIA: Randomised controlled trials in patients with asthma more than two years of age were included. The study duration had to be in excess of 4 weeks. Double blind trials were preferred, but single-blind and open trials were also reviewed for possible inclusion. Three reviewers read each paper, blind to its identity. Decisions concerning inclusion were made by simple majority. Quality assessment was performed by all three reviewers independently. DATA COLLECTION AND ANALYSIS: The only comparison possible was between marine n-3 fatty acid supplementation and placebo. There were insufficient trials to examine dietary manipulation alone. MAIN RESULTS: Eight randomised controlled trials conducted between 1986 and 1998 satisfied the inclusion criteria. Six were of parallel design and two were cross-over studies. Seven compared fish oil with placebo whilst one compared high dose vs low dose marine n-3 fatty acid supplementation. None of the included studies reported asthma exacerbations, health status or hospital admissions. There was no consistent effect on any of the analyzable outcomes: FEV1, peak flow rate, asthma symptoms, asthma medication use or bronchial hyper reactivity. The single study performed in children also combined dietary manipulation with fish oil supplementation and showed improved peak flow and reduced asthma medication use. There were no adverse events associated with fish oil supplements. REVIEWER'S CONCLUSIONS: There is little evidence to recommend that people with asthma supplement or modify their dietary intake of marine n-3 fatty acids (fish oil) in order to improve their asthma control. Equally, there is no evidence that they are at risk if they do so.

Adult↗
PubMed1999

Asthma care practices, perceptions, and beliefs of Chicago-area asthma specialists. Chicago Asthma Surveillance Initiative Project Team.

INTRODUCTION: Few studies have closely explored how well physicians who consider themselves specialists in asthma adhere to national guideline recommendations for the diagnosis and treatment of asthma. The purpose of this study is to characterize current knowledge, attitudes, beliefs, and self-reported treatment practices of the asthma specialists working in one large metropolitan area. METHODS: In 1997, a cross-sectional survey was mailed to asthma specialists (allergists or pulmonologists) engaged in direct patient care with a practice location in the Chicago area (Cook County or one of the five surrounding counties). An approximately 50% random sample of asthma specialists was surveyed. The survey included items on (1) asthma diagnosis; (2) clinical monitoring of asthma patients; (3) pharmacologic and nonpharmacologic asthma treatment; (4) opinions and beliefs about asthma treatment options and reasons for referrals; (5) involvement in continuing medical education; (6) experiences with managed care; (7) use of asthma practice guidelines; (8) demographic information about the respondents; and (9) characteristics of the practice settings. RESULTS: A total of 113 eligible surveys were returned (response rate, 72.0%). Ninety-nine percent of the respondents indicated they would prescribe inhaled corticosteroids for patients > or = 5 years old with moderate persistent asthma, and 85.5% would prescribe them for patients < 5 years old. The respondents reported that 71.2% of their patients with moderate or severe persistent asthma were routinely given written treatment plans. The use of these plans was reported more frequently by allergists than pulmonologists (77.6% vs 58.9%, p = 0.01). Nearly half of the respondents were involved in the development of hospital-based asthma programs; fewer (14.9%) were involved in developing asthma programs for managed care organizations. A majority (63.4%) of the physicians had given a formal professional education presentation on asthma in the past year. A majority of the respondents who care for patients under managed care contracts reported that these patients have encountered barriers to access in seeking specialty care. CONCLUSION: The results suggest that asthma specialists in the Chicago area are providing asthma care that is, in many ways, consistent with national guidelines. However, there are also important differences in care that are not consistent with the guideline recommendations. Perhaps even more notable are differences in reported asthma care between the two subspecialty groups of allergists and pulmonologists. The effect of these differences on the management of persons with asthma is not known. It is hoped that information from this community-based survey will serve to catalyze discussions among Chicago-area asthma specialists as to how they might envision improving care for persons with asthma in their community.

Adolescent↗
PubMed1999

Relationships between duration of asthma and asthma severity among children in the Childhood Asthma Management Program (CAMP)

BACKGROUND: Many factors, including heredity, atopic status, and environment, have been implicated in the determination of asthma severity. Relatively little is known about the degree to which asthma duration influences asthma severity. OBJECTIVE: The Childhood Asthma Management Program (CAMP), consisting of 1041 children (age 8. 9 +/- 2.1 years at enrollment) with mild-to-moderate asthma, offers an opportunity to examine the relationship between asthma duration and asthma severity. METHODS: By using the extensive CAMP baseline cross-sectional data on asthma duration, spirometry, bronchial responsiveness, symptomatology, and markers of atopy, univariate and multivariate regression models were used to evaluate whether asthma duration is associated with asthma severity. RESULTS: Duration of asthma in the study cohort from time of diagnosis until randomization into CAMP ranged from 0.3 to 12.1 years (mean, 5.0; SD, 2.7; median, 4.8). Asthma duration is associated in univariate analyses both with lower levels of several lung functions (P <.001), including methacholine bronchial reactivity (natural log [ln] FEV1 PC20, mg/mL; r = -0.112), prebronchodilator and postbronchodilator percent predicted FEV1 (r = -0.176 and r = -0.130, respectively), and prebronchodilator and postbronchodilator FEV1 /forced vital capacity (FVC) (%) (r = -0.237 and r = -0.211, respectively), as well as higher levels of symptoms (symptom score: r = 0.147, P <. 001) and borderline greater use of albuterol for symptoms (r = 0.058, P =.064) during a 28-day screening period before randomization. Simple linear regression detected the following differences in lung functions per year of asthma duration: ln FEV1 PC20, -0.050 mg/mL/y; prebronchodilator FEV1, -0.907 percent predicted/y; and prebronchodilator FEV1 /FVC, -0.729 percent predicted/y. After controlling for potential explanatory variables (atopy, inflammatory markers, household Der p 1 levels, anti-inflammatory medication use, and clinical center), regression models revealed that the duration of asthma remained significantly and independently associated with ln FEV1 PC20 (P =.004), prebronchodilator percent predicted FEV1 (P =.043), and prebronchodilator and postbronchodilator FEV1 /FVC (%) (P <.001), as well as being positively associated with mean daily symptom score (P <.001) and albuterol use for symptoms (P =.003) during a 28-day screening period. Duration was also found to be significantly associated with physician/nurse assessment of asthma severity and other historical measures of medication use. CONCLUSIONS: These data demonstrate that asthma duration is associated with lower lung function, greater methacholine responsiveness, more asthma symptomatology, and greater use of as-needed albuterol, which are all measures of asthma severity. As such, early diagnosis and intervention may be necessary to ameliorate these adverse effects of persistent asthma.

Adrenergic beta-2 Receptor Agonists↗
PubMed1999

The effects of asthma experience and social demographic characteristics on responses to the Chicago Community Asthma Survey-32. Chicago Asthma Surveillance Initiative Project Team.

INTRODUCTION: The Chicago Community Asthma Survey (CCAS-32) is an instrument for characterizing the general public's knowledge, attitudes, and beliefs related to asthma. The purpose of this study was to examine the effects of asthma experience and social demographic characteristics on asthma awareness among the general public. METHODS: The CCAS-32 consists of 21 dichotomous items, designed primarily to test asthma knowledge, and 11 Likert-scale items, focusing on asthma attitudes and beliefs. From December 1997 through February 1998, a random-digit dialing method was used to administer the CCAS-32 via a telephone survey of Chicago-area (seven-county) residents > or = 18 years. Each respondent's asthma experience was classified as "person with asthma," "family/household experience," or "no/low asthma experience." Demographic variables included sex, age, education, race/ethnicity, urban vs suburban residence, and income. RESULTS: Five hundred sixty-eight Chicago-area residents completed the survey (response rate of 40.6%). Of these, 43.3% were aged 35 to 64 years, 71.3% were women, 66.7% were white, and 71.3% had completed at least some college. Sixty-two percent had no or low asthma experience, 28.5% had family or household experience, and 9.5% were persons with asthma. The mean percentage (+/- SE) of correct, or desirable, responses to asthma knowledge questions was 71.9 +/- 0.5%, with a range from 31.9 to 95.1%. The mean percentage of desirable responses differed significantly between persons with no or low asthma experience, family or household asthma experience, and persons with asthma (70.0 +/- 0.6%, 74.0 +/- 0.9%, and 77.7 +/- 1.2%, respectively, p < 0.01 for trend). Social demographic factors also appeared to result in statistically significant differences in the responses to many items. Of the demographic variables studied, age and education appeared to have the strongest effect on responses to knowledge items, with statistically significant differences in responses seen for 10 (47.6%) and 8 (38.1%) of the 21 dichotomous items. Race or ethnicity and education were each associated with differences in responses for 7 of the 11 Likert-scale items (63%). CONCLUSIONS: The results of this study suggest that the CCAS-32 can detect meaningful differences between groups with different degrees of asthma experience (ie, discriminative validity). Using the CCAS-32, it may be possible to identify subpopulations with differences in asthma awareness, thus providing guidance for the design of messages to target community and public awareness of asthma.

Adolescent↗
PubMed2000

Holding chambers versus nebulisers for beta-agonist treatment of acute asthma.

BACKGROUND: In acute asthma inhaled beta-agonists are often administered to relieve bronchospasm by wet nebulisation, but some have argued that metered-dose inhalers with a holding chamber (spacer) can be equally effective. In the community setting nebulisers are more expensive, require a power source and need regular maintenance. OBJECTIVES: There is controversy as to whether wet nebulisers are better than metered dose inhalers with holding chambers to deliver beta2-agonist medications for acute asthma. Comparisons of hospital and home use are also of interest. The objective of this review was to assess the effects of holding chambers compared to nebulisers for the delivery of beta2-agonists for acute asthma. SEARCH STRATEGY: We searched the Cochrane Airways Group trials register and the Cochrane Controlled Trials Register. SELECTION CRITERIA: Randomised trials in adults and children (from two years of age) with asthma, where holding chamber beta2-agonist delivery was compared with wet nebulisation. DATA COLLECTION AND ANALYSIS: One reviewer applied study inclusion criteria and extracted the data. Trial quality was assessed independently by two reviewers. Missing data were obtained from the authors or estimated. MAIN RESULTS: This review analysed 686 children and 375 adults included in 16 trials. Method of delivery of beta2-agonist did not appear to affect hospital admission rates. In adults, the odds ratio of holding chamber versus nebuliser was 1.12, 95% confidence interval 0.45 to 2.76. The odds ratio for children was 0.91, 95% confidence interval 0.4 to 2.1. Children's length of stay in the emergency department was significantly shorter when the holding chamber was used, with a weighted mean difference of -0.62 hours, 95% confidence interval -0.84 to -0.40 hours. Adults' length of stay in the emergency department was similar for the two delivery methods. Peak flow and forced expiratory volume were also similar for the two delivery methods. Pulse rate was lower for holding chamber in children, weighted mean difference -8.3% baseline, 95% confidence interval -11.5 to -5.0,. REVIEWER'S CONCLUSIONS: Metered-dose inhalers with holding chamber produced outcomes that were at least equivalent to nebuliser delivery. Holding chambers may have some advantages compared to nebulisers for children with acute asthma.

Acute Disease↗
PubMed2000

Early use of inhaled corticosteroids in the emergency department treatment of acute asthma.

BACKGROUND: Systemic corticosteroids therapy is central to the management of acute asthma The use of inhaled steroids may also be beneficial in this setting. OBJECTIVES: To determine the benefit of ICS for the treatment of patients with acute asthma managed in the emergency department (ED). SEARCH STRATEGY: Randomised controlled trials (RCTs) were identified from the Cochrane Airways Review Group register. Bibliographies from included studies, known reviews, and texts also were searched. SELECTION CRITERIA: Only RCTs or quasi-randomised trials were eligible for inclusion. Studies were included if patients presented with acute asthma to the ED or its equivalent, and were treated with ICS or placebo, in addition to standard therapy. Two reviewers independently selected potentially relevant articles, and then independently selected articles for inclusion. Methodological quality was independently assessed by two reviewers. DATA COLLECTION AND ANALYSIS: Data were extracted independently by two reviewers if the authors were unable to verify the validity of extracted information. Missing data were obtained from the authors or calculated from other data presented in the paper. MAIN RESULTS: Seven trials were selected for inclusion, but data were not available for one of them. In the six usable rials, (4 adult, 2 paediatric), a total of 352 patients were studied (179 ICS, 173 non-ICS treated). Patients treated with ICS were less likely to be admitted to hospital (OR: 0.30; 95% CI: 0.16, 0.57). This benefit was confined to patients not receiving concomitant systemic steroids. Such patients showed the same, but non-significant, trend towards reduced admissions compared to placebo treatment (OR 0.46; 95% CI: 0. 19, 1.11). In children, ICS appeared to be at least as effective as systemic steroids (OR 0.5; 95% CI: 0.24, 1.06). Patients receiving ICS demonstrated small, significant improvements in peak expiratory flows (PEFR WMD: 7%; 95% CI: 3, 13) and forced expiratory volumes (FEV-FEV1 WMD: 5.0%; 95% CI: 0.4, 9.7). The treatment was well tolerated, with few reported adverse side effects. REVIEWER'S CONCLUSIONS: Inhaled steroids reduced admission rates in patients with acute asthma who were not receiving concomitant systemic steroids. In children, inhaled steroids appear to be at least as effective as systemic steroids. Further research is needed to clarify the effect of ICS when used in addition to systemic corticosteroids, and to determine the optimal dose, agent, and frequency of ICS administration.

Acute Disease↗
PubMed2002

Nocturnal awakening caused by asthma in children with mild-to-moderate asthma in the childhood asthma management program.

BACKGROUND: Nocturnal symptoms of asthma are a cause of significant morbidity and are included as a central feature in the categorization of asthma severity. OBJECTIVES: Data from the Childhood Asthma Management Program were used to estimate the prevalence of nocturnal awakenings in 1041 children with mild-to-moderate asthma and to investigate the relationships between awakenings and peak flows, severity of asthma, and allergen sensitivity and exposure. METHODS: Daily diary care data were recorded during a 28-day interval in the Childhood Asthma Management Program screening process. The data on morning and evening peak flows, overall symptom codes, albuterol use for symptoms, and nocturnal awakenings for asthma symptoms were analyzed and compared with measures of personal characteristics, pulmonary function, and environmental characteristics of the patients. RESULTS: Three hundred fifty-one (33.7%) children experienced 1 or more night awakenings caused by asthma during the 28-day screening period while not taking any maintenance medications. Greater risk of night awakening was associated with more severe asthma (greater responsiveness to bronchodilator, airway reactivity to methacholine, peak flow variability, and use of albuterol for symptoms, all P <.0001) and atopy (increased IgE and allergy skin test reactivity, both P =.0002). Those with a positive skin test response to dog and a high level of dog allergen in the home had a greater risk of night awakening caused by asthma (P =.01), as did those with a positive skin test response to cat and a high level of cat allergen in the home (P =.04). Mean daily symptom code and use of albuterol for asthma symptoms increased in the 3 days immediately before a single awakening compared with in the 4 to 6 days before the awakening (P =.02 and P =.01, respectively); however, both morning and evening peak flows as a percentage of personal best were similar in both intervals. Mean daily symptom code and daily use of albuterol were greater in the 3 days after an awakening than in the 3 days before (P <.0001 and P =.0002, respectively). Mean evening peak flow percentage of personal best the day after an episode of awakening was lower when a second consecutive awakening occurred than when there was only a single awakening (P =.01). CONCLUSIONS: Nocturnal awakening occurred in one third of the children with mild-to-moderate asthma during a month of relative stability and appears to be an indicator of asthma that is becoming increasingly severe.

Albuterol↗
PubMed2000

Manual therapy for asthma.

BACKGROUND: A variety of manual therapies with similar postulated biologic mechanisms of action are commonly used to treat patients with asthma. Manual therapy practitioners are also varied, including physiotherapists, respiratory therapists, chiropractic and osteopathic physicians. A systematic review across disciplines is warranted. OBJECTIVES: To evaluate the evidence for the effects of manual therapies for treatment of patients with bronchial asthma. SEARCH STRATEGY: Trials were searched in computerized general (EMBASE, CINAHL and MEDLINE) and specialized databases (Cochrane Complementary Medicine Field, Cochrane Rehabilitation Field, ICL, and MANTIS). In addition, bibliographies from included studies were assessed, and authors of known studies were contacted for additional information about published and unpublished trials. Date of most recent search: December 1998. SELECTION CRITERIA: Trials were included if they: (1) were randomised; (2) included asthmatic children or adults; (3) examined one or more types of manual therapy; and (4) included clinical outcomes. DATA COLLECTION AND ANALYSIS: All three reviewers independently extracted data and assessed trial quality using a standard form. MAIN RESULTS: From an initial 316 unique citations, 48 full text articles were retrieved and evaluated, which resulted in nine citations to five RCTs (290 patients) suitable for inclusion. Trials could not be pooled statistically because studies that addressed similar interventions used disparate patient groups or outcomes. The methodological quality of one of two trials examining chiropractic manipulation was good and neither trial found significant differences between chiropractic spinal manipulation and a sham manoeuvre on any of the outcomes measured. Quality of the remaining three trials was poor. One small trial compared massage therapy with a relaxation control group and found significant differences in many of the lung function measures obtained. However, this trial had poor reporting characteristics and the data have yet to be confirmed. One small trial compared chest physiotherapy to placebo and one small trial compared footzone therapy to a no treatment control. Neither trial found differences in lung function between groups. REVIEWER'S CONCLUSIONS: There is insufficient evidence to support the use of manual therapies for patients with asthma. There is a need to conduct adequately-sized RCTs that examine the effects of manual therapies on clinically relevant outcomes. Future trials should maintain observer blinding for outcome assessments, and report on the costs of care and adverse events. Currently, there is insufficient evidence to support or refute the use of manual therapy for patients with asthma.

Adult↗
PubMed1993

Skin eosinophilia in patients with allergic asthma, patients with nonallergic asthma, and healthy controls. II: 20-Hydroxy-leukotriene B4 is a potent in vivo and in vitro eosinophil chemotactic factor in nonallergic asthma.

BACKGROUND: In allergic and nonallergic asthma, eosinophils play an important effector role. However, because the pathogenesis of these types of asthma seems different, the mechanisms responsible for the tissue mobilization of those cells may be different. The in vivo and in vitro migratory response of eosinophils from patients with allergic and nonallergic asthma toward 20-hydroxy-leukotriene B4 (20-OH-LTB4), which is reported here, illustrates this. METHODS: By means of the Rebuck skin window technique the in vivo skin mobilizing capacity of intracutaneously applied buffer, LTB4, and 20-hydroxy (OH)-LTB4 was evaluated in healthy subjects (n = 6), subjects with allergic asthma (n = 14), and subjects with nonallergic asthma (n = 17). Also the in vitro chemotactic responsiveness of eosinophils from the circulation of both patient groups (both n = 8) toward buffer, LTB4, and 20-OH-LTB4 were tested by use of a microchemotaxis chamber technique. RESULTS: Although none of the substances were capable of inducing macroscopic observable skin reactions, intracutaneously applied 20-OH-LTB4 had an almost similar capacity to mobilize eosinophils in the skin of the subjects with nonallergic asthma as allergens had in subjects with allergic asthma. In 92% of the tested subjects with nonallergic asthma significant skin eosinophilia was observed. By contrast, LTB4 did not induce significant skin eosinophilia in both patient groups compared with buffer solution. This in vivo eosinophil mobilizing capacity of 20-OH-LTB4 in subjects with nonallergic asthma was confirmed by in vitro chemotaxis studies. Dose ranges of both LTB4 and 20-OH-LTB4 proved to be potent chemoattractants for eosinophils from patients with nonallergic asthma, but not for those of healthy subjects and those with allergic asthma. CONCLUSIONS: Our results indicate that 20-OH-LTB4 may be involved in the tissue mobilization of eosinophils in nonallergic asthma and that in vitro 20-OH-LTB4 (and LTB4) may act as potent chemotactic factors on eosinophils from those patients.

Adult↗
PubMed2000

Relationships of active smoking to asthma and asthma severity in the EGEA study. Epidemiological study on the Genetics and Environment of Asthma.

The role of smoking as potential risk factor, selection factor ("healthy smoker" effect) and modifying factor (severity) of asthma was studied in the Epidemiological study on the Genetics and Environment of Asthma, bronchial hyperresponsiveness and atopy (EGEA). The analysis involved 200 adult asthmatic cases recruited in chest clinics, 265 nonasthmatic controls and 586 relatives of asthmatics (147 with asthma). Asthma in childhood was not associated with a reduced take-up of smoking (odds ratio (OR)=1.06 in males and 0.98 in females), but smoker asthmatic cases quit more often than controls (OR = 2.20 (95% confidence interval (95% CI) 1.11-4.34) in males and 2.76 (1.19-6.42) in females). Adult onset asthma was unrelated to ever smoking (OR 1.07 in males and 1.02 in females). In asthmatic cases, active smoking was associated with asthma severity. Current smokers, compared to never and exsmokers, had more asthma symptoms, more frequent (> or =1 attack x day(-1)) asthma attacks (OR 2.39 (95% CI 1.06-5.36)) and higher asthma severity scores. No clear pattern regarding the relationships of smoking habits with asthma was observed in first degree relatives. It is concluded that active smoking is not a risk factor for asthma in adulthood, but that smoking increases asthma severity.

Adolescent↗
PubMedDate not supplied

Asthma in adolescents: a randomized, controlled trial of an asthma program for adolescents and young adults with severe asthma.

BACKGROUND: Asthma is common and is often poorly controlled in adolescent subjects. OBJECTIVE: To determine the impact of an age-specific asthma program on asthma control, particularly on exacerbations of asthma requiring emergency department treatment, and on the quality of life of adolescents with asthma. METHODS: The present randomized, controlled trial included patients who were 15 to 20 years of age and had visited emergency departments for management of their asthma. The interventional group attended an age-specific asthma program that included assessment, education and management by a team of asthma educators, respiratory therapists and respiratory physicians. In the control group, spirometry was performed, and the patients continued to receive usual care from their regular physicians. The outcomes were assessed by a questionnaire six months after entry into the study. RESULTS: Ninety-three subjects entered the study and were randomly assigned to the intervention or control group. Of these, only 62 patients were available for review after six months. Subjects in both the control and the intervention groups showed a marked improvement in their level of asthma control, reflected primarily by a 73% reduction in the rate of emergency department attendance for asthma. Other indexes of disease control, including disease-specific quality of life, as assessed by questionnaires, were improved. There was, however, no discernible difference between the subjects in the two groups, with the exception of an improvement in favour of the intervention group in the symptom (actual difference 0.7, P=0.048) and emotional (actual difference 0.8, P=0.028) domains of the asthma quality of life questionnaire. The overall quality of life score favoured the intervention group by a clinically relevant difference of 0.6, but this difference did not reach statistical significance (P=0.06). CONCLUSIONS: Although all subjects demonstrated a significant improvement in asthma control and quality of life, the improvement attributable to this intervention was limited to two domains in disease-specific quality of life.

Adolescent↗
PubMed2000

House dust mite control measures for asthma.

BACKGROUND: The major allergen in house dust comes from mites. Chemical, physical and combined methods of reducing mite allergen levels are intended to reduce asthma symptoms in people who are sensitive to house dust mites. OBJECTIVES: The objective of this review was to assess the effects of reducing exposure to house dust mite antigens in the homes of mite-sensitive asthmatics. SEARCH STRATEGY: We searched the Cochrane Airways Group trials register, checked reference lists of articles and hand-searched Respiration (1980 to 1996) and Clinical and Experimental Allergy (1980 to 1996). SELECTION CRITERIA: Randomised trials of mite control measures in asthmatic people known to be sensitive to house dust mites. DATA COLLECTION AND ANALYSIS: Two reviewers applied the trial inclusion criteria and extracted the data independently. One reviewer applied the trial quality assessment criteria. Study authors were contacted to clarify information. MAIN RESULTS: Twenty-three trials were included, with four trials awaiting assessment. There was little difference in improvement of asthma between people in experimental groups compared to control groups (odds ratio 1.2, 95% confidence interval 0.66 to 2.18). Asthma symptom scores were also similar for the experimental and control groups (standardised mean difference -0. 06, 95% confidence interval -0.54 to 0.41). These scores showed a high degree of heterogeneity. No significant difference was noted for medication usage (standardised mean difference -0.14, 95% confidence interval -0.43 to 0.15). Peak flow in the morning showed no significant difference between the experimental and the control groups (standardised mean difference -0.03, 95% confidence interval -0.25 to 0.19). REVIEWER'S CONCLUSIONS: Current chemical and physical methods aimed at reducing exposure to house dust mite allergens seem to be ineffective and cannot be recommended as prophylaxis for mite sensitive asthmatics.

Allergens↗
PubMed1999

Australian divisions of general practice asthma survey 1997. General Practitioner's Asthma Group of the National Asthma Campaign.

AIM: To conduct an attitudinal postal survey of all 118 divisions of general practice known to the National Asthma Campaign. METHOD: A questionnaire aimed to determine the perceived barriers to improved asthma care in the divisions, current asthma projects and the most suitable way that the General Practitioners Asthma Group (GPAG) and the National Asthma Campaign (NAC) could assist divisions of general practice. RESULTS: Eighty seven (74%) replies were received. Twenty-four divisions (28%) were running asthma projects, mostly about asthma education. The greatest barrier to asthma care for the doctor was a lack of time (57% of respondents) and the greatest barrier for the patient was perceived to be a lack of asthma education (34% of respondents). Asthma educators employed by the division or individual surgeries were ranked as the preferred method for overcoming these difficulties. CONCLUSIONS: Divisions of general practice are becoming involved in the management of asthma throughout Australia although there are considerable hurdles to overcome. The role of the GPAG and NAC in this process is discussed.

Asthma↗
PubMed2001

The prevalence of environmental exposure to perceived asthma triggers in children with mild-to-moderate asthma: data from the Childhood Asthma Management Program (CAMP).

BACKGROUND: The Childhood Asthma Management Program, a 5-year randomized clinical trial of treatments for childhood asthma, has enrolled and characterized a cohort of 1041 children with mild-to-moderate asthma. OBJECTIVE: We sought to describe self-reported sensitivities and environmental exposures and investigate the relationships between self-report of these exposures as asthma triggers and their prevalence in the home. METHODS: Self-reports of sensitivities and home exposures were obtained by interview with the child or parent. Sensitivities were further assessed by using allergy skin testing (prick or puncture) against a core battery of allergens. Home exposures were further assessed by using analysis of a home dust sample. RESULTS: Environmental exposures were surprisingly common despite self-reported sensitivities to environmental factors. Of patients reporting that cigarette smoking frequently causes asthma symptoms, 26% reported having at least one parent who smokes cigarettes. Thirty-nine percent of patients reporting that exposure to animals frequently causes asthma symptoms live with a furry pet in their home. We found a smaller proportion of homes with a high level of cat allergen (P <.001) among the children who reported that animals frequently or always trigger asthma symptoms compared with those who reported that animals never or occasionally trigger asthma symptoms, suggesting modification of the home environment. No such results were seen for dog exposure. However, clinical symptoms did not reduce exposure to parental cigarette smoking (P =.15), house dust (P =.31), or damp and musty areas (P =.51). CONCLUSION: These data suggest that children with mild-to-moderate asthma are frequently symptomatic and exposed to a wide variety of environmental exposures that are perceived to trigger symptoms by means of self-report. Although environmental modification of asthmatic homes may occur, many children remain exposed to agents that are known to trigger their asthma.

Asthma↗
PubMed2000

Neurocognitive functioning in children with mild and moderate asthma in the childhood asthma management program. The Childhood Asthma Management Program (CAMP) Research Group.

BACKGROUND: The Childhood Asthma Management Program (CAMP) is a multicenter double-blind, randomized, placebo-controlled, clinical trial of two anti-inflammatory agents and placebo in children with mild and moderate asthma. OBJECTIVE: The interrelationship between asthma severity and neurocognitive functioning among 1041 children (age range, 5-12 years) enrolled in the CAMP trial was examined. METHODS: Asthma severity was established at baseline with a clinical history of asthma symptomatology and measures of lung function (spirometry and methacholine challenge). Diary cards were used in a screening to record nighttime awakenings and doctor contacts caused by asthma symptoms, symptom severity, and number of puffs from a rescue inhaler. All children received a comprehensive neurocognitive assessment at the end of the 28-day screening period (before randomization), including measures of intelligence, attention, memory, and academic achievement. RESULTS: Significant differences were found between children with mild and moderate asthma on lung function and symptom outcome variables (log(e)FEV(1)PC(20), DeltaFEV(1) percent predicted, change in peak flow percent predicted, nighttime awakenings caused by asthma, average symptom severity score, and average daily number of puffs from a rescue inhaler) but not on neurocognitive variables. Multiple regression analyses revealed that asthma outcomes could not be predicted by neurocognitive variables despite controlling for socioeconomic status. The prevalence of neurocognitive dysfunction, as indicated by the use of psychostimulant medication, was found to be consistent with that found in the existing literature. CONCLUSION: Mild and moderate asthma symptoms are not related to neurocognitive functioning in the children enrolled in CAMP. Mean performance on neurocognitive variables was found to be similar to that of national normative data.

Asthma↗
PubMed1996

[European study on asthma. Prevalence of bronchial hyperreactivity and asthma in young adults from 5 Spanish areas. Spanish Group of the European Study on Asthma].

BACKGROUND: The European Study on Asthma is a multicentric survey designed to determine variations in the prevalence of asthma and its determinants in Europe. The first phase of the study in Spain, by means of a short questionnaire, allowed to estimate the prevalence of symptoms related to asthma in representative samples of five Spanish areas: Albacete, Barcelona, Galdakao, Huelva and Oviedo. MATERIAL AND METHODS: The annual prevalence of symptoms related to asthma was determined with a respiratory questionnaire adapted from the IUATLD questionnaire. Participants performed a forced spirometry and bronchial hyperresponsiveness was measured through a methacholine challenge. A hyperreactive individual was defined as a subject with a fall in FEV1 of 20% or more during the challenge (cumulative dose of inhaled methacholine of 5.117 mumols) or extrapolating to 8 mumols. RESULTS: The prevalence of bronchial hyperresponsiveness ranged from 8.3% in Galdakao (95% CI 5.5-11.2) to 31.7% in Albacete (95% CI 28.6-36.6). The prevalence of asthma, defined as presence of bronchial hyperresponsiveness and symptoms related to asthma was: 4.7% in Albacete (95% CI 2.4-6.9); 3.5% in Barcelona (95% CI 0.7-6.2); 1.1% in Galdakao (95% CI 0.0-2.2); 1.0 in Huelva (95% CI 0.0-2.2); and 1.7 in Oviedo (95% CI 0.0-3.3). Different definitions of asthma produced variations of 3.1 to 4.7 fold in the prevalence of asthma between the five participating areas. CONCLUSIONS: Asthma is a common disorder in Spain and there are substantial variations in the prevalence of bronchial hyperresponsiveness and asthma between the five Spanish areas surveyed.

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