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Sample records for adult asthma patients

  1. Clinical profile of patients with adult-onset eosinophilic asthma

    PubMed Central

    Storm, Huib; Amelink, Marijke; de Nijs, Selma B.; Eichhorn, Edwin; Reitsma, Bennie H.; Bel, Elisabeth H.D.; ten Brinke, Anneke

    2016-01-01

    Adult-onset eosinophilic asthma is increasingly recognised as a severe and difficult-to-treat subtype of asthma. In clinical practice, early recognition of patients with this asthma subtype is important because it may have treatment implications. Therefore, physicians need to know the distinct characteristics of this asthma phenotype. The objective of the present study was to determine the characteristic profile of patients with adult-onset eosinophilic asthma. 130 patients with adult-onset (>18 years of age) asthma and high blood eosinophil counts (≥0.3×109 L−1) were compared with 361 adult-onset asthma patients with low (<0.3×109 L−1) blood eosinophils. Measurements included a series of clinical, functional and imaging parameters. Patients with high blood eosinophils were more often male, had less well controlled asthma and higher exacerbation rates, despite the use of higher doses of inhaled corticosteroids. They had higher levels of total IgE without more sensitisation to common inhaled allergens. In addition, these patients had worse lung function, and more often showed fixed airflow limitation, air trapping, nasal polyposis and abnormalities on sinus computed tomography scanning. Chronic rhinosinusitis, air trapping and male sex were three independent factors associated with blood eosinophilia (adjusted OR 3.8 (95% CI 1.7–8.1), 3.0 (95% CI 1.1–8.1) and 2.4 (95% CI 1.3–4.4), respectively). Patients with adult-onset asthma with elevated blood eosinophils exhibit a distinct profile, which can readily be recognised in clinical practice. PMID:27730197

  2. Study of inhaler technique in asthma patients: differences between pediatric and adult patients

    PubMed Central

    Manríquez, Pablo; Acuña, Ana María; Muñoz, Luis; Reyes, Alvaro

    2015-01-01

    Objective: Inhaler technique comprises a set of procedures for drug delivery to the respiratory system. The oral inhalation of medications is the first-line treatment for lung diseases. Using the proper inhaler technique ensures sufficient drug deposition in the distal airways, optimizing therapeutic effects and reducing side effects. The purposes of this study were to assess inhaler technique in pediatric and adult patients with asthma; to determine the most common errors in each group of patients; and to compare the results between the two groups. Methods: This was a descriptive cross-sectional study. Using a ten-step protocol, we assessed inhaler technique in 135 pediatric asthma patients and 128 adult asthma patients. Results: The most common error among the pediatric patients was failing to execute a 10-s breath-hold after inhalation, whereas the most common error among the adult patients was failing to exhale fully before using the inhaler. Conclusions: Pediatric asthma patients appear to perform most of the inhaler technique steps correctly. However, the same does not seem to be true for adult patients. PMID:26578130

  3. Asthma in adults (acute)

    PubMed Central

    2011-01-01

    Introduction About 10% of adults have suffered an attack of asthma, and up to 5% of these have severe disease that responds poorly to treatment. Patients with severe disease have an increased risk of death, but patients with mild to moderate disease are also at risk of exacerbations. Most guidelines about the management of asthma follow stepwise protocols. This review does not endorse or follow any particular protocol, but presents the evidence about specific interventions. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for acute asthma? We searched: Medline, Embase, The Cochrane Library, and other important databases up to April 2010 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 100 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: beta2 agonists (plus ipratropium bromide, pressured metered-dose inhalers, short-acting continuous nebulised, short-acting intermittent nebulised, short-acting iv, and inhaled formoterol); corticosteroids (inhaled); corticosteroids (single oral, combined inhaled, and short courses); education about acute asthma; generalist care; helium–oxygen mixture (heliox); magnesium sulphate (iv and adding isotonic nebulised magnesium to inhaled beta2 agonists); mechanical ventilation; oxygen supplementation (controlled 28% oxygen and controlled 100% oxygen); and specialist care. PMID:21463536

  4. Prevalence and risk factors for depression in Korean adult patients with asthma: is there a difference between elderly and non-elderly patients?

    PubMed

    Choi, Gil-Soon; Shin, Yoo Seob; Kim, Joo-Hee; Choi, Seon Yoon; Lee, Soo-Keol; Nam, Young-Hee; Lee, Young-Mok; Park, Hae-Sim

    2014-12-01

    Depression is an important comorbidity of asthma. However, little information is available about depression and its potential impact on asthma control in Korean adult asthma patients. We aimed to estimate the prevalence and risk factors for depression in Korean adults with persistent asthma. The 127 non-elderly (20-64 yr) and 75 elderly (≥65 yr) patients with asthma were recruited. Demographic and clinical data were extracted, and the patients completed the Asthma Specific Quality of Life (AQOL) questionnaire and asthma control test (ACT). Depression status was defined using the Korean version of the Patient Health Questionnaire-9 (PHQ-9). Depression was more prevalent in non-elderly (18.9%) than in elderly patients with asthma (13.3%). Patients with depression were significantly younger, had lower economic status, shorter disease duration, poorer asthma control, and worse AQOL scores (P<0.05). Within the non-elderly group, younger age and shorter disease duration were significantly associated with depression (P<0.05). Within the elderly group, a higher body mass index and current smoking status were significantly associated with depression (P<0.05). The PHQ-9 score was significantly correlated with worse ACT and AQOL scores in both groups. In conclusion, depression is strongly associated with poor asthma control and quality of life in Korean adult asthma patients. Our results provide important clues that used to target modifiable factors which contribute to development of depression in asthma patients.

  5. The effectiveness of one-on-one nurse education on the outcomes of high-risk adult and pediatric patients with asthma.

    PubMed

    Forshee, J D; Whalen, E B; Hackel, R; Butt, L T; Smeltzer, P A; Martin, J; Lavin, P T; Buchner, D A

    1998-12-01

    The effects of an asthma self-management program on asthma outcomes were evaluated in adult and pediatric patients with asthma who were considered at high risk (i.e., those who were not in control of their disease as determined by resource utilization, medication use, or lack of use). The program consisted of one-on-one nurse-to-patient ("nurse champion") education and subsequent assessment of asthma outcomes using the Asthma Quality Assessment System (AQAS) questionnaire, which measured asthma severity, patient quality of life, asthma awareness and knowledge, confidence in managing asthma, use of peak flow meters, asthma symptoms, medication use, lost work or school days, and affect of asthma. Over the course of six months, nurse champions educated 201 patients from four managed care plans and collected data at baseline and during four follow-up sessions. Adult patients and pediatric patient caregivers reported significant improvements in quality of life, and clinical and process measures. Significant increases in asthma knowledge were observed immediately after patient education, including greater than 89% increase in the proportion of patients who reported that they know "a lot" about the "things that cause asthma symptoms." Significant decreases were also found in work or school days missed, urgent care utilization, and hospital admission rates. Appropriate preventive care visits increased by more than 40%. These results indicate that the nurse champion program was associated with an improvement in asthma outcomes in high-risk adult and pediatric patients and warrant further evaluation in controlled studies. Incorporating one-on-one education programs into asthma management is an effective and rapid means of improving asthma outcomes.

  6. Randomised controlled trial of montelukast plus inhaled budesonide versus double dose inhaled budesonide in adult patients with asthma

    PubMed Central

    Price, D; Hernandez, D; Magyar, P; Fiterman, J; Beeh, K; James, I; Konstantopoulos, S; Rojas, R; van Noord, J A; Pons, M; Gilles, L; Leff, J

    2003-01-01

    Background: Inhaled corticosteroids (ICS) affect many inflammatory pathways in asthma but have little impact on cysteinyl leukotrienes. This may partly explain persistent airway inflammation during chronic ICS treatment and failure to achieve adequate asthma control in some patients. This double blind, randomised, parallel group, non-inferiority, multicentre 16 week study compared the clinical benefits of adding montelukast to budesonide with doubling the budesonide dose in adults with asthma. Methods: After a 1 month single blind run in period, patients inadequately controlled on inhaled budesonide (800 µg/day) were randomised to receive montelukast 10 mg + inhaled budesonide 800 µg/day (n=448) or budesonide 1600 µg/day (n=441) for 12 weeks. Results: Both groups showed progressive improvement in several measures of asthma control compared with baseline. Mean morning peak expiratory flow (AM PEF) improved similarly in the last 10 weeks of treatment compared with baseline in both the montelukast + budesonide group and in the double dose budesonide group (33.5 v 30.1 l/min). During days 1–3 after start of treatment, the change in AM PEF from baseline was significantly greater in the montelukast + budesonide group than in the double dose budesonide group (20.1 v 9.6 l/min, p<0.001), indicating faster onset of action in the montelukast group. Both groups showed similar improvements with respect to "as needed" ß agonist use, mean daytime symptom score, nocturnal awakenings, exacerbations, asthma free days, peripheral eosinophil counts, and asthma specific quality of life. Both montelukast + budesonide and double dose budesonide were generally well tolerated. Conclusion: The addition of montelukast to inhaled budesonide is an effective and well tolerated alternative to doubling the dose of inhaled budesonide in adult asthma patients experiencing symptoms and inadequate control on budesonide alone. PMID:12612295

  7. The Efficacy and Safety of Antiinterleukin 13, a Monoclonal Antibody, in Adult Patients With Asthma

    PubMed Central

    Luo, Jian; Liu, Dan; Liu, Chun-Tao

    2016-01-01

    Abstract Effects of antiinterleukin 13 therapies in patients with asthma remain inconsistent. Therefore, we aimed to further clarify the efficacy and safety of antiinterleukin 13 therapies in adult asthmatics by a systematic review and meta-analysis. Randomized controlled trials which reported pulmonary functions, fraction of exhaled nitric oxide (FeNO), Asthma Control Questionnaire (ACQ), rescue use of short-acting-β-agonist (SABA), and rate of asthmatic exacerbation and adverse events were identified in Pubmed, Embase, Medline, Cochrane Central Register of Controlled Trials (CENTRAL), American College of Physician (ACP) Journal Club, and ISI Web of Science, reference lists and by manual searches. Randomized-effect models were used in meta-analysis to calculate pooled mean difference and relative risks (RR). Eight studies with 957 patients were enrolled. Systematic review showed that treatment with antiinterleukin 13 antibodies could significantly improve peak expiratory flow (PEF), decrease FeNO and asthmatic exacerbation, but could not decrease blood and sputum eosinophil levels, improve FEV1, inhibit methacholine PC20, or reduce ACQ scores. Two studies reported opposite results in reducing rescue use of SABA. Meta-analysis showed that antiinterleukin 13 monoclonal therapies could significantly decrease asthmatic exacerbation (RR 0.55, 95% CI: 0.31–0.96, z = 2.10, P = 0.04), but did not significantly improve the FEV1 (95% CI: −1.03 to 2.22, z = 0.72, P = 0.47) or increasing adverse events (RR 1.00, 95% CI: 0.91–1.10, z = 0.00, P = 1.00). Antiinterleukin 13 monoclonal therapies could be safely used to improve PEF, decrease FeNO and asthmatic exacerbation, and probably reduce rescue use of SABA, but could not decrease blood and sputum eosinophil levels, improve FEV1, inhibit methacholine PC20, or reduce ACQ scores. PMID:26871775

  8. Environment and asthma in adults.

    PubMed

    Le Moual, Nicole; Jacquemin, Bénédicte; Varraso, Raphaëlle; Dumas, Orianne; Kauffmann, Francine; Nadif, Rachel

    2013-09-01

    The present review addresses recent advances and especially challenging aspects regarding the role of environmental risk factors in adult-onset asthma, for which the causes are poorly established. In the first part of the review, we discuss aspects regarding some environmental risk factors for adult-onset asthma: air pollution, occupational exposures with a focus on an emerging risk represented by exposure to cleaning agents (both at home and in the workplace), and lifestyle and nutrition. The second part is focused on perspectives and challenges, regarding relevant topics on which research is needed to improve the understanding of the role of environmental factors in asthma. Aspects of exposure assessment, the complexity of multiple exposures, the interrelationships of the environment with behavioral characteristics and the importance of studying biological markers and gene-environment interactions to identify the role of the environment in asthma are discussed. We conclude that environmental and lifestyle exposures play an important role in asthma or related phenotypes. The changes in lifestyle and the environment in recent decades have modified the specific risk factors in asthma even for well-recognized risks such as occupational exposures. To better understand the role of the environment in asthma, the use of objective (quantitative measurement of exposures) or modern tools (bar code, GPS) and the development of multidisciplinary collaboration would be very promising. A better understanding of the complex interrelationships between socio-economic, nutritional, lifestyle and environmental conditions might help to study their joint and independent roles in asthma.

  9. Pathophysiology, diagnosis, and clinical assessment of asthma in the adult.

    PubMed

    Killeen, Kathryn; Skora, Elizabeth

    2013-03-01

    Asthma is a chronic inflammatory disorder that is characterized by 3 distinct responses in the airways: inflammation, hyperresponsiveness, and remodeling. Clinical diagnosis of asthma is often based on the presence of symptoms, such as cough, wheeze, breathlessness, and chest tightness; but the presence of these symptoms is not exclusive to asthma, and clinical correlation with spirometry and other diagnostic testing is essential. Once a diagnosis of asthma is established, the focus of care should be toward control of the disease. This article discusses the pathophysiology, diagnosis, and clinical assessment of asthma in the adult patient population.

  10. Differences in the effects of Asian dust on pulmonary function between adult patients with asthma and those with asthma–chronic obstructive pulmonary disease overlap syndrome

    PubMed Central

    Watanabe, Masanari; Noma, Hisashi; Kurai, Jun; Sano, Hiroyuki; Ueda, Yasuto; Mikami, Masaaki; Yamamoto, Hiroyuki; Tokuyasu, Hirokazu; Kato, Kazuhiro; Konishi, Tatsuya; Tatsukawa, Toshiyuki; Shimizu, Eiji; Kitano, Hiroya

    2016-01-01

    Background Asian dust (AD) exposure exacerbates pulmonary dysfunction in patients with asthma. Asthma–chronic obstructive pulmonary disease overlap syndrome (ACOS), characterized by coexisting symptoms of asthma and chronic obstructive pulmonary disease, is considered a separate disease entity. Previously, we investigated the effects of AD on pulmonary function in adult patients with asthma. Here, we present the findings of our further research on the differences in the effects of AD exposure on pulmonary function between patients with asthma alone and those with ACOS. Methods Between March and May 2012, we conducted a panel study wherein we monitored daily peak expiratory flow (PEF) values in 231 adult patients with asthma. These patients were divided into 190 patients with asthma alone and 41 patients with ACOS in this study. Daily AD particle levels were measured using light detection and ranging systems. Two heavy AD days (April 23 and 24) were determined according to the Japan Meteorological Agency definition. A linear mixed model was used to estimate the association between PEF and AD exposure. Results Increments in the interquartile range of AD particles (0.018 km−1) led to PEF changes of −0.50 L/min (95% confidence interval, −0.98 to −0.02) in patients with asthma alone and −0.11 L/min (−0.11 to 0.85) in patients with ACOS. The PEF changes after exposure to heavy AD were −2.21 L/min (−4.28 to −0.15) in patients with asthma alone and −2.76 L/min (−6.86 to 1.35) in patients with ACOS. In patients with asthma alone, the highest decrease in PEF values was observed on the heavy AD day, with a subsequent gradual increase over time. Conclusion Our results suggest that the effects of AD exposure on pulmonary function differ between patients with asthma alone and ACOS, with the former exhibiting a greater likelihood of decreased pulmonary function after AD exposure. PMID:26869784

  11. Associated Markers for Adult-onset Allergic Asthma.

    PubMed

    Bedolla-Barajas, Martín; Morales-Romero, Jaime; Ramses-Bedolla-Pulido, Tonatiuh; Fabiola-García-Padilla, Lourdes; Hernández-Colín, Dante

    2015-10-01

    The clinical behavior of asthma varies with age at onset. This study was undertaken to identify associated markers of adult-onset allergic asthma (age ≥20 years).This cross-sectional study compared two groups: 58 patients with asthma onset at ≥20 years and 66 with onset at ≥20 years. They were compared depending on results of clinical history, and body mass index (BMI), aeroallergen sensitization, total serum IgE, eosinophil count, asthma control test, and asthma severity level.Ages at first asthma episode were 10.0 ± 6.6 and 33.4 ± 10.5 (p<0.001) in the <20 and ≥20 group, respectively. BMI was higher in adult asthmatic subjects (29.8 versus 27.1, P=0.017), but BMI ≥30 kg/m(2) was not associated with asthma onset in ≥20 years (odds ratio [OR] = 1.56, 95% confidence interval [CI] 0.759 to 3.211; p= 0.227). After multivariate analysis, allergic rhinitis and IgE ≥150 IU/mL were negatively correlated with asthma onset in ≥20 years old (OR adjusted [ORa] = 0.255, 95% CI 0.078 to 0.837, P= 0.024, and ORa =0.385, 95% CI 0.175 to 0.849, p= 0.018, respectively).Adult-onset allergic asthma was not different from early-onset asthma. PMID:26742445

  12. Associated Markers for Adult-onset Allergic Asthma.

    PubMed

    Bedolla-Barajas, Martín; Morales-Romero, Jaime; Ramses-Bedolla-Pulido, Tonatiuh; Fabiola-García-Padilla, Lourdes; Hernández-Colín, Dante

    2015-10-01

    The clinical behavior of asthma varies with age at onset. This study was undertaken to identify associated markers of adult-onset allergic asthma (age ≥20 years).This cross-sectional study compared two groups: 58 patients with asthma onset at ≥20 years and 66 with onset at ≥20 years. They were compared depending on results of clinical history, and body mass index (BMI), aeroallergen sensitization, total serum IgE, eosinophil count, asthma control test, and asthma severity level.Ages at first asthma episode were 10.0 ± 6.6 and 33.4 ± 10.5 (p<0.001) in the <20 and ≥20 group, respectively. BMI was higher in adult asthmatic subjects (29.8 versus 27.1, P=0.017), but BMI ≥30 kg/m(2) was not associated with asthma onset in ≥20 years (odds ratio [OR] = 1.56, 95% confidence interval [CI] 0.759 to 3.211; p= 0.227). After multivariate analysis, allergic rhinitis and IgE ≥150 IU/mL were negatively correlated with asthma onset in ≥20 years old (OR adjusted [ORa] = 0.255, 95% CI 0.078 to 0.837, P= 0.024, and ORa =0.385, 95% CI 0.175 to 0.849, p= 0.018, respectively).Adult-onset allergic asthma was not different from early-onset asthma.

  13. Emerging Comorbidities in Adult Asthma: Risks, Clinical Associations, and Mechanisms

    PubMed Central

    Kankaanranta, Hannu; Kauppi, Paula; Tuomisto, Leena E.; Ilmarinen, Pinja

    2016-01-01

    Asthma is a heterogeneous disease with many phenotypes, and age at disease onset is an important factor in separating the phenotypes. Most studies with asthma have been performed in patients being otherwise healthy. However, in real life, comorbid diseases are very common in adult patients. We review here the emerging comorbid conditions to asthma such as obesity, metabolic syndrome, diabetes mellitus type 2 (DM2), and cardiac and psychiatric diseases. Their role as risk factors for incident asthma and whether they affect clinical asthma are evaluated. Obesity, independently or as a part of metabolic syndrome, DM2, and depression are risk factors for incident asthma. In contrast, the effects of comorbidities on clinical asthma are less well-known and mostly studies are lacking. Cross-sectional studies in obese asthmatics suggest that they may have less well controlled asthma and worse lung function. However, no long-term clinical follow-up studies with these comorbidities and asthma were identified. These emerging comorbidities often occur in the same multimorbid adult patient and may have in common metabolic pathways and inflammatory or other alterations such as early life exposures, systemic inflammation, inflammasome, adipokines, hyperglycemia, hyperinsulinemia, lung mechanics, mitochondrial dysfunction, disturbed nitric oxide metabolism, and leukotrienes. PMID:27212806

  14. Self-care in adults with asthma: how they cope.

    PubMed

    Mäkinen, S; Suominen, T; Lauri, S

    2000-07-01

    The purpose of this study was to find out how well adult asthma patients in Finland cope with self-care in three areas of asthma treatment. The areas of physical, psychological and social asthma treatment were examined. Associations between demographic background data and self-care were also studied. Data (n = 130) for the study were collected using a questionnaire specially developed for this study. A deductive perspective was employed in data analysis. Respondents showed fairly good competence in self-care in all three areas of asthma treatment. However, up to 30% of the asthma patients had pets and 16% were smokers. Extra stress was reduced by exercise and positive thinking. Humour was also important in helping most of the respondents cope mentally. Social support played a significant part in fighting the sense of powerlessness which is caused by asthma. According to the results, women coped better than men in the social area of self-care. PMID:11261136

  15. Lung Disease Including Asthma and Adult Vaccination

    MedlinePlus

    ... Healthcare Professionals Lung Disease including Asthma and Adult Vaccination Language: English Español (Spanish) Recommend on Facebook Tweet ... more about health insurance options. Learn about adult vaccination and other health conditions Asplenia Diabetes Heart Disease, ...

  16. Office Work Exposures and Adult-Onset Asthma

    PubMed Central

    Jaakkola, Maritta S.; Jaakkola, Jouni J.K.

    2007-01-01

    Background Office exposures have been linked to symptoms of sick building syndrome, but their relation to the development of asthma has not been studied previously. These exposures have increasing importance because an increasing proportion of the workforce is working in office environments. Objectives The aim of this study was to assess the relations of exposure to carbonless copy paper (CCP), paper dust, and fumes from photocopiers and printers to adult-onset asthma. Methods We conducted a population-based incident case–control study of adults 21–63 years of age living in the Pirkanmaa District in South Finland. All new clinically diagnosed cases (n = 521) of asthma were recruited during a 3-year study period. A random sample of the source population formed the controls (n = 1,016). This part focused on 133 cases and 316 controls who were office workers according to their current occupation classified by the 1988 International Standard Classification of Occupations. All participants answered a questionnaire on health, smoking, occupation, and exposures at work and home. Subjects with previous asthma were excluded. Results Exposures to paper dust [adjusted odds ratio (OR) = 1.97; 95% confidence interval (CI), 1.25–3.10] and CCP (OR = 1.66; 95% CI, 1.03–2.66) were related to significantly increased risk of adult-onset asthma. An exposure–response relation was observed between exposure to paper dust and risk of asthma. Conclusions This study provides new evidence that exposures to paper dust and CCP in office work are related to increased risk of adult-onset asthma. Reduction of these exposures could prevent asthma in office workers. Clinicians seeing asthma patients should be aware of this link to office exposures. PMID:17637914

  17. Association of Sand Dust Particles with Pulmonary Function and Respiratory Symptoms in Adult Patients with Asthma in Western Japan Using Light Detection and Ranging: A Panel Study.

    PubMed

    Watanabe, Masanari; Noma, Hisashi; Kurai, Jun; Shimizu, Atsushi; Sano, Hiroyuki; Kato, Kazuhiro; Mikami, Masaaki; Ueda, Yasuto; Tatsukawa, Toshiyuki; Ohga, Hideki; Yamasaki, Akira; Igishi, Tadashi; Kitano, Hiroya; Shimizu, Eiji

    2015-10-16

    Light detection and ranging (LIDAR) can estimate daily volumes of sand dust particles from the East Asian desert to Japan. The objective of this study was to investigate the relationship between sand dust particles and pulmonary function, and respiratory symptoms in adult patients with asthma. One hundred thirty-seven patients were included in the study. From March 2013 to May 2013, the patients measured their morning peak expiratory flow (PEF) and kept daily lower respiratory symptom diaries. A linear mixed model was used to estimate the correlation of the median daily levels of sand dust particles, symptoms scores, and PEF. A heavy sand dust day was defined as an hourly concentration of sand dust particles of >0.1 km(-1). By this criterion, there were 8 heavy sand dust days during the study period. Elevated sand dust particles levels were significantly associated with the symptom score (0.04; 95% confidence interval (CI); 0.03, 0.05), and this increase persisted for 5 days. There was no significant association between PEF and heavy dust exposure (0.01 L/min; 95% CI, -0.62, 0.11). The present study found that sand dust particles were significantly associated with worsened lower respiratory tract symptoms in adult patients with asthma, but not with pulmonary function.

  18. Association of Sand Dust Particles with Pulmonary Function and Respiratory Symptoms in Adult Patients with Asthma in Western Japan Using Light Detection and Ranging: A Panel Study

    PubMed Central

    Watanabe, Masanari; Noma, Hisashi; Kurai, Jun; Shimizu, Atsushi; Sano, Hiroyuki; Kato, Kazuhiro; Mikami, Masaaki; Ueda, Yasuto; Tatsukawa, Toshiyuki; Ohga, Hideki; Yamasaki, Akira; Igishi, Tadashi; Kitano, Hiroya; Shimizu, Eiji

    2015-01-01

    Light detection and ranging (LIDAR) can estimate daily volumes of sand dust particles from the East Asian desert to Japan. The objective of this study was to investigate the relationship between sand dust particles and pulmonary function, and respiratory symptoms in adult patients with asthma. One hundred thirty-seven patients were included in the study. From March 2013 to May 2013, the patients measured their morning peak expiratory flow (PEF) and kept daily lower respiratory symptom diaries. A linear mixed model was used to estimate the correlation of the median daily levels of sand dust particles, symptoms scores, and PEF. A heavy sand dust day was defined as an hourly concentration of sand dust particles of >0.1 km−1. By this criterion, there were 8 heavy sand dust days during the study period. Elevated sand dust particles levels were significantly associated with the symptom score (0.04; 95% confidence interval (CI); 0.03, 0.05), and this increase persisted for 5 days. There was no significant association between PEF and heavy dust exposure (0.01 L/min; 95% CI, −0.62, 0.11). The present study found that sand dust particles were significantly associated with worsened lower respiratory tract symptoms in adult patients with asthma, but not with pulmonary function. PMID:26501307

  19. Revisiting early intervention in adult asthma

    PubMed Central

    Selroos, Olof; O'Byrne, Paul M.

    2015-01-01

    The term “early intervention” with inhaled corticosteroids (ICS) in asthma is used in different ways, thereby causing confusion and misinterpretation of data. We propose that the term should be reserved for start of ICS therapy in patients with a diagnosis of asthma but within a short period of time after the first symptoms, not from the date of diagnosis. Prospective clinical studies suggest a time frame of 2 years for the term “early” from the onset of symptoms to starting anti-inflammatory treatment with ICS. The current literature supports early intervention with ICS for all patients with asthma including patients with mild disease, who often have normal or near-normal lung function. This approach reduces symptoms rapidly and allows patients to achieve early asthma control. Later introduction of ICS therapy may not reduce effectiveness in terms of lung function but delays asthma control and exposes patients to unnecessary morbidity. Results of nationwide intervention programmes support the early use of ICS, as it significantly minimises the disease burden. Acute asthma exacerbations are usually preceded by progressing symptoms and lung function decline over a period of 1–2 weeks. Treatment with an increased dose of ICS together with a rapid- and long-acting inhaled β2-agonist during this phase has reduced the risk of severe exacerbations. PMID:27730140

  20. The Importance of Bacterial and Viral Infections Associated with Adult Asthma Exacerbations in Clinical Practice

    PubMed Central

    Iikura, Motoyasu; Hojo, Masayuki; Koketsu, Rikiya; Watanabe, Sho; Sato, Ayano; Chino, Haruka; Ro, Shoki; Masaki, Haruna; Hirashima, Junko; Ishii, Satoru; Naka, Go; Takasaki, Jin; Izumi, Shinyu; Kobayashi, Nobuyuki; Yamaguchi, Sachiko; Nakae, Susumu; Sugiyama, Haruhito

    2015-01-01

    Background Viral infection is one of the risk factors for asthma exacerbation. However, which pathogens are related to asthma exacerbation in adults remains unclear. Objective The relation between various infections and adult asthma exacerbations was investigated in clinical practice. Methods The study subjects included 50 adult inpatients due to asthma exacerbations and 20 stable outpatients for comparison. The pathogens from a nasopharyngeal swab were measured by multiplex PCR analysis. Results Asthma exacerbations occurred after a common cold in 48 inpatients. The numbers of patients with viral, bacterial, or both infections were 16, 9, and 9, respectively. The dominant viruses were rhinoviruses, respiratory syncytial virus, influenza virus, and metapneumovirus. The major bacteria were S. pneumoniae and H. influenzae. Compared to pathogen-free patients, the patients with pathogens were older and non-atopic and had later onset of disease, lower FeNO levels, lower IgE titers, and a higher incidence of comorbid sinusitis, COPD, or pneumonia. Compared to stable outpatients, asthma exacerbation inpatients had a higher incidence of smoking and comorbid sinusitis, COPD, or pneumonia. Viruses were detected in 50% of stable outpatients, but a higher incidence of rhinovirus, respiratory syncytial virus, and metapneumovirus infections was observed in asthma exacerbation inpatients. H. influenzae was observed in stable asthmatic patients. Other bacteria, especially S. pneumoniae, were important in asthma exacerbation inpatients. Conclusion Viral or bacterial infections were observed in 70% of inpatients with an asthma exacerbation in clinical practice. Infection with S. pneumoniae was related to adult asthma exacerbation. PMID:25901797

  1. Primary Care of the Patient with Asthma.

    PubMed

    Lenaeus, Michael J; Hirschmann, Jan

    2015-09-01

    Obstructive lung disease includes asthma and chronic obstructive pulmonary disease (COPD). Because a previous issue of Medical Clinics of North America (2012;96[4]) was devoted to COPD, this article focuses on asthma in adults, and addresses some topics about COPD not addressed previously. Asthma is a heterogeneous disease marked by variable airflow obstruction and bronchial hyperreactivity. Onset is most common in early childhood, although many people develop asthma later in life. Adult-onset asthma presents a particular challenge in the primary care clinic because of incomplete understanding of the disorder, underreporting of symptoms, underdiagnosis, inadequate treatment, and high rate of comorbidity.

  2. A patient's view of asthma.

    PubMed Central

    Donaldson, J M

    1995-01-01

    A medical consultation is seen as a meeting between cultures which have developed from different standpoints. These cultures are described, as are the ways in which they may contribute to, or impede a full understanding between the doctor and the patient with asthma, or concerned parent. PMID:8537950

  3. Validity of symptom and clinical measures of asthma severity for primary outpatient assessment of adult asthma.

    PubMed Central

    Ng, T P

    2000-01-01

    BACKGROUND: Symptom and pulmonary function measures of asthma severity are used for severity classification in practice guidelines. However, there is limited methodological evidence in support of their validity and utility. AIM: To validate initial symptom and forced expiratory volume (FEV1) measures of asthma severity with the subsequent risks of exacerbations resulting in emergency room (ER) visits, hospitalisation, and sickness absence from work. In addition, symptom-based measures of change in asthma severity were also evaluated against the concurrent risks of asthma exacerbations. METHOD: A cohort of 361 adult asthmatic patients in general outpatient clinics was studied. At initial interview, frequencies of asthmatic symptoms and nocturnal exacerbations, FEV1, and a severity score combining these measures, were recorded. At re-interview in the third year, the frequencies of asthma exacerbations resulting in ER visits, hospitalisation, and sickness absence, and a self-assessed global measure of change in severity and serially-assessed change in symptom frequencies, were measured. RESULTS: All individual symptom and FEV1 measures were strongly related to the subsequent risks of ER visits, hospitalisation, and sick absence. A severity score of more than 3 (moderate to severe asthma) and self-assessed change in asthma severity were most strongly and significantly associated with greatly increased risks of all outcomes. Individual symptoms and FEV1 measures alone did not show high sensitivities, but the severity score combining these measures gave much more satisfactory validity. Perhaps not surprisingly, self-assessed change in asthma appeared to give the most satisfactory validity. CONCLUSION: These results support the validity and clinical utility of a simple clinical score based on symptom and FEV1 measures, and self-assessed measure of change in severity, for risk classification in contemporary clinical practice guidelines. PMID:10695059

  4. Relationship between childhood body mass index and young adult asthma

    PubMed Central

    Porter, Minto; Wegienka, Ganesa; Havstad, Suzanne; Nageotte, Christian G.; Johnson, Christine Cole; Ownby, Dennis R.; Zoratti, Edward M.

    2013-01-01

    Background The relationship between obesity and asthma is an area of debate. Objective To investigate the association of elevated body mass index (BMI) at a young age and young adult asthma. Methods BMI, questionnaires, and serologic tests results were analyzed in participants of a predominantly white, middle-class, population-based birth cohort from Detroit, Michigan at 6 to 8 and 18 years of age. Asthma diagnosis was based on medical record data. Allergen specific IgE was analyzed using UniCAP, with atopy defined as 1 or more allergen specific IgE levels of 0.35 kU/L or higher. Overweight was defined as a BMI in 85th percentile or higher. Results A total of 10.6% of overweight males at 6 to 8 years of age had current asthma at 18 to 20 years of age compared with 3.2% of males who were normal or underweight (relative risk [RR], 3.3; 95% confidence interval [CI], 1.0–11.0; P=.048). A total of 19.6% of females who were overweight at 6 to 8 years of age had asthma compared with 10.3% of females who were normal or underweight (RR, 1.9; 95% CI, 0.9–3.9; P=.09). After adjustment for atopy at 6 to 8 years of age, overweight males had an adjusted RR of 4.7 (95% CI, 1.4–16.2; P=.01), and overweight females had an adjusted RR of 1.7 (95% CI, 0.8–3.3; P=.15). Change in BMI between 6 to 8 years of age and 18 to 20 years of age was also examined. Patients with persistently elevated BMI exhibited increased risk of asthma as young adults (RR, 2.4; 95% CI, 1.2–4.7) but not with an increasing BMI (RR, 0.8; 95% CI, 0.3–2.2) or a decreasing BMI (RR, 0.8; 95% CI, 0.3–2.2). Conclusion Overweight males 6 to 8 years of age have increased risk of asthma as young adults. Being overweight remains a predictor of asthma after adjustment for early atopy. A similar but not statistically significant trend was also seen among overweight females. Overweight body habitus throughout childhood is a risk factor for young adult asthma. PMID:23176878

  5. Asthma patient education opportunities in predominantly minority urban communities.

    PubMed

    Zayas, Luis E; McLean, Don

    2007-12-01

    Disenfranchised ethnic minority communities in the urban United States experience a high burden of asthma. Conventional office-based patient education often is insufficient to promote proper asthma management and coping practices responsive to minority patients' environments. This paper explores existing and alternative asthma information and education sources in three urban minority communities in western New York State to help design other practical educational interventions. Four focus groups (n = 59) and four town hall meetings (n = 109) were conducted in one Hispanic and two black communities. Focus groups included adult asthmatics or caretakers of asthmatics, and town meetings were open to all residents. A critical theory perspective informed the study. Asthma information and education sources, perceptions of asthma and ways of coping were elicited through semi-structured interviews. Data analysis followed a theory-driven immersion-crystallization approach. Several asthma education and information resources from the health care system, media, public institutions and communities were identified. Intervention recommendations highlighted asthma workshops that recognize participants as teachers and learners, offer social support, promote advocacy, are culturally appropriate and community-based and include health care professionals. Community-based, group health education couched on people's experiences and societal conditions offers unique opportunities for patient asthma care empowerment in minority urban communities.

  6. Promoting Self-Management in Adults with Asthma: An Overview of the UAB Program.

    ERIC Educational Resources Information Center

    Bailey, William C.; And Others

    1987-01-01

    A study at the University of Alabama/Birmingham (UAB) compared adult asthma patients receiving a self-care workbook with those receiving only asthma pamphlets. Outcomes were assessed in five areas: (1) health care utilization, (2) functional status, (3) knowledge, (4) adherence, and (5) psychological reactions. (Author/CH)

  7. Internet-based self-management support for adults with asthma: a qualitative study among patients, general practitioners and practice nurses on barriers to implementation

    PubMed Central

    van Gaalen, Johanna L; van Bodegom-Vos, Leti; Bakker, Moira J; Snoeck-Stroband, Jiska B; Sont, Jacob K

    2016-01-01

    Objectives The aim of this study was to explore barriers among patients, general practitioners (GPs) and practice nurses to implement internet-based self-management support as provided by PatientCoach for asthma in primary care. Setting Primary care within South Holland, the Netherlands. Participants Twenty-two patients (12 women, mean age 38 years), 21 GPs (6 women, mean age 52 years) and 13 practice nurses (all women, mean age 41 years). Design A qualitative study using focus groups and interviews. Outcomes Barriers as perceived by patients, GPs and practice nurses to implementation of PatientCoach. Methods 10 focus groups and 12 interviews were held to collect data: 4 patient focus groups, 4 GP focus groups, 2 practice nurse focus group, 2 patient interviews, 5 GP interviews and 5 practice nurse interviews. A prototype of PatientCoach that included modules for coaching, personalised information, asthma self-monitoring, medication treatment plan, feedback, e-consultations and a forum was demonstrated. A semistructured topic guide was used. Directed content analysis was used to analyse data. Reported barriers were classified according to a framework by Grol and Wensing. Results A variety of barriers emerged among all participant groups. Barriers identified among patients include a lack of a patient–professional partnership in using PatientCoach and a lack of perceived benefit in improving asthma symptoms. Barriers identified among GPs include a low sense of urgency towards asthma care and current work routines. Practice nurses identified a low level of structured asthma care and a lack of support by colleagues as barriers. Among all participant groups, insufficient ease of use of PatientCoach, lack of financial arrangements and patient characteristics such as a lack of asthma symptoms were reported as barriers. Conclusions We identified a variety of barriers to implementation of PatientCoach. An effective implementation strategy for internet-based self

  8. Asthma as a Comorbidity in Hospitalized Patients: A Potential Missed Opportunity to Intervene.

    PubMed

    Self, Timothy H; Owens, Ryan E; Mancell, Jimmie; Nahata, Milap C

    2016-06-01

    Asthma is a frequent comorbidity in hospitalized children and adults. Patients with a history of asthma may have no breathing complaints or abnormal chest exam findings to trigger care for this comorbidity during hospitalization. Consequently, this may lead to a potential missed opportunity to discuss asthma as a comorbidity and ongoing issue to ensure its optimal management at home. Our goal is to raise awareness that such patient encounters may represent opportunities for health care professionals to optimize asthma management. Despite focusing on the present illness and limited time availability, asthma care may be improved in a time-efficient manner in these patients.

  9. Phenotypes, Risk Factors, and Mechanisms of Adult-Onset Asthma.

    PubMed

    Ilmarinen, Pinja; Tuomisto, Leena E; Kankaanranta, Hannu

    2015-01-01

    Asthma is a heterogeneous disease with many phenotypes, and age at disease onset is an important factor in separating the phenotypes. Genetic factors, atopy, and early respiratory tract infections are well-recognized factors predisposing to childhood-onset asthma. Adult-onset asthma is more often associated with obesity, smoking, depression, or other life-style or environmental factors, even though genetic factors and respiratory tract infections may also play a role in adult-onset disease. Adult-onset asthma is characterized by absence of atopy and is often severe requiring treatment with high dose of inhaled and/or oral steroids. Variety of risk factors and nonatopic nature of adult-onset disease suggest that variety of mechanisms is involved in the disease pathogenesis and that these mechanisms differ from the pathobiology of childhood-onset asthma with prevailing Th2 airway inflammation. Recognition of the mechanisms and mediators that drive the adult-onset disease helps to develop novel strategies for the treatment. The aim of this review was to summarize the current knowledge on the pathogenesis of adult-onset asthma and to concentrate on the mechanisms and mediators involved in establishing adult-onset asthma in response to specific risk factors. We also discuss the involvement of these mechanisms in the currently recognized phenotypes of adult-onset asthma. PMID:26538828

  10. Phenotypes, Risk Factors, and Mechanisms of Adult-Onset Asthma

    PubMed Central

    Ilmarinen, Pinja; Tuomisto, Leena E.; Kankaanranta, Hannu

    2015-01-01

    Asthma is a heterogeneous disease with many phenotypes, and age at disease onset is an important factor in separating the phenotypes. Genetic factors, atopy, and early respiratory tract infections are well-recognized factors predisposing to childhood-onset asthma. Adult-onset asthma is more often associated with obesity, smoking, depression, or other life-style or environmental factors, even though genetic factors and respiratory tract infections may also play a role in adult-onset disease. Adult-onset asthma is characterized by absence of atopy and is often severe requiring treatment with high dose of inhaled and/or oral steroids. Variety of risk factors and nonatopic nature of adult-onset disease suggest that variety of mechanisms is involved in the disease pathogenesis and that these mechanisms differ from the pathobiology of childhood-onset asthma with prevailing Th2 airway inflammation. Recognition of the mechanisms and mediators that drive the adult-onset disease helps to develop novel strategies for the treatment. The aim of this review was to summarize the current knowledge on the pathogenesis of adult-onset asthma and to concentrate on the mechanisms and mediators involved in establishing adult-onset asthma in response to specific risk factors. We also discuss the involvement of these mechanisms in the currently recognized phenotypes of adult-onset asthma. PMID:26538828

  11. Usability testing of AsthmaWise with older adults.

    PubMed

    Burns, Pippa; Jones, Sandra C; Iverson, Don; Caputi, Peter

    2013-05-01

    There are many reasons why online self-management education is attractive to both patients and providers. AsthmaWise, an online self-management program, was developed using a Moodle platform, to enable older adults to learn asthma self-management skills. This study aimed to improve AsthmaWise through conducting: usability testing with a sample of end users; a cognitive walk-through undertaken by an independent health researcher; and assessment of content readability. A Perceived Health Web Site Usability Questionnaire score of 67% was achieved, indicating that there were usability issues that needed to be addressed. The cognitive walk-through and readability assessment identified unique issues that were not identified through usability testing with end users. The testing process allowed issues to be identified and rectified before piloting AsthmaWise, creating a more accessible and refined end product. The involvement of the site designer in the testing process was valuable and is highly recommended. This study shows that usability testing involving both end users and experts is an essential part of the design process that is relatively easy and inexpensive to undertake and can be effectively conducted by a nonexpert. PMID:23542306

  12. Identification of Susceptibility Genes of Adult Asthma in French Canadian Women

    PubMed Central

    Bérubé, Jean-Christophe; Gaudreault, Nathalie; Lavoie-Charland, Emilie; Sbarra, Laura; Henry, Cyndi; Madore, Anne-Marie; Paré, Peter D.; van den Berge, Maarten; Nickle, David; Laviolette, Michel; Laprise, Catherine; Boulet, Louis-Philippe; Bossé, Yohan

    2016-01-01

    Susceptibility genes of asthma may be more successfully identified by studying subgroups of phenotypically similar asthma patients. This study aims to identify single nucleotide polymorphisms (SNPs) associated with asthma in French Canadian adult women. A pooling-based genome-wide association study was performed in 240 allergic asthmatic and 120 allergic nonasthmatic women. The top associated SNPs were selected for individual genotyping in an extended cohort of 349 asthmatic and 261 nonasthmatic women. The functional impact of asthma-associated SNPs was investigated in a lung expression quantitative trait loci (eQTL) mapping study (n = 1035). Twenty-one of the 38 SNPs tested by individual genotyping showed P values lower than 0.05 for association with asthma. Cis-eQTL analyses supported the functional contribution of rs17801353 associated with C3AR1 (P = 7.90E − 10). The asthma risk allele for rs17801353 is associated with higher mRNA expression levels of C3AR1 in lung tissue. In silico functional characterization of the asthma-associated SNPs also supported the contribution of C3AR1 and additional genes including SYNE1, LINGO2, and IFNG-AS1. This pooling-based GWAS in French Canadian adult women followed by lung eQTL mapping suggested C3AR1 as a functional locus associated with asthma. Additional susceptibility genes were suggested in this homogenous subgroup of asthma patients. PMID:27445529

  13. Identification of Susceptibility Genes of Adult Asthma in French Canadian Women.

    PubMed

    Bérubé, Jean-Christophe; Gaudreault, Nathalie; Lavoie-Charland, Emilie; Sbarra, Laura; Henry, Cyndi; Madore, Anne-Marie; Paré, Peter D; van den Berge, Maarten; Nickle, David; Laviolette, Michel; Laprise, Catherine; Boulet, Louis-Philippe; Bossé, Yohan

    2016-01-01

    Susceptibility genes of asthma may be more successfully identified by studying subgroups of phenotypically similar asthma patients. This study aims to identify single nucleotide polymorphisms (SNPs) associated with asthma in French Canadian adult women. A pooling-based genome-wide association study was performed in 240 allergic asthmatic and 120 allergic nonasthmatic women. The top associated SNPs were selected for individual genotyping in an extended cohort of 349 asthmatic and 261 nonasthmatic women. The functional impact of asthma-associated SNPs was investigated in a lung expression quantitative trait loci (eQTL) mapping study (n = 1035). Twenty-one of the 38 SNPs tested by individual genotyping showed P values lower than 0.05 for association with asthma. Cis-eQTL analyses supported the functional contribution of rs17801353 associated with C3AR1 (P = 7.90E - 10). The asthma risk allele for rs17801353 is associated with higher mRNA expression levels of C3AR1 in lung tissue. In silico functional characterization of the asthma-associated SNPs also supported the contribution of C3AR1 and additional genes including SYNE1, LINGO2, and IFNG-AS1. This pooling-based GWAS in French Canadian adult women followed by lung eQTL mapping suggested C3AR1 as a functional locus associated with asthma. Additional susceptibility genes were suggested in this homogenous subgroup of asthma patients.

  14. Sleep Disorders in Patients with Bronchial Asthma

    PubMed Central

    Cukic, Vesna; Lovre, Vladimir; Dragisic, Dejan

    2011-01-01

    Respiratory disturbances during sleep are recognized as extremely common disorders with important clinical consequences. Breathing disorders during sleep can result in broad range of clinical manifestations, the most prevalent of which are unrefreshing sleep, daytime sleepiness and fatigue, and cognitive impairmant. There is also evidence that respiratory-related sleep disturbances can contribute to several common cardiovascular and metabolic disorders, including systemic hypertension, cardiac dysfunction, and insulin-resistance. Correlations are found between asthma-related symptoms and sleep disturbances. Difficulties inducing sleep, sleep fragmentation on polysomnography, early morning awakenings and daytime sleepiness are more common in asthmatics compared with subjects without asthma. The “morning deep” in asthma is relevant for the characterization of asthma severity, and impact drugs’ choices. Sleep and night control of asthma could be relevant to evaluate disease’s control. Appropriate asthma control recovering is guarantor for better sleep quality in these patients and less clinical consequences of respiratory disturbances during sleep. PMID:23678304

  15. Risk factors for death among adults with severe asthma

    PubMed Central

    Omachi, Theodore A; Iribarren, Carlos; Sarkar, Urmimala; Tolstykh, Irina; Yelin, Edward H.; Katz, Patricia P.; Blanc, Paul D.; Eisner, Mark D.

    2009-01-01

    Background Mortality risk in adult asthma is poorly understood, especially the interplay between race, disease severity, and health-care access. Objective To examine mortality risk factors in adult asthma. Methods In a prospective cohort study of 865 adults with severe asthma in a closed-panel managed-care organization, we used structured interviews to assess baseline sociodemographics, asthma history, and health status. Subjects were followed until death or end of study, with a two-year average follow-up time. We used Cox proportional hazards regression to evaluate the impact of sociodemographics, cigarette smoking, and validated measures of perceived asthma control, physical health status, and severity-of-asthma on the risk of death. Results We confirmed 123 deaths, a mortality rate of 6.7 per 100 person-years. In analysis adjusted for sociodemographics and tobacco history, higher severity-of-asthma scores (hazard ratios [HR], 1.11 per ½ standard deviation increase in severity-of-asthma score; 95% confidence interval [CI], 1.01 - 1.23) and lower perceived asthma control scores (HR, 0.91 per ½ standard deviation increase in perceived asthma control score, 95% CI, 0.83 - 0.99) were each associated with risk of all-cause mortality. In the same adjusted analysis, African American race was not associated with an increased mortality risk relative to white race (HR 0.63; 95% CI 0.35 - 1.12). Conclusions In a large managed-care organization in which access to care is unlikely to vary widely, greater severity-of-asthma scores and poorer perceived asthma control scores are each associated with increased mortality risk among adults with severe asthma, but African Americans are not at increased risk of death relative to whites. PMID:18727467

  16. Do indoor environments influence asthma and asthma-related symptoms among adults in homes?: a review of the literature.

    PubMed

    Jie, Yu; Ismail, Noor Hassim; Jie, Xu; Isa, Zaleha Md

    2011-09-01

    This review summarizes the results of epidemiological studies focusing on the detrimental effects of home environmental factors on asthma morbidity in adults. We reviewed the literature on indoor air quality (IAQ), physical and sociodemographic factors, and asthma morbidity in homes, and identified commonly reported asthma, allergic, and respiratory symptoms involving the home environment. Reported IAQ and asthma morbidity data strongly indicated positive associations between indoor air pollution and adverse health effects in most studies. Indoor factors most consistently associated with asthma and asthma-related symptoms in adults included fuel combustion, mold growth, and environmental tobacco smoke. Environmental exposure may increase an adult's risk of developing asthma and also may increase the risk of asthma exacerbations. Evaluation of present IAQ levels, exposure characteristics, and the role of exposure to these factors in relation to asthma morbidity is important for improving our understanding, identifying the burden, and for developing and implementing interventions aimed at reducing asthma morbidity.

  17. The Association of Health Literacy with Illness and Medication Beliefs Among Older Adults with Asthma

    PubMed Central

    Federman, Alex D.; Wolf, Michael; Sofianou, Anastasia; Wilson, Elizabeth A.H.; Martynenko, Melissa; Halm, Ethan A.; Leventhal, Howard; Wisnivesky, Juan P.

    2013-01-01

    Background Suboptimal health literacy (HL) and asthma beliefs are associated with poor asthma self-management and outcomes. We tested the hypothesis that low HL is associated with inaccurate beliefs. Methods Asthmatics ≥ 60 were recruited from hospital and community practices in New York, NY and Chicago, IL (n=420). HL was measured with the Short Test of Functional Health Literacy in Adults; validated instruments derived from the Self Regulation model were used to assess beliefs. The association of beliefs with HL was evaluated with multivariate models. Results Thirty-six percent of patients had low HL; 54% believed they only have asthma when symptoms are present, 29% believed they will not always have asthma and 20% believed that their doctor can cure asthma. HL was associated with beliefs of not having asthma all the time and that asthma can be cured (OR: 1.84, 95% CI: 1.2 to 2.82; OR: 2.22, 95% CI: 1.29 to 3.82, respectively). Patients with low HL were also more likely to be concerned about medication use (β = 0.92, p = .05), despite recognizing their necessity (β = -1.36, p = .01). Conclusions Older asthmatics with low HL endorse erroneous asthma beliefs. Practice implications Health communications for improving self-management behaviors in asthma should employ both health literacy-appropriate strategies and messages to counter illness-related misconceptions. PMID:23523196

  18. Health Service Utilization and Poor Health Reporting in Asthma Patients

    PubMed Central

    Behr, Joshua G.; Diaz, Rafael; Akpinar-Elci, Muge

    2016-01-01

    The management and treatment of adult asthma has been associated with utilization of health services. Objectives: First, to investigate the likelihood of health service utilization, including primary care, emergency department, and hospital stays, among persons diagnosed with an asthma condition relative to those that do not have an asthma condition. Second, to examine the likelihood of poor physical health among asthma respondents relative to those that do not have an asthma condition. Third, to demonstrate that these relationships vary with frequency of utilization. Fourth, to discuss the magnitude of differences in frequent utilization between asthma and non-asthma respondents. Data Source: Data is derived from a random, stratified sampling of Hampton Roads adults, 18 years and older (n = 1678). Study Design: Study participants are interviewed to identify asthma diagnosis, access to primary care, frequency of emergency department utilization, hospital admissions, and days of poor physical health. Odds-ratios establish relationships with the covariates on the outcome variable. Findings: Those with asthma are found more likely (OR 1.50, 95% CI 1.05–2.15) to report poor physical health relative to non-asthma study participants. Further, asthma respondents are found more likely (OR 4.23, 95% CI 1.56–11.69) to frequently utilize primary care that may be associated with the management of the condition and are also more likely to utilize treatment services, such as the emergency department (OR 1.87, 95% CI 1.32–2.65) and hospitalization (OR 2.21, 95% CI 1.39–3.50), associated with acute and episodic care. Further, it is a novel finding that these likelihoods increase with frequency of utilization for emergency department visits and hospital stays. Conclusion: Continuity in care and better management of the diseases may result in less demand for emergency department services and hospitalization. Health care systems need to recognize that asthma patients are

  19. Acceptance of Asthma Pharmacogenetic Study by Children and Adults

    PubMed Central

    Wu, Ann Chen; Davis, Robert; Tantisira, Kelan; Dutta-Linn, M. Maya; Hemmes, Mia; Weiss, Scott T.

    2012-01-01

    Background Pharmacogenetic testing may change clinical medicine by allowing clinicians to tailor medications based on a patient’s genetic makeup, however, these tests must first be validated in large, real-life populations of subjects that include children. A dearth of knowledge exists for whether pediatric populations are as willing as adult populations to provide samples for such studies. Objective (1) To assess whether pediatric and adult patients with persistent asthma are willing to provide specimens for DNA extraction and genetic studies. (2) To assess whether patients’ willingness to provide blood as compared to buccal smear specimens differ. Methods Of 644 patients ages 4–38 years who had three or more prescription fills for inhaled corticosteroids in one year, 60% (385) were randomized to the blood specimen group and 40% (259) were randomized to the buccal smear group in order to study acceptance of different biospecimen collection methods. Research assistants contacted subjects to obtain consent, perform a phone survey, and request a specimen. Results There were no baseline differences between subjects randomized to the blood specimen group versus buccal smear group with respect to age, gender, or number of dispensings of inhaled corticosteroids. Of 259 subjects in the buccal smear group, 30% (78) provided samples, and of 385 subjects in the blood specimen group, 16% (60) provided samples. Subjects randomized to the buccal smear group were more likely to provide specimens for genetic study compared to subjects randomized to the blood specimen group (RR 1.21; 95% CI 1.10 – 1.32), even after adjusting for age. Pediatric subjects were more likely to provide specimens for genetic study than adult subjects with 23% (113) of pediatric subjects providing samples and 15% (25) of adult subjects providing samples (p=0.03). Conclusion Children with asthma are as likely to participate in genetic studies as adults. Both children and adult subjects are more

  20. Clinical and inflammatory characteristics of the European U-BIOPRED adult severe asthma cohort.

    PubMed

    Shaw, Dominick E; Sousa, Ana R; Fowler, Stephen J; Fleming, Louise J; Roberts, Graham; Corfield, Julie; Pandis, Ioannis; Bansal, Aruna T; Bel, Elisabeth H; Auffray, Charles; Compton, Chris H; Bisgaard, Hans; Bucchioni, Enrica; Caruso, Massimo; Chanez, Pascal; Dahlén, Barbro; Dahlen, Sven-Erik; Dyson, Kerry; Frey, Urs; Geiser, Thomas; Gerhardsson de Verdier, Maria; Gibeon, David; Guo, Yi-Ke; Hashimoto, Simone; Hedlin, Gunilla; Jeyasingham, Elizabeth; Hekking, Pieter-Paul W; Higenbottam, Tim; Horváth, Ildikó; Knox, Alan J; Krug, Norbert; Erpenbeck, Veit J; Larsson, Lars X; Lazarinis, Nikos; Matthews, John G; Middelveld, Roelinde; Montuschi, Paolo; Musial, Jacek; Myles, David; Pahus, Laurie; Sandström, Thomas; Seibold, Wolfgang; Singer, Florian; Strandberg, Karin; Vestbo, Jorgen; Vissing, Nadja; von Garnier, Christophe; Adcock, Ian M; Wagers, Scott; Rowe, Anthony; Howarth, Peter; Wagener, Ariane H; Djukanovic, Ratko; Sterk, Peter J; Chung, Kian Fan

    2015-11-01

    U-BIOPRED is a European Union consortium of 20 academic institutions, 11 pharmaceutical companies and six patient organisations with the objective of improving the understanding of asthma disease mechanisms using a systems biology approach.This cross-sectional assessment of adults with severe asthma, mild/moderate asthma and healthy controls from 11 European countries consisted of analyses of patient-reported outcomes, lung function, blood and airway inflammatory measurements.Patients with severe asthma (nonsmokers, n=311; smokers/ex-smokers, n=110) had more symptoms and exacerbations compared to patients with mild/moderate disease (n=88) (2.5 exacerbations versus 0.4 in the preceding 12 months; p<0.001), with worse quality of life, and higher levels of anxiety and depression. They also had a higher incidence of nasal polyps and gastro-oesophageal reflux with lower lung function. Sputum eosinophil count was higher in severe asthma compared to mild/moderate asthma (median count 2.99% versus 1.05%; p=0.004) despite treatment with higher doses of inhaled and/or oral corticosteroids.Consistent with other severe asthma cohorts, U-BIOPRED is characterised by poor symptom control, increased comorbidity and airway inflammation, despite high levels of treatment. It is well suited to identify asthma phenotypes using the array of "omic" datasets that are at the core of this systems medicine approach.

  1. Clinical and inflammatory characteristics of the European U-BIOPRED adult severe asthma cohort.

    PubMed

    Shaw, Dominick E; Sousa, Ana R; Fowler, Stephen J; Fleming, Louise J; Roberts, Graham; Corfield, Julie; Pandis, Ioannis; Bansal, Aruna T; Bel, Elisabeth H; Auffray, Charles; Compton, Chris H; Bisgaard, Hans; Bucchioni, Enrica; Caruso, Massimo; Chanez, Pascal; Dahlén, Barbro; Dahlen, Sven-Erik; Dyson, Kerry; Frey, Urs; Geiser, Thomas; Gerhardsson de Verdier, Maria; Gibeon, David; Guo, Yi-Ke; Hashimoto, Simone; Hedlin, Gunilla; Jeyasingham, Elizabeth; Hekking, Pieter-Paul W; Higenbottam, Tim; Horváth, Ildikó; Knox, Alan J; Krug, Norbert; Erpenbeck, Veit J; Larsson, Lars X; Lazarinis, Nikos; Matthews, John G; Middelveld, Roelinde; Montuschi, Paolo; Musial, Jacek; Myles, David; Pahus, Laurie; Sandström, Thomas; Seibold, Wolfgang; Singer, Florian; Strandberg, Karin; Vestbo, Jorgen; Vissing, Nadja; von Garnier, Christophe; Adcock, Ian M; Wagers, Scott; Rowe, Anthony; Howarth, Peter; Wagener, Ariane H; Djukanovic, Ratko; Sterk, Peter J; Chung, Kian Fan

    2015-11-01

    U-BIOPRED is a European Union consortium of 20 academic institutions, 11 pharmaceutical companies and six patient organisations with the objective of improving the understanding of asthma disease mechanisms using a systems biology approach.This cross-sectional assessment of adults with severe asthma, mild/moderate asthma and healthy controls from 11 European countries consisted of analyses of patient-reported outcomes, lung function, blood and airway inflammatory measurements.Patients with severe asthma (nonsmokers, n=311; smokers/ex-smokers, n=110) had more symptoms and exacerbations compared to patients with mild/moderate disease (n=88) (2.5 exacerbations versus 0.4 in the preceding 12 months; p<0.001), with worse quality of life, and higher levels of anxiety and depression. They also had a higher incidence of nasal polyps and gastro-oesophageal reflux with lower lung function. Sputum eosinophil count was higher in severe asthma compared to mild/moderate asthma (median count 2.99% versus 1.05%; p=0.004) despite treatment with higher doses of inhaled and/or oral corticosteroids.Consistent with other severe asthma cohorts, U-BIOPRED is characterised by poor symptom control, increased comorbidity and airway inflammation, despite high levels of treatment. It is well suited to identify asthma phenotypes using the array of "omic" datasets that are at the core of this systems medicine approach. PMID:26357963

  2. [Thoracic surgery for patients with bronchial asthma].

    PubMed

    Iyoda, A; Satoh, Y

    2012-07-01

    Thoracic surgery poses a risk for complications in the respiratory system. In particular, for patients with bronchial asthma, we need to care for perioperative complications because it is well known that these patients frequently have respiratory complications after surgery, and they may have bronchial spasms during surgery. If we can get good control of their bronchial asthma, we can usually perform surgery for these patients without limitations. For safe postoperative care, it is desirable that these patients have stable asthma conditions that are well-controlled before surgery, as thoracic surgery requires intrabronchial intubation for anesthesia and sometimes bronchial resection. These stimulations to the bronchus do not provide for good conditions because of the risk of bronchial spasm. Therefore, we should use the same agents that are used to control bronchial asthma if it is already well controlled. If it is not, we have to administer a β₂ stimulator, aminophylline, or steroidal agents for good control. Isoflurane or sevoflurane are effective for the safe control of anesthesia during surgery, and we should use a β₂ stimulator, with or without inhalation, or steroidal agents after surgery. It is important to understand that we can perform thoracic surgery for asthma patients if we can provide perioperative control of bronchial asthma, although these patients still have severe risks. PMID:22868432

  3. Intake of paracetamol and risk of asthma in adults.

    PubMed

    Thomsen, Simon Francis; Kyvik, Kirsten Ohm; Skadhauge, Lars; Steffensen, Ida; Backer, Vibeke

    2008-10-01

    Intake of paracetamol has been associated with development of asthma. The aim of this study was to address a possible association between intake of paracetamol and risk of adult-onset asthma. Using a multidisciplinary postal questionnaire survey concerning health and lifestyle we prospectively studied 19,349 adult twins enrolled in the nationwide Danish Twin Registry. There was a higher prevalence of new-onset asthma in subjects who reported frequent intake of paracetamol at baseline compared with subjects without this determinant (12.0% vs. 4.3%), OR = 3.03 (1.51-6.11), p = 0.005. The result remained significant after adjusting for sex, age, smoking, BMI, hay fever, eczema, and intake of medications other than paracetamol, OR = 2.16 (1.03-4.53), p = 0.041. Frequent intake of paracetamol is an independent risk factor for adult-onset asthma.

  4. The impact of asthma control on salivary cortisol level in adult asthmatics.

    PubMed

    Shin, Yoo Seob; Liu, Jing Nan; Kim, Joo-Hee; Nam, Young-Hee; Choi, Gil Soon; Park, Hae-Sim

    2014-09-01

    Asthma is a chronic disease causing psychological stress which leads to the activation of hypothalamus-pituitary-adrenal axis. The purpose of this study is to compare morning salivary cortisol levels in persistent asthma patients according to their disease severities and control status. Total 206 adult asthma patients were recruited from four university hospitals. Spirometry, questionnaire of Asthma Quality of Life (AQOL) and Asthma Control Test (ACT) were completed, and saliva samples were collected prospectively to measure morning cortisol level. The mean patient age was 56.5±15.3 years with mean asthma duration of 9.1±11.1 years. Sixty five patents (31.6%) were classified as mild persistent asthma, and 141 patients (68.4%) were classified as moderate persistent asthma according to the Expert Panel Report 3. The mean predicted FEV1 was 88.8%±18.4%, and the methacholine PC20 was 9.6±8.5 mg/mL in all study population. The mean ACT score for all patients was 19.9±3.6, and there were 71 (34.5%) patients in poorly controlled and 135 (65.5%) in well controlled asthma. The poorly controlled asthma patients were characterized by significantly lower FEV1 (84.6%±17.6% vs 91.1%±18.5%, P=0.018), lower AQOL scores (46.0±13.9 vs 73.8±26.3, P<0.001), and lower salivary cortisol levels (0.14±0.08 vs 0.18±0.11 µg/dL, P=0.04) compared to well controlled asthma. The ACT score was significantly related to salivary cortisol levels (P=0.034) after adjusting for age. There was no significant difference in salivary cortisol levels (0.17±0.12 vs 0.16±0.08, P=0.725) when analyzed according to the dose of used corticosteroid and lung function. Asthma control status affects morning salivary cortisol level. Measuring the morning salivary cortisol level might be a simple and new way to assess asthma control status.

  5. Birth weight, body mass index and asthma in young adults

    PubMed Central

    Shaheen, S.; Sterne, J.; Montgomery, S.; Azima, H.

    1999-01-01

    BACKGROUND—Impaired fetal growth may be a risk factor for asthma although evidence in children is conflicting and there are few data in adults. Little is known about risk factors which may influence asthma in late childhood or early adult life. Whilst there are clues that fatness may be important, this has been little studied in young adults. The relations between birth weight and childhood and adult anthropometry and asthma, wheeze, hayfever, and eczema were investigated in a nationally representative sample of young British adults.
METHODS—A total of 8960 individuals from the 1970 British Cohort Study (BCS70) were studied. They had recently responded to a questionnaire at 26 years of age in which they were asked whether they had suffered from asthma, wheeze, hayfever, and eczema in the previous 12 months. Adult body mass index (BMI) was calculated from reported height and weight.
RESULTS—The prevalence of asthma at 26 years fell with increasing birth weight. After controlling for potential confounding factors, the odds ratio comparing the lowest birth weight group (<2 kg) with the modal group (3-3.5 kg) was 1.99 (95% CI 0.96 to 4.12). The prevalence of asthma increased with increasing adult BMI. After controlling for birth weight and other confounders, the odds ratio comparing highest with lowest quintile was 1.72 (95% CI 1.29 to 2.29). The association between fatness and asthma was stronger in women; odds ratios comparing overweight women (BMI 25-29.99) and obese women (BMI ⩾30) with those of normal weight (BMI <25) were 1.51 (95% CI 1.11 to 2.06) and 1.84 (95% CI 1.19to 2.84), respectively. The BMI at 10 years was not related to adult asthma. Similar associations with birth weight and adult BMI were present for wheeze but not for hayfever or eczema.
CONCLUSIONS—Impaired fetal growth and adult fatness are risk factors for adult asthma.

 PMID:10212102

  6. Smoking cessation strategies for patients with asthma: improving patient outcomes.

    PubMed

    Perret, Jennifer L; Bonevski, Billie; McDonald, Christine F; Abramson, Michael J

    2016-01-01

    Smoking is common in adults with asthma, yet a paucity of literature exists on smoking cessation strategies specifically targeting this subgroup. Adverse respiratory effects from personal smoking include worse asthma control and a predisposition to lower lung function and chronic obstructive pulmonary disease. Some data suggest that individuals with asthma are more likely than their non-asthmatic peers to smoke regularly at an earlier age. While quit attempts can be more frequent in smokers with asthma, they are also of shorter duration than in non-asthmatics. Considering these asthma-specific characteristics is important in order to individualize smoking cessation strategies. In particular, asthma-specific information such as "lung age" should be provided and longer-term follow-up is advised. Promising emerging strategies include reminders by cellular phone and web-based interventions using consumer health informatics. For adolescents, training older peers to deliver asthma education is another promising strategy. For smokers who are hospitalized for asthma, inpatient nicotine replacement therapy and counseling are a priority. Overall, improving smoking cessation rates in smokers with asthma may rely on a more personalized approach, with the potential for substantial health benefits to individuals and the population at large. PMID:27445499

  7. Smoking cessation strategies for patients with asthma: improving patient outcomes

    PubMed Central

    Perret, Jennifer L; Bonevski, Billie; McDonald, Christine F; Abramson, Michael J

    2016-01-01

    Smoking is common in adults with asthma, yet a paucity of literature exists on smoking cessation strategies specifically targeting this subgroup. Adverse respiratory effects from personal smoking include worse asthma control and a predisposition to lower lung function and chronic obstructive pulmonary disease. Some data suggest that individuals with asthma are more likely than their non-asthmatic peers to smoke regularly at an earlier age. While quit attempts can be more frequent in smokers with asthma, they are also of shorter duration than in non-asthmatics. Considering these asthma-specific characteristics is important in order to individualize smoking cessation strategies. In particular, asthma-specific information such as “lung age” should be provided and longer-term follow-up is advised. Promising emerging strategies include reminders by cellular phone and web-based interventions using consumer health informatics. For adolescents, training older peers to deliver asthma education is another promising strategy. For smokers who are hospitalized for asthma, inpatient nicotine replacement therapy and counseling are a priority. Overall, improving smoking cessation rates in smokers with asthma may rely on a more personalized approach, with the potential for substantial health benefits to individuals and the population at large. PMID:27445499

  8. The Revised Asthma Problem Behavior Checklist: adaptation for use in Spanish asthmatic patients.

    PubMed

    Belloch, A; Perpiñá, M; Pascual, L M; de Diego, A; Creer, T L

    1997-01-01

    Behavioral problems associated with asthma management were examined in a group of 100 adult Spanish outpatients with asthma (57 women, 43 men; 17-69 years of age). All of them completed a Spanish version of the Revised Asthma Problem Behavior Checklist (RAPBC). Data about duration, severity, and self-management of asthma (self-efficacy expectancies and health care utilization), as well as dyspnea and FEV1, were also recorded. The highest-reliability Cronbach alpha indices were for the criteria related to emotions and behaviors that could precipitate asthma attacks. Concurrent criterion validity was examined first by Pearson correlations between the RAPBC scores and clinical data about asthma (duration, FEV1, and dyspnea), and second, by examining the differences in RAPBC scores (ANOVAs) among three severity groups of patients. Severe patients reported more behavioral problems associated with poor life-styles and self-management of their asthma and showed more psychological and physical negative consequences related to asthma. In conclusion, while the RAPBC could be considered a valid instrument to assess the behavioral problems associated with asthma in Spanish patients, and shows a good concurrent criterion validity, its reliability (internal consistency) with respect to life-style and self-management behaviors related to asthma should be improved, to ensure its utility as a screening instrument for behavior-related problems in asthmatic Spanish patients.

  9. Enablers of Physician Prescription of a Long-Term Asthma Controller in Patients with Persistent Asthma

    PubMed Central

    McKinney, Martha L.; Desplats, Eve; Ernst, Pierre

    2016-01-01

    Objective. We aimed to identify key enablers of physician prescription of a long-term controller in patients with persistent asthma. Methods. We conducted a mailed survey of randomly selected Quebec physicians. We sent a 102-item questionnaire, seeking reported management regarding one of 4 clinical vignettes of a poorly controlled adult or child and endorsement of enablers to prescribe long-term controllers. Results. With a 56% participation rate, 421 physicians participated. Most (86%) would prescribe a long-term controller (predominantly inhaled corticosteroids, ICS) to the patient in their clinical vignette. Determinants of intention were the recognition of persistent symptoms (OR 2.67), goal of achieving long-term control (OR 5.31), and high comfort level in initiating long-term ICS (OR 2.33). Decision tools, pharmacy reports, reminders, and specific training were strongly endorsed by ≥60% physicians to support optimal management. Physicians strongly endorsed asthma education, lung function testing, specialist opinion, accessible asthma clinic, and paramedical healthcare professionals to guide patients, as enablers to improve patient adherence to and physicians' comfort with long-term ICS. Interpretation. Tools and training to improve physician knowledge, skills, and perception towards long-term ICS and resources that increase patient adherence and physician comfort to facilitate long-term ICS prescription should be considered as targets for implementation. PMID:27445537

  10. Asthma - what to ask the doctor - adult

    MedlinePlus

    ... I have a fire in my fireplace or wood-burning stove? What sort of changes do I ... 38. National Asthma Education and Prevention Program Expert Panel Report 3: Guidelines for the Diagnosis and Management ...

  11. Survey on the impact of comorbid allergic rhinitis in patients with asthma

    PubMed Central

    Valovirta, Erkka; Pawankar, Ruby

    2006-01-01

    Background Allergic rhinitis (AR) and asthma are inflammatory conditions of the airways that often occur concomitantly. This global survey was undertaken to understand patient perspectives regarding symptoms, treatments, and the impact on their well-being of comorbid AR and asthma. Methods Survey participants were adults with asthma (n = 813) and parents of children with asthma (n = 806) from four countries each in the Asia-Pacific region and Europe. Patients included in the survey also had self-reported, concomitant AR symptoms. Patients and parents were recruited by telephone interview or by direct interview. Results Most patients (73%) had pre-existing symptoms of AR when their asthma was first diagnosed. Shortness of breath (21%) was the most troublesome symptom for adults, and wheezing (17%) and coughing (17%) the most troublesome for children. Patients used different medications for treating asthma (most commonly short-acting β-agonists and inhaled corticosteroids) and for treating AR (most commonly oral antihistamines). The concomitant presence of AR and asthma disrupted the ability to get a good night's sleep (79%), to participate in leisure and sports activities (75%), to concentrate at work or school (69% of adults, 73% of children), and to enjoy social activities (57% of adults, 51% of children). Most patients (79%) reported worsening asthma symptoms when AR symptoms flared up. Many (56%) avoided the outdoors during the allergy season because of worsening asthma symptoms. Many (60%) indicated difficulty in effectively treating both conditions, and 72% were concerned about using excessive medication. In general, respondents from the Asia-Pacific region reported more disruption of activities caused by symptoms and more concerns and difficulties with medications than did those from Europe. Differences between the two regions in medication use included more common use of inhaled corticosteroids in Europe and more common use of Chinese herbal remedies in the

  12. Level of asthma control and its relationship with medication use in asthma patients in Brazil*

    PubMed Central

    Marchioro, Josiane; Gazzotti, Mariana Rodrigues; Nascimento, Oliver Augusto; Montealegre, Federico; Fish, James; Jardim, José Roberto

    2014-01-01

    OBJECTIVE: To assess asthma patients in Brazil in terms of the level of asthma control, compliance with maintenance treatment, and the use of rescue medication. METHODS: We used data from a Latin American survey of a total of 400 asthma patients in four Brazilian state capitals, all of whom completed a questionnaire regarding asthma control and treatment. RESULTS: In that sample, the prevalence of asthma was 8.8%. Among the 400 patients studied, asthma was classified, in accordance with the Global Initiative for Asthma criteria, as controlled, partially controlled, and uncontrolled in 37 (9.3%), 226 (56.5%), and 137 (34.3%), respectively. In those three groups, the proportion of patients on maintenance therapy in the past four weeks was 5.4%, 19.9%, and 41.6%, respectively. The use of rescue medication was significantly more common in the uncontrolled asthma group (86.9%; p < 0.001). CONCLUSIONS: Our findings suggest that, in accordance with the established international criteria, asthma is uncontrolled in the vast majority of asthma patients in Brazil. Maintenance medications are still underutilized in Brazil, and patients with partially controlled or uncontrolled asthma are more likely to use rescue medications and oral corticosteroids. PMID:25410836

  13. Treatment of adult asthma: is the diagnosis relevant?

    PubMed Central

    Littlejohns, P; Ebrahim, S; Anderson, R

    1989-01-01

    The diagnosis and management of chronic respiratory symptoms was studied in all adults aged 40-70 years in a group general practice. A respiratory symptoms screening questionnaire was sent to 2387 men and women, of whom 1444 (85% of those who had not moved or died) responded. The 509 subjects reporting symptoms were sent a detailed questionnaire and invited to have their respiratory function tested. Of these, 324 (64%) responded, of whom 256 (79%) had spirometry. A diagnosis of chronic bronchitis was reported by 3.9% of the men and 2.1% of the women, and a diagnosis of asthma by 4.7% of the men and 3.3% of the women. Wheezing in the preceding year was reported by 18% of the men and 15% of the women, and 16.7% of the men and 7.1% of the women satisfied the Medical Research Council criteria for chronic bronchitis. Bronchodilator treatment was being taken by 12% of the patients with symptoms, regular cough linctus by 10%, and regular antibiotics by 5%. After the frequency and severity of respiratory symptoms had been controlled for wheezing patients reporting a diagnosis of asthma were prescribed bronchodilatory drugs three times more often than those labelled as having chronic bronchitis and 12 times more often than those without a diagnostic label. Eleven per cent of general practitioner consultations resulted in a referral to hospital. Referral was unrelated to the diagnosis given, but depended on the degree of respiratory disability and handicap experienced by the patient. Our findings confirm the relevance of the diagnostic label to the drug management of chronic wheezing disorders, but further investigation of the diagnostic process is needed to establish why some patients with severe wheeze remain untreated. PMID:2595621

  14. Quality of life in asthma patients.

    PubMed

    Ferreira, Lara Noronha; Brito, Ulisses; Ferreira, Pedro Lopes

    2010-01-01

    In this paper we present a study whose main aim is the measurement of the Health Related Quality of Life (HRQoL) of patients with asthma and the presentation of a first draft of normative values as measured by the SF-6D for asthma patients. In addition, we investigate how far non-disease-specific HRQoL measures can distinguish groups in terms of sociodemographic characteristics. The Portuguese versions of the EQ-5D, SF-6D, AQLQ(S) and ACQ were administered using personal interviews to a representative sample of the Portuguese population with asthma. Most of the individuals did not report significant problems in the dimensions used, with the exception of the physical functioning, where individuals reported moderate limitations. The mean utility value was 0.86. Male gender, young, single, individuals with high educational attainment level, employed, individuals with high income and those residing in urban areas reported higher utility levels. As expected, those who were in a severe stadium of the disease reported lower mean utility levels than those who were in a less severe stadium of the disease. Normative values for the SF-6D were computed for patients with asthma by gender, age, marital status, educational attainment level, employment status, area of residence and average monthly net income. The preference-based measures used in this study distinguish patient groups with asthma in terms of socio- demographic groups. The normative values can be used in economic evaluation and clinical studies as they incorporate patients' preferences and translate the value attributed to patients' health state. PMID:20054507

  15. Quality of life in asthma patients.

    PubMed

    Ferreira, Lara Noronha; Brito, Ulisses; Ferreira, Pedro Lopes

    2010-01-01

    In this paper we present a study whose main aim is the measurement of the Health Related Quality of Life (HRQoL) of patients with asthma and the presentation of a first draft of normative values as measured by the SF-6D for asthma patients. In addition, we investigate how far non-disease-specific HRQoL measures can distinguish groups in terms of sociodemographic characteristics. The Portuguese versions of the EQ-5D, SF-6D, AQLQ(S) and ACQ were administered using personal interviews to a representative sample of the Portuguese population with asthma. Most of the individuals did not report significant problems in the dimensions used, with the exception of the physical functioning, where individuals reported moderate limitations. The mean utility value was 0.86. Male gender, young, single, individuals with high educational attainment level, employed, individuals with high income and those residing in urban areas reported higher utility levels. As expected, those who were in a severe stadium of the disease reported lower mean utility levels than those who were in a less severe stadium of the disease. Normative values for the SF-6D were computed for patients with asthma by gender, age, marital status, educational attainment level, employment status, area of residence and average monthly net income. The preference-based measures used in this study distinguish patient groups with asthma in terms of socio- demographic groups. The normative values can be used in economic evaluation and clinical studies as they incorporate patients' preferences and translate the value attributed to patients' health state.

  16. The Use of Household Cleaning Sprays and Adult Asthma

    PubMed Central

    Zock, Jan-Paul; Plana, Estel; Jarvis, Deborah; Antó, Josep M.; Kromhout, Hans; Kennedy, Susan M.; Künzli, Nino; Villani, Simona; Olivieri, Mario; Torén, Kjell; Radon, Katja; Sunyer, Jordi; Dahlman-Hoglund, Anna; Norbäck, Dan; Kogevinas, Manolis

    2007-01-01

    Rationale: Cleaning work and professional use of certain cleaning products have been associated with asthma, but respiratory effects of nonprofessional home cleaning have rarely been studied. Objectives: To investigate the risk of new-onset asthma in relation to the use of common household cleaners. Methods: Within the follow-up of the European Community Respiratory Health Survey in 10 countries, we identified 3,503 persons doing the cleaning in their homes and who were free of asthma at baseline. Frequency of use of 15 types of cleaning products was obtained in a face-to-face interview at follow-up. We studied the incidence of asthma defined as physician diagnosis and as symptoms or medication usage at follow-up. Associations between asthma and the use of cleaning products were evaluated using multivariable Cox proportional hazards or log-binomial regression analysis. Measurements and Main Results: The use of cleaning sprays at least weekly (42% of participants) was associated with the incidence of asthma symptoms or medication (relative risk [RR], 1.49; 95% confidence interval [CI], 1.12−1.99) and wheeze (RR, 1.39; 95% CI, 1.06−1.80). The incidence of physician-diagnosed asthma was higher among those using sprays at least 4 days per week (RR, 2.11; 95% CI, 1.15−3.89). These associations were consistent for subgroups and not modified by atopy. Dose–response relationships (P < 0.05) were apparent for the frequency of use and the number of different sprays. Risks were predominantly found for the commonly used glass-cleaning, furniture, and air-refreshing sprays. Cleaning products not applied in spray form were not associated with asthma. Conclusions: Frequent use of common household cleaning sprays may be an important risk factor for adult asthma. PMID:17585104

  17. [Asthma and scuba diving Absolute contraindication? in all asthma patients?].

    PubMed

    Coëtmeur, D; Briens, E; Dassonville, J; Vergne, M

    2001-09-01

    Physical and psychological fitness are required for scuba diving, leading to medical contraindications in certain subjects. Asthma, a condition exhibiting increasing prevalence in the general population is currently considered an absolute contraindication for scuba diving by the French Federation for Submarine Sports and Education (FFESSM). There is however no documented evidence demonstrating a higher risk in asthmatic divers. Our English-speaking colleagues have suggested that certain asthmatic subjects could participate in scuba diving sports under certain conditions without any higher risk compared with non-asthmatic divers. We recall here the impact of diving on respiratory function and potential consequences in asthmatic subjects, proposing that the formal contraindication against scuba diving should be maintained for asthmatic patients who experience frequent symptoms (step 2 or more of the International Consensus Report on Diagnosis and Treatment of Asthma) and/or have a baseline obstructive syndrome. It would appear reasonable to discuss the contraindication concerning patients with rare acute episodes and who have a perfectly normal respiratory function. The question of bronchodilator inhalation prior to diving may be a question to debate. However, such a proposal cannot be considered to be valid unless well-conducted studies of the clinical manifestations are available (frequency and severity of the acute episodes, triggering factors) for the diver candidate. Because of the highly restrictive nature of the contraindication notification and the absence of arguments backing up the decision, the question should be put to competent authorities (sports federations, learned societies) in order to ascertain the pathophysiological mechanisms involved and collect reliable epidemiological data before proposing a consensus discussion. This process may lead to the delivery of scuba diving authorizations for selected asthmatic subjects without a higher risk than non

  18. The impact of depression in older patients with chronic obstructive pulmonary disease and asthma.

    PubMed

    Connolly, M J; Yohannes, A M

    2016-10-01

    Respiratory diseases are common in older people. However, the impact of comorbid depression in older patients with chronic obstructive pulmonary disease (COPD) and asthma has not been fully explored. This narrative review examines the impact of comorbid depression and its management in COPD and asthma in older adults. The causes of depression in patients with COPD and asthma are multifactorial and include physical, physiological and behavioural factors. Depression is associated with hospital readmission in older adults with asthma and COPD. We focus on the most current literature that has examined the efficacy of pulmonary rehabilitation (PR), cognitive behavioural therapy (CBT) and antidepressant drug therapy for patients with depression in the context of COPD and asthma. Our findings indicate that PR and CBT are beneficial in improving depressive symptoms and quality of life in short-term intervention studies. However, the long-term efficacy of CBT and PR is unknown. To date, the efficacy of antidepressant drug therapy for depression in patients with COPD and asthma is inconclusive. In addition, there has been no clear evidence that antidepressants can induce remission of depression or ameliorate dyspnoea or physiological indices of COPD. Factors that contribute to 'inadequate' assessment and treatment of depression in patients with COPD and asthma may include misconception of the disease by patients and their caregivers and stigma attached to depression. Thus, well-controlled randomized controlled trials are needed. PMID:27621232

  19. Self-management of acute asthma among low-income urban adults.

    PubMed

    George, Maureen; Campbell, Jacquelyn; Rand, Cynthia

    2009-08-01

    One approach to address asthma disparities has been to create evidence-based guidelines to standardize asthma care and education. However, the adoption of these recommendations has been suboptimal among many providers. As a result, low-income minority patients may not be receiving adequate instruction in asthma self-management. In addition, these patients may fail to follow guideline-based recommendations. We conducted 25 interviews to identify the extent to which urban low-income adults have received training in, and implement, self-management protocols for acute asthma. Twenty-five adults (92% female; 76% African American; mean age 39) were enrolled. Only one subject had received asthma self-management training and only 10 (40%) used short-acting beta-(2) agonist-based (SABA) self-management protocols for the early treatment of acute asthma. No subject used a peak flow meter or an asthma action plan. Most (52%) chose to initially treat acute asthma with complementary and alternative medicine (CAM) despite the availability of SABAs. Importantly, 21 (84%) preferred an integrated approach using both conventional and CAM treatments. Four themes associated with acute asthma self-management emerged from the qualitative analysis. The first theme safety reflected subjects' perception that CAM was safer than SABA. Severity addressed the calculation that subjects made in determining if SABA or CAM was indicated based on the degree of symptoms they were experiencing. The third theme speed and strength of the combination described subjects' belief in the superiority of integrating CAM and SABA for acute asthma self-management. The final themesense of identity spoke to the ability of CAM to provide a customized self-management strategy that subjects desired. It is unclear if subjects' greater use of CAM or delays in using SABA-based self-management protocols were functions of inadequate instruction or personal preference. Regardless, delays in, or under use of, conventional

  20. Self-Management of Acute Asthma among Low-Income Urban Adults

    PubMed Central

    George, Maureen; Campbell, Jacquelyn; Rand, Cynthia

    2009-01-01

    One approach to address asthma disparities has been to create evidence-based guidelines to standardize asthma care and education. However, the adoption of these recommendations has been suboptimal among many providers. As a result, low-income minority patients may not be receiving adequate instruction in asthma self-management. In addition, these patients may fail to follow guideline-based recommendations. We conducted 25 interviews to identify the extent to which urban low-income adults have received training in, and implement, self-management protocols for acute asthma. Twenty-five adults (92% female; 76% African American; mean age 39) were enrolled. Only one subject had received asthma self-management training and only 10 (40%) used short-acting beta-2 agonist-based (SABA) self-management protocols for the early treatment of acute asthma. No subject used a peak flow meter or an asthma action plan. Most (52%) chose to initially treat acute asthma with complementary and alternative medicine (CAM) despite the availability of SABAs. Importantly, 21 (84%) preferred an integrated approach using both conventional and CAM treatments. Four themes associated with acute asthma self-management emerged from the qualitative analysis. The first theme safety reflected subjects’ perception that CAM was safer than SABA. Severity addressed the calculation that subjects made in determining if SABA or CAM was indicated based on the degree of symptoms they were experiencing. The third theme speed and strength of the combination described subjects’ belief in the superiority of integrating CAM and SABA for acute asthma self-management. The final themesense of identity spoke to the ability of CAM to provide a customized self-management strategy that subjects desired. It is unclear if subjects’ greater use of CAM or delays in using SABA-based self-management protocols were functions of inadequate instruction or personal preference. Regardless, delays in, or under use of

  1. Asthma.

    PubMed Central

    Calverley, P. M.

    1996-01-01

    Bronchial asthma is now recognised to be a major cause of morbidity and even mortality in people of all ages. Two important ideas have changed our approach to asthma management. The first is understanding that asthma is a chronic inflammatory disorder which needs regular treatment with anti-inflammatory drugs such as inhaled corticosteroids to prevent further attacks. The second development is the availability of prescribable peak flow meters, which allows both confident diagnosis and early prediction of relapse. Asthma management guidelines provide a logical treatment framework for most patients, but a few difficult cases still consume large amounts of medical time. The commonest problem is one of compliance with treatment which may respond to patient education, although this is not universally so. Other problems include misdiagnosis, acid reflux and, rarely, true corticosteroid-resistant asthma. Several potentially important new treatments have been developed. These include longer acting anticholinergic drugs, drugs with bronchodilator and some anti-inflammatory properties which antagonise or inhibit the production of leukotrienes, sub-types of phosphodiesterase inhibitor with anti-inflammatory properties and immunosuppressive drugs such as cyclosporin. Ultimately these new treatments must be rigorously tested and integrated into a care plan that remains centred on patient education. PMID:8746278

  2. Impact of Physician Asthma Care Education on Patient Outcomes

    ERIC Educational Resources Information Center

    Cabana, Michael D.; Slish, Kathryn K.; Evans, David; Mellins, Robert B.; Brown, Randall W.; Lin, Xihong; Kaciroti, Niko; Clark, Noreen M.

    2014-01-01

    Objective: We evaluated the effectiveness of a continuing medical education program, Physician Asthma Care Education, in improving pediatricians' asthma therapeutic and communication skills and patients' health care utilization for asthma. Methods: We conducted a randomized trial in 10 regions in the United States. Primary care providers…

  3. The effects of a multisite aerobic exercise intervention on asthma morbidity in sedentary adults with asthma: the Ex-asthma study randomised controlled trial protocol

    PubMed Central

    Bacon, Simon L; Lavoie, Kim L; Bourbeau, Jean; Ernst, Pierre; Maghni, Karim; Gautrin, Denyse; Labrecque, Manon; Pepin, Veronique; Pedersen, Bente Klarlund

    2013-01-01

    Objective Aerobic exercise can improve cardiovascular fitness and does not seem to be detrimental to patients with asthma, though its role in changing asthma control and inflammatory profiles is unclear. The main hypothesis of the current randomised controlled trial is that aerobic exercise will be superior to usual care in improving asthma control. Key secondary outcomes are asthma quality of life and inflammatory profiles. Design A total of 104 sedentary adults with physician-diagnosed asthma will be recruited. Eligible participants will undergo a series of baseline assessments including: the asthma control questionnaire; the asthma quality-of-life questionnaire and the inflammatory profile (assessed from both the blood and sputum samples). On completion of the assessments, participants will be randomised (1:1 allocation) to either 12-weeks of usual care or usual care plus aerobic exercise. Aerobic exercise will consist of three supervised training sessions per week. Each session will consist of taking a short-acting bronchodilator, 10 min of warm-up, 40 min of aerobic exercise (50–75% of heart rate reserve for weeks 1–4, then 70–85% for weeks 5–12) and a 10 min cool-down. Within 1 week of completion, participants will be reassessed (same battery as at baseline). Analyses will assess the difference between the two intervention arms on postintervention levels of asthma control, quality of life and inflammation, adjusting for age, baseline inhaled corticosteroid prescription, body weight change and pretreatment dependent variable level. Missing data will be handled using standard multiple imputation techniques. Ethics and dissemination The study has been approved by all relevant research ethics boards. Written consent will be obtained from all participants who will be able to withdraw at any time. Results The result will be disseminated to three groups of stakeholder groups: (1) the scientific and professional community; (2) the research

  4. Risk of Migraine in Patients With Asthma: A Nationwide Cohort Study.

    PubMed

    Peng, Yi-Hao; Chen, Kuan-Fei; Kao, Chia-Hung; Chen, Hsuan-Ju; Hsia, Te-Chun; Chen, Chia-Hung; Liao, Wei-Chih

    2016-03-01

    Asthma has been described as an "acephalic migraine" and "pulmonary migraine." However, no study has investigated the temporal frequency of migraine development in patients with asthma, and the results of previous studies may be difficult to generalize.We investigated the effect of asthma on the subsequent development of migraine by using a population-based data set in Taiwan.We retrieved our study sample from the National Health Insurance Research Database. Specifically, 25,560 patients aged 12 years and older with newly diagnosed asthma were identified as the asthma group, and 102,238 sex and age-matched patients without asthma were identified as the nonasthma group. Cox proportional-hazards regression models were employed to measure the risk of migraine for the asthmatic group compared with that for the nonasthmatic group.The risk of migraine in the asthmatic group was 1.45-fold higher (95% confidence interval 1.33-1.59) than that in the nonasthmatic group after adjustment for sex, age, the Charlson comorbidity index, common medications prescribed for patients with asthma, and annual outpatient department visits. An additional stratified analysis revealed that the risk of migraine remained significantly higher in both sexes and all age groups older than 20 years.Asthma could be an independent predisposing risk factor for migraine development in adults.

  5. NAC Manchester Asthma and Allergy Study (NACMAAS): risk factors for asthma and allergic disorders in adults.

    PubMed

    Simpson, B M; Custovic, A; Simpson, A; Hallam, C L; Walsh, D; Marolia, H; Campbell, J; Woodcock, A

    2001-03-01

    Asthma and atopic disorders are the most common chronic diseases in the developed countries. Knowledge of the risk factors for these disorders may facilitate the development of preventive strategies aimed at reducing prevalence rates. To investigate the risk factors for asthma and allergic diseases in a large number of adults who are the parents of children in the National Asthma Campaign Manchester Asthma and Allergy Study. All pregnant women and their partners attending "Booking" antenatal clinics were invited to take part in the study. Questionnaire data were collected including the history of asthma and other atopic diseases, pet ownership and smoking habits, and skin prick tests were performed. The prevalence of atopy and the risk factors for asthma and allergic disorders were investigated in all subjects who completed the questionnaire and underwent skin testing. Statistical analysis was carried out using logistic regression. Initially, risk factors were assessed by univariate analysis to see how each potential explanatory variable affected the probability of having allergic disease. Variables were then tested in a forward stepwise multivariate analysis. In 5687 adult subjects there was a very high (48.2%) prevalence of atopy, and 9.7% of subjects had a diagnosis of asthma. In a multivariate regression analysis sensitization to dust mite, cat, dog and mixed grasses were all independently associated with asthma. The odds ratios for current asthma increased with the increasing number of positive skin tests (any two allergens - OR 4.3, 95% CI 3.3-5.5; any three allergens - OR 7.0 95% CI 5.3-9.3; all four allergens - OR 10.4, 95% CI 7.7-14; P < 0.00001). Dog ownership (OR 1.31, 95% CI 1.10-1.57; P = 0.003) and current smoking (OR 1.36, 95% CI 1.15-1.62; P = 0.0004) were significantly and directly associated with "asthma ever". Thirteen per cent of participants reported a history of eczema. In the multivariate analysis the strongest independent associate of eczema

  6. Determinants of patients' needs in asthma treatment: a cross-sectional study.

    PubMed

    Loerbroks, Adrian; Sheikh, Aziz; Leucht, Verena; Apfelbacher, Christian J; Icks, Andrea; Angerer, Peter

    2016-01-01

    Patients' needs in asthma remain insufficiently understood and met. We therefore aimed to investigate the potential determinants of patients' needs in asthma treatment. Our study was based on survey data on 189 adults with asthma. Needs were measured using the 13-item Needs in Asthma Treatment questionnaire, which yields a total score and subscale-specific scores ('exacerbations', 'patient expertise', 'handling drugs' and 'drug effects'). We considered age, sex, education, years since diagnosis and anxiety/depression (measured by the Patient Health Questionnaire-4) as potential determinants. Associations were estimated by multivariable linear regression. Overall, we observed that younger age, poor mental health and a more recently established asthma diagnosis were independently associated with increased needs. Information on drug effects was an exception to this pattern as the need in that domain was solely determined by sex (being greater in men). In conclusion, our study provides novel evidence on patient characteristics that are associated with needs in asthma treatment. If confirmed by future studies, our observations may assist healthcare professionals to identify asthma patients with potentially elevated information, support and training needs and could contribute to the development of tailored interventions. PMID:27510157

  7. Minocycline treatment results in reduced oral steroid requirements in adult asthma.

    PubMed

    Daoud, Ammar; Gloria, C J; Taningco, Gladys; Hammerschlag, Margaret R; Weiss, Steven; Gelling, Maureen; Roblin, Patricia M; Joks, Rauno

    2008-01-01

    The tetracycline antibiotics have pleiotropic anti-inflammatory properties that may explain their therapeutic benefit in rheumatoid arthritis and acne. As these agents suppress both cellular and humoral immune responses, they may be of benefit in treating asthma and other allergic disorders. The purpose of this study was to determine whether minocycline therapy of asthma has steroid sparing effects beyond its inherent antibiotic properties. Adult asthmatic patients (n = 17) were treated with minocycline 150 mg p.o. twice daily or placebo for 8 weeks in a randomized, double-blind, placebo-controlled crossover study. Patients were evaluated for clinical improvement in oral steroid requirements, spirometry, and symptom scores (Asthma Quality of Life Questionnaire). They underwent assessment for preexisting infection (CT facial sinuses, Chlamydia pneumoniae nasopharyngeal culture, and C. pneumoniae and Mycoplasma pneumoniae serology). Minocycline use was associated with a 30% reduction in mean daily prednisone use compared with placebo (8.8 mg versus 14.4 mg, respectively; p = 0.02). Pulmonary function testing showed improvement in forced vital capacity (FVC; percent predicted; p = 0.03) and improvement in actual FVC and forced expiratory volume in 1 second (percent predicted) approached statistical significance (p = 0.05 and 0.08, respectively). Minocycline treatment was associated with significant improvement in asthma symptoms brought on by environmental triggers (p = 0.01). This preliminary study of minocycline therapy showed oral steroid-sparing properties for those with moderate persistent and severe persistent asthma.

  8. Global burden of allergic bronchopulmonary aspergillosis with asthma and its complication chronic pulmonary aspergillosis in adults.

    PubMed

    Denning, David W; Pleuvry, Alex; Cole, Donald C

    2013-05-01

    Allergic bronchopulmonary aspergillosis (ABPA) complicates asthma and may lead to chronic pulmonary aspergillosis (CPA) yet global burdens of each have never been estimated. Antifungal therapy has a place in the management of ABPA and is the cornerstone of treatment in CPA, reducing morbidity and probably mortality. We used the country-specific prevalence of asthma from the Global Initiative for Asthma (GINA) report applied to population estimates to calculate adult asthma cases. From five referral cohorts (China, Ireland, New Zealand, Saudi Arabia and South Africa), we estimated the prevalence of ABPA in adults with asthma at 2.5% (range 0.72-3.5%) (scoping review). From ABPA case series, pulmonary cavitation occurred in 10% (range 7-20%), allowing an estimate of CPA prevalence worldwide using a deterministic scenario-based model. Of 193 million adults with active asthma worldwide, we estimate that 4,837,000 patients (range 1,354,000-6,772,000) develop ABPA. By WHO region, the ABPA burden estimates are: Europe, 1,062,000; Americas, 1,461,000; Eastern Mediterranean, 351,000; Africa, 389,900; Western Pacific, 823,200; South East Asia, 720,400. We calculate a global case burden of CPA complicating ABPA of 411,100 (range 206,300-589,400) at a 10% rate with a 15% annual attrition. The global burden of ABPA potentially exceeds 4.8 million people and of CPA complicating ABPA ˜ 400,000, which is more common than previously appreciated. Both conditions respond to antifungal therapy justifying improved case detection. Prospective population and clinical cohort studies are warranted to more precisely ascertain the frequency of ABPA and CPA in different locations and ethnic groups and validate the model inputs.

  9. Clinical characteristics of adult asthma associated with small airway dysfunction.

    PubMed

    Kjellberg, S; Houltz, B K; Zetterström, O; Robinson, P D; Gustafsson, Per M

    2016-08-01

    Suboptimal asthma control is common despite modern asthma therapy. The degree of peripheral airway involvement remains unclear and poor medication delivery to these regions might be a contributing reason for this failure in obtaining adequate symptom control. A cohort of 196 adults (median (range) age 44 (18-61) years, 109 females, 54 ex-smokers, six current smokers) with physician-diagnosed asthma were recruited from primary care. Subjects were characterized clinically by interviews, questionnaires, skin prick tests (SPT) and blood eosinophil counts. Lung function was assessed by spirometry, impulse oscillometry (IOS) and nitrogen multiple breath washout (N2 MBW). IOS assessed peripheral airway resistance (FDR, frequency dependence of resistance). N2 MBW assessed global ventilation inhomogeneity (LCI, lung clearance index), specific indices of peripheral airway function (Scond × VT and Sacin × VT; VT, tidal volume), and inter-regional inhomogeneity (specific ventilation ratio). Never-smoking healthy cohorts of 158 and 400 adult subjects provided local reference values for IOS and N2 MBW variables, respectively. Peripheral airway dysfunction was detected in 31% (FDR or specific ventilation ratio) to 47% (Scond x VT) of subjects. Risk factors for peripheral airway dysfunction were identified. Among subjects with low FEV1 and either positive smoking history and/or blood eosinophilia (>4.0%), 63% had abnormality across all peripheral airway outcomes, whilst only one subject was completely normal. Abnormal peripheral airway function was present in a large proportion of adult asthmatics at baseline. Reduced FEV1, a positive smoking history, and/or blood eosinophilia identified "a small airway asthma subtype" that might benefit from peripheral airway targeted therapy. PMID:27492518

  10. Importance of patient/parents education in childhood asthma.

    PubMed

    Gupta, A; Gupta, R

    2001-09-01

    Asthma is fairly common in pediatric age group and the suffering due to asthma continues to increase despite excellent treatments available. One of the four major components of asthma management is patient education and is critical to the success of asthma management. Reasons for continued suffering include that our management strategies are not easily understood by the patient/parents without a simple and careful approach towards this step. Eliciting common concerns and fears is the single and foremost strategy to develop a relationship of trust with the patients/parents. Making them understand about the chronic nature of asthma, need for a long-term care approach, what happens during acute attacks and where medications act are some of the important areas you should be educating about in the beginning. Then comes the skill transfer, i.e. giving them skills to monitor asthma including use of peakflowmeter and use of inhalation devices effectively. Joint development of written plans for medications is essential. Development of plans to control of asthma; jointly with them; including learning about warning signs and a plan to manage acute attack at home is also very important and patient/parents should be having an active participation. Finally, educating them how to identify asthma triggers helps as a long-term strategy to keep control over asthma with or without medications. Reminding patient/parents when to come for follow-up and what would be discussed next time are some important tricks of the trade. PMID:11980470

  11. Risk factors for death in patients with severe asthma*

    PubMed Central

    Fernandes, Andréia Guedes Oliva; Souza-Machado, Carolina; Coelho, Renata Conceição Pereira; Franco, Priscila Abreu; Esquivel, Renata Miranda; Souza-Machado, Adelmir; Cruz, Álvaro Augusto

    2014-01-01

    OBJECTIVE: To identify risk factors for death among patients with severe asthma. METHODS: This was a nested case-control study. Among the patients with severe asthma treated between December of 2002 and December of 2010 at the Central Referral Outpatient Clinic of the Bahia State Asthma Control Program, in the city of Salvador, Brazil, we selected all those who died, as well as selecting other patients with severe asthma to be used as controls (at a ratio of 1:4). Data were collected from the medical charts of the patients, home visit reports, and death certificates. RESULTS: We selected 58 cases of deaths and 232 control cases. Most of the deaths were attributed to respiratory causes and occurred within a health care facility. Advanced age, unemployment, rhinitis, symptoms of gastroesophageal reflux disease, long-standing asthma, and persistent airflow obstruction were common features in both groups. Multivariate analysis showed that male gender, FEV1 pre-bronchodilator < 60% of predicted, and the lack of control of asthma symptoms were significantly and independently associated with mortality in this sample of patients with severe asthma. CONCLUSIONS: In this cohort of outpatients with severe asthma, the deaths occurred predominantly due to respiratory causes and within a health care facility. Lack of asthma control and male gender were risk factors for mortality. PMID:25210958

  12. Exercise for Asthma Patients. Little Risk, Big Rewards.

    ERIC Educational Resources Information Center

    Disabella, Vincent; Sherman, Carl

    1998-01-01

    Asthma patients can benefit from 20 to 30 minutes of exercise at 60 to 85% of maximum heart rate several times a week. Improved fitness can reduce airway reactivity and medication use. The capacity to exercise requires good general control of asthma. Patients must learn to prevent exercise-induced bronchoconstriction by using inhaled medications…

  13. Asthma

    MedlinePlus

    ... that you have asthma. Your doctor will diagnose asthma based on lung function tests, your medical history, and a physical exam. You may also have allergy tests. When your asthma symptoms become worse than usual, it's called an ...

  14. Asthma

    MedlinePlus

    ... Got Homework? Here's Help White House Lunch Recipes Asthma KidsHealth > For Kids > Asthma Print A A A ... it can take several days. continue Who Gets Asthma? No one really knows why one person's airways ...

  15. Asthma Education Programme in Russia: Educating Patients.

    ERIC Educational Resources Information Center

    Maslennikova, G. Ya.; Morosova, M. E.; Salman, N. V.; Kulikov, S. M.; Oganov, R. G.

    1998-01-01

    U.S. recommendations for asthma management were adapted for use in educating Moscow families with children with asthma (N=252). Use of anti-inflammatory drugs, doctor visits, peak flow rates, and daily peak flow were also measured. One-year follow up showed significant improvement in asthma self-management skills among the education group.…

  16. Inverse Relationship Between Helicobacter Pylori Infection and Asthma Among Adults Younger than 40 Years: A Cross-Sectional Study.

    PubMed

    Lim, Joo Hyun; Kim, Nayoung; Lim, Seon Hee; Kwon, Jin-Won; Shin, Cheol Min; Chang, Yoon-Seok; Kim, Joo Sung; Jung, Hyun Chae; Cho, Sang-Heon

    2016-02-01

    Recent studies have suggested that Helicobacter pylori could prevent allergic disease, particularly in children. However, whether this is true in adults is controversial. The aim of this study was to investigate whether there is negative association between H. pylori infection and asthma among adults in an area with a high prevalence of H. pylori.This was a cross-sectional study using 2011 health surveillance data. Blood samples were taken from all participants to measure serum H. pylori IgG status. Information on demographics, socioeconomic status, and medical history, including asthma and other allergic conditions were collected by a questionnaire.Of the 15,032 patients, 9492 (63.1%) had a history of H. pylori infection, 359 (2.4%) had asthma, and 3277 (21.8%) had other allergic conditions. H. pylori infection was positively correlated with age (OR, 1.050; 95% CI, 1.047-1.053, P < 0.001). Asthma history was positively correlated with age (OR, 1.022; 95% CI, 1.013-1.032, P < 0.001). H. pylori and age were shown to have interaction on asthma in the total participants (OR, 1.041; 95% CI, 1.021-1.062, P < 0.001). In subgroup analysis, H. pylori infection among those < 40 years old was inversely correlated with asthma (OR, 0.503; 95% CI, 0.280-0.904, P = 0.021). Other allergic conditions were not related with H. pylori infection among the total and those <40 years old.The inverse association between H. pylori infection and asthma among young adults suggests that the underlying immune mechanism induced by H. pylori infection may affect allergic reactions associated with asthma in young adults.

  17. Beliefs About Asthma and Complementary and Alternative Medicine in Low-Income Inner-City African-American Adults

    PubMed Central

    George, Maureen; Birck, Kathleen; Hufford, David J; Jemmott, Loretta Sweet; Weaver, Terri E

    2006-01-01

    BACKGROUND The gap in asthma prevalence, morbidity, and mortality is increasing in low-income racial/ethnic minority groups as compared with Caucasians. In order to address these disparities, alternative beliefs and behaviors need to be identified. OBJECTIVE To identify causal models of asthma and the context of conventional prescription versus complementary and alternative medicine (CAM) use in low-income African-American (AA) adults with severe asthma. DESIGN Qualitative analysis of 28 in-depth interviews. PARTICIPANTS Twenty-six women and 2 men, aged 21 to 48, who self-identified as being AA, low-income, and an inner-city resident. APPROACH Transcripts of semi-structured in-depth qualitative interviews were inductively analyzed using the constant comparison approach. RESULTS Sixty-four percent of participants held biologically correct causal models of asthma although 100% reported the use of at least 1 CAM for asthma. Biologically based therapies, humoral balance, and prayer were the most popular CAM. While most subjects trusted prescription asthma medicine, there was a preference for integration of CAM with conventional asthma treatment. Complementary and alternative medicine was considered natural, effective, and potentially curative. Sixty-three percent of participants reported nonadherence to conventional therapies in the 2 weeks before the research interview. Neither CAM nor nonmedical causal models altered most individuals (93%) willingness to use prescription medication. Three possibly dangerous CAM were identified. CONCLUSIONS Clinicians should be aware of patient-generated causal models of asthma and use of CAM in this population. Discussing patients' desire for an integrated approach to asthma management and involving social networks are 2 strategies that may enhance patient-provider partnerships and treatment fidelity. PMID:16995890

  18. Association of sugar-sweetened beverage intake frequency and asthma among U.S. adults, 2013

    PubMed Central

    Park, Sohyun; Akinbami, Lara J.; McGuire, Lisa C.; Blanck, Heidi M.

    2016-01-01

    Objectives Sugar-sweetened beverage (SSB) intake among U.S. adults is associated with obesity and type 2 diabetes. An association between SSB intake and asthma has been shown among U.S. children and Australian adults, but scant published information exists for U.S. adults. We examined associations between SSB intake and current asthma among U.S. adults, and the role of obesity in this association. Methods We analyzed 2013 Behavioral Risk Factor Surveillance System data for 146,990 adults (≥18 years) from 23 states and the District of Columbia. We used multivariable logistic regression to estimate associations between current asthma and frequency (none, <1 time/day, once/day, ≥2 times/day) of SSB intake (soda, fruit drink, sweet tea, and sports/energy drink). SSB intake was measured using two questions. Covariates included age, sex, race/ethnicity, education, and smoking. Obesity, based on self-reported height and weight, was assessed as an effect modifier. Results Overall, 9.1% of adults reported current asthma: 8.5% of adults who did not consume SSBs had current asthma vs 12.1% of adults who consumed SSBs ≥2 times/day. There was no difference in asthma prevalence with SSB intake <1 time/day (8.7%) or once/day (8.7%). Among non-obese adults, the odds of having current asthma were higher among those who consumed SSBs ≥2 times/day (aOR=1.66, 95%CI=1.39, 1.99) than non-SSB consumers. However, SSB intake frequency was not associated with asthma among obese adults. Conclusions Frequent SSB consumption was associated with asthma among non-obese adults. Research on asthma prevention should further consider the potential adverse effects of high SSB intake among U.S. adults. PMID:27496394

  19. Targeted Therapy for Older Patients with Uncontrolled Severe Asthma: Current and Future Prospects.

    PubMed

    de Roos, E W; In 't Veen, J C C M; Braunstahl, G-J; Lahousse, L; Brusselle, G G O

    2016-09-01

    Severe asthma in the elderly places a high burden on affected individuals and society. Emerging therapies target specific phenotypes of the asthma disease spectrum, and can be beneficial for older asthmatics, albeit their response might be altered due to age-related characteristics. Paradoxically, these characteristics are often ground for exclusion from clinical trials. The question thus arises how the senior asthmatic population can successfully enter the era of targeted therapy. Therefore, we highlight characteristics of this population relevant to effective treatment, and review the evidence for targeted therapy in elderly patients. For targeted therapy it is important to account for aging, as this affects the distribution of phenotypes (e.g. late-onset asthma, non-eosinophilic asthma) and may alter biomarkers and drug metabolism. Elderly asthmatics suffer from age-related comorbidities and subsequent polypharmacy. A systematic search into targeted asthma therapy yielded no randomized clinical trials dedicated to older asthmatics. Post hoc analyses of the anti-immunoglobulin E agent omalizumab indicate similar efficacy in both younger and older adults. Conference abstracts on anti-interleukin-5 and anti-interleukin-13 therapy suggest even more pronounced effects of targeted treatments in late-onset disease and in asthmatic patients 65 years or older, but full reports are lacking. For non-eosinophilic asthma in the elderly, there is not yet high-level evidence for targeted therapy, but macrolides may offer a viable option. In conclusion, there is a gap in knowledge regarding the effect of older age on the safety and efficacy of targeted asthma therapy. Further investigations in the elderly are needed, with special emphasis on both late-onset asthma and therapeutics for non-eosinophilic asthma. PMID:27638817

  20. The link between mold sensitivity and asthma severity in a cohort of northern Chinese patients

    PubMed Central

    Tian, Guizhen; Tang, Fei; Yu, Bing; Chen, Yanwen; Cui, Yueli; He, Quanying; Gao, Zhancheng

    2015-01-01

    Background Mold sensitivity in asthmatic patients has recently attracted clinical interest; however the links between mold sensitivity and asthma severity in the Chinese population have been poorly characterized. In this study, we assess the relationship between asthma severity and airborne mold sensitivity in a cohort of northern Chinese patients. Methods Ninety-three non-smoking adult outpatients with asthma completed a questionnaire and underwent skin prick testing with five aeroallergens. For all patients, eosinophil cell counts, total serum IgE (sIgE) levels, and pulmonary function were measured. An asthma severity score was calculated based on the patient’s forced expiratory volume in one second (FEV1), number of asthma attacks, number of hospital admissions, and use of inhaled or oral corticosteroids in the past year. Results Ninety-three patients were divided into three groups based on the results of their allergy tests: negative results for all tested allergens (group A, n=32); positive reactions to aeroallergens including mold antigens (group B, n=41); and positive reactions to aeroallergens other than molds (group C, n=20). Patients in group B had a lower FEV1 (74.46%±23.09% predicted) compared with group A (85.52%±19.53%, P=0.023). Patients in both group B and C had elevated absolute eosinophil count (AEC) (group A: 3.12%±2.71%, group B: 5.41%±2.85%, group C: 6.1%±4.49%; group A vs. group B, P=0.008; group A vs. group C, P=0.002), and total sIgE values (group A: 117.36±144.90 IU/mL, group B: 195.86±155.87 IU/mL, group C: 253.31±152.41 IU/mL; group A vs. group B, P=0.031; group A vs. group C, P=0.002) compared with patients in group A. Asthma severity scores were higher in patients in group B compared to patients in group C (7 vs. 5.5, P<0.05). Patients allergic to molds were more likely to have severe asthma [odds ratio 3.636, 95% confidence interval (CI): 1.394 to 9.484; for severe versus mild asthma, P<0.05]. There was no association between

  1. Relief of asthma in two patients receiving danazol for endometriosis.

    PubMed Central

    Pride, S M; Yuen, B H

    1984-01-01

    This paper describes two patients with endometriosis in whom treatment with danazol resulted in a concomitant remission of asthma. Neither patient reported an association of clinical symptoms with phases of their menstrual cycle. Whether the remission was fortuitous or related to suppression of the activity of the endometriotic tissue or to the ability of danazol to increase the serum levels of two protease inhibitors that are deficient in patients with asthma remains to be determined. PMID:6478366

  2. Clinical factors affecting quality of life of patients with asthma

    PubMed Central

    Uchmanowicz, Bartosz; Panaszek, Bernard; Uchmanowicz, Izabella; Rosińczuk, Joanna

    2016-01-01

    Background In recent years, there has been increased interest in the subjective quality of life (QoL) of patients with bronchial asthma. QoL is a significant indicator guiding the efforts of professionals caring for patients, especially chronically ill ones. The identification of factors affecting the QoL reported by patients, despite their existing condition, is important and useful to provide multidisciplinary care for these patients. Aim To investigate the clinical factors affecting asthma patients’ QoL. Methods The study comprised 100 patients (73 female, 27 male) aged 18–84 years (mean age was 45.7) treated in the Allergy Clinic of the Wroclaw Medical University Department and Clinic of Internal Diseases, Geriatrics and Allergology. All asthma patients meeting the inclusion criteria were invited to participate. Data on sociodemographic and clinical variables were collected. In this study, we used medical record analysis and two questionnaires: the Asthma Quality of Life Questionnaire (AQLQ) to assess the QoL of patients with asthma and the Asthma Control Test to measure asthma control. Results Active smokers were shown to have a significantly lower QoL in the “Symptoms” domain than nonsmokers (P=0.006). QoL was also demonstrated to decrease significantly as the frequency of asthma exacerbations increased (R=−0.231, P=0.022). QoL in the domain “Activity limitation” was shown to increase significantly along with the number of years of smoking (R=0.404; P=0.004). Time from onset and the dominant symptom of asthma significantly negatively affected QoL in the “Activity limitation” domain of the AQLQ (R=−0.316, P=0.001; P=0.029, respectively). QoL scores in the “Emotional function” and “Environmental stimuli” subscale of the AQLQ decreased significantly as time from onset increased (R=−0.200, P=0.046; R=−0.328, P=0.001, respectively). Conclusion Patients exhibiting better symptom control have higher QoL scores. Asthma patients’ Qo

  3. Optimising the management of patients with difficult asthma.

    PubMed

    Palmer, Evelyn; Higgins, Bernard

    2015-11-01

    Asthma affects 5.4 million people in the UK, around 1 in 12 of the population. Between 5 and 10% of asthma (depending on the definition used) is categorised as difficult asthma, a term which generally refers to patients who continue to experience symptoms and frequent exacerbations despite the prescription of high-dose asthma therapy. Difficult asthma is an indication for specialist review by an appropriate respiratory physician, but close liaison between primary, secondary and tertiary care is critical and it is therefore important that primary care health professionals should be aware of the principles of management. One of the most important questions to ask is whether the individual with difficult asthma is taking their treatment Identifying this, however, is not easy. GPs could assess prescription uptake, looking for low use of preventers and excess use of short-acting bronchodilators. Newer means of assessing adherence have been developed. Inhaler devices that can monitor completion and timing of actuations have been produced. Meters that measure FeNO are available. A recent UK study found that 12 out of 100 patients referred for difficult asthma did not have reversible airflow obstruction or a history suggestive of asthma. Diagnoses included COPD, cystic fibrosis, cardiomyopathy, respiratory muscle dysfunction and severe anxiety with vocal cord dysfunction. PMID:26753269

  4. Optimising the management of patients with difficult asthma.

    PubMed

    Palmer, Evelyn; Higgins, Bernard

    2015-11-01

    Asthma affects 5.4 million people in the UK, around 1 in 12 of the population. Between 5 and 10% of asthma (depending on the definition used) is categorised as difficult asthma, a term which generally refers to patients who continue to experience symptoms and frequent exacerbations despite the prescription of high-dose asthma therapy. Difficult asthma is an indication for specialist review by an appropriate respiratory physician, but close liaison between primary, secondary and tertiary care is critical and it is therefore important that primary care health professionals should be aware of the principles of management. One of the most important questions to ask is whether the individual with difficult asthma is taking their treatment Identifying this, however, is not easy. GPs could assess prescription uptake, looking for low use of preventers and excess use of short-acting bronchodilators. Newer means of assessing adherence have been developed. Inhaler devices that can monitor completion and timing of actuations have been produced. Meters that measure FeNO are available. A recent UK study found that 12 out of 100 patients referred for difficult asthma did not have reversible airflow obstruction or a history suggestive of asthma. Diagnoses included COPD, cystic fibrosis, cardiomyopathy, respiratory muscle dysfunction and severe anxiety with vocal cord dysfunction.

  5. Changing clinical practice: views about the management of adult asthma

    PubMed Central

    Dawson, S.; Sutherland, K.; Dopson, S.; Miller, R.

    1999-01-01

    A case study of clinical practice in adult asthma is presented. The case is part of a larger project, funded by the North Thames NHS Executive Research and Development Programme, that sought to explore the part played by clinicians in the implementation of research and development into practice in two areas: adult asthma and glue ear in children. The first case of glue ear in children was reported in a previous issue of this journal (Quality in Health Care 1999;8:99-107). Background information from secondary sources on the condition, treatment, and organisation and location of care is followed by an account of the results of semistructured interviews with 159 clinicians. The findings are reported in two sections: clinical management and the organisation of care, and clinicians' accounts of what, why, and how they introduce changes into their practice. The way clinicians talk about their learning, their expressed views on acceptable practice, and their willingness to change were shown to be informed by construction of legitimate and sufficient evidence, respected colleagues, and accumulated individual experience. There was little open acknowledgment of the influence of organisational factors in influencing practice. To investigate whether relationships between task performance and organisational arrangements found in other sectors apply to UK health, more robust measures by which performance can be evaluated are needed. PMID:10847888

  6. Telematic system for monitoring of asthma severity in patients' homes.

    PubMed

    Finkelstein, J; Hripcsak, G; Cabrera, M

    1998-01-01

    Despite advances in the treatment of asthma the morbidity and mortality of this disease has increased significantly in the past several years. Recent studies have shown that monitoring of asthma severity in the patient home especially combined with patient education can reduce incidence of asthma exacerbation and subsequent hospitalization. The existing methods for home asthma monitoring are limited by four factors; they completely rely on a patient's ability to document and to evaluate test results; there is no easy way for a physician to review data in a timely manner; they use imprecise tools for evaluation of asthma severity and they don't provide clinical decision support tools. The goal of this study is to develop and to evaluate a telematic system for asthma severity monitoring which will minimize patients' efforts in performing self-testing at their homes and allow prompt reciprocal exchange of all relevant information between patients and health care providers. In our setting, patients use portable spirometer and pocket-sized palmtop computer for data exchange. Our system allows daily serial monitoring of asthma severity at patients' homes using Forced Vital Capacity test and symptom diary. The results of the tests become available for physicians review immediately after completion of self-testing procedures via Web browser. The results can be transmitted from patients' homes (or any other remote location) to the medical records database via landline or wireless networks in several minutes. Each time the remote server receives patient's results, it invokes the application which tests the validity of data, analyzes parameters trends and dispatches corresponding messages for the patient and, if necessary, for physicians. Such an approach provides constant feedback loop between asthma patient and physician. The system has been tested in 10 healthy volunteers and asthma patients. Patients participated in the study from two to 21 days. The test results showed

  7. Can Vitamin D Supplementation in Addition to Asthma Controllers Improve Clinical Outcomes in Patients With Asthma?

    PubMed Central

    Luo, Jian; Liu, Dan; Liu, Chun-Tao

    2015-01-01

    Abstract Effects of vitamin D on acute exacerbation, lung function, and fraction of exhaled nitric oxide (FeNO) in patients with asthma are controversial. We aim to further evaluate the roles of vitamin D supplementation in addition to asthma controllers in asthmatics. From 1946 to July 2015, we searched the PubMed, Embase, Medline, Cochrane Central Register of Controlled Trials, and ISI Web of Science using “Vitamin D,” “Vit D,” or “VitD” and “asthma,” and manually reviewed the references listed in the identified articles. Randomized controlled trials which reported rate of asthma exacerbations and adverse events, forced expiratory volume in 1 s (FEV1, % of predicted value), FeNO, asthma control test (ACT), and serum 25-hydroxyvitamin D levels were eligible. We conducted the heterogeneities test and sensitivity analysis of the enrolled studies, and random-effects or fixed-effects model was applied to calculate risk ratio (RR) and mean difference for dichotomous and continuous data, respectively. Cochrane systematic review software Review Manager (RevMan) was used to test the hypothesis by Mann–Whitney U test, which were displayed in Forest plots. Seven trials with a total of 903 patients with asthma were pooled in our final studies. Except for asthma exacerbations (I2 = 81%, χ2 = 10.28, P = 0.006), we did not find statistical heterogeneity in outcome measures. The pooled RR of asthma exacerbation was 0.66 (95% confidence interval: 0.32–1.37), but without significant difference (z = 1.12, P = 0.26), neither was in FEV1 (z = 0.30, P = 0.77), FeNO (z = 0.28, P = 0.78), or ACT (z = 0.92, P = 0.36), although serum 25-hydroxyvitamin D was significantly increased (z = 6.16, P < 0.001). Vitamin D supplementation in addition to asthma controllers cannot decrease asthma exacerbation and FeNO, nor improve lung function and asthma symptoms, although it can be safely applied to increase serum 25

  8. Compliance amongst asthma patients registered for an asthma disease risk-management programme in South Africa.

    PubMed

    Opedun, Ntombombuso; Ehlers, Valerie J; Roos, Janetta H

    2011-09-27

    The study attempted to identify the factors that influence compliance amongst 1039 members and their dependants of a particular medical aid scheme in South Africa who were registered for an asthma disease risk-management (DRM) programme. The sample consisted of 200 systematically selected individuals or their dependants. A quantitative, exploratory, and descriptive study was undertaken. Questionnaires for completion were posted to the individuals or their dependants. The Statistica 7.1 computer program was used to analyse the data.Most asthma patients did not comply with the DRM programme because they lacked knowledge of the programme. Asthma patients' compliance with the DRM programme can be enhanced by the sustained, positive attitudes of their health providers and case managers; better promotion of the programme; and by involving the patients to a greater extent in the long-term management of their disease.Asthma patients require education about healthy lifestyles that would empower them to successfully manage their condition, which would prevent or at least reduce asthma attacks and/or hospital admissions.

  9. Asthma

    MedlinePlus

    ... Month with a Google+ Hangout on Air for parents and caregivers to learn how to help control a child's asthma so that they can breathe ... parents build up their asthma team. Jose, his parents, a doctor and a nurse, ... forces to help Jose control his asthma. The video is recorded in Spanish ...

  10. [Asthma and scuba diving: can asthmatic patients dive?].

    PubMed

    Sade, Kobi; Wiesel, Ory; Kivity, Shmuel; Levo, Yoram

    2007-04-01

    Self-contained underwater breathing apparatus (scuba) diving has grown in popularity, with millions of divers enjoying the sport worldwide. This activity presents unique physical and physiological challenges to the respiratory system, raising numerous concerns about individuals with asthma who choose to dive. Asthma had traditionally been a contraindication to recreational diving, although this caveat has been ignored by large numbers of such patients. Herein we review the currently available literature to provide evidence-based evaluation of the risks associated with diving that are posed to asthmatics. Although there is some indication that asthmatics may be at an increased risk of pulmonary barotrauma, the risk seems to be small. Thus, under the right circumstances, patients with asthma can safely participate in recreational diving without any apparent increased risk of an asthma-related event. Decisions on whether or not diving is hazardous must be made on an individual basis and be founded upon an informed decision shared by both patient and physician.

  11. Out-Patient Management of Bronchial Asthma

    PubMed Central

    Cockcroft, D.W.

    1989-01-01

    Asthma, seen primarily as an inflammatory disease with secondary airway hyper-responsiveness, causes symptoms through contraction of the airway's smooth muscles. The management of chronic asthma relies on bronchodilators for symptomatic relief of bronchospasm, while primary therapy is used to either prevent or reverse the inflammatory component of the disease. Anti-inflammatory therapeutic strategies include environmental control (where relevant), sodium cromoglycate (where appropriate), and both inhaled and oral glucocorticosteroids. Management of acute severe asthma is similar; bronchodilators are used to ”buy time” while systemic corticosteroids control the inflammatory process. PMID:21248908

  12. [Preoperative Management of Patients with Bronchial Asthma or Chronic Bronchitis].

    PubMed

    Hagihira, Satoshi

    2015-09-01

    Bronchial asthma is characterized by chronic airway inflammation. The primary goal of treatment of asthma is to maintain the state of control. According to the Japanese guidelines (JGL2012), long-term management consists of 4 therapeutic steps, and use of inhaled corticosteroids (ICS) is recommended at all 4 steps. Besides ICS, inhalation of long-acting β2-agonist (LABA) is also effective. Recently, omalizumab (a humanized antihuman IgE antibody) can be available for patients with severe allergic asthma. Although there is no specific strategy for preoperative treatment of patients with asthma, preoperative systemic steroid administration seemed to be effective to prevent asthma attack during anesthesia. The most common cause of chronic bronchitis is smoking. Even the respiratory function is within normal limits, perioperative management of patients with chronic bronchitis is often troublesome. The most common problem is their sputum. To minimize perioperative pulmonary complication in these patients, smoking cessation and pulmonary rehabilitation are essential. It is known that more than 1 month of smoking cessation is required to reduce perioperative respiratory complication. However, even one or two weeks of smoking cessation can decrease sputum secretion. In summary, preoperative optimization is most important to prevent respiratory complication in patients with bronchial asthma or chronic bronchitis. PMID:26466493

  13. Assessment of second-line treatments for patients with uncontrolled moderate asthma

    PubMed Central

    Wang, Ke; Tian, Panwen; Fan, Yu; Wang, Ye; Liu, Chuntao

    2015-01-01

    Aim: To evaluate the best second-line treatments for patients with uncontrolled moderate asthma. Methods: A single-center, random study was conducted in adult patients with uncontrolled moderate asthma to evaluate the effects of add-on treatments. After add-on treatments for 4 and 12 weeks, the concentration of exhaled nitric oxide (FeNO), average daily durnal peak expiratory flow (PEF) variability and asthma control test (ACT) score were measured. Results: 94 patients have been divided into three groups to take different add-on treatments, in tiotropium bromide group, montelukast sodium group and double-dose inhaled corticosteroid (ICS) group. After four weeks, most patients improved their symptoms and ACT scores, with lower concentration of FeNO and small PEF variability. In double-dose ICS group, almost all patients took the complete controls of asthma, compared to those in other two groups. After additional 12 weeks’ therapy, patients in all three groups nearly achieved complete controls of asthma. There were two patients with pneumonia in double-dose ICS group. Patients in double-dose ICS group had higher ACT scores, lower concentrations of FeNO and smaller PEF variabilities, but a higher risk of pneumonia, compared to those in other two groups. The differences of PEF variabilities and ACT scores between tiotropium group and double-dose ICS group were not significant. Conclusion: Tiotropium in combination with ICS plus LABA showed the similar effects with double-dose ICS plus LABA, without adverse effects, which might be the best option for optimal control of asthma. PMID:26770595

  14. Allergic Patients with Long-Term Asthma Display Low Levels of Bifidobacterium adolescentis.

    PubMed

    Hevia, Arancha; Milani, Christian; López, Patricia; Donado, Carmen D; Cuervo, Adriana; González, Sonia; Suárez, Ana; Turroni, Francesca; Gueimonde, Miguel; Ventura, Marco; Sánchez, Borja; Margolles, Abelardo

    2016-01-01

    Accumulated evidence suggests a relationship between specific allergic processes, such as atopic eczema in children, and an aberrant fecal microbiota. However, little is known about the complete microbiota profile of adult individuals suffering from asthma. We determined the fecal microbiota in 21 adult patients suffering allergic asthma (age 39.43 ± 10.98 years old) and compare it with the fecal microbiota of 22 healthy controls (age 39.29 ± 9.21 years old) using culture independent techniques. An Ion-Torrent 16S rRNA gene-based amplification and sequencing protocol was used to determine the fecal microbiota profile of the individuals. Sequence microbiota analysis showed that the microbial alpha-diversity was not significantly different between healthy and allergic individuals and no clear clustering of the samples was obtained using an unsupervised principal component analysis. However, the analysis of specific bacterial groups allowed us to detect significantly lower levels of bifidobacteria in patients with long-term asthma. Also, in allergic individuals the Bifidobacterium adolescentis species prevailed within the bifidobacterial population. The reduction in the levels on bifidobacteria in patients with long-term asthma suggests a new target in allergy research and opens possibilities for the therapeutic modulation of the gut microbiota in this group of patients.

  15. Allergic Patients with Long-Term Asthma Display Low Levels of Bifidobacterium adolescentis

    PubMed Central

    Hevia, Arancha; Milani, Christian; López, Patricia; Donado, Carmen D.; Cuervo, Adriana; González, Sonia; Suárez, Ana; Turroni, Francesca; Gueimonde, Miguel; Ventura, Marco; Sánchez, Borja; Margolles, Abelardo

    2016-01-01

    Accumulated evidence suggests a relationship between specific allergic processes, such as atopic eczema in children, and an aberrant fecal microbiota. However, little is known about the complete microbiota profile of adult individuals suffering from asthma. We determined the fecal microbiota in 21 adult patients suffering allergic asthma (age 39.43 ± 10.98 years old) and compare it with the fecal microbiota of 22 healthy controls (age 39.29 ± 9.21 years old) using culture independent techniques. An Ion-Torrent 16S rRNA gene-based amplification and sequencing protocol was used to determine the fecal microbiota profile of the individuals. Sequence microbiota analysis showed that the microbial alpha-diversity was not significantly different between healthy and allergic individuals and no clear clustering of the samples was obtained using an unsupervised principal component analysis. However, the analysis of specific bacterial groups allowed us to detect significantly lower levels of bifidobacteria in patients with long-term asthma. Also, in allergic individuals the Bifidobacterium adolescentis species prevailed within the bifidobacterial population. The reduction in the levels on bifidobacteria in patients with long-term asthma suggests a new target in allergy research and opens possibilities for the therapeutic modulation of the gut microbiota in this group of patients. PMID:26840903

  16. The Saudi Initiative for Asthma - 2016 update: Guidelines for the diagnosis and management of asthma in adults and children

    PubMed Central

    Al-Moamary, Mohamed S.; Alhaider, Sami A.; Idrees, Majdy M.; Al Ghobain, Mohammed O.; Zeitouni, Mohammed O.; Al-Harbi, Adel S.; Yousef, Abdullah A.; Al-Matar, Hussain; Alorainy, Hassan S.; Al-Hajjaj, Mohamed S.

    2016-01-01

    This is an updated guideline for the diagnosis and management of asthma, developed by the Saudi Initiative for Asthma (SINA) group, a subsidiary of the Saudi Thoracic Society. The main objective of SINA is to have guidelines that are up to date, simple to understand and easy to use by nonasthma specialists, including primary care and general practice physicians. SINA approach is mainly based on symptom control and assessment of risk as it is the ultimate goal of treatment. The new SINA guidelines include updates of acute and chronic asthma management, with more emphasis on the use of asthma control in the management of asthma in adults and children, inclusion of a new medication appendix, and keeping consistency on the management at different age groups. The section on asthma in children is rewritten and expanded where the approach is stratified based on the age. The guidelines are constructed based on the available evidence, local literature, and the current situation in Saudi Arabia. There is also an emphasis on patient–doctor partnership in the management that also includes a self-management plan. PMID:26933455

  17. Ambient Air Pollution and Adult Asthma Incidence in Six European Cohorts (ESCAPE)

    PubMed Central

    Siroux, Valérie; Sanchez, Margaux; Carsin, Anne-Elie; Schikowski, Tamara; Adam, Martin; Bellisario, Valeria; Buschka, Anna; Bono, Roberto; Brunekreef, Bert; Cai, Yutong; Cirach, Marta; Clavel-Chapelon, Françoise; Declercq, Christophe; de Marco, Roberto; de Nazelle, Audrey; Ducret-Stich, Regina E.; Ferretti, Virginia Valeria; Gerbase, Margaret W.; Hardy, Rebecca; Heinrich, Joachim; Janson, Christer; Jarvis, Deborah; Al Kanaani, Zaina; Keidel, Dirk; Kuh, Diana; Le Moual, Nicole; Nieuwenhuijsen, Mark J.; Marcon, Alessandro; Modig, Lars; Pin, Isabelle; Rochat, Thierry; Schindler, Christian; Sugiri, Dorothea; Stempfelet, Morgane; Temam, Sofia; Tsai, Ming-Yi; Varraso, Raphaëlle; Vienneau, Danielle; Vierkötter, Andrea; Hansell, Anna L.; Krämer, Ursula; Probst-Hensch, Nicole M.; Sunyer, Jordi; Künzli, Nino; Kauffmann, Francine

    2015-01-01

    Background Short-term exposure to air pollution has adverse effects among patients with asthma, but whether long-term exposure to air pollution is a cause of adult-onset asthma is unclear. Objective We aimed to investigate the association between air pollution and adult onset asthma. Methods Asthma incidence was prospectively assessed in six European cohorts. Exposures studied were annual average concentrations at home addresses for nitrogen oxides assessed for 23,704 participants (including 1,257 incident cases) and particulate matter (PM) assessed for 17,909 participants through ESCAPE land-use regression models and traffic exposure indicators. Meta-analyses of cohort-specific logistic regression on asthma incidence were performed. Models were adjusted for age, sex, overweight, education, and smoking and included city/area within each cohort as a random effect. Results In this longitudinal analysis, asthma incidence was positively, but not significantly, associated with all exposure metrics, except for PMcoarse. Positive associations of borderline significance were observed for nitrogen dioxide [adjusted odds ratio (OR) = 1.10; 95% CI: 0.99, 1.21 per 10 μg/m3; p = 0.10] and nitrogen oxides (adjusted OR = 1.04; 95% CI: 0.99, 1.08 per 20 μg/m3; p = 0.08). Nonsignificant positive associations were estimated for PM10 (adjusted OR = 1.04; 95% CI: 0.88, 1.23 per 10 μg/m3), PM2.5 (adjusted OR = 1.04; 95% CI: 0.88, 1.23 per 5 μg/m3), PM2.5absorbance (adjusted OR = 1.06; 95% CI: 0.95, 1.19 per 10–5/m), traffic load (adjusted OR = 1.10; 95% CI: 0.93, 1.30 per 4 million vehicles × meters/day on major roads in a 100-m buffer), and traffic intensity (adjusted OR = 1.10; 95% CI: 0.93, 1.30 per 5,000 vehicles/day on the nearest road). A nonsignificant negative association was estimated for PMcoarse (adjusted OR = 0.98; 95% CI: 0.87, 1.14 per 5 μg/m3). Conclusions Results suggest a deleterious effect of ambient air pollution on asthma incidence in adults. Further

  18. Level of asthma control and its impact on activities of daily living in asthma patients in Brazil*

    PubMed Central

    Gazzotti, Mariana Rodrigues; Nascimento, Oliver Augusto; Montealegre, Federico; Fish, James; Jardim, José Roberto

    2013-01-01

    OBJECTIVE: To evaluate the impact of asthma on activities of daily living and on health status in patients with controlled, partially controlled, or uncontrolled asthma in Brazil. METHODS: We used data related to 400 patients in four Brazilian cities (São Paulo, Rio de Janeiro, Salvador, and Curitiba), obtained in a survey conducted throughout Latin America in 2011. All study subjects were > 12 years of age and completed a standardized questionnaire in face-to-face interviews. The questions addressed asthma control, hospitalizations, emergency room visits, and school/work absenteeism, as well as the impact of asthma on the quality of life, sleep, and leisure. The level of asthma control was determined in accordance with the Global Initiative for Asthma criteria. RESULTS: Among the 400 respondents, asthma was controlled in 37 (9.3%), partially controlled in 226 (56.5%), and uncontrolled in 137 (34.2%). The numbers of patients with uncontrolled or partially controlled asthma who visited the emergency room, who were hospitalized, and who missed school/work were higher than were those of patients with controlled asthma (p = 0.001, p = 0.05, and p = 0.01, respectively). Among those with uncontrolled asthma, the impact of the disease on activities of daily living, sleep, social activities, and normal physical exertion was greater than it was among those with controlled or partially controlled asthma (p < 0.001). CONCLUSIONS: In Brazil, asthma treatment should be monitored more closely in order to increase treatment adherence and, consequently, the level of asthma control, which can improve patient quality of life and minimize the negative impact of the disease. PMID:24310625

  19. Two Phase II randomized trials on the CRTh2 antagonist AZD1981 in adults with asthma

    PubMed Central

    Kuna, Piotr; Bjermer, Leif; Tornling, Göran

    2016-01-01

    Background Chemoattractant receptor-homologous molecule expressed on T helper type 2 (Th2) cell (CRTh2) receptor antagonists is being investigated for asthma. Objectives The aim of this study was to assess the effects of the CRTh2 receptor antagonist, AZD1981 (with/without inhaled corticosteroids [ICSs]), on lung function and asthma control. Patients and methods Adults aged 18–60 years were enrolled in two randomized, placebo-controlled, parallel-group trials (protocol number: D9830C00003 [study 1, n=209] and protocol number: D9830C00004 [study 2, n=510]). In study 1, patients with stable asthma (forced expiratory volume in 1 second [FEV1]: 65%−110%) were withdrawn from ICS (<400 µg/d) and randomized to AZD1981 1,000 mg twice daily (bid) or placebo. In study 2, patients with uncontrolled asthma (FEV1: 40%−85%) despite ICS therapy (≥500 µg/d) were randomized to 50 mg, 400 mg, or 1,000 mg bid AZD1981 or placebo. The primary efficacy variable for both trials was the change in morning peak expiratory flow after 4 weeks of treatment. Secondary variables included Asthma Control Questionnaire (ACQ-5) scores, FEV1 assessments, safety, and tolerability. In study 2, efficacy was also assessed according to atopic status. Results Following 4 weeks of treatment, there was a nonsignificant increase in morning peak expiratory flow on AZD1981 1,000 mg bid (9.5 L/min vs placebo, P=0.086 [study 1] and 12 L/min vs placebo, P=0.16 [study 2]). In study 2, all doses of AZD1981 provided significant improvements in ACQ-5 scores (0.26–0.3 units vs placebo, P=0.010–0.022); however, there was no dose–response relationship. Improved ACQ-5 scores and FEV1 were observed in the majority of atopic patients treated with AZD1981. AZD1981 was well tolerated across treatment groups. Conclusion Further research may be warranted in atopic patients to fully evaluate the clinical efficacy of AZD1981. PMID:27621597

  20. Two Phase II randomized trials on the CRTh2 antagonist AZD1981 in adults with asthma

    PubMed Central

    Kuna, Piotr; Bjermer, Leif; Tornling, Göran

    2016-01-01

    Background Chemoattractant receptor-homologous molecule expressed on T helper type 2 (Th2) cell (CRTh2) receptor antagonists is being investigated for asthma. Objectives The aim of this study was to assess the effects of the CRTh2 receptor antagonist, AZD1981 (with/without inhaled corticosteroids [ICSs]), on lung function and asthma control. Patients and methods Adults aged 18–60 years were enrolled in two randomized, placebo-controlled, parallel-group trials (protocol number: D9830C00003 [study 1, n=209] and protocol number: D9830C00004 [study 2, n=510]). In study 1, patients with stable asthma (forced expiratory volume in 1 second [FEV1]: 65%−110%) were withdrawn from ICS (<400 µg/d) and randomized to AZD1981 1,000 mg twice daily (bid) or placebo. In study 2, patients with uncontrolled asthma (FEV1: 40%−85%) despite ICS therapy (≥500 µg/d) were randomized to 50 mg, 400 mg, or 1,000 mg bid AZD1981 or placebo. The primary efficacy variable for both trials was the change in morning peak expiratory flow after 4 weeks of treatment. Secondary variables included Asthma Control Questionnaire (ACQ-5) scores, FEV1 assessments, safety, and tolerability. In study 2, efficacy was also assessed according to atopic status. Results Following 4 weeks of treatment, there was a nonsignificant increase in morning peak expiratory flow on AZD1981 1,000 mg bid (9.5 L/min vs placebo, P=0.086 [study 1] and 12 L/min vs placebo, P=0.16 [study 2]). In study 2, all doses of AZD1981 provided significant improvements in ACQ-5 scores (0.26–0.3 units vs placebo, P=0.010–0.022); however, there was no dose–response relationship. Improved ACQ-5 scores and FEV1 were observed in the majority of atopic patients treated with AZD1981. AZD1981 was well tolerated across treatment groups. Conclusion Further research may be warranted in atopic patients to fully evaluate the clinical efficacy of AZD1981.

  1. Adherence to asthma guidelines in general practices.

    PubMed

    Roghmann, M C; Sexton, M

    1999-06-01

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

  2. Improved ability to perform strenuous activities after treatment with fluticasone propionate/salmeterol combination in patients with persistent asthma.

    PubMed

    Nathan, Robert A; Dorinsky, Paul; Rosenzweig, Jacqueline R Carranza; Shah, Tushar; Edin, Heather; Prillaman, Barbara

    2003-01-01

    Patients with asthma experience disruptions in usual activities that can impair their quality of life, and in patients whose daily routine involves an active lifestyle, these disruptions can be severe. We assessed the patient-perceived effect of treatment with fluticasone propionate/salmeterol combination (FSC), compared with fluticasone propionate (FP) or salmeterol (SAL) alone, on activity limitations, particularly strenuous physical activities. The Asthma Quality of Life Questionnaire (AQLQ) was administered in two 12-week, randomized, double-blind, placebo-controlled trials comparing FSC 100/50 or 250/50 microg twice daily vs. the individual components alone in 686 adults and adolescents with asthma. In one study, patients were stratified by prior treatment [low to medium doses of inhaled corticosteroids (ICS) or SAL], and in the other study, all patients were previously treated with medium to high doses of ICS. Patients prospectively identified five activities they performed regularly and were asked how these activities were limited by their asthma. The effect of randomized treatment on strenuous activities (e.g., aerobics, cycling, hiking, and basketball) was assessed. In both studies, treatment with FSC resulted in clinically meaningful improvements (i.e., change in AQLQ of > or = 0.5) and was statistically significantly better than SAL in both studies and FP in one study. Treatment of the two main components of asthma--inflammation and bronchoconstriction--with FSC results in clinically meaningful improvements in the ability of patients with persistent asthma to perform not only their usual activities but also strenuous activities.

  3. Inhaled corticosteroid beliefs, complementary and alternative medicine and uncontrolled asthma in urban minority adults

    PubMed Central

    George, Maureen; Topaz, Maxim; Rand, Cynthia; Sommers, Marilyn (Lynn) Sawyer; Glanz, Karen; Pantalon, Michael V.; Mao, Jun J.; Shea, Judy A.

    2014-01-01

    Background Many factors contribute to uncontrolled asthma; negative inhaled corticosteroid (ICS) beliefs and complementary and alternative medicine (CAM) endorsement are two that are more prevalent in Black as compared to White adults. Objectives This mixed methods study 1) developed and psychometrically tested a brief self-administered tool with low literacy demands to identify negative ICS beliefs and CAM endorsement and; 2) evaluated the clinical utility of the tool as a communication prompt in primary care. Methods Comprehensive literature reviews and content experts identified candidate items for our instrument that was distributed to 304 individuals for psychometric testing. In the second phase, content analysis of 33 audio recorded primary care visits provided a preliminary evaluation of the instrument's clinical utility. Results Psychometric testing of the instrument identified 17 items representing ICS beliefs (α .59) and CAM endorsement (α .68). Test-retest analysis demonstrated a high level of reliability (ICC .77 for CAM items and .79 for ICS items). We found high rates of CAM endorsement (93%), negative ICS beliefs (68%), and uncontrolled asthma (69%). CAM endorsement was significantly associated with uncontrolled asthma (p=.04). Qualitative data analysis provided preliminary evidence for the instrument's clinical utility in that knowledge of ICS beliefs and CAM endorsement prompted providers to initiate discussions with patients. Conclusion Negative ICS beliefs and CAM endorsement were common and were associated with uncontrolled asthma. A brief self-administered instrument that identifies beliefs and behaviors that likely undermine ICS adherence may be a leveraging tool to change the content of communication during clinic visits. PMID:25218286

  4. Asthma.

    PubMed

    Bergmann, Karl-Christian

    2014-01-01

    'Asthma' is derived from the Greek root ασθμαινω, meaning 'gasp for breath'. The term originally did not define a disease, but was employed to describe respiratory symptoms of a variety of pulmonary conditions. Over the centuries, several models have been proposed to understand the pathophysiologic abnormalities of asthma. By the beginning of the 20th century, asthma was seen to be a unique illness characterized by 'spasmodic afflictions of the bronchial tubes'. Consistent with the nature of asthma as a complex disease, the models for asthma pathogenesis have become increasingly complex. Research has moved from antiquated ideas to a descriptive functional approach to one that relies on pathophysiology in cellular and molecular biology, immunology, microbiology and genetics/genomics. As more advanced technologies for measuring lung function were developed, the features of asthma were steadily unraveled and its pathophysiology clarified. Asthma was shown to be associated with transient increases in airway resistance, reductions in forced expiratory volumes and flows, hyperinflation of the lungs and increased work of breathing, as well as abnormalities in the distribution of ventilation, perfusion and arterial blood gases. Today, asthma is seen as a chronic inflammatory disease which is not yet fully understood in its pathophysiology; therefore, therapy is still on the path to becoming optimal. PMID:24925386

  5. Asthma.

    PubMed

    Bergmann, Karl-Christian

    2014-01-01

    'Asthma' is derived from the Greek root ασθμαινω, meaning 'gasp for breath'. The term originally did not define a disease, but was employed to describe respiratory symptoms of a variety of pulmonary conditions. Over the centuries, several models have been proposed to understand the pathophysiologic abnormalities of asthma. By the beginning of the 20th century, asthma was seen to be a unique illness characterized by 'spasmodic afflictions of the bronchial tubes'. Consistent with the nature of asthma as a complex disease, the models for asthma pathogenesis have become increasingly complex. Research has moved from antiquated ideas to a descriptive functional approach to one that relies on pathophysiology in cellular and molecular biology, immunology, microbiology and genetics/genomics. As more advanced technologies for measuring lung function were developed, the features of asthma were steadily unraveled and its pathophysiology clarified. Asthma was shown to be associated with transient increases in airway resistance, reductions in forced expiratory volumes and flows, hyperinflation of the lungs and increased work of breathing, as well as abnormalities in the distribution of ventilation, perfusion and arterial blood gases. Today, asthma is seen as a chronic inflammatory disease which is not yet fully understood in its pathophysiology; therefore, therapy is still on the path to becoming optimal.

  6. Intake of multivitamin supplements and incident asthma in Norwegian adults: the HUNT study

    PubMed Central

    Jiang, Lin; Brumpton, Ben; Langhammer, Arnulf; Chen, Yue

    2015-01-01

    Although intake of multivitamin supplements is becoming increasingly popular, the relationship between intake of multivitamin supplements and incident asthma remains unclear. Prospective studies in adults with long-term follow-up are especially scarce. Our objective was to investigate the association between intake of multivitamin supplements and asthma development in Norwegian adults. We followed 16 952 adult subjects from the second survey of the Nord-Trøndelag Health Study (1995–1997) up to 2006–2008, who, at baseline, were free of asthma and provided information on their intake of multivitamin supplements and cod liver oil. Regular intake of multivitamin supplements or cod liver oil was defined as daily intake for ≥3 months during the year prior to baseline. Incident asthma was defined as reported new-onset asthma after the 11-year follow-up. Intake of multivitamin supplements only was associated with an increased odds ratio for incident asthma (OR 1.55, 95% CI 1.12–2.13) after adjustment for a number of common confounding factors (model I). Similar odds ratios were found for intake of cod liver oil only and for intake of both supplements (1.59 and 1.73, respectively). Regular intake of multivitamin supplements was associated with an increased odds ratio for incident asthma in Norwegian adults. PMID:27730154

  7. Influence of asthma on quality of life and clinical characteristics of patients with nasal polyposis.

    PubMed

    Dudvarski, Zoran; Djukic, Vojko; Janosevic, Ljiljana; Tomanovic, Nada; Soldatovic, Ivan

    2013-03-01

    Recent studies have evidenced that nasal polyposis (NP) may lead to significant limitations in physical, emotional and social aspects of life of the affected patients. The study is aimed to investigate the influence of asthma on quality of life (QoL), intensity of symptoms, endoscopic and computerized tomography (CT) sinus findings in patients with NP. The cross-sectional study included 88 adult patients with NP out of whom 35 (39.8 %) were asthmatic while 53 (60.2 %) were non-asthmatic. QoL is assessed based on Short Form-36 Health Survey (SF-36) questionnaire, while symptom intensity was presented using visual analogue scale (VAS). The objective finding is presented as endoscopic and CT score. Comparison of individual symptom intensity, total score and major symptom score failed to evidence any statistically significant difference between the groups. Minor symptom score which include intensity of headache, fetor ex ore, fatigue/malaise, dental pain, cough, pressure/fullness in the ears and fever was higher in the group with asthma (p < 0.05). Comparison of scores according to SF-36 domains, as well as summary scores for physical and mental health did not reveal statistically significant difference between the observed groups. Mean value of the endoscopic score in the group with asthma was 8.57 ± 2.22, being 8.38 ± 1.93 in the group without asthma (p > 0.05). Mean value of the CT score in the groups with and without asthma was 20.37 ± 4.34 and 17.47 ± 4.75, respectively (p < 0.01). Asthma has no influence on QoL and endoscopic findings of patients with NP, however it influences minor symptom score and CT findings. PMID:23135235

  8. The Challenge of Delivering Therapeutic Aerosols to Asthma Patients

    PubMed Central

    Lavorini, Federico

    2013-01-01

    The number of people with asthma continues to grow around the world, and asthma remains a poorly controlled disease despite the availability of management guidelines and highly effective medication. Patient noncompliance with therapy is a major reason for poor asthma control. Patients fail to comply with their asthma regimen for a wide variety of reasons, but incorrect use of inhaler devices is amongst the most common. The pressurised metered-dose inhaler (pMDI) is still the most frequently used device worldwide, but many patients fail to use it correctly, even after repeated tuition. Breath-actuated inhalers are easier to use than pMDIs. The rationale behind inhaler choice should be evidence based rather than empirical. When choosing an inhaler device, it is essential that it is easy to use correctly, dosing is consistent, adequate drug is deposited in both central and peripheral airways, and that drug deposition is independent of airflow. Regular checking of inhalation technique is crucial, as correct inhalation is one of the cornerstones of successful asthma management. PMID:23984095

  9. Socioeconomic Risk Factors for Asthma in Chilean Young Adults

    PubMed Central

    Corvalán, Camila; Amigo, Hugo; Bustos, Patricia; Rona, Roberto J.

    2005-01-01

    Objectives. We studied the association between socioeconomic status (SES) and asthma symptoms, severity of asthma, atopy, and bronchial hyperresponsiveness (BHR) to methacholine. Methods. We studied 1232 men and women born between 1974 and 1978 in a semirural area of Chile. We assessed asthma symptoms with a standardized questionnaire, atopy with a skin-prick test to 8 allergens, and BHR to methacholine with the tidal breathing method. SES was derived from several indicators: education, occupation, completion of a welfare form, belongings, housing, number of siblings, and overcrowding. Results. Those with fewer belongings had more asthma symptoms. Those who had higher education and those who owned cars had fewer asthma symptoms and BHR. Overcrowding was negatively related to atopy, atopy with asthma symptoms, and BHR. Higher education and noncompletion of a welfare form were risk factors for atopy. Conclusion. The strength and direction of the association between asthma and SES depended on what definition of asthma was analyzed. Asthma symptoms were more common among poor people. There was some support for the hygiene hypothesis, as overcrowding was associated with less wheezing with atopy, less atopy, and less BHR. PMID:15985644

  10. Prevalence and risk factors for work related asthma in young adults

    PubMed Central

    Caldeira, R D; Bettiol, H; Barbieri, M A; Terra‐Filho, J; Garcia, C A; Vianna, E O

    2006-01-01

    Objectives To investigate the prevalence and predictors of work related asthma in young adults from the general population. Methods A total of 1922 subjects randomly selected from a birth cohort 1978/79 in Brazil, aged 23–25 years, completed a respiratory symptoms questionnaire based on the European Community Respiratory Health Survey, and underwent spirometry, bronchial challenge test with methacholine, and skin prick test. For subjects presenting with bronchial hyperresponsiveness, workplace exposure and its relationship with symptoms were assessed by a specific questionnaire and individualised job description to define cases of work related asthma. Results The prevalence of work related asthma was 4.2% (81 cases): 1.5% (29 cases) were classified as aggravated asthma and 2.7% (52 cases) as occupational asthma. Work related asthma was associated with atopy and education. Lower educational level (1–8 years of schooling) was associated with work related asthma (odds ratio 7.06, 95% CI 3.25 to 15.33). There was no association between work related asthma and smoking, gender, or symptoms of rhinitis. Conclusion The prevalence of work related asthma was high (4.2%), and was associated with low schooling, probably because of low socioeconomic level. The disease may therefore be a consequence of poverty. PMID:16728501

  11. The influence of atopy and asthma on immune responses in inner-city adults.

    PubMed

    Kakumanu, Sujani; Jaffee, Katy; Visness, Cynthia M; Dresen, Amy; Burger, Melissa; Witter, Frank R; O'Connor, George T; Cruikshank, William W; Shreffler, Wayne G; Bacharier, Leonard B; Gern, James E

    2016-03-01

    Asthma in the inner-city population is usually atopic in nature, and is associated with significant morbidity and mortality. However, the underlying immune abnormalities that underlie asthma in urban adults have not been well defined. We investigated the influence of atopy and asthma on cytokine responses of inner-city adult women to define immune abnormalities associated with asthma and atopy. Blood samples were collected from 509 of 606 inner-city women enrolled in the Urban Environment and Childhood Asthma (URECA) study. We tested for associations between atopy and asthma status and cytokine responses in peripheral blood mononuclear cells incubated ex vivo with a panel of innate and adaptive immune stimulants. Atopic subjects had heightened Th2 cytokine responses (IL-4, IL-5, IL-13) to cockroach and dust mite antigens, tetanus toxoid, and phytohemagglutinin (P < 0.05 for all). Differences in cytokine responses were greatest in response to stimulation with cockroach and dust mite. In a multivariate analysis, atopy was broadly related to increased Th2-like responses to all antigens and PHA, while asthma was only weakly related to mitogen-induced IL-4 and IL-5 responses. There were few asthma or allergy-related differences in responses to innate stimuli, including IFN-α and IFN-γ responses. In this inner-city adult female population, atopy is associated with enhanced Th2 responses to allergens and other stimuli, and there was little or no additional signal attributable to asthma. In particular, these data indicate that altered systemic interferon and innate immune responses are not associated with allergies and/or asthma in inner-city women. PMID:27042305

  12. Association between Western diet pattern and adult asthma: a focused review

    PubMed Central

    Brigham, Emily P.; Kolahdooz, Fariba; Hansel, Nadia; Breysse, Patrick N.; Davis, Meghan; Sharma, Sangita; Matsui, Elizabeth C.; Diette, Gregory; McCormack, Meredith C.

    2016-01-01

    Objective Radical changes in diet have paralleled the increase in asthma with shifts toward a “Western” diet pattern, characterized by the high intake of processed meats and refined grains, high-fat dairy products, and sugary desserts and drinks. Because diet represents a modifiable risk factor in numerous chronic diseases, the authors examined the association between consumption of a Western diet pattern and asthma incidence, prevalence, and morbidity in adults. Data Sources PubMed, Cochrane, Web of Science, and Scopus were searched for peer-reviewed publications published from January 1980 to April 2014. Study Selection Studies retrieved for inclusion assessed dietary patterns representative of a Western diet and asthma incidence, prevalence, respiratory symptoms, and lung function. Results Ten observational studies conducted in North American, European, and Asian countries, ranging from 153 to more than 70,000 individuals, did not provide evidence to support an association between a Western dietary pattern and asthma incidence and prevalence. Five of these studies also investigated asthma morbidity, with variable findings. Conclusion Current evidence does not support an association between a Western diet and incident or prevalent adult asthma but does suggest a possible link between a Western diet pattern and adult asthma morbidity. PMID:25524748

  13. Interaction between asthma and smoking increases the risk of adult airway obstruction.

    PubMed

    Aanerud, Marianne; Carsin, Anne-Elie; Sunyer, Jordi; Dratva, Julia; Gislason, Thorarinn; Jarvis, Deborah; deMarco, Roberto; Raherison, Chantal; Wjst, Matthias; Dharmage, Shyamali C; Svanes, Cecilie

    2015-03-01

    The aim of the present study was to analyse the interaction between asthma and smoking in the risk of adult airway obstruction, accounting for atopy. In the European Community Respiratory Health Survey, 15 668 persons aged 20-56 years underwent spirometry in 1991-1993 and 9 years later (n=8916). Risk of airway obstruction and lung function decline associated with smoking and early-onset (<10 years of age) and late-onset (>10 years of age) asthma were analysed with generalised estimating equation models and random-effect linear models, adjusting for covariates. Interaction of asthma with smoking was expressed as relative excess risk due to interaction (RERI). A 20-fold increase in adult airway obstruction was found among those with early-onset asthma independently of smoking status (never-smokers: OR 21.0, 95% CI 12.7-35; current smokers: OR 23.7, 95% CI 13.9-40.6). Late-onset asthma was associated with airway obstruction, with a stronger association among current smokers (OR 25.6, 95% CI 15.6-41.9) than among never-smokers (OR 11.2, 95% CI 6.8-18.6) (RERI 12.02, 95% CI 1.96-22.07). Stratifying by atopy, the association between smoking and asthma was most pronounced among nonatopics. Early- and late-onset asthma were associated with 10-20-fold increased risk of adult airway obstruction. Smoking increased the risk of adult airway obstruction in subjects with asthma onset after age 10 years. Investigation of measures potentially preventive of chronic obstructive pulmonary disease development following asthma is urgently needed.

  14. Asthma Medications and Pregnancy

    MedlinePlus

    ... Asthma: Associated Conditions Asthma and Pregnancy Asthma Medications Asthma Medications Make an Appointment Refer a Patient Ask ... make sure you are using it correctly. Other Asthma Related Medication Treatment Annual influenza vaccine (flu shot) ...

  15. The need to differentiate between adults and children when treating severe asthma.

    PubMed

    Fainardi, Valentina; Saglani, Sejal

    2015-08-01

    Severe asthma at all ages is heterogeneous incorporating several phenotypes that are distinct in children and adults, however, there are also numerous similar features including the limitation that they may not remain stable longitudinally. Severe asthma in both children and adults is characterized by eosinophilic airway inflammation and evidence of airway remodeling. In adults, targeting eosinophilia with anti-IL-5 antibody therapy is very successful, resulting in the recommendation that sputum eosinophils should be used to guide treatment. In contrast, data for the efficacy of blocking IL-5 remain unavailable in children. However, its effectiveness is uncertain since many children with severe asthma have normal blood eosinophils and the dominance of Th2-mediated inflammation is controversial. Approaches that have revealed gene signatures and biomarkers such as periostin that are specific to adult disease now need to be adopted in children to identify effective pediatric specific therapeutics and minimize the extrapolation of adult therapeutics to children.

  16. Influence of Asian Desert Dust on Lower Respiratory Tract Symptoms in Patients with Asthma over 4 Years.

    PubMed

    Watanabe, Masanari; Kurai, Jun; Igishi, Tadashi; Yamasaki, Akira; Burioka, Naoto; Takeuchi, Hiromi; Sako, Takanori; Touge, Hirokazu; Nakamoto, Masaki; Hasegawa, Yasuyuki; Chikumi, Hiroki; Matsumoto, Shingo; Yamasaki, Chie; Minato, Sayaka; Ueda, Yutaka; Horasaki, Kazunori; Watanabe, Tetsushi; Shimizu, Eiji

    2012-06-01

    The Asian Dust Storm (ADS) aggravates symptoms and pulmonary dysfunction in adult asthma patients. Our objective was to investigate the association of air pollutants and metals in desert dust with worsening of asthma symptoms during the ADS. A telephone survey was performed to investigate the upper and lower respiratory tract symptoms, ocular symptoms and skin symptoms of asthma patients during the ADS in March between 2007 and 2010. Four surveys were conducted in 46 patients. Two patients noted worsening of lower respiratory tract symptoms in all four surveys, as well as 2 patients in three surveys, 7 patients in two surveys, and 9 patients in one survey. There was no worsening of lower respiratory tract symptoms in 26 patients. In each patient, the influence of the ADS on lower respiratory tract symptoms varied between surveys. In 2010, the level of suspended particulate matter was highest in all four years, but the smallest number of patients noted worsening of lower respiratory tract symptoms. Among pollutants, only the maximum concentration of nitrogen dioxide during the ADS was significantly associated with the worsening of lower respiratory tract symptoms. The influence of the ADS on lower respiratory tract symptoms of adult asthma patients is variable. PMID:24031138

  17. Clinical assessment of asthma progression in children and adults.

    PubMed

    Spahn, Joseph D; Covar, Ronina

    2008-03-01

    Asthma is a heterogeneous disorder with a variable course, characterized by episodes of cough, wheezing and shortness of breath, reversible airflow limitation, and bronchial hyperresponsiveness. It begins early in life in many subjects with intermittent symptoms occurring with viral respiratory tract infections. Over time, and in genetically susceptible children (those with an atopic predisposition), the disease becomes more persistent with symptoms occurring in the absence of respiratory tract infections. Children with persistent wheezing are eventually diagnosed with asthma, with those at greatest risk having developed allergic sensitization early in life. Among children with asthma, some will have lifelong asthma with active symptoms and progressive loss of lung function over time, whereas other children will undergo asthma remission in adolescence. Once in remission, the disease may remain quiescent, or it may relapse in midadult life. This review focuses on studies that have enhanced our understanding of the progression of asthma from infancy to adulthood. Studies evaluating progressive loss of lung function, the best-studied measure of asthma progression, are also reviewed, followed by a brief discussion of whether asthma progression can be modified by inhaled glucocorticoid therapy.

  18. Adult-Onset Asthma to Coronary Heart Disease and Stroke

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Asthma has been associated with atherosclerotic disease in several studies with some evidence that this association may be limited to women. However, most previous studies have failed to account for the heterogeneity of asthma subtypes. We previously reported increased carotid intima medial thickne...

  19. Asthma

    MedlinePlus

    ... for Parents for Kids for Teens Teens Home Body Mind Sexual Health Food & Fitness Diseases & Conditions Infections Q& ... exercise. It's a great way to keep the body and mind healthy, so if you get exercise-induced asthma ...

  20. Pesticide use and adult-onset asthma among male farmers in the Agricultural Health Study

    PubMed Central

    Hoppin, Jane A.; Umbach, David M.; London, Stephanie J.; Henneberger, Paul K.; Kullman, Greg J.; Coble, Joseph; Alavanja, Michael C.R.; Beane Freeman, Laura E.; Sandler, Dale P.

    2010-01-01

    Although specific pesticides have been associated with wheeze in farmers, little is known about pesticides and asthma. We used data from 19,704 male farmers in the Agricultural Health Study to evaluate lifetime use of 48 pesticides and prevalent adult-onset asthma, defined as doctor-diagnosed asthma after age 20. We categorized asthma cases as allergic (N=127) and non-allergic (N=314) based on their history of eczema or hayfever. We used polytomous logistic regression controlling for age, state, smoking, and body mass to assess pesticide associations. High pesticide exposure events were associated with a doubling of both allergic and non-allergic asthma. For ever use, 12 individual pesticides were associated with allergic asthma and four with non-allergic asthma. For allergic asthma, coumaphos (odds ratio (OR) =2.34, 95% Confidence Interval (CI) =1.49,3.70), heptachlor (OR=2.01, 95%CI=1.30,3.11), parathion (OR=2.05, 95%CI=1.21,3.46), 80/20 mix (carbon tetrachloride/carbon disulfide) (OR=2.15, 95%CI=1.23,3.76) and ethylene dibromide (OR=2.07, 95%CI=1.02,4.20), all had odds ratios greater than 2.0 and significant exposure-response trends. For non-allergic asthma, DDT had the strongest association (OR=1.41, 95%CI=1.09,1.84) but with little evidence of increasing asthma with increasing use. Current animal handling and farm activities did not confound these results. We saw little evidence that allergy alone was driving these associations. Pesticides may be an overlooked contributor to asthma risk among farmers. PMID:19541724

  1. Occupational irritants and asthma: an Estonian cross-sectional study of 34,000 adults.

    PubMed

    Dumas, Orianne; Laurent, Emeline; Bousquet, Jean; Metspalu, Andres; Milani, Lili; Kauffmann, Francine; Le Moual, Nicole

    2014-09-01

    Occupational exposures make important contributions to asthma morbidity. The role of low/moderate level irritant exposures remains unclear. We aimed to determine which occupational exposures are associated with asthma in an eastern European country with low asthma prevalence. The Estonian Genome Center of University of Tartu collected data from 50 077 adults in 2002-2011. Asthma was assessed through a questionnaire regarding diagnosed diseases, current health status and medication. Exposures to 22 agents during the current and longest held jobs were estimated using an asthma-specific job-exposure matrix. Analyses included 34 015 subjects (aged 18-65 years, 67.0% females), of which 1209 (3.6%) reported asthma (608 with physician-confirmed diagnosis). After adjusting for age, sex and smoking habits, lifetime occupational exposure to known asthmagens (20.4%) was significantly associated with physician-diagnosed asthma (OR 1.28, 95% CI 1.03-1.59), especially high molecular weight agents (flour: OR 2.36, 95% CI 1.31-4.27; animals: OR 1.62, 95% CI 1.00-2.60). Exposure to low/moderate levels of irritants (17.4%) was associated with physician-diagnosed asthma (OR 1.88, 95% CI 1.48-2.37). More pronounced associations were observed in subjects reporting current treated asthma. Beyond confirming the effect of known asthmagens (which are well-known, mostly from observations in western countries), the results provide evidence for a role of low/moderate exposure to irritants. This finding, observed in a country with a low prevalence of asthma and atopy, provides new insight into the understanding of asthma heterogeneity.

  2. Asthma, COPD and overlap syndrome: a longitudinal study in young European adults.

    PubMed

    de Marco, Roberto; Marcon, Alessandro; Rossi, Andrea; Antó, Josep M; Cerveri, Isa; Gislason, Thorarinn; Heinrich, Joachim; Janson, Christer; Jarvis, Deborah; Kuenzli, Nino; Leynaert, Bénédicte; Probst-Hensch, Nicole; Svanes, Cecilie; Wjst, Matthias; Burney, Peter

    2015-09-01

    We compared risk factors and clinical characteristics, 9-year lung function change and hospitalisation risk across subjects with the asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS), asthma or COPD alone, or none of these diseases.Participants in the European Community Respiratory Health Survey in 1991-1993 (aged 20-44 years) and 1999-2001 were included. Chronic airflow obstruction was defined as pre-bronchodilator forced expiratory volume in 1 s (FEV1)/forced vital capacityasthma alone (n=941), COPD alone (n=166), ACOS (n=218) and none of these (n=5659).Subjects with ACOS shared risk factors and clinical characteristics with subjects with asthma alone, but they had an earlier age of asthma onset. FEV1 change in the ACOS group (-25.9 mL·year(-1)) was similar to that in the asthma group (-25.3 mL·year(-1)), and lower (p<0.001) than in the COPD group (-37.3 mL·year(-1)). ACOS was associated with the highest hospitalisation rate.Among young adults aged 20-44 years, ACOS seems to represent a form of severe asthma, characterised by more frequent hospitalisations, and to be the result of early-onset asthma that has progressed to fixed airflow obstruction.

  3. Using a Narrative Approach to Enhance Clinical Care for Patients With Asthma.

    PubMed

    Owton, Helen; Allen-Collinson, Jacquelyn; Siriwardena, A Niroshan

    2015-07-01

    There are currently > 230 million people in the world with asthma, and asthma attacks result in the hospitalization of someone every 7 min. The National Heart, Lung, and Blood Institute outlines four components of clinical practice guidelines for the diagnosis and management of asthma, which tend to take a biomedical focus: (1) measures of assessment and monitoring, obtained by objective tests, physical examination, patient history, and patient report, to diagnose and assess the characteristics and severity of asthma and to monitor whether asthma control is achieved and maintained; (2) education for a partnership in asthma care; (3) control of environmental factors and comorbid conditions that affect asthma; and (4) pharmacologic therapy. Many national guidelines include providing patients with asthma with (1) written action plans, (2) inhaler technique training, and (3) structured annual reviews. Although current guidelines help improve clinical processes of care for asthma, there is also a need to improve self-care of asthma by empowering individuals to take more control of their condition. There is a growing appreciation that a narrative approach with patients with asthma, which focuses on the illness experience and aims to enhance patient-clinician understanding, might improve self-care. We explore how a framework for clinicians to listen to patients' stories, developed from research on individuals with asthma, might enhance communication, improve patient-clinician relationship, and foster better patient self-care. The article closes with the implications of this approach for clinical practice and future research.

  4. DIRECT PERSONAL COARSE PARTICULATE MATTER CONCENTRATIONS ASSOCIATED WITH THE NORTH CAROLINA ADULT ASTHMA AND ENVIRONMENT STUDY.

    EPA Science Inventory

    A prototype coarse particulate matter PM(10-2.5) monitor was field evaluated as part of the North Carolina Adult Asthma and Environment Study (NCAAES). The NCAAES was designed to evaluate if airway and blood inflammatory markers in moderate asthmatic adults vary with changes in ...

  5. Beating and insulting children as a risk for adult cancer, cardiac disease and asthma.

    PubMed

    Hyland, Michael E; Alkhalaf, Ahmed M; Whalley, Ben

    2013-12-01

    The use of physical punishment for children is associated with poor psychological and behavioral outcomes, but the causal pathway is controversial, and the effects on later physical health unknown. We conducted a cross-sectional survey of asthma, cancer, and cardiac patients (150 in each category, 75 male) recruited from outpatient clinics and 250 healthy controls (125 male). All participants were 40-60 years old and citizens of Saudi Arabia, where the use of beating and insults is an acceptable parenting style. Demographic data and recalled frequency of beatings and insults as a child were assessed on an 8-point scale. Beating and insults were highly correlated (ρ = 0.846). Propensity score matching was used to control for demographic differences between the disease and healthy groups. After controlling for differences, more frequent beating (once or more per month) and insults were associated with a significantly increased risk for cancer (RR = 1.7), cardiac disease (RR = 1.3) and asthma (RR = 1.6), with evidence of increased risk for cancer and asthma with beating frequency of once every 6 months or more. Our results show that a threatening parenting style of beating and insults is associated with increased risk for somatic disease, possibly because this form of parenting induces stress. Our findings are consistent with previous research showing that child abuse and other early life stressors adversely affect adult somatic health, but provide evidence that the pathogenic effects occur also with chronic minor stress. A stress-inducing parenting style, even when normative, has long term adverse health consequences. PMID:23054177

  6. [Explanation of Evidence-based Guidelines of Clinical Practice with Acupuncture and Moxibustion: Adult Bronchial Asthma].

    PubMed

    Jiao, Yue; Wu, Zhongchao; Zhou, Wenna; Si, Xiaohua; Wang, Jingjing; Zhou, Jincao; Chen, Zhongjie; Li, Rongjun; Zhao, Xiaoguang; Xiao, Liwei

    2016-05-01

    The development and compilation of Evidence-based Guidelines of Clinical Practice with Acupuncture and Moxibustion: Adult Bronchial Asthma are introduced from three aspects, named the guideline methodology, the guideline structure and the guideline content. Based on the acupuncture-moxibustion practice and clinical research, the evidence-based medicine method is adopted. During the development and compilation of the guideline, the characteristics and advantages of acupuncture and moxibustion are specially considered in the treatment of this disease; the latest optimum evidences at home and abroad, experts' experience and patients' value are closely integrated with each other. Additionally, the worldwide accepted assessments of evidence quality and the recommendation (GRADE system) are combined with the clinical evidences of the ancient and modern famous acupuncture-moxibustion experts, and the clinical research evidences are with the experts' consensus to the large extent. The purpose of the guideline is to provide the maximal guidance to the clinical physicians.

  7. [Explanation of Evidence-based Guidelines of Clinical Practice with Acupuncture and Moxibustion: Adult Bronchial Asthma].

    PubMed

    Jiao, Yue; Wu, Zhongchao; Zhou, Wenna; Si, Xiaohua; Wang, Jingjing; Zhou, Jincao; Chen, Zhongjie; Li, Rongjun; Zhao, Xiaoguang; Xiao, Liwei

    2016-05-01

    The development and compilation of Evidence-based Guidelines of Clinical Practice with Acupuncture and Moxibustion: Adult Bronchial Asthma are introduced from three aspects, named the guideline methodology, the guideline structure and the guideline content. Based on the acupuncture-moxibustion practice and clinical research, the evidence-based medicine method is adopted. During the development and compilation of the guideline, the characteristics and advantages of acupuncture and moxibustion are specially considered in the treatment of this disease; the latest optimum evidences at home and abroad, experts' experience and patients' value are closely integrated with each other. Additionally, the worldwide accepted assessments of evidence quality and the recommendation (GRADE system) are combined with the clinical evidences of the ancient and modern famous acupuncture-moxibustion experts, and the clinical research evidences are with the experts' consensus to the large extent. The purpose of the guideline is to provide the maximal guidance to the clinical physicians. PMID:27509620

  8. Prediction of relapse within eight weeks after an acute asthma exacerbation in adults.

    PubMed

    McCarren, M; McDermott, M F; Zalenski, R J; Jovanovic, B; Marder, D; Murphy, D G; Kampe, L M; Misiewicz, V M; Rydman, R J

    1998-02-01

    Associations between historical, presenting, and treatment-related characteristics and relapse within 8 weeks after a moderate to severe asthma exacerbation were studied in a cohort of 284 adult asthmatics. Data were collected prospectively, and a multivariate model was developed and internally validated. Within 10 days, only 8% had relapsed, increasing to 45% by 8 weeks. Three variables that could be identified at the time of discharge were independently associated with relapse. These included: having made three or more visits to an emergency department in the prior 6 months (hazard ratio (HR) = 2.3, 95% CI = 1.6-3.4); difficulty performing work or activities as a result of physical health in the 4 weeks prior (HR = 2.7, 95% CI = 1.6-4.3); discontinuing hospital-based treatment for the exacerbation within 24 hours without having achieved a peak expiratory flow rate of at least 50% of predicted (HR = 2.6, 95% CI = 1.6-4.1). These risk factors may help to identify patients with poorly controlled asthma in need of more intensive and comprehensive management. PMID:9474071

  9. A multi-hit endocrine model of intrinsic adult-onset asthma.

    PubMed

    Atwood, Craig S; Bowen, Richard L

    2008-04-01

    Epidemiological studies indicate that adult-onset asthma is initiated by stress (anxiety and depression), obesity and menopause. Ironically, despite our understanding of the various stressors that promote chronic adult-onset asthma, most of which are known to elevate cortisol production via the hypothalamic-pituitary-adrenal (HPA) axis, inhaled and systemic corticosteroids are the mainstay for the treatment of chronic asthma. This implicates other endocrine or cellular changes independent of cortisol synthesis in non-allergic adult-onset asthma. The mechanism by which corticosteroids are thought to modulate bronchial tone in relieving asthma is via corticosteroid-responsive genes that increase PGE(2) and cAMP production which promote muscle relaxation. Therefore, any physiological condition that suppresses intracellular PGE(2) and cAMP production would counter cortisol-induced muscle relaxation and potentially trigger non-allergic adult-onset asthma. Stress, obesity and menopause act on three interrelated endocrine pathways, the serotonergic, leptinergic and hypothalamic pathways, all of which operate through receptors to modulate cAMP and Ca(2+) metabolism in smooth muscle cells (SMCs). We propose that the level of SMC cAMP, as determined by overall signaling through corticosteroid receptors, leptin receptors and the GPCRs of the HPG and serotonergic pathways, will regulate bronchial tone (i.e. the 'Multi-Hit Endocrine Model of Adult-Onset Asthma'). Thus, decreases in HPG (menopause) and serotonergic (depression) signaling and increases in leptinergic (obesity) signaling relative to HPA signaling would decrease cellular SMC cAMP and promote muscle contraction. This model can explain the discrepant epidemiological data associating stress, obesity, depression and menopause with adult-onset asthma and is supported by basic and clinical data. Treatment of depressed or menopausal asthmatics with selective serotonin reuptake inhibitors or hormone replacement therapy

  10. Contrasting associations of body mass index and measles with asthma and rhinitis in young adults.

    PubMed

    Kimura, Hirokazu; Konno, Satoshi; Isada, Akira; Maeda, Yukiko; Musashi, Manabu; Nishimura, Masaharu

    2015-01-01

    Asthma and allergic rhinitis often coexist and are increasing worldwide, particularly among the younger generation. Although the prevalences of adult asthma and allergic rhinitis and their risk factors have been reported, there have been few studies focusing on young adults. The aim of this study was to evaluate the prevalences of asthma and allergic rhinitis and their associated factors in Japanese young adults. A questionnaire survey of new students at Hokkaido University about the presence of current wheeze and rhinitis and a history of several viral infections during childhood was conducted in 2008 and 2010. The prevalences of wheeze and rhinitis and their associated factors were evaluated. Of 4076 nonsmoking subjects aged 18-25 years, 261 (6.4%) had current wheeze and 1373 (33.7%) had allergic rhinitis. On multivariate analyses, current wheeze was associated with high body mass index (BMI), atopic dermatitis, allergic rhinitis, food allergy, and a history of measles infection. In contrast, allergic rhinitis was associated with low BMI, current wheeze, atopic dermatitis, food allergy, and no history of measles. When subjects were classified into four groups by the presence or absence of wheeze and rhinitis, both high BMI and a history of measles were positively associated with wheeze without rhinitis but negatively associated with rhinitis without wheeze. High BMI and past measles infection showed contrasting associations with asthma and allergic rhinitis in nonsmoking young adults. It is important to not only recognize the common pathophysiological characteristics of asthma and allergic rhinitis but also to understand their differences.

  11. [Experience with ciclesonide in patients with mild persistent bronchial asthma].

    PubMed

    Bartosíková, L; Necas, J; Frána, L; Bartosík, T

    2007-12-01

    Experience with ciclesonide in patients with mild persistent bronchial asthma The study aimed to monitor the effectiveness and safety of the treatment with ciclesonide, administered once a day in a 160 microg dose, over a 3-month period, to a group of 100 patients diagnosed with mild persistent bronchial asthma with deterioration of problems after exercise. The results of the study prove significant positive effects of the preparation used. A significant improvement of FEV1 and PEF values was observed, as well as a statistically significant remission of both day and nocturnal symptoms of the disease, a significantly lower consumption of short-acting beta2-sympathomimetics, and an improvement of all evaluated data relating to the quality of life of the asthmatic patients. No adverse effects were registered. PMID:18257418

  12. DOES VITAMIN D DEFICIENCY CONTRIBUTE TO THE SEVERITY OF ASTHMA IN CHILDREN AND ADULTS?

    PubMed

    Ahmed, Syed Zaryab; Jaleel, Anila; Hameed, Kamran; Qazi, Salman; Suleman, Ahsan

    2015-01-01

    Role of vitamin D in the health of bones has been well established for over decades; It was known that its deficiency caused rickets in children and osteomalacia in adults. Later it was discovered that these can be corrected by giving vitamin D. Researchers discovered that vitamin D can be synthesized by exposure to sun. Hence it was also named "the sunshine vitamin". As time passed it was observed that low levels of vitamin D were associated with multiple diseases. This sparked the interest of the scientific community to further the research on vitamin D which led to the studies that started associating vitamin D with various diseases like cancers (prostate, colon and breast), autoimmune diseases (rheumatoid arthritis), infectious diseases (tuberculosis, hepatitis B, hepatitis C, HIV), cardiovascular diseases, mental illnesses (schizophrenia), diabetes mellitus (type 1, type 2 and gestational) and allergic conditions like asthma. With time, more studies were carried out relating levels of vitamin D to development of asthma, asthma exacerbations and risk factors leading to development of asthma like respiratory tract infections with positive associations. A number of studies were carried out which tried to explain the possible molecular mechanisms relating deficiency of vitamin D in pathogenesis of asthma. This review summarizes the role of vitamin D in development of asthma and probable mechanisms relating vitamin D to the pathogenesis of asthma. PMID:26411139

  13. Smoking Cessation and the Microbiome in Induced Sputum Samples from Cigarette Smoking Asthma Patients

    PubMed Central

    Munck, Christian; Helby, Jens; Westergaard, Christian G.; Porsbjerg, Celeste; Backer, Vibeke; Hansen, Lars H.

    2016-01-01

    Asthma is a common disease causing cough, wheezing and shortness of breath. It has been shown that the lung microbiota in asthma patients is different from the lung microbiota in healthy controls suggesting that a connection between asthma and the lung microbiome exists. Individuals with asthma who are also tobacco smokers experience more severe asthma symptoms and smoking cessation is associated with improved asthma control. In the present study we investigated if smoking cessation in asthma patients is associated with a change in the bacterial community in the lungs, examined using induced sputum. We found that while tobacco smokers with asthma have a greater bacterial diversity in the induced sputum compared to non-smoking healthy controls, smoking cessation does not lead to a change in the microbial diversity. PMID:27391160

  14. Asthma in an Adult Female Vervet Monkey (Chlorocebus sabaeus)

    PubMed Central

    Köster, Liza S; Simon, Bradley; Rawlins, Gilda; Beierschmitt, Amy

    2016-01-01

    A 9-y-old, colony-bred, female vervet monkey (Chlorocebus sabaeus) presented with a 6-y history of open-mouth breathing, tachypnea, and sibilant wheezing. These symptoms did not significantly affect her activity or quality of life. Thoracic radiographs and results of bronchoalveolar lavage supported the diagnosis of asthma. Treatment comprising intramuscular prednisolone (tapered over 2 mo from twice daily to every other day), inhaled salmeterol–fluticasone (25 µg–250 µg per actuation twice daily) by mask, and a metered dose inhaler was successful in restoring a normal respiratory pattern. Despite the availability of several primate models of human asthma, this case represents the first report of spontaneous asthma in a NHP. PMID:26884413

  15. Novel imaging approaches in adult asthma and their clinical potential.

    PubMed

    Hartley, Ruth; Baldi, Simonetta; Brightling, Chris; Gupta, Sumit

    2015-01-01

    Currently, imaging in asthma is confined to chest radiography and CT. The emergence of new imaging techniques and tremendous improvement of existing imaging methods, primarily due to technological advancement, has completely changed its research and clinical prospects. In research, imaging in asthma is now being employed to provide quantitative assessment of morphology, function and pathogenic processes at the molecular level. The unique ability of imaging for non-invasive, repeated, quantitative, and in vivo assessment of structure and function in asthma could lead to identification of 'imaging biomarkers' with potential as outcome measures in future clinical trials. Emerging imaging techniques and their utility in the research and clinical setting is discussed in this review. PMID:26289375

  16. AB019. Longitudinal asthma management profiles: visualisation of patient histories using multiple data sources

    PubMed Central

    Van Ganse, Eric; Herbage, Sandrine; Dima, Alexandra L.; de Bruin, Marijn; Texier, Nathalie; Jacoud, Flore; Nolin, Maëva; Langlois, Carole; Laforest, Laurent

    2016-01-01

    Background Electronic medical records (EMR) offer valuable information for research and clinical case management, but are currently underused. Barriers to EMR use include the limited information on medication use and health outcomes provided by single data sources, the challenge of linking multiple sources, and the lack of methods to integrate all information to reconstitute patients’ complete medical trajectories. The ASTRO-LAB cohort study, assessing the safety of long-acting β-agonists (LABA) in asthma, collected data from direct patient follow-up and healthcare databases, and thus allowed a more comprehensive exploration of medication use patterns, asthma control and exacerbations over time. To develop longitudinal asthma management patient profiles for the ASTROLAB cohort by integrating data on prescription and dispensation events, and patient-reported medication exposure and occurrence of severe asthma exacerbations (SAEx). Methods Children and adults with persistent asthma (aged 6–40) were included in France and the United Kingdom (UK) if on a stable therapy pattern of either LABA without inhaled corticosteroids (ICs), ICs without LABAs, LABAs and ICs in separate canisters, or fixed-dose combination (FDC) for ≥6 of 12 baseline months. The main study outcome was occurrence of asthma-related courses of oral corticosteroids, unscheduled medical contacts or death (SAEx). Patients were followed for ≤24 months via 4-monthly computer-assisted telephone interviews (CATIs) inquiring on recent asthma control, medication use, and SAEx, and via monthly text messages. Linkage was performed with prescription data (UK primary care records, physician reports in France) and dispensing data (French health insurance records). Prescription and exposure patterns were described and data visualization plots of longitudinal medication management profiles during follow-up developed for each patient. Results At inclusion, of 1,051 patients [(48.3% women, mean (SD) age =21

  17. Inhaler Reminders Significantly Improve Asthma Patients' Use of Controller Medications

    MedlinePlus

    American Academy of Allergy Asthma & Immunology Menu Search Main navigation Skip to content Conditions & Treatments Allergies Asthma Primary Immunodeficiency Disease Related Conditions Drug Guide Conditions Dictionary Just ...

  18. Long-term ambient ozone concentration and the incidence of asthma in nonsmoking adults: The Ahsmog study

    SciTech Connect

    McDonnell, W.F.; Abbey, D.E.; Nishino, N.; Lebowitz, M.D.

    1999-02-01

    The authors conducted a prospective study of a cohort of 3091 nonsmokers, ages 27 to 87 years, to evaluate the association between long-term ambient ozone exposure and development of adult-onset asthma. Over a 15-year period, 3.2% of males and 4.3% of females reported new doctor diagnoses of asthma. For males, they observed a significant relationship between report of doctor diagnosis of asthma and 20-year mean 8-h average ambient ozone concentration. The authors observed no such relationship for females. Other variables significantly related to development of asthma were a history of ever-smoking for males, and for females, number of years worked with a smoker, age, and a history of childhood pneumonia or bronchitis. Addition of other pollutants to the models did not diminish the relationship between ozone and asthma for males. These data suggest that long-term exposure to ambient ozone is associated with development of asthma in adult males.

  19. Airway obstruction worsens in young adults with asthma who become obese

    PubMed Central

    Strunk, Robert C.; Colvin, Ryan; Bacharier, Leonard B.; Fuhlbrigge, Anne; Forno, Erick; Arbelaez, Ana Maria; Tantisira, Kelan G.

    2015-01-01

    Background Few studies have examined how developing obesity in early adulthood affects the course of asthma. Objective We analyzed lung function and asthma impairment and risk among non-obese children with asthma, comparing those who were obese in young adulthood to those who remained non-obese. Methods Post-hoc analysis of 771 subjects with mild-moderate asthma who were not obese (pediatric definition, body mass index (BMI) <95th percentile) when enrolled in the Childhood Asthma Management Program at ages 5–12 years. Subjects were then followed to age ≥ 20 years. For visits at ages ≥ 20 years, spirometry values as percent predicted and recent asthma symptom scores and prednisone exposure were compared between 579 subjects who were non-obese at all visits and 151 who obese (adult definition of BMI ≥ 30 kg/m2) on at least one visit (median number of visits when obese = 4, IQR 2–7). Results Compared to participants who were non-obese (BMI 23.4 ± 2.6 kg/m2), those who became obese (BMI 31.5 ± 3.8 kg/m2) had significant decreases in FEV1/FVC (p<0.0003) and FEV1 (p = 0.001), without differences in FVC (p=0.15) during visits at ages ≥ 20 years. For each unit increase of BMI, FEV1 percent predicted decreased by 0.29 (p=0.0009). The relationship between BMI and lung function was not confounded by sex or BMI at baseline. Asthma impairment (symptom scores) and risk (prednisone use) did not differ between the two groups. Conclusion Becoming obese in early adulthood was associated with increased airway obstruction, without impact on asthma impairment or risk. PMID:26164807

  20. Canadian Thoracic Society 2012 guideline update: Diagnosis and management of asthma in preschoolers, children and adults

    PubMed Central

    Lougheed, M Diane; Lemiere, Catherine; Ducharme, Francine M; Licskai, Chris; Dell, Sharon D; Rowe, Brian H; FitzGerald, Mark; Leigh, Richard; Watson, Wade; Boulet, Louis-Philippe

    2012-01-01

    BACKGROUND: In 2010, the Canadian Thoracic Society (CTS) published a Consensus Summary for the diagnosis and management of asthma in children six years of age and older, and adults, including an updated Asthma Management Continuum. The CTS Asthma Clinical Assembly subsequently began a formal clinical practice guideline update process, focusing, in this first iteration, on topics of controversy and/or gaps in the previous guidelines. METHODS: Four clinical questions were identified as a focus for the updated guideline: the role of noninvasive measurements of airway inflammation for the adjustment of anti-inflammatory therapy; the initiation of adjunct therapy to inhaled corticosteroids (ICS) for uncontrolled asthma; the role of a single inhaler of an ICS/long-acting beta2-agonist combination as a reliever, and as a reliever and a controller; and the escalation of controller medication for acute loss of asthma control as part of a self-management action plan. The expert panel followed an adaptation process to identify and appraise existing guidelines on the specified topics. In addition, literature searches were performed to identify relevant systematic reviews and randomized controlled trials. The panel formally assessed and graded the evidence, and made 34 recommendations. RESULTS: The updated guideline recommendations outline a role for inclusion of assessment of sputum eosinophils, in addition to standard measures of asthma control, to guide adjustment of controller therapy in adults with moderate to severe asthma. Appraisal of the evidence regarding which adjunct controller therapy to add to ICS and at what ICS dose to begin adjunct therapy in children and adults with poor asthma control supported the 2010 CTS Consensus Summary recommendations. New recommendations for the adjustment of controller medication within written action plans are provided. Finally, priority areas for future research were identified. CONCLUSIONS: The present clinical practice guideline

  1. Fungi and indoor conditions in asthma patients.

    PubMed

    Ceylan, Emel; Ozkutuk, Aydan; Ergor, Gul; Yucesoy, Mine; Itil, Oya; Caymaz, Sibel; Cimrin, Arif

    2006-12-01

    This study was carried out with 127 asthmatic patients and 127 controls, which aimed to compare and evaluate the environmental conditions in the homes of asthmatic patients and the control group. Air samples were obtained by using an air sampler and the mean mould colony counts were established. Aspergillus and Penicillium were the most common isolated species. No significant difference was observed with regard to various house conditions and the mean mould colony counts between the houses of patients and controls. The mould colony counts were found to be lower in houses with wooden parquet flooring. The odds ratio for stone floors vs. wood floors was 2.3 (95% CI 1.08-4.98) for mould growth. PMID:17169833

  2. Fungi and indoor conditions in asthma patients.

    PubMed

    Ceylan, Emel; Ozkutuk, Aydan; Ergor, Gul; Yucesoy, Mine; Itil, Oya; Caymaz, Sibel; Cimrin, Arif

    2006-12-01

    This study was carried out with 127 asthmatic patients and 127 controls, which aimed to compare and evaluate the environmental conditions in the homes of asthmatic patients and the control group. Air samples were obtained by using an air sampler and the mean mould colony counts were established. Aspergillus and Penicillium were the most common isolated species. No significant difference was observed with regard to various house conditions and the mean mould colony counts between the houses of patients and controls. The mould colony counts were found to be lower in houses with wooden parquet flooring. The odds ratio for stone floors vs. wood floors was 2.3 (95% CI 1.08-4.98) for mould growth.

  3. ‘Get Your Life Back’: process and impact evaluation of an asthma social marketing campaign targeting older adults

    PubMed Central

    2013-01-01

    Background Asthma in older adults is underdiagnosed and poorly self-managed. This population has little knowledge about the key symptoms, the prevalence among older adults, and the serious consequences of untreated asthma. The purpose of this study was to undertake a multifaceted evaluation of a social marketing campaign to increase asthma awareness among older adults in a regional Australian community. Methods A cohort of older adults in an intervention region (n = 316) and a control region (n = 394) were surveyed immediately prior to and following the social marketing campaign. Campaign awareness, message recall, materials recognition, and actions taken as a result of the campaign were assessed in both regions. Asthma knowledge and perceptions, experience of asthma symptoms, and general health were also assessed in both regions at baseline and follow-up. Analyses were conducted to explore the effects of the campaign in the intervention region, and to examine outcomes among different audience segments. Results The survey data showed that those in the target segments (Wheezers and Strugglers) had better message recall, and were more likely to report having taken action to control their respiratory symptoms. The campaign significantly increased the number of calls to an asthma information line from the target audience in the intervention community. Conclusions A theory-based social marketing campaign conducted over 3-months increased the asthma information seeking behaviours of older adults in the intervention community compared to the control community. Recommendations are outlined for future community health promotion campaigns targeting older adults. PMID:23947479

  4. Higher environmental relative moldiness index values measured in homes of adults with asthma, rhinitis, or both conditions

    EPA Science Inventory

    Higher values of the Environmental Relative Moldiness Index (ERMI), a DNA-based method for quantifying indoor molds, have been associated with asthma in children. In this study, settled dust samples were collected from the homes of adults with asthma and rhinitis (n=202 homes) i...

  5. Randomised, double blind, placebo‐controlled trial of selenium supplementation in adult asthma

    PubMed Central

    Shaheen, Seif O; Newson, Roger B; Rayman, Margaret P; Wong, Angela P‐L; Tumilty, Michael K; Phillips, Joanna M; Potts, James F; Kelly, Frank J; White, Patrick T; Burney, Peter G J

    2007-01-01

    Background Epidemiological evidence from observational studies has suggested that blood levels and dietary intake of selenium of adults with asthma are lower than those of controls. The only previous trial of selenium supplementation in adults with asthma found no objective evidence of benefit but involved only 24 participants. Methods A randomised, double blind, placebo‐controlled trial of selenium supplementation was performed in adults with asthma in London, UK, the majority of whom (75%) reported inhaled steroid use at baseline. 197 participants were randomised to receive either a high‐selenium yeast preparation (100 µg daily, n = 99) or placebo (yeast only, n = 98) for 24 weeks. The primary outcome was asthma‐related quality of life (QoL) score. Secondary outcomes included lung function, asthma symptom scores, peak flow and bronchodilator usage. Linear regression was used to analyse the change in outcome between the two treatment arms by “intention to treat”. Results There was a 48% increase in plasma selenium between baseline and end of trial in the active treatment group but no change in the placebo group. While the QoL score improved more in the active treatment group than in the placebo group, the difference in change in score between the two groups was not significant (−0.05 (95% CI −0.19 to 0.09); p = 0.47). Selenium supplementation was not associated with any significant improvement in secondary outcomes compared with placebo. Conclusions Selenium supplementation had no clinical benefit in adults with asthma, the majority of whom were taking inhaled steroids. PMID:17234657

  6. Occupations with an increased prevalence of self-reported asthma in Indian adults

    PubMed Central

    Pearce, Neil; Millett, Christopher; Subramanian, S.V.; Ebrahim, Shah

    2014-01-01

    Objectives Occupational asthma remains relatively under-recognized in India with little or no information regarding preventable causes. We studied occupations with an increased prevalence of self-reported asthma among adult men and women in India. Methods Analysis is based on 64 725 men aged 15–54 years and 52 994 women aged 15–49 years who participated in India’s third National Family Health Survey, 2005–2006, and reported their current occupation. Prevalence odds ratios (ORs) for specific occupations and asthma were estimated using multivariate logistic regression, separately for men and women, adjusting for age, education, household wealth index, current tobacco smoking, cooking fuel use, rural/urban residence and access to healthcare. Results The prevalence of asthma among the working population was 1.9%. The highest odds ratios for asthma were found among men in the plant and machine operators and assemblers major occupation category (OR: 1.67; 95% CI: 1.14–2.45; p = 0.009). Men working in occupation subcategories of machine operators and assemblers (OR: 1.85; 95% CI: 1.24–2.76; p = 0.002) and mining, construction, manufacturing and transport (OR: 1.33; 95% CI: 1.00–1.77; p = 0.051) were at the highest risk of asthma. Reduced odds of asthma prevalence in men was observed among extraction and building trades workers (OR: 0.72; 95% CI: 0.53–0.97; p = 0.029). Among women none of the occupation categories or subcategories was found significant for asthma risk. Men and women employed in high-risk occupations were not at a higher risk of asthma when compared with those in low-risk occupations. Conclusions This large population-based, nationally representative cross-sectional study has confirmed findings from high income countries showing high prevalence of asthma in men in a number of occupational categories and subcategories; however, with no evidence of increased risks for women in the same occupations. PMID:24712498

  7. Exposure to house dust phthalates in relation to asthma and allergies in both children and adults.

    PubMed

    Ait Bamai, Yu; Shibata, Eiji; Saito, Ikue; Araki, Atsuko; Kanazawa, Ayako; Morimoto, Kanehisa; Nakayama, Kunio; Tanaka, Masatoshi; Takigawa, Tomoko; Yoshimura, Takesumi; Chikara, Hisao; Saijo, Yasuaki; Kishi, Reiko

    2014-07-01

    Although an association between exposure to phthalates in house dust and childhood asthma or allergies has been reported in recent years, there have been no reports of these associations focusing on both adults and children. We aimed to investigate the relationships between phthalate levels in Japanese dwellings and the prevalence of asthma and allergies in both children and adult inhabitants in a cross-sectional study. The levels of seven phthalates in floor dust and multi-surface dust in 156 single-family homes were measured. According to a self-reported questionnaire, the prevalence of bronchial asthma, allergic rhinitis, allergic conjunctivitis, and atopic dermatitis in the 2 years preceding the study was 4.7%, 18.6%, 7.6%, and 10.3%, respectively. After evaluating the interaction effects of age and exposure categories with generalized liner mixed models, interaction effects were obtained for DiNP and bronchial asthma in adults (Pinteraction=0.028) and for DMP and allergic rhinitis in children (Pinteraction=0.015). Although not statistically significant, children had higher ORs of allergic rhinitis for DiNP, allergic conjunctivitis for DEHP, and atopic dermatitis for DiBP and BBzP than adults, and liner associations were observed (Ptrend<0.05). On the other hand, adults had a higher OR for atopic dermatitis and DEHP compared to children. No significant associations were found in phthalates levels collected from multi-surfaces. This study suggests that the levels of DMP, DEHP, DiBP, and BBzP in floor dust were associated with the prevalence of allergic rhinitis, conjunctivitis, and atopic dermatitis in children, and children are more vulnerable to phthalate exposure via household floor dust than are adults. The results from this study were shown by cross-sectional nature of the analyses and elaborate assessments for metabolism of phthalates were not considered. Further studies are needed to advance our understanding of phthalate toxicity.

  8. Asthma-like symptoms in a patient with rheumatoid arthritis and Adalimumab treatment.

    PubMed

    Mărgineanu, Ioana; Crişan, Radu; Mihăescu, Traian

    2015-01-01

    After the introduction of anti-TNFα medication for treatment of autoimmune conditions, clinicians have investigated not only other possible uses for the drugs, but also less common side-effects and interactions with other pathologies. Despite some succes registered with Adalimumab as an antiinflammatory agent in severe asthma, there have been case reports of patients developing asthma or asthma-like symptoms following anti-TNFα therapy. The case presents a patient without previous family or personal history of respiratory or atopic conditions that developed bronchospasm immediately after the initiation of Adalimumab and Methotrexate treatment for rheumatoid arthritis. Despite the patient presenting asthma characteristics (expiratory wheezing, dry cough, partial reversibility at post bronchodilator test) and asthma medication alleviating simtomathology, biological markers (eosenophil granulocytes in sputum, serum IgE) for asthma are absent. The relationship between bronchospasm and medication and other possible causes for her respiratory symptoms are discussed. PMID:27451592

  9. Asthma-like symptoms in a patient with rheumatoid arthritis and Adalimumab treatment.

    PubMed

    Mărgineanu, Ioana; Crişan, Radu; Mihăescu, Traian

    2015-01-01

    After the introduction of anti-TNFα medication for treatment of autoimmune conditions, clinicians have investigated not only other possible uses for the drugs, but also less common side-effects and interactions with other pathologies. Despite some succes registered with Adalimumab as an antiinflammatory agent in severe asthma, there have been case reports of patients developing asthma or asthma-like symptoms following anti-TNFα therapy. The case presents a patient without previous family or personal history of respiratory or atopic conditions that developed bronchospasm immediately after the initiation of Adalimumab and Methotrexate treatment for rheumatoid arthritis. Despite the patient presenting asthma characteristics (expiratory wheezing, dry cough, partial reversibility at post bronchodilator test) and asthma medication alleviating simtomathology, biological markers (eosenophil granulocytes in sputum, serum IgE) for asthma are absent. The relationship between bronchospasm and medication and other possible causes for her respiratory symptoms are discussed.

  10. A review of standard pharmacological therapy for adult asthma – Steps 1 to 5.

    PubMed

    Patel, Mitesh; Shaw, Dominick

    2015-05-01

    The aim of pharmacological therapy for asthma is to improve symptoms and lung function and minimize the risk of asthma attacks. The intensity of treatment is based on the level of asthma control and the potential risk of future deterioration. In the British asthma guidelines, treatments are divided into steps 1 to 5, with each step signifying a need for an increase in therapy in response to symptoms or to prevent exacerbations. Treatments comprise of inhaled or systemic medications. Inhaled therapy includes short-acting and long-acting medication to improve symptoms and inhaled corticosteroids that reduce airway inflammation. Systemic treatments include medications that act on specific biological pathways, such as the leukotriene or immunoglobulin E pathways, or systemic corticosteroids. In choosing a particular therapy, treatment benefits are balanced by the potential risks of medication-related adverse effects. This review will provide a practical guide to the key pharmacological therapies for adult asthma at steps 1 to 5 based on British guidelines and consider future options for new treatments.

  11. Fraction of exhaled nitric oxide measurements in the diagnoses of asthma in elderly patients

    PubMed Central

    Godinho Netto, Antonio Carlos Maneira; dos Reis, Túlio Gonçalves; Matheus, Cássia Franco; Aarestrup, Beatriz Julião Vieira; Aarestrup, Fernando Monteiro

    2016-01-01

    Objective To assess the value of fraction of exhaled nitric oxide (FeNO) measurements in the diagnosis of asthma in elderly patients. Methods The clinical symptoms of 202 elderly patients were assessed with the asthma module of the International Study of Asthma and Allergies in Childhood test, which had been modified for the elderly patients, and the diagnostic routine for chronic obstructive pulmonary disease (COPD), which was based on the Global initiative for chronic Obstructive Lung Disease criteria. Of the 202 patients assessed, 43 were subjected to pulmonary function evaluations (spirometry) and FeNO measurements. Results Of the 202 elderly patients, 34 had asthma (23 definite and eleven probable), 20 met COPD criteria, 13 presented with an overlap of asthma and COPD, and 135 did not fit the criteria for obstructive pulmonary disease. Among the 43 elderly patients who were subjected to FeNO measurements, ten showed altered results (23.2%) and 33 had normal results (76.7%). The average value of FeNO in patients with definite and probable asthma undergoing this procedure was 29.2 parts per billion whereas that in nonasthmatic patients was 17.5 parts per billion (P=0.0002). Conclusion We show a clear relationship between FeNO levels and asthma symptoms and previous asthma diagnoses in elderly patients. PMID:27274212

  12. Activity limitation and exertional dyspnea in adult asthmatic patients: What do we know?

    PubMed

    Vermeulen, François; Garcia, Gilles; Ninane, Vincent; Laveneziana, Pierantonio

    2016-08-01

    Limitation of activity is the most cited symptom described by uncontrolled asthma patients. Assessment of activity limitation can be undertaken through several ways, more or less complex, subjective or objective. Yet little is known about the link between patients sensations and objective measurements. The present review reports the current knowledge regarding activity limitation and symptom perception (i.e., exertional dyspnea) in adult patients with asthma. This work is based on references indexed by PubMed, irrespective of the year of publication. Overall, patients with stable asthma do not have a more sedentary lifestyle than healthy subjects. However, during a cycle ergometric test, the maximal load is reduced when FEV1, FVC and muscle strengths are decreased. Additionally, during the six-minute walking test, mild asthma patients walk less than healthy subjects even if the minimal clinically important difference is not reached. The major complaint of asthma patients when exercising is dyspnea that is mainly related to the inspiratory effort and also to dynamic hyperinflation in some circumstances. Finally, the administration of bronchodilator does not improve the ventilatory pattern and the exercise capacity of asthma patients and little is known on its effect on exertional dyspnea. The present review allows to conclude that until now there is no gold standard test allowing the objective assessment of "activity limitation and exertional dyspnea" in asthma patients. PMID:27492522

  13. Korean Asthma Guideline 2014: Summary of Major Updates to the Korean Asthma Guideline 2014.

    PubMed

    Kim, Deog Kyeom; Park, Yong Bum; Oh, Yeon-Mok; Jung, Ki-Suck; Yoo, Ji Hong; Yoo, Kwang-Ha; Kim, Kwan Hyung

    2016-07-01

    Asthma is a prevalent and serious health problem in Korea. Recently, the Korean Asthma Guideline has been updated by The Korean Academy of Tuberculosis and Respiratory Diseases (KATRD) in an effort to improve the clinical management of asthma. This guideline focuses on adult patients with asthma and aims to deliver up to date scientific evidence and recommendations to general physicians for the management of asthma. For this purpose, this guideline was updated following systematic review and meta-analysis of recent studies and adapting some points of international guidelines (Global Initiative for Asthma [GINA] report 2014, National Asthma Education and Prevention Program [NAEPP] 2007, British Thoracic Society [BTS/SIGN] asthma guideline 2012, and Canadian asthma guideline 2012). Updated issues include recommendations derived using the population, intervention, comparison, and outcomes (PICO) model, which produced 20 clinical questions on the management of asthma. It also covers a new definition of asthma, the importance of confirming various airflow limitations with spirometry, the epidemiology and the diagnostic flow of asthma in Korea, the importance and evidence for inhaled corticosteroids (ICS) and ICS/formoterol as a single maintenance and acute therapy in the stepwise management of asthma, assessment of severity of asthma and management of exacerbation, and an action plan to cope with exacerbation. This guideline includes clinical assessments, and treatment of asthma-chronic obstructive pulmonary disease overlap syndrome, management of asthma in specific conditions including severe asthma, elderly asthma, cough variant asthma, exercise-induced bronchial contraction, etc. The revised Korean Asthma Guideline is expected to be a useful resource in the management of asthma.

  14. Korean Asthma Guideline 2014: Summary of Major Updates to the Korean Asthma Guideline 2014.

    PubMed

    Kim, Deog Kyeom; Park, Yong Bum; Oh, Yeon-Mok; Jung, Ki-Suck; Yoo, Ji Hong; Yoo, Kwang-Ha; Kim, Kwan Hyung

    2016-07-01

    Asthma is a prevalent and serious health problem in Korea. Recently, the Korean Asthma Guideline has been updated by The Korean Academy of Tuberculosis and Respiratory Diseases (KATRD) in an effort to improve the clinical management of asthma. This guideline focuses on adult patients with asthma and aims to deliver up to date scientific evidence and recommendations to general physicians for the management of asthma. For this purpose, this guideline was updated following systematic review and meta-analysis of recent studies and adapting some points of international guidelines (Global Initiative for Asthma [GINA] report 2014, National Asthma Education and Prevention Program [NAEPP] 2007, British Thoracic Society [BTS/SIGN] asthma guideline 2012, and Canadian asthma guideline 2012). Updated issues include recommendations derived using the population, intervention, comparison, and outcomes (PICO) model, which produced 20 clinical questions on the management of asthma. It also covers a new definition of asthma, the importance of confirming various airflow limitations with spirometry, the epidemiology and the diagnostic flow of asthma in Korea, the importance and evidence for inhaled corticosteroids (ICS) and ICS/formoterol as a single maintenance and acute therapy in the stepwise management of asthma, assessment of severity of asthma and management of exacerbation, and an action plan to cope with exacerbation. This guideline includes clinical assessments, and treatment of asthma-chronic obstructive pulmonary disease overlap syndrome, management of asthma in specific conditions including severe asthma, elderly asthma, cough variant asthma, exercise-induced bronchial contraction, etc. The revised Korean Asthma Guideline is expected to be a useful resource in the management of asthma. PMID:27433170

  15. [Occupational asthma in Hungary].

    PubMed

    Endre, László

    2015-05-10

    Occupational asthma belongs to communicable diseases, which should be reported in Hungary. During a 24-year period between January 1990 and December 2013, 180 occupational asthma cases were reported in Hungary (52 cases between 1990 and 1995, 83 cases between 1996 and 2000, 40 cases between 2001 and 2006, and 5 cases between 2007 and 2013). These data are unusual, because according to the official report of the National Korányi Pulmonology Institute in Budapest, at least 14,000 new adult asthma cases were reported in every year between 2000 and 2012 in Hungary. Also, international data indicate that at least 2% of adult patients with asthma have occupational asthma and at least 50 out of 1 million employees develop occupational asthma in each year. In 2003, 631 new occupational asthma patients were reported in the United Kingdom, but only 7 cases in Hungary. Because it is unlikely that the occupational environment in Hungary is much better than anywhere else in the world, it seems that not all new occupational asthma cases are reported in Hungary. Of the 180 reported cases in Hungary, 55 were bakers or other workers in flour mills. There were 11 metal-workers, 10 health care assistants, 9 workers dealing with textiles (tailors, dressmakers, workers in textile industry) and 9 employees worked upon leather and animal fur. According to international data, the most unsafe profession is the animal keeper in scientific laboratories, but only 4 of them were reported as having occupational asthma during the studied 24 years in Hungary. Interestingly, 3 museologists with newly-diagnosed occupational asthma were reported in 2003, but not such cases occurred before or after that year. In this paper the Hungarian literature of occupational asthma is summarized, followed by a review on the classification, pathomechanism, clinical presentation, predisposing factors, diagnostics and therapeutic aspects of the disease. Epidemiological data of adult asthma in Hungary and data from

  16. Relationships between adult asthma and oxidative stress markers and pH in exhaled breath condensate: a systematic review.

    PubMed

    Aldakheel, F M; Thomas, P S; Bourke, J E; Matheson, M C; Dharmage, S C; Lowe, A J

    2016-06-01

    Oxidative stress has a recognized role in the pathophysiology of asthma. Recently, interest has increased in the assessment of pH and airway oxidative stress markers. Collection of exhaled breath condensate (EBC) and quantification of biomarkers in breath samples can potentially indicate lung disease activity and help in the study of airway inflammation, and asthma severity. Levels of oxidative stress markers in the EBC have been systematically evaluated in children with asthma; however, there is no such systematic review conducted for adult asthma. A systematic review of oxidative stress markers measured in EBC of adult asthma was conducted, and studies were identified by searching MEDLINE and SCOPUS databases. Sixteen papers met the inclusion criteria. Concentrations of exhaled hydrogen ions, nitric oxide products, hydrogen peroxide and 8-isoprostanes were generally elevated and related to lower lung function tests in adults with asthma compared to healthy subjects. Assessment of EBC markers may be a noninvasive approach to evaluate airway inflammation, exacerbations, and disease severity of asthma, and to monitor the effectiveness of anti-inflammatory treatment regimens. Longitudinal studies, using standardized analytical techniques for EBC collection, are required to establish reference values for the interpretation of EBC markers in the context of asthma.

  17. [Phototherapy and sleep deprivation as additional methods of treating bronchial asthma patients].

    PubMed

    Maevskiĭ, A A

    1991-05-01

    Correction of internal desynchronosis in bronchial asthma by means of phototherapy and partial sleep deprivation was instituted in 4 hormone-dependent patients with bronchial asthma for 13 months. The results were positive: the frequency and severity of night attacks reduced, the condition of the patients improved.

  18. Do self-management plans reduce morbidity in patients with asthma?

    PubMed Central

    Hoskins, G; Neville, R G; Smith, B; Clark, R A

    1996-01-01

    BACKGROUND: Self-management plans may help patients with asthma intervene when symptoms deteriorate, thus preventing asthma attacks. AIM: A study set out to test whether a self-management plan tailored to the circumstances of the individual reduces morbidity from asthma. METHOD: General practitioners who had participated in a national audit of asthma attacks were randomized into intervention and control groups. Six months after the intervention group had issued self-management plans to patients with asthma, both groups of practitioners completed morbidity questionnaires on patients. Morbidity outcomes were compared for the 6-month periods before and after the issue of the plans. RESULTS: In the 6 months before the study, the 376 patients enrolled by the intervention group experienced higher levels of morbidity than the 530 patients for whom details were recorded by the control group. In the 6 months after the issue of the plans, control group patients showed little change in levels of morbidity, but intervention group patients showed significant reductions in hospital admissions, consultations for asthma symptoms, asthma review consultations, courses of oral steroids and use of emergency nebulized bronchodilators. CONCLUSION: General practitioners appeared to operate enthusiast bias' and issued more self-management plans to patients with uncontrolled asthma. The reduction in morbidity in this group is probably a result of the use of the plans, but the verdict on whether plans reduce morbidity must be deemed 'not proven'. PMID:8731624

  19. Comparative epidemiology of atopic and non-atopic wheeze and diagnosed asthma in a national sample of English adults

    PubMed Central

    Court, C; Cook, D; Strachan, D

    2002-01-01

    Background: There is debate as to whether asthma has distinct atopic and non-atopic forms and whether in epidemiological studies asthma cases should be defined by a physician diagnosis or by self-reported asthma symptoms. Methods: A total of 24 952 people aged 11 and over were surveyed as part of the 1995–6 health surveys for England. Participants were asked if they had experienced wheezing in the past year and if they had ever been given a diagnosis of asthma by a doctor. Serum total IgE and house dust mite (HDM) specific IgE were measured. Results: Wheeze in the past year without an asthma diagnosis was more common in men and older age groups, whereas wheeze with an asthma diagnosis was more common in women and younger people. Both types of wheeze were more common in the lower social classes, among ex-smokers and current smokers, and in urban areas. Thirty two percent of people reporting wheezing and 22% of those with diagnosed asthma had neither raised total IgE nor HDM IgE. Among the non-atopic subjects the prevalence of wheeze rose with age and lower social class, largely due to an increase in wheeze without diagnosed asthma. In contrast, among atopic subjects there was no overall trend with age or social class, but wheeze with diagnosed asthma decreased with age. Conclusions: Clear epidemiological differences are evident between adult wheeze with and without an asthma diagnosis and between atopic and non-atopic wheeze. Subjects with diagnosed asthma are more likely to be atopic, but the results challenge the premise that adult asthma is almost always associated with some IgE mediated reaction. PMID:12403877

  20. Fluticasone furoate/vilanterol: a review of its use in patients with asthma.

    PubMed

    Syed, Yahiya Y

    2015-03-01

    Fluticasone furoate/vilanterol (Relvar(®)) is a once-daily, fixed combination of an inhaled corticosteroid (ICS) and a long-acting β2-adrenoreceptor agonist (LABA), delivered via a dry powder inhaler (Ellipta(®)). It is approved for the treatment of asthma in the EU and Japan, and is the first once-daily ICS/LABA to be available for this indication. Fluticasone furoate is an enhanced-affinity glucocorticoid receptor agonist, with potent anti-inflammatory activity. Vilanterol produces rapid and prolonged bronchodilation. In phase III trials in adolescents and adults with various levels of asthma uncontrolled on ICS and/or ICS/LABA, fluticasone furoate/vilanterol 100/25 or 200/25 µg once daily (approved dosages in the EU) significantly improved pulmonary function compared with placebo or equivalent dosages of fluticasone furoate alone (in some trials) or fluticasone propionate. In similar trials, fluticasone furoate/vilanterol 100/25 µg once daily was as effective as fluticasone propionate/salmeterol 250/50 µg twice daily in improving pulmonary function and significantly reduced the risk of severe asthma exacerbation relative to fluticasone furoate alone. In clinical trials, fluticasone furoate/vilanterol was generally well tolerated with fewer than 15 % of patients experiencing treatment-related adverse events, the most common of which were oral/oropharyngeal candidiasis, dysphonia, extrasystoles and cough. The tolerability profile of fluticasone furoate/vilanterol was generally similar to that of fluticasone propionate/salmeterol. Thus, fluticasone furoate/vilanterol is an effective and generally well tolerated ICS/LABA option for the treatment of uncontrolled asthma.

  1. Predictors of Asthma Control by Stepwise Treatment in Elderly Asthmatic Patients.

    PubMed

    Ban, Ga-Young; Ye, Young-Min; Lee, Yunhwan; Kim, Jeong-Eun; Nam, Young-Hee; Lee, Soo-Keol; Kim, Joo-Hee; Jung, Ki-Suck; Kim, Sang-Ha; Park, Hae-Sim

    2015-08-01

    The geriatric population is increasing, and asthma severity increases with age. We determined the predictors of asthma control, exacerbation, and the factors that affect asthma-specific quality of life (A-QOL) in elderly asthmatic patients. This was a prospective, multicenter, real-life study for 6 months with stepwise pharmacologic treatment based on the Global Initiative for Asthma (GINA) guideline. A total of 296 asthmatic patients aged ≥ 60 yr were recruited from 5 university centers in Korea. The improved-asthma control group was defined as the group of patients who maintained well-controlled or improved disease and the not-improved asthma control group was defined as the remaining patients. Fewer number of medications for comorbidities (2.8 ± 3.3 in the improved vs. 4.5 ± 4.4 in the control) and higher physical functioning (PF) scale (89.8 ± 14.2 in the improved vs. 82.0 ± 16.4 in the control) were significant predictors in the improved-asthma control group (OR = 0.863, P = 0.004 and OR = 1.028, P = 0.018, respectively). An asthma control test (ACT) score of ≤ 19 at baseline was a significant predictor of asthma exacerbation (OR = 3.938, P = 0.048). Asthma duration (F = 5.656, P = 0.018), ACT score (F = 12.237, P = 0.001) at baseline, and the presence of asthma exacerbation (F = 5.565, P = 0.019) were significant determinants of changes in A-QOL. The number of medications for comorbidities and performance status determined by the PF scale may be important parameters for assessing asthma control in elderly asthmatic patients.

  2. Asthma in Children

    MedlinePlus

    ... have asthma. Nearly 9 million of them are children. Children have smaller airways than adults, which makes asthma especially serious for them. Children with asthma may experience wheezing, coughing, chest tightness, ...

  3. Risk of adenocarcinomas of the oesophagus and gastric cardia in patients hospitalized for asthma

    PubMed Central

    Ye, W; Chow, W-H; Lagergren, J; Boffetta, P; Boman, G; Adami, H-O; Nyrén, O

    2001-01-01

    In the first cohort study of the question we followed 92 986 (42 663 men and 50 323 women) adult patients hospitalized for asthma in Sweden from 1965 to 1994 for an average of 8.5 years to evaluate their risk of oesophageal and gastric cardia adenocarcinoma. Standardized incidence ratio (SIR) adjusted for gender, age and calendar year was used to estimate relative risk, using the Swedish nationwide cancer incidence rates as reference. Asthmatic patients overall had a moderately elevated risk for oesophageal adenocarcinoma (SIR = 1.5, 95% confidence interval CI, 0.9–2.5) and gastric cardia cancer (SIR = 1.4, 95% CI, 1.0–1.9). However, the excess risks were largely confined to asthmatic patients who also had a discharge record of gastro-oesophageal reflux (SIR = 7.5, 95% CI, 1.6–22.0 and SIR = 7.1, 95% CI, 3.1–14.0, respectively). No significant excess risk for oesophageal squamous-cell carcinoma or distal stomach cancer was observed. In conclusion, asthma is associated with a moderately elevated risk of developing oesophageal or gastric cardia adenocarcinoma. Special clinical vigilance vis-à-vis gastro-esophageal cancers seems unwarranted in asthmatic patients, but may be appropriate in those with clinically manifest gastro-oesophageal reflux.   http://www.bjcancer.com © 2001 Cancer Research Campaign PMID:11720467

  4. Postoperative Adverse Outcomes in Patients With Asthma: A Nationwide Population-based Cohort Study.

    PubMed

    Lin, Chao-Shun; Chang, Chuen-Chau; Yeh, Chun-Chieh; Chung, Chi-Li; Chen, Ta-Liang; Liao, Chien-Chang

    2016-01-01

    Outcome after surgery in patients with asthma remains unknown. The purpose of this study is to investigate postoperative major complications and mortality in surgical patients with asthma.Using reimbursement claims from the Taiwan National Health Insurance Research Database, the authors identified 24,109 surgical patients with preoperative asthma and 24,109 nonasthma patients undergoing major surgeries using matching procedure with propensity score by sociodemographics, coexisting medical conditions, and surgical characteristics. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for 30-day postoperative complications and mortality associated with asthma were analyzed in the multivariate logistic regressions.Asthma increased postoperative pneumonia (OR 1.48; 95% CI 1.34-1.64), septicemia (OR 1.11; 95% CI 1.02-1.21), and urinary tract infection (OR 1.17; 95% CI 1.09-1.26). Preoperative emergency care for asthma was significantly associated with postoperative 30-day in-hospital mortality, with an OR of 1.84 (95% CI 1.11-3.04). Preoperative emergency service, hospitalizations, admission to intensive care unit, and systemic use of corticosteroids for asthma were also associated with higher postoperative complication rates for asthmatic patients.Postoperative complications and mortality were significantly increased in asthmatic patients. We suggest urgent efforts to revise protocols for asthma patients' perioperative care.

  5. Who Is Providing and Who Is Getting Asthma Patient Education: An Analysis of 2001 National Ambulatory Medical Care Survey Data

    ERIC Educational Resources Information Center

    Shah, Shaival S.; Lutfiyya, May Nawal; McCullough, Joel Emery; Henley, Eric; Zeitz, Howard Jerome; Lipsky, Martin S.

    2008-01-01

    Patient education in asthma management is important; however, there is little known about the characteristics of patients receiving asthma education or how often primary care physicians provide it. The objective of the study was to identify the characteristics of patients receiving asthma education. It was a cross-sectional study using 2001…

  6. Self-Management Behaviors among Older Adults with Asthma: Associations with Health Literacy

    PubMed Central

    Federman, Alex D.; Wolf, Michael S.; Sofianou, Anastasia; Martynenko, Melissa; O’Connor, Rachel; Halm, Ethan A.; Leventhal, Howard; Wisnivesky, Juan P.

    2014-01-01

    Background/Objectives: Older adults asthmatics experience high rates of morbidity and mortality yet little is known about their self-management behaviors. We examined self-management behaviors, including medication adherence and inhaler technique, among older adults and their association with health literacy. Design: Observational cohort study. Setting: Primary care and pulmonary specialty practices in two tertiary academic medical centers and three Federally Qualified Health Centers in New York City, NY and Chicago, IL. Participants: Adults with moderate or severe persistent asthma, ages 60 years and older (n=433). Measurements: Outcomes were adherence to asthma controller medications, metered dose inhaler (MDI) and dry powder inhaler (DPI) techniques, having a usual asthma physician, and avoidance of four common triggers. Health literacy was assessed with the Short Test of Functional Health Literacy in Adults. Results: The mean age was 67 years and 36% had marginal or low health literacy. Adherence was low (38%) overall and worse among individuals with low health literacy (22% vs. 47%, p<0.0001) and after adjusting for demographic factors and health status (odds ratio [OR] 0.48, 95% confidence [CI] 0.31-0.73). Similarly, inhaler technique was poor: only 38% and 54% had good MDI and DPI technique, respectively. Technique was worse among those with low health literacy (MDI technique: OR 0.57, 95% CI 0.38-0.85; DPI technique: OR 0.42, 95% CI 0.25 to 0.71). Asthma self-monitoring and avoidance of triggers occurred infrequently but were less consistently associated with low health literacy. Conclusion: Adherence to medications and inhaler technique are poor among older asthmatics, and worse among those with low health literacy. Clinicians should routinely assess controller medication adherence and inhaler technique, and use low-literacy communication strategies to support self-management in older asthmatics. PMID:24779482

  7. Effect of long-term ionized air treatment on patients with bronchial asthma.

    PubMed

    Jones, D P; O'Connor, S A; Collins, J V; Watson, B W

    1976-08-01

    Seven patients with bronchial asthma requiring continuous medication were subjected to eight weeks of nocturnal exposure to negatively ionized air, and their progress was followed using objective tests of lung function and clinical assessment. During exposure, four patients showed significant increases in morning PEFR, which in two of these patients was not sustained when exposure ceased. In two patients the observed increase in PEFR was accompanied by subjective improvement. From the results of all our assessments we conclude that, although this treatment may lead to an improvement in some patients with asthma, further objective studies are required to determine the value of negatively ionized air in the routine management of asthma.

  8. Korean Asthma Guideline 2014: Summary of Major Updates to the Korean Asthma Guideline 2014

    PubMed Central

    Kim, Deog Kyeom; Park, Yong Bum; Oh, Yeon-Mok; Jung, Ki-Suck; Yoo, Ji Hong

    2016-01-01

    Asthma is a prevalent and serious health problem in Korea. Recently, the Korean Asthma Guideline has been updated by The Korean Academy of Tuberculosis and Respiratory Diseases (KATRD) in an effort to improve the clinical management of asthma. This guideline focuses on adult patients with asthma and aims to deliver up to date scientific evidence and recommendations to general physicians for the management of asthma. For this purpose, this guideline was updated following systematic review and meta-analysis of recent studies and adapting some points of international guidelines (Global Initiative for Asthma [GINA] report 2014, National Asthma Education and Prevention Program [NAEPP] 2007, British Thoracic Society [BTS/SIGN] asthma guideline 2012, and Canadian asthma guideline 2012). Updated issues include recommendations derived using the population, intervention, comparison, and outcomes (PICO) model, which produced 20 clinical questions on the management of asthma. It also covers a new definition of asthma, the importance of confirming various airflow limitations with spirometry, the epidemiology and the diagnostic flow of asthma in Korea, the importance and evidence for inhaled corticosteroids (ICS) and ICS/formoterol as a single maintenance and acute therapy in the stepwise management of asthma, assessment of severity of asthma and management of exacerbation, and an action plan to cope with exacerbation. This guideline includes clinical assessments, and treatment of asthma–chronic obstructive pulmonary disease overlap syndrome, management of asthma in specific conditions including severe asthma, elderly asthma, cough variant asthma, exercise-induced bronchial contraction, etc. The revised Korean Asthma Guideline is expected to be a useful resource in the management of asthma. PMID:27433170

  9. Genome-wide association study of lung function decline in adults with and without asthma

    PubMed Central

    Imboden, Medea; Bouzigon, Emmanuelle; Curjuric, Ivan; Ramasamy, Adaikalavan; Kumar, Ashish; Hancock, Dana B; Wilk, Jemma B; Vonk, Judith M; Thun, Gian A; Siroux, Valerie; Nadif, Rachel; Monier, Florent; Gonzalez, Juan R; Wjst, Matthias; Heinrich, Joachim; Loehr, Laura R; Franceschini, Nora; North, Kari E; Altmüller, Janine; Koppelman, Gerard H.; Guerra, Stefano; Kronenberg, Florian; Lathrop, Mark; Moffatt, Miriam F; O’Connor, George T; Strachan, David P; Postma, Dirkje S; London, Stephanie J; Schindler, Christian; Kogevinas, Manolis; Kauffmann, Francine; Jarvis, Debbie L; Demenais, Florence; Probst-Hensch, Nicole M

    2012-01-01

    Background Genome-wide association studies (GWAS) have identified determinants of chronic obstructive pulmonary disease, asthma and lung function level, however none addressed decline in lung function. Aim We conducted the first GWAS on age-related decline in forced expiratory volume in the first second (FEV1) and in its ratio to forced vital capacity (FVC) stratified a priori by asthma status. Methods Discovery cohorts included adults of European ancestry (1441 asthmatics, 2677 non-asthmatics; Epidemiological Study on the Genetics and Environment of Asthma (EGEA); Swiss Cohort Study on Air Pollution And Lung And Heart Disease In Adults (SAPALDIA); European Community Respiratory Health Survey (ECRHS)). The associations of FEV1 and FEV1/FVC decline with 2.5 million single nucleotide polymorphisms (SNPs) were estimated. Thirty loci were followed-up by in silico replication (1160 asthmatics, 10858 non-asthmatics: Atherosclerosis Risk in Communities (ARIC); Framingham Heart Study (FHS); British 1958 Birth Cohort (B58C); Dutch asthma study). Results Main signals identified differed between asthmatics and non-asthmatics. None of the SNPs reached genome-wide significance. The association between the height related gene DLEU7 and FEV1 decline suggested for non-asthmatics in the discovery phase was replicated (discovery P=4.8×10−6; replication P=0.03) and additional sensitivity analyses point to a relation to growth. The top ranking signal, TUSC3, associated with FEV1/FVC decline in asthmatics (P=5.3×10−8) did not replicate. SNPs previously associated with cross-sectional lung function were not prominently associated with decline. Conclusions Genetic heterogeneity of lung function may be extensive. Our results suggest that genetic determinants of longitudinal and cross-sectional lung function differ and vary by asthma status. PMID:22424883

  10. The Effect of a Training Program on Oral Health and Behavior Change in Asthma Patients

    PubMed Central

    Yılmaz, Feride Taşkın; Çınar, Sezgi; Yılmaz, Adnan; Kumsar, Azime Karakoç

    2016-01-01

    Background: Asthma is a chronic disease which is prevalent throughout the world. Physical problems such as deterioration in oral health, which may occur due to the triggering factors of asthma as well as the ineffective use of asthma medicine, seem to affect the daily lives of asthma patients. Therefore, it is important to protect oral health and promote positive behavior changes in asthma patients in order to achieve effective treatment and asthma control. Aims: The present study aimed to determine the effects of a training program provided for asthma patients on oral health, inhaler use skills, and behavior change. Study Design: Controlled experimental study. Methods: A total of 124 asthma patients were included in the study. Of the patients, 62 were assigned to the experimental group and the other 62 were assigned to the control group. Data were collected using the patient identification form, the oral assessment guide, the inhaler use skill form, and the evaluation form for behavior change over time. The experimental group received training provided by the researchers on the first meeting and one month later. Written and visual training material were used. Both groups were subject to a final evaluation which was conducted 4 months after their first meeting. Results: It was determined that the oral assessment guide scores (p<0.01) and inhaler use skills of the experimental group improved significantly after the training compared to the control group (p<0.01). In addition, it was observed that the number of patients in the experimental group who quit smoking (p<0.05), used their medicine (p<0.01) and brushed their teeth on a regular basis (p<0.01), and washed their mouth after inhaler use significantly increased in the experimental group after training compared to the control group (p<0.01). Conclusion: The study demonstrated that the training provided for asthma patients improved oral health and promoted inhaler use skills and was partially effective in

  11. Unrecognised psychopathology in patients with difficult asthma: major mental and personality disorders

    PubMed Central

    van Son, Maarten J.M.; van Keimpema, Anton R.J.; Meijer, Jan-Willem G.; Bühring, Martina E.F.; Pop, Victor J.M.

    2015-01-01

    Background Difficult asthma is a severe subgroup of asthma in which the main feature is uncontrollability of symptoms. Psychopathology is suggested to be prominent in patients with difficult asthma and considered important in its treatment; however, the evidence is scarce. Aims To describe psychopathology in difficult asthma, both major mental and personality disorders, based on diagnostic interviews. Method This study was conducted in a specialised asthma care centre. A total of 51 patients with difficult asthma were diagnosed at the start of the treatment programme using two structured clinical interviews for both major mental (SCID-I) and personality disorders (SCID-II) according to DSM-IV-TR. Results About 55% of the patients with difficult asthma had a psychiatric disorder of which 89% was undiagnosed and untreated before being interviewed. About 49% had a minimum of one major mental disorder of which the cluster of anxiety disorders was the most common cluster of major mental disorders, followed by somatoform disorders. About 20% were diagnosed with a personality disorder. Of the 10 patients with a personality disorder, 9 had an obsessive–compulsive personality disorder. Conclusions This study demonstrates that more than half of patients with difficult asthma had a psychiatric disorder of which 89% was unrecognised. This study highlights the importance of offering patients with difficult asthma a psychiatric diagnostic interview and/or a psychiatric consultation as part of their routine medical examination and provision of appropriate psychiatric treatment. Moreover, it highlights the urgency of further research into the role of psychopathology in the development of difficult asthma. Declaration of interest None. Copyright and usage © The Royal College of Psychiatrists 2015. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.

  12. Influence of Delivery Devices on Efficacy of Inhaled Fluticasone Propionate: A Comparative Study in Stable Asthma Patients

    PubMed Central

    Kolasani, Bhanu Prakash; Lanke, Venu Madhavi; Diyya, Sudheer

    2013-01-01

    Background: Inhaled corticosteroids are the preferred treatment for long-term control of all grades of persistent asthma. These are administered by various delivery devices with very little information whether these devices can affect the efficacy of inhaled corticosteroids. Fluticasone propionate is a relatively new inhalational corticosteroid compared to older ones like beclomethasone and budesonide. Aims & Objective: To assess the relative efficacy of fluticasone propionate administered from different delivery devices to adult patients of chronic stable bronchial asthma as measured by pulmonary function test parameters. Material and Methods: This prospective study was undertaken to assess the relative efficacy of fluticasone propionate administered from different delivery devices to adult patients of chronic stable bronchial asthma as measured by pulmonary function test parameters. Fourty eight subjects were administered, fluticasone propionate (250 μg) by dry powder inhaler, metered dose inhaler, metered dose inhaler with spacer and fluticasone (1mg) via nebulizer consecutively each week for four weeks under direct supervision. Pulmonary function test was done before and one hour after administration of the drug on each visit. Results: After excluding nine patients who were lost to follow up, data was analysed for the remaining thirty nine patients and no significant difference in peak expiratory flow rate (p=0.77), forced expiratory volume in one second (p=0.95), forced vital capacity (p=0.24) and forced expiratory volume in one second and forced vital capacity ratio (p=0.22) was seen after giving fluticasone by different devices. Conclusion: Fluticasone propionate delivered by different devices like dry powder inhaler, metered dose inhaler, metered dose inhaler with spacer and nebulizer have similar effect on lung function in patients of chronic stable bronchial asthma and may be used interchangeably. PMID:24179895

  13. The Saudi initiative for asthma – 2012 update: Guidelines for the diagnosis and management of asthma in adults and children

    PubMed Central

    Al-Moamary, Mohamed S.; Alhaider, Sami A.; Al-Hajjaj, Mohamed S.; Al-Ghobain, Mohammed O.; Idrees, Majdy M.; Zeitouni, Mohammed O.; Al-Harbi, Adel S.; Al Dabbagh, Maha M.; Al-Matar, Hussain; Alorainy, Hassan S.

    2012-01-01

    This an updated guidelines for the diagnosis and management of asthma, developed by the Saudi Initiative for Asthma (SINA) group, a subsidiary of the Saudi Thoracic Society. The main objective of SINA is to have updated guidelines, which are simple to understand and easy to use by non-asthma specialists, including primary care and general practice physicians. This new version includes updates of acute and chronic asthma management, with more emphasis on the use of Asthma Control Test in the management of asthma, and a new section on “difficult-to-treat asthma.” Further, the section on asthma in children was re-written to cover different aspects in this age group. The SINA panel is a group of Saudi experts with well-respected academic backgrounds and experience in the field of asthma. The guidelines are formatted based on the available evidence, local literature, and the current situation in Saudi Arabia. There was an emphasis on patient–doctor partnership in the management that also includes a self-management plan. The approach adopted by the SINA group is mainly based on disease control as it is the ultimate goal of treatment. PMID:23189095

  14. Definition of critical asthma syndromes.

    PubMed

    Kenyon, Nicholas; Zeki, Amir A; Albertson, Timothy E; Louie, Samuel

    2015-02-01

    Urgent visits to the clinic and emergency department for acute severe asthma exacerbations are all too frequent. Existing national guidelines do not present consistent or specific recommendations for the evaluation and treatment of individual asthma patients in respiratory distress. In this vein, we propose the term "critical asthma syndrome" (CAS) to describe any child or adult who is at high risk for fatal asthma. Acute severe asthma, refractory asthma, status asthmaticus, and near-fatal asthma all describe CAS where physical exhaustion from the overwhelming work of breathing leads to respiratory arrest and death from hypoxia or related complications. The authors of this supplement seek to emphasize the importance of early recognition, prompt and coordinated evaluation, and treatment of CAS in the emergency department, hospital, and intensive care units by experienced healthcare provider teams. CAS is not severe persistent asthma where control of symptoms and prevention of exacerbations are targets of chronic disease management in the outpatient setting. The authors address the distinctions between the two entities throughout the supplement, and elaborate on the considerations important in the care of a critically ill patient, including the common errors to avoid. In addition, gaps in knowledge and clinical experience in regards to critical asthma are highlighted. Knowledge gaps include a lack of understanding of how to recognize CAS, how to coordinate and integrate hospital and outpatient resources, when to further phenotype patients with critical asthma in order to facilitate effective treatment, and how to prevent future acute exacerbations. Lastly, CAS is complicated by the fact that asthma care in diverse healthcare settings is haphazard. We recommend that primary care physicians refer patients promptly to an asthma specialist for consultation to reduce the frequency of acute exacerbations and prevent the development of CAS.

  15. Management of the patient with eosinophilic asthma: a new era begins

    PubMed Central

    ten Brinke, Anneke; Bel, Elisabeth H.D.

    2015-01-01

    Now that it is generally accepted that asthma is a heterogeneous condition, phenotyping of asthma patients has become a mandatory part of the diagnostic workup of all patients who do not respond satisfactorily to standard therapy with inhaled corticosteroids. Late-onset eosinophilic asthma is currently one of the most well-defined asthma phenotypes and seems to have a different underlying pathobiology to classical childhood-onset, allergic asthma. Patients with this phenotype can be identified in the clinic by typical symptoms (few allergies and dyspnoea on exertion), typical lung function abnormalities (“fixed” airflow obstruction, reduced forced vital capacity and increased residual volume), typical comorbidities (nasal polyposis) and a good response to systemic corticosteroids. The definitive diagnosis is based on evidence of eosinophilia in bronchial biopsies or induced sputum, which can be estimated with reasonable accuracy by eosinophilia in peripheral blood. Until recently, patients with eosinophilic asthma had a very poor quality of life and many suffered from frequent severe exacerbations or were dependent on oral corticosteroids. Now, for the first time, novel biologicals targeting the eosinophil have become available that have been shown to be able to provide full control of this type of refractory asthma, and to become a safe and efficacious substitute for oral corticosteroids. PMID:27730141

  16. Immunological characteristics and management considerations in obese patients with asthma

    PubMed Central

    Ather, Jennifer L; Poynter, Matthew E; Dixon, Anne E

    2015-01-01

    Obesity is associated with severe, poorly controlled asthma that does not respond as well to therapy as asthma in leaner asthmatics. Important insights gained from animal models of obesity and asthma suggests that different forms of obesity may lead to different manifestations of airway disease: obesity is associated with both innate increased airway reactivity and altered responses to aeroallergen and pollutant challenges. In humans, at least two broad groups of obese asthmatics have been recognized: one that is likely unique to obesity and another that is likely lean allergic asthma much complicated by obesity. This article will discuss what we have learned about the immunological and pathophysiological basis of asthma in obesity from animal and human studies, and how this might guide therapy. PMID:25914932

  17. Interleukin-8 in airway inflammation in patients with asthma and chronic obstructive pulmonary disease.

    PubMed

    Nocker, R E; Schoonbrood, D F; van de Graaf, E A; Hack, C E; Lutter, R; Jansen, H M; Out, T A

    1996-02-01

    We have investigated whether IL-8 is present in airway secretions from patients with asthma and chronic obstructive pulmonary disease (COPD) to obtain information on its possible role in airway inflammation in obstructive airways disease. In the bronchoalveolar lavage fluid (BALF) from 11 clinically stable patients with asthma the levels of IL-8 were increased compared to 10 healthy subjects (median: controls 21.5 pg/ml, asthma 244 pg/ml: p < 0.005). In the patients with asthma the levels of IL-8 correlated with the percentage neutrophils in the BALF (r = 0.81; p < 0.001) and with a parameter of the permeability of the respiratory membrane, the quotient (alpha 2-macroglobulin in BALF)/(alpha 2-macroglobulin in serum) (r = 0.66; p < 0.025). In the sputum sol phase of 9 patients with symptomatic asthma the levels of IL-8 were lower than in 9 patients with COPD (asthma: 6.4 ng/ml; COPD: 16.3 ng/ml; p < 0.02) and significantly correlated with those of neutrophilic myeloperoxidase (MPO; r = 0.85; p < 0.005). The increased levels of IL-8 in the airway secretions from both patients with asthma and COPD may be markers of an ongoing inflammatory process, which is more pronounced in patients with COPD. In patients with asthma the strong correlation between the levels of IL-8 and the percentage neutrophils and/or the levels of MPO points to a role of IL-8 in the recruitment and activation of neutrophils in the airway lumen.

  18. Asthma out of control? A structured review of recent patient surveys

    PubMed Central

    Holgate, Stephen T; Price, David; Valovirta, Erkka

    2006-01-01

    Background An understanding of the needs and behaviors of asthma patients is important in developing an asthma-related healthcare policy. The primary goal of the present review was to assess patient perspectives on key issues in asthma and its management, as captured in patient surveys. Methods Local, national, and multinational asthma surveys were reviewed to assess patient perspectives, and where possible healthcare provider (HCP) perspectives, on key issues, including diagnosis, treatment, control, quality of life, and other patient-centered outcomes. Twenty-four surveys, conducted or published between 1997 and 2003 in Europe and North America, were included in this review. Substantial differences among studies prevented a formal meta-analysis; instead, data were pooled to allow for general comparisons and qualitative analysis. Results The results indicate that patients' knowledge of the underlying causes of asthma and treatment options remains inadequate. Moreover, patients often tolerate poor symptom control, possess meager knowledge of correct drug usage, and display insufficient adherence to therapy. Many patients have a low expectation of receiving an appropriate therapy or of having a positive encounter with the HCP. Among HCPs, there is evidence of inadequate understanding of disease etiology and poor or unstructured communication with patients, resulting often in inaccurate assessment of disease severity. Moreover, patients often underreport their symptoms and severity, which in turn could lead to misclassification and undertreatment. Conclusion Improving patient education about the importance of achieving optimal asthma control, along with improved communication between patients and HCPs, emphasizing treatment options and optimal treatment of inflammation, may lead to better outcomes and improved asthma management in daily practice. PMID:17140420

  19. Assistance model for patients with asthma in the primary care.

    PubMed

    Leal, Renata Cristina de Angelo Calsaverini; Braile, Domingo Marcolino; Souza, Dorotéia Rossi Silva; Batigália, Fernando

    2011-01-01

    To create a program structured for the control and prevention towards asthma worsening, it is necessary to settle down actions of regionalization, planning and management. Currently, the Ministerial orders allow each municipality district to cope their needs with local initiatives, based on the search of the health indicators with University partnerships. Taking into account this context, it is feasible the implantation of an effective model through organized demand of attendance flow and physical structure, besides the withdrawal of medications and professional training. To describe the modus operandi situation currently in the Primary Health Care Units regarding these patients' reception, diagnosis, and follow-up, as well as the current situation according to the professional profile and sector. To introduce an assistance model for reception, of these patients in these primary care units. This is a bibliographical review based on the specialized literature such as scientific papers selected through the search on the SciELO and Bireme databases, from Medline and Lilacs data sources. A Committee was set up by members from the Health and Service , the Medical School, and scientific societies for discussion and planning.

  20. Recognizing asthma mimics and asthma complications.

    PubMed

    Amundson, Dennis; Seda, Gilbert; Daheshia, Massoud

    2011-10-01

    Asthma is a chronic inflammatory disorder of the airways characterized by airflow obstruction, bronchial hyperreactivity, and underlying inflammation. Two common reasons asthmatics fail standard therapy are incorrect diagnosis and failure to recognize underlying contributing factors. A correct diagnosis of asthma is of great importance to military practitioners since misdiagnosis or uncontrolled asthma affects an individual's operational readiness or determines whether one can receive a medical waiver to enlist in military service. This article presents four cases of patients with dyspnea that have conditions which mimic asthma or complicate asthma management: vocal cord dysfunction misdiagnosed as asthma, respiratory bronchiolitis interstitial lung disease mistaken as asthma, difficult-to-control asthma because of bronchiectasis and allergic bronchopulmonary aspergillosis, and difficult and fatal asthma. Asthma is contrasted to other respiratory disorders, and an outlined approach to asthma diagnosis and management is presented using the Global Initiative for Asthma guidelines.

  1. The Saudi Initiative for Asthma

    PubMed Central

    Al-Moamary, Mohamed S.; Al-Hajjaj, Mohamed S.; Idrees, Majdy M.; Zeitouni, Mohamed O.; Alanezi, Mohammed O.; Al-Jahdal, Hamdan H.; Al Dabbagh, Maha

    2009-01-01

    The Saudi Initiative for Asthma (SINA) provides up-to-date guidelines for healthcare workers managing patients with asthma. SINA was developed by a panel of Saudi experts with respectable academic backgrounds and long-standing experience in the field. SINA is founded on the latest available evidence, local literature, and knowledge of the current setting in Saudi Arabia. Emphasis is placed on understanding the epidemiology, pathophysiology, medications, and clinical presentation. SINA elaborates on the development of patient-doctor partnership, self-management, and control of precipitating factors. Approaches to asthma treatment in SINA are based on disease control by the utilization of Asthma Control Test for the initiation and adjustment of asthma treatment. This guideline is established for the treatment of asthma in both children and adults, with special attention to children 5 years and younger. It is expected that the implementation of these guidelines for treating asthma will lead to better asthma control and decrease patient utilization of the health care system. PMID:19881170

  2. Effects of antioxidant supplements and nutrients on patients with asthma and allergies.

    PubMed

    Moreno-Macias, Hortensia; Romieu, Isabelle

    2014-05-01

    Asthma and allergic diseases have become a worldwide public health concern because of their increased prevalence. Despite decades of research on risk factors, the causes of these disorders are poorly understood. They are thought to develop through complex interactions between genetic and environmental factors. Because pulmonary and systemic oxidative stress increase inflammatory responses relevant to asthma and allergy, dietary or vitamin supplementation with antioxidants (a broad and varied category) has been proposed as an approach to reducing asthma incidence or morbidity. Meta-analyses of observational epidemiologic studies of variable methodological quality suggest associations of relatively low dietary intake of antioxidants and higher asthma and allergy prevalence. However, there have been few longitudinal studies of maternal or child dietary or vitamin/supplement antioxidant intake and asthma/allergy development. Moreover, there are no clinical trial data to support the use of dietary antioxidants or supplements to prevent asthma or allergy. A few small clinical trials suggest that specific antioxidants from diet or vitamin supplements might improve asthma control or lung function in asthmatic children or adults. Studies suggest that responses to antioxidants might be modified by life stage, genetic susceptibility, and environmental sources of oxidative stress. Large trials of antioxidant vitamin supplementation to prevent cancer suggest an increase in overall mortality with antioxidant vitamin supplementation, at least in populations with sufficient dietary antioxidant intake. This cautionary experience suggests that future trials to assess whether antioxidants reduce asthma incidence or improve asthma control should focus on supplementation of dietary sources of antioxidants. The potential benefits and risks of trials of vitamin supplements might be considered in special situations in which vulnerable populations have marked deficiency in dietary

  3. Teaching the adult ostomy patient.

    PubMed

    O'Shea, H S

    2001-01-01

    Ostomy education is based on principles of adult learning, including assessment of the learners' readiness, ability, and need to learn. Such teaching incorporates specific strategies designed to promote cognitive, affective, and psychomotor learning and strategies to overcome potential cultural barriers. In addition, modifications may be included to meet the needs of aged or disabled patients who have cognitive deficits or low literacy skills. Finally, ostomy education must include an evaluation of its effectiveness. This article reviews general guidelines for planning, implementing, and evaluating patient education for adult patients with ostomies.

  4. A Halotyrosine Antibody that Detects Increased Protein Modifications in Asthma Patients

    SciTech Connect

    Jin, Hongjun; Hallstrand, Teal S.; Daly, Don S.; Matzke, Melissa M.; Nair, Parameswaran; Bigelow, Diana J.; Pounds, Joel G.; Zangar, Richard C.

    2014-01-31

    Background-Airway inflammation plays an important pathophysiological role in asthma. Eosinophils produce hypobromite and bromotyrosine while neutrophils produce hypochlorite and chlorotyrosine. Objective-To evaluate halotyrosine modifications of individual airway proteins as a marker of inflammation in asthma using an antibody-based assay. Methods-We developed a novel monoclonal antibody (BTK-94C) that binds halogenated tyrosine residues, and used this antibody in a custom enzyme-linked immunosorbent assay (ELISA) microarray platform to examine halotyrosine levels in 23 proteins in three independent sets of sputum samples (52 samples total). Results-In 15 subjects with either no asthma, or with asthma characterized by high or low sputum eosinophil counts, we found associations between increased halotyrosine levels of at least three proteins and severity of airway hyperresponsiveness (AHR). Treatment with mepolizumab in 17 patients with sputum eosinophilia markedly reduced the sputum eosinophilia and significantly reduced halotyrosine levels in one sputum protein. Further analysis of 10 subjects with neutrophilic asthma and 10 health controls demonstrated a broad increase in halotyrosine in the patients with airway neutrophilia. Conclusions-Significantly higher levels of halotyrosine are associated with asthma in the asthma phenotypes we examined. The halotyrosine levels correlated with indirect AHR in the form of exercise-induced bronchoconstriction. Clinical Implication-An antibody-based assay for tyrosine halogenation in specific proteins may prove useful for assessing airway inflammation in asthma. Capsule Summary-An antibody to measure protein monobrominated tyrosine and other halotyrosine modifications was developed and used to evaluate halogenation in specific proteins in the airways for the first time. Associations were found between levels of halotyrosine and exercise-induced bronchoconstriction, and eosinophil and neutrophil inflammation in sputum from

  5. Prevalence and risk factors for self-reported asthma in an adult Indian population: a cross-sectional survey

    PubMed Central

    Pearce, N.; Ebrahim, S.

    2013-01-01

    BACKGROUND AND METHODS: We estimated the prevalence of self-reported asthma in adult Indians and examined several risk factors influencing disease prevalence. Analysis is based on 99 574 women and 56 742 men aged 20–49 years included in India’s third National Family Health Survey, 2005–2006. Multiple logistic regression analysis was used to estimate the prevalence odds ratios for asthma, adjusting for various risk factors. RESULTS: The prevalence of self-reported asthma was 1.8% (95%CI 1.6–2.0) among men and 1.9% (95%CI 1.8–2.0) among women, with higher rates in rural than in urban areas and marked geographic differences. After adjustment for known asthma risk factors, women were 1.2 times more likely to have asthma than men. Daily/weekly consumption of milk/milk products, green leafy vegetables and fruits were associated with a lower asthma risk, whereas consumption of chicken/meat, a lower body mass index (BMI; <16 kg/m2, OR 2.08, 95%CI 1.73–2.50) as well as a higher BMI (>30 kg/m2, OR 1.67, 95%CI 1.36–2.06), current tobacco smoking (OR 1.30, 95%CI 1.12–1.50) and ever use of alcohol (OR 1.21, 95%CI 1.05–1.39) were associated with an increased asthma risk. CONCLUSIONS: There are wide regional variations in the prevalence of asthma in India. With the exception of the findings for BMI, however, most of the associations of asthma with the risk factors are relatively weak and account for only a small proportion of cases. PMID:23317966

  6. Identifying patients with asthma in primary care electronic medical record systems

    PubMed Central

    Xi, Nancy; Wallace, Rebecca; Agarwal, Gina; Chan, David; Gershon, Andrea; Gupta, Samir

    2015-01-01

    Objective To develop and test a variety of electronic medical record (EMR) search algorithms to allow clinicians to accurately identify their patients with asthma in order to enable improved care. Design A retrospective chart analysis identified 5 relevant unique EMR information fields (electronic disease registry, cumulative patient profile, billing diagnostic code, medications, and chart notes); asthma-related search terms were designated for each field. The accuracy of each term was tested for its ability to identify the asthma patients among all patients whose charts were reviewed. Increasingly sophisticated search algorithms were then designed and evaluated by serially combining individual searches with Boolean operators. Setting Two large academic primary care clinics in Hamilton, Ont. Participants Charts for 600 randomly selected patients aged 16 years and older identified in an initial EMR search as likely having asthma (n = 150), chronic obstructive pulmonary disease (n = 150), other respiratory conditions (n = 150), or nonrespiratory conditions (n = 150) were reviewed until 100 patients per category were identified (or until all available names were exhausted). A total of 398 charts were reviewed in full and included. Main outcome measures Sensitivity and specificity of each search for asthma diagnosis (against the reference standard of a physician chart review–based diagnosis). Results Two physicians reviewed the charts identified in the initial EMR search using a standardized data collection form and ascribed the following diagnoses in 398 patients: 112 (28.1%) had asthma, 81 (20.4%) had chronic obstructive pulmonary disease, 104 (26.1%) had other respiratory conditions, and 101 (25.4%) had nonrespiratory conditions. Concordance between reviewers in chart abstraction diagnosis was high (κ = 0.89, 95% CI 0.80 to 0.97). Overall, the algorithm searching for patients who had asthma in their cumulative patient profiles or for whom an asthma billing code

  7. Dietary antioxidants and ozone-induced bronchial hyperresponsiveness in adults with asthma.

    PubMed

    Trenga, C A; Koenig, J Q; Williams, P V

    2001-01-01

    Ozone exposure aggravates asthma, as has been demonstrated in both controlled exposures and epidemiologic studies. In the current double-blind crossover study, the authors evaluated the effects of dietary antioxidants (i.e., 400 IU vitamin E/500 mg vitamin C) on ozone-induced bronchial hyperresponsiveness in adult subjects with asthma. Seventeen subjects were exposed to 0.12 ppm of ozone or to air for 45 min during intermittent moderate exercise. Bronchial hyperresponsiveness was assessed with 10-min sulfur dioxide (i.e., 0.10 ppm and 0.25 ppm) inhalation challenges. Subjects who were given dietary antioxidants responded less severely to sulfur dioxide challenge than subjects given a placebo (i.e., forced expiratory volume in the 1st sec: -1.2% vs. 4.4%, respectively; peak flow: +2.2% vs. -3.0%, respectively; and mid-forced expiratory flow: +2.0% vs. -4.3%, respectively). Effects were more pronounced when subjects were grouped by response to sulfur dioxide at the screening visit. The results suggest that dietary supplementation with vitamins E and C benefits asthmatic adults who are exposed to air pollutants. PMID:11480500

  8. Prevalence of bronchial hyperresponsiveness and asthma in a rural adult population.

    PubMed Central

    Woolcock, A J; Peat, J K; Salome, C M; Yan, K; Anderson, S D; Schoeffel, R E; McCowage, G; Killalea, T

    1987-01-01

    The prevalence of bronchial hyperresponsiveness in adult populations is not known. To document its prevalence and distribution and to determine the factors associated with it, a random sample of the adult population of Busselton, Western Australia, was studied. Spirometric function, bronchial responsiveness to histamine, and atopic responses to skin prick tests were measured. Respiratory symptoms were determined by questionnaire. Data were obtained from 916 subjects. Of these, 876 underwent a histamine inhalation test and bronchial hyperresponsiveness to histamine (defined as a dose of histamine provoking a 20% fall in FEV1 equal to or less than 3.9 mumol) was found in 10.5%. Another 40 subjects with poor lung function were tested with a bronchodilator and 12 were found to have bronchial hyperresponsiveness (defined as a greater than 15% increase in FEV1), making the total prevalence of bronchial hyperresponsiveness 11.4%. The prevalence of current asthma, defined as bronchial hyperresponsiveness plus symptoms consistent with asthma in the last 12 months, was 5.9%. The distribution of bronchial hyperresponsiveness in the studied population was continuous. There was a significant association between it and respiratory symptoms, atopy, smoking, and abnormal lung function (p less than 0.001 for all associations). There was no association with age, sex, or recent respiratory tract infection. Images PMID:3660290

  9. Development and validation of the RAND Asthma Control Measure.

    PubMed

    Lara, Marielena; Edelen, Maria Orlando; Eberhart, Nicole K; Stucky, Brian D; Sherbourne, Cathy D

    2014-11-01

    Patient-based measures for asthma control are important in assessing the worldwide impact of this highly prevalent chronic illness. We sought to refine an asthma symptom scale that RAND had previously developed to shorten it and validate it further, as well as reflect updated international expert definitions of asthma control. We conducted rigorous psychometric testing of new and adapted self-administered survey items in a sample of 2032 adults with asthma. The reliability and preliminary validity of the resulting measure, henceforth referred to as the RAND Asthma Control Measure (RAND-ACM), matched or exceeded that of the original RAND measure and others in the literature. RAND-ACM scores for worse asthma control were significantly associated with worse asthma-related quality of life, increased asthma-related healthcare use, Hispanic ethnicity and lower educational level. Evidence for internal consistency was strong with a Cronbach's α of 0.84. We also found adequate concordance between the RAND-ACM and the Global Initiative for Asthma categories of "uncontrolled", "partly controlled" and "controlled" asthma. The RAND-ACM, a five-item self-reported asthma control survey measure, performs well in a large ethnically-diverse sample of US adults with asthma and provides a cost-free alternative to other asthma control measures currently available.

  10. Microbial communities in the upper respiratory tract of patients with asthma and chronic obstructive pulmonary disease.

    PubMed

    Park, HeeKuk; Shin, Jong Wook; Park, Sang-Gue; Kim, Wonyong

    2014-01-01

    Respiratory infections are well-known triggers of chronic respiratory diseases. Recently, culture-independent tools have indicated that lower airway microbiota may contribute to pathophysiologic processes associated with asthma and chronic obstructive pulmonary disease (COPD). However, the relationship between upper airway microbiota and chronic respiratory diseases remains unclear. This study was undertaken to define differences of microbiota in the oropharynx of asthma and COPD patients relative to those in healthy individuals. To account for the qualitative and quantitative diversity of the 16S rRNA gene in the oropharynx, the microbiomes of 18 asthma patients, 17 COPD patients, and 12 normal individuals were assessed using a high-throughput next-generation sequencing analysis. In the 259,572 total sequence reads, α and β diversity measurements and a generalized linear model revealed that the oropharynx microbiota are diverse, but no significant differences were observed between asthma and COPD patients. Pseudomonas spp. of Proteobacteria and Lactobacillus spp. of Firmicutes were highly abundant in asthma and COPD. By contrast, Streptococcus, Veillonella, Prevotella, and Neisseria of Bacteroidetes dominated in the healthy oropharynx. These findings are consistent with previous studies conducted in the lower airways and suggest that oropharyngeal airway microbiota are important for understanding the relationships between the various parts of the respiratory tract with regard to bacterial colonization and comprehensive assessment of asthma and COPD.

  11. A retrospective assessment of cost avoidance associated with the use of nedocromil sodium metered-dose inhaler in the treatment of patients with asthma.

    PubMed

    Thomas, P; Ross, R N; Farrar, J R

    1996-01-01

    A retrospective analysis of patient charts was performed for a single, multioffice pulmonary practice in Toronto, Ontario. Canada, to assess hospital care utilization and associated cost reductions after asthma prophylaxis with nedocromil sodium inhalation aerosol. Data were obtained from 310 adult patients with mild, moderate, or severe asthma who were treated in the practice between January 1988 and June 1994 and who had been placed on nedocromil sodium for at least 1 year. The number of office visits increased with nedocromil sodium therapy due to initial surveillance of the new medication, but no other changes were made in the usual protocol for each visit. After initiation of nedocromil sodium therapy, patients showed better asthma control as measured by improvements in pulmonary function scores and by reduced hospital utilization (both emergency department visits and hospital admissions). It is likely that the improvements in asthma control could result in cost savings, and savings projections for the Canadian health care system were made using the retrospective data collected for asthma-related hospital services. Prospective data are needed to confirm our findings.

  12. AB022. Validity of the five-level new version of the EQ-5D in asthma patients

    PubMed Central

    Gimena Hernandez, Hernandez; Pont, Àngels; Garin, Olatz; Martí, Marc; Alonso, Jordi; Van Ganse, Eric; Laforest, Laurent; Dima, Alexandra L.; de Bruin, Marijn; Ferrer, Montserrat

    2016-01-01

    Background A previous study evaluating the psychometric properties of the traditional EQ-5D in asthmatic patients showed a high ceiling effect (59% of patients with perfect health) questioning its usefulness in these patients. Therefore, the EuroQol Group developed a new EQ-5D version increasing the number of responses from 3 to 5 levels. This new version, the EQ-5D-5L, has never been tested in asthmatic patients. The aim of this study is to examine the distribution and construct validity of the new EQ-5D-5L in a European cohort of asthmatic adolescents and adults. Methods A subgroup of 316 patients between 12–40 years included in the ASTROLAB cohort who completed EQ-5D-5L in the online questionnaire were analysed. It is a brief, multi-attribute, generic, preference-based health status measure consisting of five dimensions of health-five response options. The index value ranges from 1 (best health possible) to −0.594 (negative values indicate health states worse than death), where 0 is the value assigned to death. Index values were calculated using the preference values from the Rasch Model developed from EQ-5D-3L French. To examine the distribution of the index measures of central tendency, dispersion, ceiling and floor effect, and observed range were calculated. Construct validity was examined by their ability to differentiate between known groups defined by the Asthma Control Questionnaire (ACQ-5) by ANOVA. ACQ-5 measures the presence of asthma symptoms during the previous week in 7 Likert scale response options, with a score ranging from 0 to 6 (lower score better asthma control). Three groups of asthma control were defined according to tertiles: good (ACQ-5 <0.4), intermediate (ACQ-5 0.4–1.2) and bad (ACQ-5 >1.2). Results Mean EQ-5D-5L index was 0.80 (SD=0.17). The observed range was from −0.03 to 1, floor and ceiling effects were 0% and 22.8%, respectively. Mean EQ-5D-5L index for patients with well-controlled asthma was 0.91 (95% CI, 0.89–0.93); 0

  13. A Website to Improve Asthma Care by Suggesting Patient Questions for Physicians: Qualitative Analysis of User Experiences

    PubMed Central

    Sciamanna, Christopher N; Blanch, Danielle C; Mui, Sarah; Lawless, Heather; Manocchia, Michael; Rosen, Rochelle K; Pietropaoli, Anthony

    2007-01-01

    Background Asthma is one of the most prevalent chronic conditions in the United Sates, yet despite the existence of national guidelines, nearly three fourths of patients with asthma do not have adequate control and clinical adherence to guidelines is low. While there are many reasons for this, physician inertia with respect to treatment change is partly to blame. Research suggests that patients who ask for specific tests and treatments are more likely to receive them. Objectives This study investigated the impact and experience of using an interactive patient website designed to give patients individual feedback about their condition and to suggest tailored questions for patients to ask their physician. The website was designed to be used prior to a physician visit, to increase the likelihood that patients would receive recommended tests and treatments. Methods A total of 37 adult patients with asthma participated in semi-structured telephone interviews aimed at eliciting information about their experiences with the website. Transcripts were coded using qualitative data analysis techniques and software. Themes were developed from subsets of codes generated through the analysis. In addition, 26 physicians were surveyed regarding their impressions of the website. Results Opportunities exist for improving website feedback, although the majority of both patient and physician respondents held favorable opinions about the site. Two major themes emerged regarding patients’ experiences with the website. First, many patients who used the website had a positive shift in their attitudes regarding interactions with their physicians. Second, use of the website prompted patients to become more actively involved in their asthma care. No patient reported any negative experiences as a result of using the website. Physicians rated the website positively. Conclusions Patients perceived that the interactive website intervention improved communication and interaction with their

  14. Asthma and its relation to smoking behavior and cessation motives among adult daily smokers.

    PubMed

    Avallone, Kimberly M; McLeish, Alison C; Zvolensky, Michael J; Kraemer, Kristen M; Luberto, Christina M; Jeffries, Emily R

    2013-06-01

    Despite the negative effects of smoking on lung functioning and overall health, smoking is more prevalent among individuals with asthma compared to those without asthma. The purpose of this study was to examine the predictive ability of asthma diagnosis in terms of smoking behavior and reasons for quitting. Participants were 251 regular daily smokers: 125 smokers with self-reported, physician-diagnosed asthma and 126 smokers without asthma. Asthma diagnosis significantly predicted age of regular smoking onset, number of quit attempts, and reasons for quitting related to self-control suggesting that smokers with asthma may have more difficulty quitting and unique reasons for quitting.

  15. Factors related to the incorrect use of inhalers by asthma patients*

    PubMed Central

    Dalcin, Paulo de Tarso Roth; Grutcki, Denis Maltz; Laporte, Paola Paganella; de Lima, Paula Borges; Menegotto, Samuel Millán; Pereira, Rosemary Petrik

    2014-01-01

    OBJECTIVE: To evaluate inhaler technique in outpatients with asthma and to determine associations between the correctness of that technique and the level of asthma control. METHODS: This was a cross-sectional study involving patients > 14 years of age with physician-diagnosed asthma. The patients were recruited from the Asthma Outpatient Clinic of the Hospital de Clínicas de Porto Alegre, in the city of Porto Alegre, Brazil. The patients completed two questionnaires (a general questionnaire and an asthma control questionnaire based on the 2011 Global Initiative for Asthma guidelines), demonstrated their inhaler technique, and performed pulmonary function tests. Incorrect inhaler technique was defined as the incorrect execution of at least two of the predefined steps. RESULTS: We included 268 patients. Of those, 81 (30.2%) showed incorrect inhaler technique, which was associated with poor asthma control (p = 0.002). Logistic regression analysis identified the following factors associated with incorrect inhaler technique: being widowed (OR = 5.01; 95% CI, 1.74-14.41; p = 0.003); using metered dose inhalers (OR = 1.58; 95% CI, 1.35-1.85; p < 0.001); having a monthly family income < 3 times the minimum wage (OR = 2.67; 95% CI, 1.35-1.85; p = 0.008), and having > 2 comorbidities (OR = 3.80; 95% CI, 1.03-14.02; p = 0.045). CONCLUSIONS: In the sample studied, incorrect inhaler technique was associated with poor asthma control. Widowhood, use of metered dose inhalers, low socioeconomic level, and the presence of > 2 comorbidities were associated with incorrect inhaler technique. PMID:24626265

  16. A comparison of clinician-rated neuropsychological and self-rated cognitive assessments in patients with asthma and rheumatologic disorders.

    PubMed

    Frol, Alan B; Vasquez, Aracely; Getahun, Yonatan; Pacheco, Maria; Khan, David A; Brown, E Sherwood

    2013-01-01

    Although data are mixed, asthma and rheumatologic conditions may be associated with cognitive impairment. Medications may play a role because corticosteroids are associated with memory impairment. Therefore, an easily administered assessment of cognition would be useful in these patients. We assessed relationships between self-rated and clinician-rated cognitive performance and mood in patients with asthma and rheumatologic diseases. Participants included 31adults treated for asthma or rheumatologic disorders (17 receiving chronic prednisone therapy, and 14 not receiving prednisone). An objective assessment of a variety of cognitive domains was administered through clinician and patient-rated assessments of cognition. Composite scores for the objective (Global Clinical Rating [GCR]) and subjective (Neuropsychological Impairment Scale: Global Measure of Impairment [GMI]) measures of cognition were derived. Depression was assessed with the 17-item Hamilton Rating Scale for Depression (HRSD-17). A linear regression was conducted with GMI scores as dependent variable and GCR, HRSD-17 scores, and prednisone-use status, as independent variables. Significant differences between prednisone-treated patients and other patients were observed on the GCR, GMI, and HRSD-17. In the regression analysis, HRSD-17 scores, but not GCR scores, significantly predicted GMI scores. Prednisone-treated patients had higher levels of depressive symptoms and subjective and objective cognitive deficits than those not taking prednisone. In the combined patient groups, subjective cognitive assessment was more strongly related to depressive symptoms than objective cognition. Findings suggest physicians should be aware of the potential for cognitive deficits in patients taking corticosteroids and, when appropriate, should consider the use of objective neurocognitive tests or neuropsychology consultation to better characterize its presence and severity.

  17. A comparison of clinician-rated neuropsychological and self-rated cognitive assessments in patients with asthma and rheumatologic disorders

    PubMed Central

    Frol, Alan B.; Vasquez, Aracely; Getahun, Yonatan; Pacheco, Maria; Khan, David A.

    2013-01-01

    Although data are mixed, asthma and rheumatologic conditions may be associated with cognitive impairment. Medications may play a role because corticosteroids are associated with memory impairment. Therefore, an easily administered assessment of cognition would be useful in these patients. We assessed relationships between self-rated and clinician-rated cognitive performance and mood in patients with asthma and rheumatologic diseases. Participants included 31adults treated for asthma or rheumatologic disorders (17 receiving chronic prednisone therapy, and 14 not receiving prednisone). An objective assessment of a variety of cognitive domains was administered through clinician and patient-rated assessments of cognition. Composite scores for the objective (Global Clinical Rating [GCR]) and subjective (Neuropsychological Impairment Scale: Global Measure of Impairment [GMI]) measures of cognition were derived. Depression was assessed with the 17-item Hamilton Rating Scale for Depression (HRSD-17). A linear regression was conducted with GMI scores as dependent variable and GCR, HRSD-17 scores, and prednisone-use status, as independent variables. Significant differences between prednisone-treated patients and other patients were observed on the GCR, GMI, and HRSD-17. In the regression analysis, HRSD-17 scores, but not GCR scores, significantly predicted GMI scores. Prednisone-treated patients had higher levels of depressive symptoms and subjective and objective cognitive deficits than those not taking prednisone. In the combined patient groups, subjective cognitive assessment was more strongly related to depressive symptoms than objective cognition. Findings suggest physicians should be aware of the potential for cognitive deficits in patients taking corticosteroids and, when appropriate, should consider the use of objective neurocognitive tests or neuropsychology consultation to better characterize its presence and severity. PMID:23484893

  18. The Effect of a Training Program on Oral Health and Behavior Change in Asthma Patients

    PubMed Central

    Yılmaz, Feride Taşkın; Çınar, Sezgi; Yılmaz, Adnan; Kumsar, Azime Karakoç

    2016-01-01

    Background: Asthma is a chronic disease which is prevalent throughout the world. Physical problems such as deterioration in oral health, which may occur due to the triggering factors of asthma as well as the ineffective use of asthma medicine, seem to affect the daily lives of asthma patients. Therefore, it is important to protect oral health and promote positive behavior changes in asthma patients in order to achieve effective treatment and asthma control. Aims: The present study aimed to determine the effects of a training program provided for asthma patients on oral health, inhaler use skills, and behavior change. Study Design: Controlled experimental study. Methods: A total of 124 asthma patients were included in the study. Of the patients, 62 were assigned to the experimental group and the other 62 were assigned to the control group. Data were collected using the patient identification form, the oral assessment guide, the inhaler use skill form, and the evaluation form for behavior change over time. The experimental group received training provided by the researchers on the first meeting and one month later. Written and visual training material were used. Both groups were subject to a final evaluation which was conducted 4 months after their first meeting. Results: It was determined that the oral assessment guide scores (p<0.01) and inhaler use skills of the experimental group improved significantly after the training compared to the control group (p<0.01). In addition, it was observed that the number of patients in the experimental group who quit smoking (p<0.05), used their medicine (p<0.01) and brushed their teeth on a regular basis (p<0.01), and washed their mouth after inhaler use significantly increased in the experimental group after training compared to the control group (p<0.01). Conclusion: The study demonstrated that the training provided for asthma patients improved oral health and promoted inhaler use skills and was partially effective in

  19. Gastroesophageal Reflux Disease in Asthma

    PubMed Central

    Bowrey, David J.; Peters, Jeffrey H.; DeMeester, Tom R.

    2000-01-01

    Objective To critique the English-language reports describing the effects of medical and surgical antireflux therapy on respiratory symptoms and function in patients with asthma. Methods The Medline computerized database (1959–1999) was searched, and all publications relating to both asthma and gastroesophageal reflux disease were retrieved. Results Seven of nine trials of histamine-receptor antagonists showed a treatment-related improvement in asthma symptoms, with half of the patients benefiting. Only one study identified a beneficial effect on objective measures of pulmonary function. Three of six trials of proton pump inhibitors documented improvement in asthma symptoms with treatment; benefit was seen in 25% of patients. Half of the studies reported improvement in pulmonary function, but the effect occurred in fewer than 15% of patients. In the one study that used optimal antisecretory therapy, asthma symptoms were improved in 67% of patients and pulmonary function was improved in 20%. Combined data from 5 pediatric and 14 adult studies of antireflux surgery indicated that almost 90% of children and 70% of adults had improvement in respiratory symptoms, with approximately one third experiencing improvements in objective measures of pulmonary function. Conclusions Fundoplication has been consistently shown to ameliorate reflux-induced asthma; results are superior to the published results of antisecretory therapy. Optimal medical therapy may offer similar results, but large studies providing support for this assertion are lacking. PMID:10674606

  20. Similarities and differences between asthma health care professional and patient views regarding medication adherence

    PubMed Central

    Peláez, Sandra; Bacon, Simon L; Aulls, Mark W; Lacoste, Guillaume; Lavoie, Kim L

    2014-01-01

    BACKGROUND: The recent literature has reported disparate views between patients and health care professionals regarding the roles of various factors affecting medication adherence. OBJECTIVE: To examine the perspectives of asthma patients, physicians and allied health professionals regarding adherence to asthma medication. METHODOLOGY: A qualitative, multiple, collective case study design with six focus-group interviews including 38 participants (13 asthma patients, 13 pulmonologist physicians and 12 allied health professionals involved in treating asthma patients) was conducted. RESULTS: Patients, physicians and allied health professionals understood adherence to be an active process. In addition, all participants believed they had a role in treatment adherence, and agreed that the cost of medication was high and that access to the health care system was restricted. Major disagreements regarding patient-related barriers to medication adherence were identified among the groups. For example, all groups referred to side effects; however, while patients expressed their legitimate concerns, health care professionals believed that patients’ opinions of medication side effects were based on inadequate perceptions. CONCLUSION: Differences regarding medication adherence and barriers to adherence among the groups examined in the present study will provide insight into how disagreements may be translated to overcome barriers to optimal asthma adherence. Furthermore, when designing an intervention to enhance medication adherence, it is important to acknowledge that perceptual gaps exist and must be addressed. PMID:24712015

  1. Pilot testing of a pharmacist led care program for asthma patients in Saudi Arabia.

    PubMed

    Meshal, Alotaby; Sarriff, Azmi; El-Shamly, Mousa

    2015-04-01

    This study aimed at evaluating the usefulness of a structured patient counseling program on clinical outcomes of asthma patients in Saudi Arabia. This cross sectional study enrolled 10 asthma patients and all were evaluated for their baseline knowledge on asthma, quality of life, compliance, patient satisfaction and drug related problems among randomly selected 5 (of the total 10) patients. The median (IQR) age of the patients was 46 (33.5-56.2) years. The baseline knowledge scores was 9 (8-11), the maximum possible scores to be 21. Cronbach alpha of the KQ was 0.65. The overall total median (IQR) compliance (Morisky) score was 4 (3-5), the maximum possible score was 5. The patient satisfaction median (IQR) score was 35.5 (32-46.25), the maximum possible score was 70. Of the total patients 3 (30%) had a history of allergy. There were total 18 allergens observed in these patients. There has been no drug-drug or drug-food interactions observed between among the prescribed drugs of the patients. Altogether 2 patients reported a total of 2 ADRs. The knowledge of the asthma patients was found to be poor. Missing the dose was the most commonly encountered drug taking behavior. The compliance was found to be good and the patient satisfaction was average.

  2. Association between Concentrations of Metals in Urine and Adult Asthma: A Case-Control Study in Wuhan, China

    PubMed Central

    Huang, Xiji; Xie, Jungang; Cui, Xiuqing; Zhou, Yun; Wu, Xiaojie; Lu, Wei; Shen, Yan; Yuan, Jing; Chen, Weihong

    2016-01-01

    Background Several metals have been reported to be associated with childhood asthma. However, the results on relationships between metals and risk of childhood asthma are inconclusive, and the research on adult asthma in the Chinese general population is rare. Objectives To investigate potential associations between levels of urinary metals and adult asthma. Methods A case-control study of 551 adult asthma cases and 551 gender- and age-matched controls was conducted in Wuhan, China. Demographic information was obtained, and lung function was assessed. The urinary concentrations of 22 metals were measured by inductively coupled plasma mass spectrometry. Results After adjusting for other metalsand other covariates, urinary cadmium, molybdenum, chromium, copper, uranium and selenium were positively associated with asthma, with odds ratios (95% CI) of 1.69 (1.00, 2.85), 3.76 (2.30, 6.16), 4.89 (3.04, 7.89), 6.06 (3.27, 11.21), 6.99 (4.37, 11.19) and 9.17 (4.16, 20.21), respectively. By contrast, urinary lead, barium, iron, zinc, nickel, manganese and rubidium were negatively associated with asthma, with odds ratios (95% CI) of 0.48 (0.29, 0.80), 0.44 (0.27, 0.71), 0.41 (0.26, 0.64), 0.40 (0.24, 0.66), 0.30 (0.22, 0.41), 0.23 (0.14, 0.39) and 0.07 (0.03, 0.15), respectively. When comparing urinary metals in different subgroups of cases with those in matched controls, the associations of above 13 metals with asthma prevalence were nearly the same. Conclusions Our results suggested that asthma prevalence in the Chinese adults was positively associated with urinary chromium, chromium, selenium, molybdenum, cadmium, and uranium, and negatively associated with urinary manganese, iron, nickel, zinc, rubidium, barium and lead. Additional research with larger populations in different regions is required to support our findings. PMID:27191859

  3. Physical inactivity and television-viewing time among Aboriginal adults with asthma: a cross-sectional analysis of the Aboriginal Peoples Survey

    PubMed Central

    Doggett, N.; Dogra, S.

    2015-01-01

    Abstract Introduction: The purpose of this analysis was to 1) determine the association between asthma and physical activity levels or sedentary time among Aboriginal adults, and 2) understand the influence of physical inactivity and sedentary time on health care use among Aboriginal adults with asthma. Methods: We analyzed 20 953 adults from the 2006 Aboriginal Peoples Survey. Those with self-reported physician-diagnosed asthma and a current prescription for asthma medication were considered to have current asthma. Insufficient physical activity was defined as < 3 hours/week of moderate to vigorous physical activity; high television screen time was defined as > 10 hours/week. Health care use was assessed using the number of health professional visits and overnight hospital stays. Results: Aboriginal adults with asthma were more likely to report high television-viewing time (OR = 1.16; CI: 1.11–1.22) and insufficient physical activity (OR = 1.15; CI: 1.10–1.20) than those without asthma. Those with asthma who reported high television-viewing time reported more health professional consults in the past 12 months (OR = 2.59; CI: 2.34–2.87), more overnight stays in hospital in the past year (OR = 1.95; CI: 1.82–2.08) and more overnight stays in the hospital in the past 5 years (OR = 1.13; CI: 1.07–1.18); results were less consistent for physical activity and health care use. Conclusion: These findings suggest that Aboriginal adults with asthma are less active than their peers without asthma and that such a lifestyle may be associated with higher health care use. These findings have implications for physical activity promotion and sedentary behaviour strategies targeting Aboriginal adults with asthma. PMID:25970805

  4. Hypnosis for Asthma and Vocal Cord Dysfunction in a Patient With Autism.

    PubMed

    Kaslovsky, Robert; Gottsegen, David

    2015-10-01

    Wheezing in children often is the result of asthma, but vocal cord dysfunction (VCD) may cause stridor or sounds that sometimes are misattributed to the wheezing of asthma. The frequent comorbidity of asthma and VCD also adds to the difficulty in making a clear diagnosis. The challenges of evaluating and treating wheezing are complicated further in children with developmental disorders, such as autism, because of the difficulties of obtaining an adequate history and assessing the clinical response to treatment. This article presents a patient with multiple psychiatric problems, including autism, with severe recurrent wheezing as a result of vocal cord dysfunction and asthma. Hypnosis has previously proven efficacious for treating vocal cord dysfunction, and in this case, hypnotic techniques were major factors in successful symptom control.

  5. Different gastoroesophageal reflux symptoms of middle-aged to elderly asthma and chronic obstructive pulmonary disease (COPD) patients.

    PubMed

    Shimizu, Yasuo; Dobashi, Kunio; Kusano, Motoyasu; Mori, Masatomo

    2012-03-01

    Symptomatic differences and the impact of gastroesophageal reflux disease (GERD) have not been clarified in patients with asthma and chronic obstructive pulmonary disease (COPD). The purpose of this study is to assess the differences of GERD symptoms among asthma, COPD, and disease control patients, and determine the impact of GERD symptoms on exacerbation of asthma or COPD by using a new questionnaire for GERD. A total of 120 subjects underwent assessment with the frequency scale for the symptoms of GERD (FSSG) questionnaire, including 40 age-matched patients in each of the asthma, COPD, and disease control groups. Asthma and control patients had more regurgitation-related symptoms than COPD patients (p<0.05), while COPD patients had more dysmotility-related symptoms than asthma patients (p<0.01) or disease control patients (p<0.01). The most distinctive symptom of asthma patients with GERD was an unusual sensation in the throat, while bloated stomach was the chief symptom of COPD patients with GERD, and these symptoms were associated with disease exacerbations. The presence of GERD diagnosed by the total score of FSSG influences the exacerbation of COPD. GERD symptoms differed between asthma and COPD patients, and the presence of GERD diagnosed by the FSSG influences the exacerbation of COPD. PMID:22448100

  6. Analysis of the quality of life of patients with asthma and allergic rhinitis after immunotherapy

    PubMed Central

    Szynkiewicz, Ewa; Cegła, Bernadeta; Bartuzi, Zbigniew

    2016-01-01

    Aim To assess the quality of life of Polish patients with asthma and/or allergic rhinitis before the implementation and after 30–36 months of immunotherapy. Material and methods Two hundred patients have been involved in the study: 101 with allergic asthma and 99 with pollinosis. In order to collect research material, the Polish versions of AQLQ (Asthma Quality of Life) and RQLQ (Rhinoconjunctivitis Quality of Life) questionnaires have been used. The self-administered questionnaires concerned such data as age, sex and the patients’ subjective evaluation of their quality of life. Results The average increase in quality of life of patients with asthma was 0.84 and of patients with allergic rhinitis – 1.50. A hypothesis was made that changes of quality of life in each examined group differed significantly. A test for two fractions showed that for patients with asthma it was 7.74 and for patients with allergic rhinitis – 10.38. A statistical analysis showed no such relation in the group of patients with asthma (coefficient of correlation = 0.08) and a slight correlation in the group of patients with allergic rhinitis (coefficient of correlation = 0.20). Applied tests did not show any significant differences, which means that an average increase in quality of life does not depend on sex and age of both examined groups. Conclusions On the basis of the research conducted among patients before and after a 3-year period of immunotherapy, the following conclusions have been drawn: 1) immunotherapy significantly improves the objective quality of life in both groups; 2) a slight correlation has been identified between the objective and subjective dimension of quality of life amongst patients with asthma, what contributes to a better quality of life; 3) in both study groups, no significant relationship between gender or age and improvement in quality of life has been noted; 4) immunotherapy, from the point of view of the improvement of quality of life, is a valuable

  7. Association of Specific Immunoglobulin E to Staphylococcal Enterotoxin with Airway Hyperresponsiveness in Asthma Patients

    PubMed Central

    Kim, Seong Han; Yang, Seo Yeon; You, Jihong; Lee, Sang Bae; You, Jin; Chang, Yoon Soo; Kim, Hyung Jung; Ahn, Chul Min; Byun, Min Kwang; Park, Jung-Won

    2016-01-01

    Background Specific immunoglobulin E (IgE) sensitization to staphylococcal enterotoxin (SE) has been recently considered to be related to allergic disease, including asthma. Despite studies on specific IgE (sIgE) to SE and its relationship to asthma diagnosis and severity, the association of sIgE to SE with airway hyperresponsiveness (AHR) remains unclear. Methods We enrolled 81 asthma patients admitted to the Severance Hospital in Korea from March 1, 2013, to February 28, 2015 and retrospectively reviewed the electronic medical records of the enrolled subjects. The serum levels of sIgE to SE (A/B) of all subjects was measured using the ImmunoCAP 250 (Phadia) system with SE-sIgE positive defined as >0.10 kU/mL. Results The SE-sIgE level was not significantly correlated with asthma severity (forced expiratory volume in 1 second [FEV1], FEV1/forced vital capacity, sputum eosinophils, and serum eosinophils), whereas the SE-sIgE level in patients with positive AHR (mean±standard error of the mean, 0.606±0.273 kU/mL) was significantly higher than that in patients with negative AHR (0.062±0.015 kU/mL, p=0.034). In regression analysis, SE sensitization (sIgE to SE ≥0.010 kU/mL) was a significant risk factor for AHR, after adjustment for age, sex, FEV1, and sputum eosinophils (odds ratio, 7.090; 95% confidence interval, 1.180–42.600; p=0.032). Prevalence of SE sensitization was higher in patients with allergic rhinitis and non-atopic asthma patients, as compared to patients without allergic rhinitis and atopic asthma patients, respectively, but without statistical significance. Conclusion SE sensitization is significantly associated with AHR. PMID:27790282

  8. Diagnosis of Asthma in Primary Health Care: A Pilot Study

    PubMed Central

    Ringsberg, Karin C.; Bjärneman, Paula; Larsson, Ronny; Wallström, Elisabeth; Löwhagen, Olle

    2014-01-01

    Some patients with an asthma diagnosis have a poor controlled asthma. One explanation may be an incorrect diagnosis. Aim. The aim of the study was to diagnose and classify patients with non-infectious lower respiratory tract problems in primary health care using internationally applied diagnostic criteria and diagnostic tests. Patients and Methods. New adult patients visiting a primary health care centre due to lower airway problems were included. The diagnostic tests included FEV1, FVC, PEF, two questionnaires, methacholine test, and skin prick test. Results. The patients (n = 43) could be divided into four groups: asthma (28%), asthma-like disorder (44%), idiopathic cough (12%), and a nonreversible bronchial obstructive group (16%). The asthma and asthma-like groups showed similar patterns of airway symptoms and trigger factors, not significantly separated by a special questionnaire. Phlegm, heavy breathing, chest pressure/pain, cough, and wheezing were the most common symptoms. Physical exercise and scents were the dominating trigger factors. Conclusions. Nonobstructive asthma-like symptoms seem to be as common as bronchial asthma in primary health care. Due to the similarities in symptoms and trigger factors the study supports the hypothesis that asthma and nonobstructive asthma-like disorders are integrated in the same “asthma syndrome,” including different mechanisms, not only bronchial obstruction. PMID:24817894

  9. Patient perspectives on fluticasone–vilanterol versus other corticosteroid combination products for the treatment of asthma

    PubMed Central

    Bollmeier, Suzanne G; Prosser, Theresa R

    2016-01-01

    Objective Fluticasone furoate (FF), an inhaled corticosteroid (ICS), and vilanterol (VI), a long-acting beta2 receptor agonist (LABA), is a new combination used in an Ellipta® device. This article compares FF–VI to other ICS–LABA combinations available, particularly emphasizing product selection from the patient perspective. Data sources A PubMED and EMBASE search completed in October 2015 identified trials using the MeSH terms “fluticasone”, “vilanterol”, and “asthma”. Additional information was gathered from references cited in the identified publications, the manufacturer, package insert, and ClinicalTrials.gov registry. Study selection/data extraction Preference was given to randomized controlled clinical trials. Animal trials, trials for COPD, and non-English sources were excluded. Data synthesis Seven efficacy trials of FF–VI in asthma were identified. Only one (24 weeks) trial compared FF–VI to another ICS–LABA combination (fluticasone propionate–salmeterol). Primary outcomes (usually lung function) and secondary outcomes (eg, quality of life and symptom scores) were comparable. In three FF–VI safety trials, the type and frequency of common adverse reactions (ie, thrush and dysphonia) were similar to those in clinical trials. Over 90% of subjects rated the Ellipta® device as “easy to use” and demonstrated correct device technique initially and at 4 weeks. Conclusion Individuals may have drug- and device-specific preferences that should be incorporated into therapeutic decision making. Limited data indicate that clinical and patient-oriented efficacy/safety outcomes of FF–VI are likely comparable to other available combinations for adults with asthma. Patient-friendly features include once-daily dosing, flexibility of dose timing, and design/ease of the use of the device. Additional larger and long-term comparative studies are needed to determine whether these features translate into greater efficacy, safety, patient

  10. Geographic Clustering of Adult Asthma Hospitalization and Residential Exposure to Pollution at a United States–Canada Border Crossing

    PubMed Central

    Oyana, Tonny J.; Rogerson, Peter; Lwebuga-Mukasa, Jamson S.

    2004-01-01

    Objectives. We conducted a case–control study of adulthood asthma and point-source respirable particulate air pollution with asthma-diagnosed case patients (n = 3717) and gastroenteritis-diagnosed control patients (n = 4129) to determine effects of particulate air pollution on public health. Methods. We used hospitalization data from Buffalo, NY, neighborhoods for a 5-year period (1996 through 2000), geographic information systems techniques, the Diggle method, and statistical analysis to compare the locations of case patients and control patients in terms of proximity to different known pollution sources in the study area. Results. We found a clustering of asthma cases in close proximity to the Peace Bridge Complex and the freeways and a dose–response relationship indicating a decreased risk of asthma prevalence the farther an individual resides from the source of exposure. Conclusions. These findings provide a basis for the development of new hypotheses relating to the spatial distribution of asthma prevalence and morbidity in this community. PMID:15226151

  11. The particularities of protein fraction in the apoptosis of lymphocytes of patients with asthma.

    PubMed

    Vodounon, C A; Abramova, Z I; Aikou, N; Sezan, A; Kotchoni, S O; Akpona, S A

    2013-12-15

    The emergence of various diseases specifically severe diseases such as bronchial asthma is associated with apoptosis of lymphocytes. One of the major biochemical features of apoptosis is chromosome DNA fragmentation implemented by apoptotic nucleases. The inactivation of these apoptotic nucleases produces undigested DNA and is linked to a number of autoimmune disorders. Instead of this we have studied the enzymatic activities of the cytoplasmic and nucleic proteins of lymphocytes from healthy donors and patients with bronchial asthma. The study of enzymatic activities of the nuclease of lymphocytes was assessed by flow cytometry, spectrofluorimetry and electrophoresis method in agarose gel. In the peripheral blood cells of healthy donors undergoing apoptosis, we found a DNAse activated by Ca2+ and Mg2+ ions. Lymphocytes of patients with bronchial asthma contain DNAses, the activity of which depends on the seriousness of the desease. In patients cells, the activity of the Mn2+-dependent DNAse increases, whereas the activity of the Ca2+, Mg(2+)-dependent DNase decreases. Taking into consideration the role of the Ca2+, Mg(2+)-dependent DNAse in apoptosis, we can propose that there is a link between the reduction of the rate of apoptosis of lymphocytes in patients with bronchial asthma and the dysfunction of the induction of "apoptotical" Ca2+, Mg(2+)-dependent nuclease. According to the results obtained, we can assume that why apoptosis of lymphocytes resist in patients with bronchial asthma is a reduction in concentration of endocellular calcium and an increase of manganese ions content, which results in the triggering of activation mechanism for Mn(2+)-dependent endonuclease activity. This leads to the change of DNA fragmentation nature in lymphocytes and as a consequence, to disorders in process of apoptotic bodies' formation, thus, hindering apoptosis of lymphocytes in patients with bronchial asthma. PMID:24517002

  12. Occupational asthma.

    PubMed Central

    Chan-Yeung, M

    1995-01-01

    Many toxic compounds found in air emissions may induce bronchoconstriction. In the workplace, workers are exposed to these compounds, often in much higher concentrations. Some of these compounds act as sensitizers. Of these, some compounds induce asthma by producing specific IgE antibodies to the compound or its protein conjugate, while others induce asthma through yet unidentified immunologic mechanisms. Some compounds, when inhaled in high concentrations, act as irritants and produce bronchoconstriction probably by inducing acute airway inflammation. The latter condition is called Reactive Airways Dysfunction Syndrome (RADS) or irritant-induced asthma. Occupational asthma is an excellent model to study the pathogenesis and the natural history of adult onset asthma because the responsible agent can be identified, complete avoidance is possible, and exposure can be measured or estimated. PMID:8549481

  13. Ambient Air Pollution Exposure and Incident Adult Asthma in a Nationwide Cohort of U.S. Women

    PubMed Central

    Young, Michael T.; Sandler, Dale P.; DeRoo, Lisa A.; Vedal, Sverre; Kaufman, Joel D.

    2014-01-01

    Rationale: Limited prior data suggest an association between traffic-related air pollution and incident asthma in adults. No published studies assess the effect of long-term exposures to particulate matter less than 2.5 μm in diameter (PM2.5) on adult incident asthma. Objectives: To estimate the association between ambient air pollution exposures (PM2.5 and nitrogen dioxide, NO2) and development of asthma and incident respiratory symptoms. Methods: The Sister Study is a U.S. cohort study of risk factors for breast cancer and other health outcomes (n = 50,884) in sisters of women with breast cancer (enrollment, 2003–2009). Annual average (2006) ambient PM2.5 and NO2 concentrations were estimated at participants’ addresses, using a national land-use/kriging model incorporating roadway information. Outcomes at follow-up (2008–2012) included incident self-reported wheeze, chronic cough, and doctor-diagnosed asthma in women without baseline symptoms. Measurements and Main Results: Adjusted analyses included 254 incident cases of asthma, 1,023 of wheeze, and 1,559 of chronic cough. For an interquartile range (IQR) difference (3.6 μg/m3) in estimated PM2.5 exposure, the adjusted odds ratio (aOR) was 1.20 (95% confidence interval [CI] = 0.99–1.46, P = 0.063) for incident asthma and 1.14 (95% CI = 1.04–1.26, P = 0.008) for incident wheeze. For NO2, there was evidence for an association with incident wheeze (aOR = 1.08, 95% CI = 1.00–1.17, P = 0.048 per IQR of 5.8 ppb). Neither pollutant was significantly associated with incident cough (PM2.5: aOR = 0.95, 95% CI = 0.88–1.03, P = 0.194; NO2: aOR = 1.00, 95% CI = 0.93–1.07, P = 0.939). Conclusions: Results suggest that PM2.5 exposure increases the risk of developing asthma and that PM2.5 and NO2 increase the risk of developing wheeze, the cardinal symptom of asthma, in adult women. PMID:25172226

  14. Comparison of gel contraction mediated by airway smooth muscle cells from patients with and without asthma

    PubMed Central

    Matsumoto, Hisako; Moir, Lyn M; Oliver, Brian G G; Burgess, Janette K; Roth, Michael; Black, Judith L; McParland, Brent E

    2007-01-01

    Backgrounds Exaggerated bronchial constriction is the most significant and life threatening response of patients with asthma to inhaled stimuli. However, few studies have investigated the contractility of airway smooth muscle (ASM) from these patients. The purpose of this study was to establish a method to measure contraction of ASM cells by embedding them into a collagen gel, and to compare the contraction between subjects with and without asthma. Methods Gel contraction to histamine was examined in floating gels containing cultured ASM cells from subjects with and without asthma following overnight incubation while unattached (method 1) or attached (method 2) to casting plates. Smooth muscle myosin light chain kinase protein levels were also examined. Results Collagen gels containing ASM cells reduced in size when stimulated with histamine in a concentration‐dependent manner and reached a maximum at a mean (SE) of 15.7 (1.2) min. This gel contraction was decreased by inhibitors for phospholipase C (U73122), myosin light chain kinase (ML‐7) and Rho kinase (Y27632). When comparing the two patient groups, the maximal decreased area of gels containing ASM cells from patients with asthma was 19 (2)% (n = 8) using method 1 and 22 (3)% (n = 6) using method 2, both of which were greater than that of cells from patients without asthma: 13 (2)% (n = 9, p = 0.05) and 10 (4)% (n = 5, p = 0.024), respectively. Smooth muscle myosin light chain kinase levels were not different between the two groups. Conclusion The increased contraction of asthmatic ASM cells may be responsible for exaggerated bronchial constriction in asthma. PMID:17412779

  15. “Causes of death in asthma, COPD and non-respiratory hospitalized patients: a multicentric study”

    PubMed Central

    2013-01-01

    Background There is limited information on the causes of death in asthma patients. To determine the causes of death in hospitalized asthmatic patients and to compare with those observed in COPD patients and non-respiratory individuals, with a particular interest in associations with previous cardiovascular disease. Methods Retrospective case–control study which analyzed the deaths of all hospitalized patients admitted for any reason during January, April, July and October of 2008 in 13 Spanish centers. Medical records of deceased patients were reviewed, and demographic and clinical data were collected. Results A total of 2,826 deaths (mean age 75 years, 56% men) were included in the analysis, of which 82 (2.9%) were of patients with asthma and 283 (10%) with COPD. The most common causes of death in asthma patients were cardiovascular diseases (29.3%), malignancies (20.7%) and infections (14.6%); in COPD patients they were malignancies (26.5%), acute respiratory failure (25.8%) and cardiovascular diseases (21.6%). Asthma, compared to COPD patients, died significantly less frequently from acute respiratory failure and lung cancer. A multivariate logistic regression analysis failed to associate asthma with cardiovascular deaths. Conclusions Cardiovascular disease is the most frequent cause of death among hospitalized asthma patients. The specific causes of death differ between asthma and COPD patients. PMID:24321217

  16. Acute adult asthma--assessment of severity and management and comparison with British Thoracic Society Guidelines.

    PubMed

    Hart, S R; Davidson, A C

    1999-01-01

    To investigate the accuracy of clinical severity assessment of asthmatics and to compare emergency and subsequent ward management with British Thoracic Society (BTS) Guidelines, the records of all patients admitted for severe asthma (46) over a 5-month period to a District General Hospital were inspected. Variations from recommended management were revealed. Appropriate oxygen administration was often not provided in casually and patients frequently left hospital before their discharge criteria were attained: recommended diurnal variations in peak flow were exceeded in 26%. Eleven per cent of discharges were against medical advice, making provision of adequate management logistically difficult. Adherence to BTS guidelines on the need for arterial blood gas (ABG) analysis would have led to a failure to detect significant hypoxaemia in 25% of cases. This study identified substantial variations from BTS management guidelines. It is suggested that oximetry is necessary on arrival to guide selection for arterial blood gas analysis.

  17. Food hypersensitivity among adult patients: epidemiological and clinical aspects.

    PubMed

    Castillo, R; Delgado, J; Quiralte, J; Blanco, C; Carrillo, T

    1996-01-01

    Food hypersensitivity (FH) is lesser frequent among adult patients than in childhood. Foods implicated in hypersensitivity reactions vary with sociocultural and diet habits from a geographic place to other. We studied 142 adult patients sensitized to foods, among 7698 patients visited at our Outpatient Clinic. Hundred and twenty patients referred clinical symptoms after consumption of one or more foods consistently. From the latest, 107 patients (89.2%) were atopics (92 of them sensitizes to dust mites) and 54 (45%) referred atopic familiar background. Most frequent recorded symptoms were: urticaria/angioedema 84 cases (70%), oral syndrome 65 (54%), asthma 48 (37%) and anaphylaxis 33 patients (27.5%). Shellfish sensitization occurred in 50 patients, fresh fruits in 33 and nuts in 29 cases. Shrimp (48 patients), squid (33), kiwi (14), papaya (14), avocado (13) and banana (12 cases) were the most frequent causes of FH. Significant statistical association between foods and inhalants was observed for fresh fruits and latex (p < 0.001), fresh fruits and pollens (p < 0.01), and shellfish and Blatta germanica (p < 0.001). Prevalence of FH among patients at our Area is around 1.6%. Tropical fruits, as other kind of fruits, seem to share common IgE-epitopes to pollens. High prevalence of shellfish and cockroach hypersensitivity could be more easily developed by previous domestic mites sensitization.

  18. [Guidelines for the diagnosis and management of bronchial asthma--a comparison of the Japanese guidelines for the adult asthma with GINA and ICR].

    PubMed

    Kabe, J

    1996-11-01

    Although the concept of asthma management of the Japanese Guidelines is basically similar in the other guidelines including GINA, ICR, of British Thoracic Society, and of the other countries, assuming that asthma is a chronic inflammatory disorder of the airway, the program of stepwise pharmacologic therapy is not the same in various points. Therapy suggested in the Japanese Guidelines is different in 1) oral antiallergic drugs are widely used, 2) patients prefer oral bronchodilators to inhaled bronchodilators, 3) sustained released theophylline in the long term management and intravenous infusion of aminophylline for the treatment of acute exacerbation are accepted and frequently used by the physicians. Also the differences in the choice of medication between GINA, which is characterized by concept of cost, and other guidelines are discussed.

  19. Associations between air pollution and peak expiratory flow among patients with persistent asthma.

    PubMed

    Qian, Zhengmin; Lin, Hung-Mo; Chinchilli, Vernon M; Lehman, Erik B; Stewart, Walter F; Shah, Nirav; Duan, Yinkang; Craig, Timothy J; Wilson, William E; Liao, Duanping; Lazarus, Stephen C; Bascom, Rebecca

    2009-01-01

    Responses of patients with persistent asthma to ambient air pollution may be different from those of general populations. For example, asthma medications may modify the effects of ambient air pollutants on peak expiratory flow (PEF). Few studies examined the association between air pollution and PEF in patients with persistent asthma on well-defined medication regimens using asthma clinical trial data. Airway obstruction effects of ambient air pollutants, using 14,919 person-days of daily self-measured peak expiratory flow (PEF), were assessed from 154 patients with persistent asthma during the 16 wk of active treatment in the Salmeterol Off Corticosteroids Study trial. The three therapies were an inhaled corticosteroid, an inhaled long-acting beta-agonist, and placebo. The participants were nonsmokers aged 12 through 63 yr, recruited from 6 university-based ambulatory care centers from February 1997 to January 1999. Air pollution data were derived from the U.S. Environmental Protection Agency Aerometric Information Retrieval System. An increase of 10 ppb of ambient daily mean concentrations of NO2 was associated with a decrease in PEF of 1.53 L/min (95% confidence interval [CI] -2.93 to -0.14) in models adjusted for age, gender, race/ethnicity, asthma clinical center, season, week, daily average temperature, and daily average relative humidity. The strongest association between NO2 and PEF was observed among the patients treated with salmeterol. Negative associations were also found between PEF and SO2 and between PEF and PM(10), respectively. The results show that the two medication regimens protected against the effects of PM(10). However, salmeterol increased the sensitivity to NO2 and triamcinalone enhanced the sensitivity to SO2.

  20. Comparison of effects of a self management booklet and audiocassette for patients with asthma.

    PubMed Central

    Jenkinson, D.; Davison, J.; Jones, S.; Hawtin, P.

    1988-01-01

    The effects on self management of asthma of a specially prepared book and audiocassette tape with similar contents were observed in a controlled study of 177 patients with asthma in general practice. After a run in period of six months patients were randomly given the book, the tape, both the book and tape, or neither. Patients' knowledge of the use of drugs, perceptions of their disability, skill in using an inhaler, consumption of drugs, consultations with their general practitioners, morbidity (from patients' entries on diary cards), and use of the educational material were measured. Knowledge about the use of drugs was significantly increased in the groups who received the material after three months and persisted after 12 months. Patients who had been given the tape or the book and tape increased their scores of knowledge of drugs more than patients given the book alone. Patients in all groups given the material considered that their disability was reduced. There were no other significant changes. Patients given both the book and the tape preferred the book. Patients with asthma can obtain useful information from such material. The paradoxical result whereby patients learnt more from the tape but preferred the book suggests that a distinction can be made between information that patients need, which may be acquired better from an audiocassette, and information that they want, which may be acquired better from a book. PMID:3416147

  1. Utility of brief questionnaires of health-related quality of life (Airways Questionnaire 20 and Clinical COPD Questionnaire) to predict exacerbations in patients with asthma and COPD

    PubMed Central

    2013-01-01

    Background There is some evidence that quality of life measured by long disease-specific questionnaires may predict exacerbations in asthma and COPD, however brief quality of life tools, such as the Airways Questionnaire 20 (AQ20) or the Clinical COPD Questionnaire (CCQ), have not yet been evaluated as predictors of hospital exacerbations. Objectives To determine the ability of brief specific health-related quality of life (HRQoL) questionnaires (AQ20 and CCQ) to predict emergency department visits (ED) and hospitalizations in patients with asthma and COPD, and to compare them to longer disease-specific questionnaires, such as the St George´s Respiratory Questionnaire (SGRQ), the Chronic Respiratory Disease Questionnaire (CRQ) and the Asthma Quality of Life Questionnaire (AQLQ). Methods We conducted a two-year prospective cohort study of 208 adult patients (108 asthma, 100 COPD). Baseline sociodemographic, clinical, functional and psychological variables were assessed. All patients completed the AQ20 and the SGRQ. COPD patients also completed the CCQ and the CRQ, while asthmatic patients completed the AQLQ. We registered all exacerbations that required ED or hospitalizations in the follow-up period. Differences between groups (zero ED visits or hospitalizations versus ≥ 1 ED visits or hospitalizations) were tested with Pearson´s X2 or Fisher´s exact test for categorical variables, ANOVA for normally distributed continuous variables, and Mann–Whitney U test for non-normally distributed variables. Logistic regression analyses were performed to estimate the predictive ability of each HRQoL questionnaire. Results In the first year of follow-up, the AQ20 scores predicted both ED visits (OR: 1.19; p = .004; AUC 0.723) and hospitalizations (OR: 1.21; p = .04; AUC 0.759) for asthma patients, and the CCQ emerged as independent predictor of ED visits in COPD patients (OR: 1.06; p = .036; AUC 0.651), after adjusting for sociodemographic, clinical, and

  2. Predicting asthma control: the role of psychological triggers.

    PubMed

    Ritz, Thomas; Bobb, Carol; Griffiths, Chris

    2014-01-01

    Asthma triggers have been linked to adverse health outcomes in asthma, but little is known about their association with asthma control. Because trigger avoidance is an integral part of successful asthma management, psychological triggers in particular may be associated with suboptimal asthma control, given the difficulty of controlling them. We examined cross-sectional and longitudinal associations of perceived asthma triggers with self-report of asthma control impairment, symptoms, and spirometric lung function (forced expiratory volume in the 1st second, [FEV1]) in 179 adult primary care asthma patients. Perceived asthma triggers explained up to 42.5% of the variance in asthma control and symptoms, but not in FEV1 alone. Allergic triggers explained up to 12.1% of the asthma control and symptom variance, three nonallergic trigger types, air pollution/irritants, physical activity, and infection, explained up to 26.2% over and above allergic triggers, and psychological triggers up to 9.5% over and above all other triggers. Psychological triggers alone explained up to 33.9% of the variance and were the only trigger class that was consistently significant in all final multiple regression models predicting control and symptoms. Psychological triggers also predicted lower asthma control 3-6 months later, although controlling for initial asthma control eliminated this association. In free reports of individually relevant triggers, only psychological triggers were associated with suboptimal asthma control. Trigger factors are important predictors of self-reported asthma control and symptoms but not actual lung function. Particular attention should be directed to psychological triggers as indicators of patients' perceptions of suboptimal asthma control.

  3. Association of airborne Aspergillus with asthma exacerbation in Southern Pakistan

    PubMed Central

    Zubairi, Ali Bin Sarwar; Azam, Iqbal; Awan, Safia; Zafar, Afia

    2014-01-01

    Background Exposure to airborne fungi has been related with exacerbation of asthma in adults and children leading to increased outpatient, emergency room visits, and hospitalizations. Hypersensitivity to these airborne fungi may be an important initial predisposing factor in the development and exacerbation of asthma. Objective This study was conducted to determine an association between fungal types and spore concentrations with the risk of asthma exacerbation in adults. Methods This cross-sectional study was conducted from May 2008 to August 2009 at the Aga Khan University Hospital Karachi, Pakistan. All adult (age≥16 years) patients presenting to the hospital with acute asthma exacerbation were enrolled after informed consent. A home survey was conducted for each patient to assess their environmental characteristics. Indoor air samples were also obtained from the patient's home to determine the type and spore concentration of fungi within the week of their enrollment in the study. Results Three hundred and ninety-one patients with an acute asthma exacerbation were enrolled during the study period. The mean age of participants was 46 years (standard deviation, ±18 years) and 247 (63.2%) were females. A trend of higher asthma enrollment associated with higher Aspergillus concentrations was found in two consecutive summers. A total of nineteen types of fungi were found in air samples. Aspergillus spp. was the most frequently isolated fungus with acute asthma exacerbation. Conclusion An association of higher concentration of indoor Aspergillus spp. with asthma exacerbation in adults was observed in this study. PMID:24809014

  4. Successful use of extracorporeal life support after double traumatic tracheobronchial injury in a patient with severe acute asthma.

    PubMed

    Valette, Xavier; Desjouis, Aurélie; Massetti, Massimo; Hanouz, Jean-Luc; Icard, Philippe

    2011-01-01

    We report the case of an asthmatic patient with blunt trachea and left main bronchus injuries who developed acute severe asthma after surgical repair. Despite medical treatment and ventilatory support, asthma persisted with high airway pressures and severe respiratory acidosis. We proposed venovenous extracorporeal life support for CO(2) removal which allowed arterial blood gas normalization and airway pressures decrease. Extracorporeal life support was removed on day five after medical treatment of acute severe asthma. So we report the successful use of extracorporeal life support for operated double blunt tracheobronchial injury with acute severe asthma. PMID:22135742

  5. Factors associated with quality of life in patients with severe asthma: the impact of pharmacotherapy

    PubMed Central

    Souza, Daiane Silva; Noblat, Lúcia de Araújo Costa Beisl; Santos, Pablo de Moura

    2015-01-01

    ABSTRACT OBJECTIVE: To identify, characterize, and quantify associations of various factors with quality of life (QoL) in patients with asthma, according to the pharmacotherapy employed. METHODS: This was a cross-sectional study involving 49 patients (≥ 18 years of age) with severe uncontrolled or refractory asthma treated at a specialized outpatient clinic of the Brazilian Unified Health Care System, regularly using high doses of inhaled corticosteroids (ICs) or other medications, and presenting comorbidities. At a single time point, QoL was assessed with the Asthma Quality of Life Questionnaire (AQLQ). The overall AQLQ score and those of its domains were correlated with demographic variables (gender and age); Asthma Control Questionnaire score; pharmacotherapy (initial IC dose, inhaler devices, and polytherapy); and comorbidities. RESULTS: Better AQLQ scores were associated with asthma control-overall (OR = 0.38; 95% CI: 0.004-0.341; p < 0.001), "symptoms" domain (OR = 0.086; 95% CI: 0.016-0.476; p = 0.001), and "emotional function" domain (OR = 0.086; 95% CI: 0.016-0.476; p = 0.001)-and with IC dose ≤ 800 µg-"activity limitation" domain (OR = 0.249; 95% CI: 0.070-0.885; p = 0.029). Worse AQLQ scores were associated with polytherapy-"activity limitation" domain (OR = 3.651; 95% CI: 1.061-12.561; p = 0.036)-and number of comorbidities ≤ 5-"environmental stimuli" domain (OR = 5.042; 95% CI: 1.316-19.317; p = 0.015). CONCLUSIONS: Our results, the importance of this issue, and the lack of studies taking pharmacotherapy into consideration warrant longitudinal studies to establish a causal relationship between the identified factors and QoL in asthma patients. PMID:26785957

  6. Absence of pulmonary aspiration of sinus contents in patients with asthma and sinusitis

    SciTech Connect

    Bardin, P.G.; Van Heerden, B.B.; Joubert, J.R. )

    1990-07-01

    The frequent association of asthma and paranasal sinusitis has been ascribed to a nasobronchial reflex, aspiration of sinus secretions, or enhanced beta-adrenergic blockade. We investigated possible pulmonary aspiration in a pilot study (eight patients) and follow-up study (13 patients) by means of a radionuclide technique. In the pilot study, the aim was to demonstrate aspiration as well as visibility of the radionuclide in the thorax during a period of 24 hours. The radionuclide was initially placed bronchoscopically in the bronchial tree in four patients and was still clearly visible in the same position after 24 hours in three patients. Aspiration from the nasopharynx was unequivocally demonstrated in two of four patients with depressed consciousness. The follow-up study population consisted of four patients with maxillary sinusitis only and nine patients with sinusitis and asthma. The radionuclide was placed in a maxillary sinus during therapeutic puncture. In the patients with only sinusitis as well as patients with asthma and sinusitis the radionuclide could be demonstrated in the maxillary sinus, nasopharynx, esophagus, and lower gastrointestinal tract during a 24-hour period. However, no pulmonary aspiration of radionuclide could be demonstrated in any patient. We conclude that seeding of the lower airways by mucopurulent secretions is unlikely to account for coexistent pulmonary disease. The association is probably related to generalized mucosal disease affecting both upper and lower airways.

  7. [Moderate asthma in adults: diagnosis and management in general medical practice].

    PubMed

    Vernejoux, J M; Tunon De Lara, J M; Guizard, A V; Villanueva, P; Taytard, A

    1996-10-01

    Moderate asthma is a frequent disorder in general medicine. In 1990, the British Thoracic Society published their first guidelines on the management of asthma. Three years later, we have studied, using a questionnaire, the diagnosis and therapeutic criteria of moderate asthma used by general physicians, and comparing these to the guideline recommendations. Out of 46 physicians questioned in Bordeaux, 40 (87 per cent) agreed to participate in the study. Thirty two physicians (80 per cent) described as moderate an asthma which was mild according to the guidelines; eight physicians (20 per cent) described a moderate asthma according to the guidelines; twenty five (63 per cent) considered as severe a moderate asthma according to the recommendations, although eleven (28 per cent) considered it as moderate and four (10 per cent) did not give an opinion. In total, four (10 per cent) judged asthma severity according to the guidelines (Group R), twenty one (52 per cent) over-estimated the severity of moderate asthma (Group S), and fifteen (37 per cent) gave an inconsistent assessment (Group 1). Twenty six (65 per cent) prescribed an association of beta-2-agonists and inhaled corticosteroids for moderate asthma. Although most of the questioned physicians gave an appropriate treatment for moderate asthma treatment adapted to the severity of the situation, their therapeutic approach did not seem to be based upon the same criteria than that recommended in the guidelines.

  8. The Mechanisms of the Regulation of Immune Response in Patients with Comorbidity of Chronic Obstructive Pulmonary Disease and Asthma

    PubMed Central

    Kalinina, Elena P.; Lobanova, Elena G.; Novgorodtseva, Tatyana P.; Antonyuk, Marina V.; Gvozdenko, Tatyana A.; Knyshova, Vera V.

    2016-01-01

    Background. Comorbidity of chronic obstructive pulmonary disease (COPD) and asthma (asthma COPD overlap syndrome, ACOS) is a significant problem in pulmonary practice, whose pathogenetic issues are not clarified yet. Objective. To study the features of the regulation of immune response in patients with comorbid COPD and asthma. Methods. We assessed the levels of CD3+, CD4+, CD8+, CD4+/CD8+, CD19+, CD25+, HLA-DR, total IgE, TNF-α, IL-4, IFN-γ, TXB2, and LTB4 in patients with comorbid COPD and asthma. Results. The study involved 44 people with COPD, 39 people with asthma, and 12 people with comorbid COPD and asthma. The specific features in comorbid COPD and asthma were lymphocytosis, increased absolute count of T-helper cells, increased cytotoxic T-lymphocytes in relative and absolute count, increased relative and absolute numbers of B-lymphocytes, and high levels of total IgE. The elevated levels of TNF-α and IL-4 and inhibition of IFN-γ production were detected. The content of LTB4 was maximal; TXB2 levels were higher than in control group but lower than in COPD and asthma. Conclusion. In comorbid COPD and asthma inflammation increased even during stable period. High levels of eicosanoids, low production of Th1-type cytokines, and active synthesis of opposition IL-4, along with increased IgE, indicate the activation of Th2-type immune response.

  9. The Mechanisms of the Regulation of Immune Response in Patients with Comorbidity of Chronic Obstructive Pulmonary Disease and Asthma

    PubMed Central

    Kalinina, Elena P.; Lobanova, Elena G.; Novgorodtseva, Tatyana P.; Antonyuk, Marina V.; Gvozdenko, Tatyana A.; Knyshova, Vera V.

    2016-01-01

    Background. Comorbidity of chronic obstructive pulmonary disease (COPD) and asthma (asthma COPD overlap syndrome, ACOS) is a significant problem in pulmonary practice, whose pathogenetic issues are not clarified yet. Objective. To study the features of the regulation of immune response in patients with comorbid COPD and asthma. Methods. We assessed the levels of CD3+, CD4+, CD8+, CD4+/CD8+, CD19+, CD25+, HLA-DR, total IgE, TNF-α, IL-4, IFN-γ, TXB2, and LTB4 in patients with comorbid COPD and asthma. Results. The study involved 44 people with COPD, 39 people with asthma, and 12 people with comorbid COPD and asthma. The specific features in comorbid COPD and asthma were lymphocytosis, increased absolute count of T-helper cells, increased cytotoxic T-lymphocytes in relative and absolute count, increased relative and absolute numbers of B-lymphocytes, and high levels of total IgE. The elevated levels of TNF-α and IL-4 and inhibition of IFN-γ production were detected. The content of LTB4 was maximal; TXB2 levels were higher than in control group but lower than in COPD and asthma. Conclusion. In comorbid COPD and asthma inflammation increased even during stable period. High levels of eicosanoids, low production of Th1-type cytokines, and active synthesis of opposition IL-4, along with increased IgE, indicate the activation of Th2-type immune response. PMID:27660519

  10. Best practices for pediatric asthma: improved clinical management for the inner-city patient.

    PubMed Central

    Jones, C. A.

    1999-01-01

    Asthma patients who live in urban areas face many challenges that contribute to and influence poor outcomes. Many inner-city asthma patients are burdened with significant barriers to care, which include difficulty in obtaining short- and long-term treatment and misperceptions about the chronic nature of the disease. Poor access to care, poor quality of care, or both have been shown to contribute to the high morbidity rate in this population. The objective of asthma therapy is to interrupt allergen/antigen exposures wherever possible and to control airway inflammation. The goal of an effective asthma program is to prevent exacerbations of the disease, achieve and maintain normal activity levels and normal or near-normal lung function, and achieve a personal best for each patient with an effective action plan. An effective action plan is often difficult to implement because it takes much effort from both physician and patient to incorporate complete treatment strategies. Nevertheless, over time these plans can be very effective. The 1997 NIH report provides specific guidelines to help accomplish these goals. PMID:12653389

  11. [Rehabilitation features in the prevention of asthma exacerbations in patients with different body weight].

    PubMed

    Galamba, A A; Tovt-Korshyns'ka, M I; Rostoka-Reznikova, M V; Sukhan, V S; Dychka, L V

    2014-01-01

    Bronchial asthma patients with excessive body weight compared to persons with normal weight had more severe course of the disease, associating with more pronounced inflammation (increased level of the proinflammatory interleukin-6, interferon-gamma, tumor necrosis factor alpha). After the rehabilitation treatment including speleotherapy we observed the improvement of clinical manifestation and reduction of the studied immune parameters.

  12. Data on the oral CRTh2 antagonist QAW039 (fevipiprant) in patients with uncontrolled allergic asthma.

    PubMed

    Erpenbeck, Veit J; Popov, Todor A; Miller, David; Weinstein, Steven F; Spector, Sheldon; Magnusson, Baldur; Osuntokun, Wande; Goldsmith, Paul; Weiss, Markus; Beier, Jutta

    2016-12-01

    This article contains data on clinical endpoints (Peak Flow Expiratory Rate, fractional exhaled nitric oxide and total IgE serum levels) and plasma pharmacokinetic parameters concerning the use of the oral CRTh2 antagonist QAW039 (fevipiprant) in mild to moderate asthma patients. Information on experimental design and methods on how this data was obtained is also described. Further interpretation and discussion of this data can be found in the article "The oral CRTh2 antagonist QAW039 (fevipiprant): a phase II study in uncontrolled allergic asthma" (Erpenbeck et al., in press) [1]. PMID:27656673

  13. Health literacy, language, and ethnicity-related factors in newcomer asthma patients to Canada: a qualitative study.

    PubMed

    Poureslami, Iraj; Rootman, Irving; Doyle-Waters, Mary M; Nimmon, Laura; Fitzgerald, J Mark

    2011-04-01

    The objectives of this study were to investigate how asthma patients from new immigrant groups are being informed and educated about asthma and its management, and to identify barriers to knowledge transfer. Four focus groups (n = 29) from Latino, Chinese, Iranian and Punjabi cultural communities were conducted with asthmatic patients in the Greater Vancouver Area. Our results from the focus group discussions can be summarized in four broad areas (a) perceptions of and ways of coping with asthma, (b) perceptions of whether the healthcare system is culturally competent, (c) perceptions of language barriers in regards to accessing the healthcare system, and (d) perceptions of how to access reliable asthma information. The results of this study highlight the importance of diverse cultural beliefs and practices as factors that should be taken into consideration when tailoring interventions to improve asthma outcomes in vulnerable populations, including patients from ethno-cultural communities.

  14. Anti-leukotriene agents compared to inhaled corticosteroids in the management of recurrent and/or chronic asthma in adults and children

    PubMed Central

    Chauhan, Bhupendrasinh F; Ducharme, Francine M

    2014-01-01

    Background Anti-leukotrienes (5-lipoxygenase inhibitors and leukotriene receptors antagonists) serve as alternative monotherapy to inhaled corticosteroids (ICS) in the management of recurrent and/or chronic asthma in adults and children. Objectives To determine the safety and efficacy of anti-leukotrienes compared to inhaled corticosteroids as monotherapy in adults and children with asthma and to provide better insight into the influence of patient and treatment characteristics on the magnitude of effects. Search methods We searched MEDLINE (1966 to Dec 2010), EMBASE (1980 to Dec 2010), CINAHL (1982 to Dec 2010), the Cochrane Airways Group trials register, and the Cochrane Central Register of Controlled Trials (Dec 2010), abstract books, and reference lists of review articles and trials. We contacted colleagues and the international headquarters of anti-leukotrienes producers. Selection criteria We included randomised trials that compared anti-leukotrienes with inhaled corticosteroids as monotherapy for a minimum period of four weeks in patients with asthma aged two years and older. Data collection and analysis Two review authors independently assessed the methodological quality of trials and extracted data. The primary outcome was the number of patients with at least one exacerbation requiring systemic corticosteroids. Secondary outcomes included patients with at least one exacerbation requiring hospital admission, lung function tests, indices of chronic asthma control, adverse effects, withdrawal rates and biological inflammatory markers. Main results Sixty-five trials met the inclusion criteria for this review. Fifty-six trials (19 paediatric trials) contributed data (representing total of 10,005 adults and 3,333 children); 21 trials were of high methodological quality; 44 were published in full-text. All trials pertained to patients with mild or moderate persistent asthma. Trial durations varied from four to 52 weeks. The median dose of inhaled corticosteroids

  15. [Effectiveness of therapeutic education and respiratory rehabilitation programs for the patient with asthma].

    PubMed

    Cano-De La Cuerda, Roberto; Useros-Olmo, Ana Isabel; Muñoz-Hellín, Elena

    2010-11-01

    Asthma is a chronic complex and heterogeneous disease, with great variability and has a huge impact, not only on patients who suffer the disease but also their families and society in general. The education of the asthmatic patient and their families is essential for therapeutic intervention. Through continuous, dynamic and adaptive education, changes in attitudes and behaviours of the patient and family can be achieved, and will undoubtedly lead to an improvement in their quality of life. Among other non-pharmacological interventions, respiratory rehabilitation is an alternative treatment, and is primarily aimed at patients with moderate to severe asthma. Although the latest clinical practice guidelines published in the scientific literature recommend two strategies for treatment, the results of relevant publications are diverse. The objective of this study was to describe the effectiveness of therapeutic and educational programs in respiratory rehabilitation of the asthmatic patient. PMID:20846775

  16. Patient perspectives in the management of asthma: improving patient outcomes through critical selection of treatment options

    PubMed Central

    Scichilone, Nicola; Contino, Adele; Figlioli, Giovanni Battista; Paglino, Giuseppe; Bellia, Vincenzo

    2010-01-01

    Asthma is a chronic inflammatory disorder of the airways that requires long-term treatment, the goal of which is to control clinical symptoms for extended periods with the least possible amount of drugs. International guidelines recommend the addition of an inhaled long-acting beta2-agonist (LABA) to a low- to medium-dose inhaled corticosteroid (ICS) when low doses of ICS fail to control asthma symptoms. The fixed combined administration of ICS/LABA improves patient compliance, reducing the risk of therapy discontinuation. The relative deposition pattern of the inhaled drug to the target site is the result of a complex interaction between the device used, the aerosol formulation and the patient’s adherence to therapy. Different inhalation devices have been introduced in clinical practice over time. The new hydrofluoroalkane (HFA) solution aerosols allow for the particle size to be modified, thus leading to deeper penetration of the medication into the lung. The Modulite® technology allows for the manipulation of inhaled HFA-based solution formulations, such as the fixed beclomethasone/formoterol combination, resulting in a uniform treatment of inflammation and bronchoconstriction. The success of any anti-asthmatic treatment depends on the choice of the correct device and the adherence to therapy. PMID:20165595

  17. Prevalence and determinants of asthma in adult male leather tannery workers in Karachi, Pakistan: A cross sectional study

    PubMed Central

    Shahzad, Khurram; Akhtar, Saeed; Mahmud, Sadia

    2006-01-01

    Background This study aimed to estimate the prevalence and to identify some risk factors of adult asthma in male leather tannery workers in Karachi, Pakistan. Methods A cross sectional study was conducted from August 2003 to March 2004 on leather tannery workers of Karachi, Pakistan. Data were collected from 641 workers engaged in 95 different tanneries in Korangi industrial area selected as sample of convenience. Face to face interviews were performed using a structured pre-tested questionnaire by trained data collectors. Results Prevalence of adult asthma was 10.8% (69/641) in this study population. The prevalence of perceived work-related asthma was 5.3% (34/641). Multivariable logistic regression model showed that after taking into account the age effect, the leather tannery worker were more likely to be asthmatic, if they were illiterate (adjusted OR = 2.13, 95% CI: 1.17–3.88), of Pathan ethnicity (adjusted OR = 2.69; 95% CI: 1.35–5.36), ever-smoked (adjusted OR = 2.22, 95% CI: 1.16–4.26), reportedly never used gloves during different tanning tasks (OR = 3.28; 95% CI : 1.72–6.26). Also, the final model showed a significant interaction between perceived allergy and duration of work. Those who perceived to have allergy were more likely to have asthma if their duration of work was 8 years (adjusted OR = 2.26; 95% CI: 1.19 – 4.29) and this relationship was even stronger if duration was 13 years (adjusted OR = 3.67; 95% CI: 1.98–6.79). Conclusion Prevalence of asthma in leather tannery workers appears to be high and is associated with educational status, ethnicity, smoking, glove use, perceived to have allergy and duration of work. PMID:17144930

  18. Reduced expression of galectin-1 and galectin-9 by leucocytes in asthma patients

    PubMed Central

    Sanchez-Cuellar, S; Fuente, H; Cruz-Adalia, A; Lamana, A; Cibrian, D; Giron, R M; Vara, A; Sanchez-Madrid, F; Ancochea, J

    2012-01-01

    Accumulating evidence shows that galectins play roles in the initiation and resolution phases of inflammatory responses by promoting anti- or proinflammatory effects. This study investigated the presence of three members of the galectin family (galectin-1, -3 and -9) in induced sputum samples of asthma patients, as well as their possible implication in the immunopathogenesis of human asthma. Levels of interleukin (IL)-5, IL-13, and galectins were determined in leucocytes isolated from induced sputum samples by reverse transcription–polymerase chain reaction (RT–PCR) immunofluorescence and flow cytometry. High levels of IL-5 and IL-13 mRNA were detected in sputum cells from asthma patients. In parallel, immunoregulatory proteins galectin-1 and galectin-9 showed a reduced expression on macrophages from sputum samples compared with cells from healthy donors. In-vitro immunoassays showed that galectin-1 and galectin-9, but not galectin-3, are able to induce the production of IL-10 by peripheral blood mononuclear cells from healthy donors. These findings indicate that macrophages from sputum samples of asthma patients express low levels of galectin-1 and galectin-9, favouring the exacerbated immune response observed in this disease. PMID:23121677

  19. Time for a new language for asthma control: results from REALISE Asia

    PubMed Central

    Price, David; David-Wang, Aileen; Cho, Sang-Heon; Ho, James Chung-Man; Jeong, Jae-Won; Liam, Chong-Kin; Lin, Jiangtao; Muttalif, Abdul Razak; Perng, Diahn-Warng; Tan, Tze-Lee; Yunus, Faisal; Neira, Glenn

    2015-01-01

    Purpose Asthma is a global health problem, and asthma prevalence in Asia is increasing. The REcognise Asthma and LInk to Symptoms and Experience Asia study assessed patients’ perception of asthma control and attitudes toward treatment in an accessible, real-life adult Asian population. Patients and methods An online survey of 2,467 patients with asthma from eight Asian countries/regions, aged 18–50 years, showed greater than or equal to two prescriptions in previous 2 years and access to social media. Patients were asked about their asthma symptoms, exacerbations and treatment type, views and perceptions of asthma control, attitudes toward asthma management, and sources of asthma information. Results Patients had a mean age of 34.2 (±7.4) years and were diagnosed with asthma for 12.5 (±9.7) years. Half had the Global Initiative for Asthma-defined uncontrolled asthma. During the previous year, 38% of patients visited the emergency department, 33% were hospitalized, and 73% had greater than or equal to one course of oral corticosteroids. About 90% of patients felt that their asthma was under control, 82% considered their condition as not serious, and 59% were concerned about their condition. In all, 66% of patients viewed asthma control as managing attacks and 24% saw it as an absence of or minimal symptoms. About 14% of patients who correctly identified their controller inhalers had controlled asthma compared to 6% who could not. Conclusion Patients consistently overestimated their level of asthma control contrary to what their symptoms suggest. They perceived control as management of exacerbations, reflective of a crisis-oriented mind-set. Interventions can leverage on patients’ trust in health care providers and desire for self-management via a new language to generate a paradigm shift toward symptom control and preventive care. PMID:26445555

  20. The Associations between Area of Residence, Sexual Violence Victimization, and Asthma Episodes among US Adult Women in 14 States and Territories, 2005–2007

    PubMed Central

    Swahn, Monica H.; Choudhary, Ekta

    2008-01-01

    Gaps in understanding of how area-based differences in exposure to violence are associated with asthma prevalence may limit the development of effective prevention programs and the identification of risk for asthma episodes. The current investigation examines the associations between sexual violence victimization and asthma episodes among US adult women across three different metropolitan settings. The association between sexual assault victimizations and asthma attacks in the past year was examined using data from the 2005, 2006, and 2007 Behavioral Risk Factor Surveillance System surveys. Cross-sectional analyses were based on adult women with current asthma (n = 4,099). Multivariate logistic regression models were used to identify associations between four categories of sexual violence victimization and asthma episodes across three categories of metropolitan and non-metropolitan settings. Our findings show that unwanted touching, attempted unwanted intercourse, forced unwanted intercourse, and any sexual violence victimization (touching, attempted intercourse, or forced intercourse) were significantly associated with asthma episodes (ORadj. = 3.67, 95% CI, 1.76–7.69; ORadj. = 1.77, 95% CI, 1.32–2.37; ORadj. = 2.24, 95% CI, 1.64–3.05, and ORadj. = 1.93, 95% CI, 1.47–2.53, respectively). While no significant differences in the associations between asthma episodes and metropolitan status were found, a significant interaction between non-metropolitan areas and attempted sexual intercourse was identified (ORadj = 0.53, 95% CI, 0.29–0.96). Sexual victimization appears to be an important, but understudied, correlate of asthma morbidity among adult women in the USA, suggesting that additional research is needed to better understand the associations between sexual violence, psychological distress, and asthma. PMID:19096937

  1. MCP-1, CCR2 and CCR5 polymorphisms in Tunisian patients with atopic asthma.

    PubMed

    Dhaouadi, Tarak; Sfar, Imen; Aounallah-Skhiri, Hajer; Jendoubi-Ayed, Saloua; Bouacha, Hend; Ben Abdallah, Taieb; Gorgi, Yousr

    2013-03-01

    Chemokines and their receptors play an important role in the late inflammatory stage of asthma. In this study, we aimed to investigate polymorphisms of MCP-1 (CCL2), CCR2 and CCR5 which can affect qualitatively and/or quantitatively their production and thus influence both susceptibility and severity of asthma and its clinical and biological features.MCP-1 (A/G -2518), CCR2 (+/64I), CCR5 (G/A -59029) and CCR5 (∆32) polymorphisms were evaluated by PCR in 107 Tunisian patients with asthma and 169 healthy controls.No significant association was found between the four investigated polymorphisms and asthma. Nevertheless the haplotype MCP1*AG/CCR2*+/+ was significantly l ess frequent in patients (20.5%) compared to controls (32.5%) (p=0.03; OR=0.54; 95% CI: 0.29-0.98). Whereas no difference was observed in CCR2/CCR5 haplotypes between patients and controls. Analysis of polymorphisms with clinical and biological features showed that the concomitant presence of MCP-1*G/CCR2*64I alleles was less frequent in severe forms (4.34%) compared to moderate disease (12%) but the difference was not significant (p=0.27). No association was observed between the four polymorphisms and the presence of atopic rhinitis or atopic conjunctivitis and an elevated rate of serum IgE over 200 IU/ml.Additional effects of MCP-1 and its receptor CCR2 polymorphisms seem to be involved in disease susceptibility to asthma in Tunisian patients; nevertheless they could be protective against its severe forms.

  2. Medications for Chronic Asthma.

    PubMed

    Falk, Nathan P; Hughes, Scott W; Rodgers, Blake C

    2016-09-15

    Chronic asthma is a major health concern for children and adults worldwide. The goal of treatment is to prevent symptoms by reducing airway inflammation and hyperreactivity. Step-up therapy for symptom control involves initiation with low-dose treatment and increasing intensity at subsequent visits if control is not achieved. Step-down therapy starts with a high-dose regimen, reducing intensity as control is achieved. Multiple randomized controlled trials have shown that inhaled corticosteroids are the most effective monotherapy. Other agents may be added to inhaled corticosteroids if optimal symptom control is not initially attained. Long-acting beta2 agonists are the most effective addition, but they are not recommended as monotherapy because of questions regarding their safety. Leukotriene receptor antagonists can be used in addition to inhaled corticosteroids, but they are not as effective as adding a long-acting beta2 agonist. Patients with mild persistent asthma who prefer not to use inhaled corticosteroids may use leukotriene receptor antagonists as monotherapy, but they are less effective. Because of their high cost and a risk of anaphylaxis, monoclonal antibodies should be reserved for patients with severe symptoms not controlled by other agents. Immunotherapy should be considered in persons with asthma triggered by confirmed allergies if they are experiencing adverse effects with medication or have other comorbid allergic conditions. Many patients with asthma use complementary and alternative agents, most of which lack data regarding their safety or effectiveness. PMID:27637121

  3. Association of ADAM33 gene polymorphisms with adult allergic asthma and rhinitis in a Chinese Han population

    PubMed Central

    Su, Dongju; Zhang, Ximei; Sui, Hong; Lü, Fuzhen; Jin, Lianhong; Zhang, Jing

    2008-01-01

    Background Rhinitis and asthma are very common diseases involving genetic and environmental factors. Most patients with asthma also have rhinitis, which suggests the concept of 'one airway, one disease.' A disintegrin and metalloproteinase 33 (ADAM33) is the first asthma-susceptible gene to be discovered by positional cloning. To evaluate the potential influence of ADAM33 gene polymorphisms on allergic rhinitis (AR) and allergic asthma (AS), a case-control study was conducted on the Han population of northeast China. Methods Six polymorphic sites (V4, T+1, T2, T1, S1, and Q-1) were genotyped in 128 patients with AR, 181 patients with AS, and 151 healthy controls (CTR). Genotypes were determined by the polymerase chain restriction fragment length polymorphism (PCR-RFLP) method. Data were analyzed using the chi-square test with Haploview software. Results The single nucleotide polymorphisms (SNPs), V4 G/C, T+1 A/G, and T1 G/A, of the ADAM33 gene may be the causal variants in AR, whereas ADAM33 V4 G/C, T2 A/G, T1 G/A, and Q-1A/G may participate in the susceptibility of AS. Conclusion These results suggest that polymorphisms of the ADAM33 gene may modify individual susceptibility to AR and AS in a Chinese Han population. PMID:18778489

  4. The Madison Avenue Effect: How drug presentation style influences adherence and outcome in patients with asthma

    PubMed Central

    Clerisme-Beaty, Emmanuelle M; Bartlett, Susan J; Teague, W. Gerald; Lima, John; Irvin, Charles G; Cohen, Rubin; Castro, Mario; Wise, Robert A; Rand, Cynthia S

    2010-01-01

    Background Little is known about how drug presentation influences medication adherence. Objective Examine the effect of an educational program aimed at increasing expectations of treatment benefit on medication adherence. Methods Data are analyzed from 99 participants who underwent electronic drug monitoring during TAPE (Trial of Asthma Patient Education), a randomized placebo-controlled multi-center trial. Participants with suboptimally-controlled asthma were randomized to placebo or montelukast in conjunction with a presentation mode that was either neutral or designed to increase outcome expectancy. Adherence was monitored electronically over 4 weeks, and was defined as ≥ 80% use of prescribed doses. Outcome expectancy, peak expiratory flow, pre-bronchodilator forced expiratory volume, asthma control (ACQ), and asthma-related quality of life were assessed at baseline and at the 4-week follow-up. Results Average electronic medication adherence was 69.9%. There was a significant interaction between presentation mode and drug assignment, with participants in the enhanced/montelukast group having a higher change in outcome expectancy (Δ 2.1 points, p < 0.001) and better medication adherence (odds ratio 4.0, CI 1.1, 14.3) compared to those in the neutral/placebo group. There was no difference in asthma symptoms, quality of life, or clinical outcomes based on presentation mode. Rather, increased outcome expectancy was associated with modest improvements in asthma symptoms after adjusting for presentation mode, drug assignment, and medication adherence. Conclusion The use of an enhanced presentation aimed at increasing outcome expectancy may lead to improved medication adherence. PMID:21281871

  5. Altered Innate Immune Responses in Neutrophils from Patients with Well- and Suboptimally Controlled Asthma

    PubMed Central

    Tang, Francesca S. M.; Foxley, Gloria J.; Gibson, Peter G.; Burgess, Janette K.; Baines, Katherine J.; Oliver, Brian G.

    2015-01-01

    Background. Respiratory infections are a major cause of asthma exacerbations where neutrophilic inflammation dominates and is associated with steroid refractory asthma. Structural airway cells in asthma differ from nonasthmatics; however it is unknown if neutrophils differ. We investigated neutrophil immune responses in patients who have good (AGood) and suboptimal (ASubopt) asthma symptom control. Methods. Peripheral blood neutrophils from AGood (ACQ < 0.75, n = 11), ASubopt (ACQ > 0.75, n = 7), and healthy controls (HC) (n = 9) were stimulated with bacterial (LPS (1 μg/mL), fMLF (100 nM)), and viral (imiquimod (3 μg/mL), R848 (1.5 μg/mL), and poly I:C (10 μg/mL)) surrogates or live rhinovirus (RV) 16 (MOI1). Cell-free supernatant was collected after 1 h for neutrophil elastase (NE) and matrix metalloproteinase- (MMP-) 9 measurements or after 24 h for CXCL8 release. Results. Constitutive NE was enhanced in AGood neutrophils compared to HC. fMLF stimulated neutrophils from ASubopt but not AGood produced 50% of HC levels. fMLF induced MMP-9 was impaired in ASubopt and AGood compared to HC. fMLF stimulated CXCL8 but not MMP-9 was positively correlated with FEV1 and FEV1/FVC. ASubopt and AGood responded similarly to other stimuli. Conclusions. Circulating neutrophils are different in asthma; however, this is likely to be related to airflow limitation rather than asthma control. PMID:26663987

  6. Acrolein and Asthma Attack Prevalence in a Representative Sample of the United States Adult Population 2000 – 2009

    PubMed Central

    deCastro, B. Rey

    2014-01-01

    Background Acrolein is an air toxic and highly potent respiratory irritant. There is little epidemiology available, but US EPA estimates that outdoor acrolein is responsible for about 75 percent of non-cancer respiratory health effects attributable to air toxics in the United States, based on the Agency's 2005 NATA (National-Scale Air Toxics Assessment) and acrolein's comparatively potent inhalation reference concentration of 0.02 µg/m3. Objectives Assess the association between estimated outdoor acrolein exposure and asthma attack reported by a representative cross-sectional sample of the adult United States population. Methods NATA 2005 chronic outdoor acrolein exposure estimates at the census tract were linked with residences oif adults (≥18 years old) in the NHIS (National Health Interview Survey) 2000 – 2009 (n = 271,348 subjects). A sample-weighted logistic regression model characterized the association between the prevalence of reporting at least one asthma attack in the 12 months prior to survey interview and quintiles of exposure to outdoor acrolein, controlling for potential confounders. Results In the highest quintile of outdoor acrolein exposure (0.05 – 0.46 µg/m3), there was a marginally significant increase in the asthma attack pOR (prevalence-odds ratio [95% CI]  = 1.08 [0.98∶1.19]) relative to the lowest quintile. The highest quintile was also associated with a marginally significant increase in prevalence-odds (1.13 [0.98∶1.29]) in a model limited to never smokers (n = 153,820). Conclusions Chronic exposure to outdoor acrolein of 0.05 – 0.46 µg/m3 appears to increase the prevalence-odds of having at least one asthma attack in the previous year by 8 percent in a representative cross-sectional sample of the adult United States population. PMID:24816802

  7. Bone mineral density and fracture risk with long-term use of inhaled corticosteroids in patients with asthma: systematic review and meta-analysis

    PubMed Central

    Loke, Yoon K; Gilbert, Daniel; Thavarajah, Menaka; Blanco, Patricia; Wilson, Andrew M

    2015-01-01

    Objectives We aimed to assess the association between long-term use of inhaled corticosteroids (ICS) and bone adverse effects in patients with asthma. Design Systematic review and meta-analysis of fracture risk and changes in bone mineral density with long-term ICS use in asthma. Methods We initially searched MEDLINE and EMBASE in July 2013, and performed an updated PubMed search in December 2014. We selected randomised controlled trials (RCTs) and controlled observational studies of any ICS (duration at least 12 months) compared to non-ICS use in patients with asthma. We conducted meta-analysis of ORs for fractures, and mean differences in bone mineral density. Heterogeneity was assessed using the I2 statistic. Results We included 18 studies (7 RCTs and 11 observational studies) in the systematic review. Meta-analysis of observational studies did not demonstrate any significant association between ICS and fractures in children (pooled OR 1.02, 95% CI 0.94 to 1.10, two studies), or adults (pooled OR 1.09, 95% CI 0.45 to 2.62, four studies). Three RCTs and three observational studies in children reported on bone mineral density at the lumbar spine, and our meta-analysis did not show significant reductions with ICS use. Three RCTs and four observational studies in adults reported on ICS use and bone mineral density at the lumbar spine and femur, with no significant reductions found in the meta-analysis compared to control. Conclusions ICS use for ≥12 months in adults or children with asthma was not significantly associated with harmful effects on fractures or bone mineral density. PMID:26603243

  8. The Digital Asthma Patient: The History and Future of Inhaler Based Health Monitoring Devices.

    PubMed

    Kikidis, Dimitrios; Konstantinos, Votis; Tzovaras, Dimitrios; Usmani, Omar S

    2016-06-01

    The wave of digital health is continuously growing and promises to transform healthcare and optimize the patients' experience. Asthma is in the center of these digital developments, as it is a chronic disease that requires the continuous attention of both health care professionals and patients themselves. The accurate and timely assessment of the state of asthma is the fundamental basis of digital health approaches and is also the most significant factor toward the preventive and efficient management of the disease. Furthermore, the necessity of inhaled medication offers a basic platform upon which modern technologies can be integrated, namely the inhaler device itself. Inhaler-based monitoring devices were introduced in the beginning of the 1980s and have been evolving but mainly for the assessment of medication adherence. As technology progresses and novel sensing components are becoming available, the enhancement of inhalers with a wider range of monitoring capabilities holds the promise to further support and optimize asthma self-management. The current article aims to take a step for the mapping of this territory and start the discussion among healthcare professionals and engineers for the identification and the development of technologies that can offer personalized asthma self-management with clinical significance. In this direction, a technical review of inhaler based monitoring devices is presented, together with an overview of their use in clinical research. The aggregated results are then summarized and discussed for the identification of key drivers that can lead the future of inhalers.

  9. ASTHMA AND MENTAL HEALTH SYMPTOMS AMONG ADULT ARAB AMERICANS IN THE DETROIT AREA

    EPA Science Inventory

    The burden of managing chronic health problems such as asthma is often compounded by psychological distress and debilitating mental health problems associated with these conditions. In this study we assessed the relationship between asthma and self-reported mental health symptom...

  10. Asthma, Smoking and BMI in Adults with Intellectual Disabilities: A Community-Based Survey

    ERIC Educational Resources Information Center

    Gale, L.; Naqvi, H.; Russ, L.

    2009-01-01

    Background: Recent research evidence from the general population has shown that tobacco smoking and raised body mass index (BMI) are associated with worse asthma outcomes. There are indications that asthma morbidity and mortality may be higher among people with intellectual disabilities (ID) than the general population, but the reason for this is…

  11. Occupational asthma: a challenge in patient management and community care

    SciTech Connect

    Reed, C.E.

    1981-08-01

    Occupational exposure to irritants accounts for 2% to 15% of all cases of asthma. Most of the offending agents evoke an IgE allergic reaction, but some seem to act through pharmacologic rather than immunologic pathways. Usually, symptoms are worse during working hours and improve in the evening and over the weekend, but in some cases onset is delayed. Symptoms may persist for weeks after exposure ceases. Skin tests or serologic tests for IgE antibody are helpful in diagnosis. Bronchial challenge with the suspected agent is valuable research procedure that occasionally is clinically useful in diagnosis. Management requires the cooperation of the medical and industrial communities. It consists of identifying asthmatic workers, removing them from exposure to the affecting environment, and treating their symptoms; preventing exposure of susceptible people through preemployment screening; and setting and adhering to reasonable occupational safety standards.

  12. Placebo-controlled challenges with perfume in patients with asthma-like symptoms.

    PubMed

    Millqvist, E; Löwhagen, O

    1996-06-01

    A group of nine patients with respiratory symptoms after nonspecific irritating stimuli, but without any IgE-mediated allergy or demonstrable bronchial obstruction, were referred to the asthma/allergy outpatient department for evaluation of suspected asthma. In order to find a provocation model and objectively assess these patients' symptoms in controlled studies, provocation with perfume or placebo was performed. The same patients were also subjected to perfume provocation with or without a carbon filter mask to ascertain whether breathing through a filter with active carbon could prevent the symptoms. The patients breathed through the mouth during the provocations, as they used a nasal clamp to prevent any smell of perfume. We found that the patients' earlier symptoms could be verified by perfume provocation. Breathing through the carbon filter had no protective effect. The conclusion is that symptoms suggesting hyperreactivity of the respiratory tract and asthma can be provoked by perfume without the presence of bronchial obstruction, and that using a carbon filter mask has no preventive effect. The symptoms are not transmitted via the olfactory nerve, since the patients could not smell the perfume, but they may have been induced by a trigeminal reflex via the respiratory tract or by the eyes.

  13. Asthma and American Indians/Alaska Natives

    MedlinePlus

    ... Minority Population Profiles > American Indian/Alaska Native > Asthma Asthma and American Indians/Alaska Natives In 2014, 218, ... Native American adults reported that they currently have asthma. American Indian/Alaska Native children are 30% more ...

  14. TLC-Asthma: An Integrated Information System for Patient-centered Monitoring, Case Management, and Point-of-Care Decision Support

    PubMed Central

    Adams, William G.; Fuhlbrigge, Anne L.; Miller, Charles W.; Panek, Celeste G.; Gi, Yangsoon; Loane, Kathleen C.; Madden, Nancy E.; Plunkett, Anne M.; Friedman, Robert H.

    2003-01-01

    A great deal of successful work has been done in the area of EMR development, implementation, and evaluation. Less work has been done in the area of automated systems for patients. Efforts to link data at multiple levels – the patient, the case manager, and the clinician have been rudimentary to-date. In this paper we present a model information system that integrates patient health information across multiple domains to support the monitoring and care of children with persistent asthma. The system has been developed for use in a multi-specialty group practice and includes three primary components: 1) a patient-centered telephone-linked communication system; 2) a web-based alert reporting and nurse case-management system; and 3) EMR-based provider communication to support clinical decision making at the point-of-care. The system offers a model for a new level of connectivity for health information that supports customized monitoring, IT-enabled nurse case-managers, and the delivery of longitudinal data to clinicians to support the care of children with persistent asthma. Systems like the one described are well -suited, perhaps essential, technologies for the care of children and adults with chronic conditions such as asthma. PMID:14728122

  15. Budesonide/formoterol combination therapy as both maintenance and reliever medication in moderate-to-severe asthma: a real-life effectiveness study of Malaysian patients.

    PubMed

    Loh, L C; Lim, B K; Raman, S; Vijayasingham, P; Mohd Yusuf, S

    2008-08-01

    Budesonide/Formoterol (Symbicort) combination therapy as both maintenance and reliever treatment (SMART) is a novel approach in asthma management. We examined its 'real-life effectiveness' in treating Malaysian patients with moderate-to-severe asthma in whom despite on combined inhaled corticosteroids and long-acting beta2-agonist, were still inadequately controlled. In a retrospective study, 22 eligible adult patients on SMART [mean (range) age: 49 (36-65) years; FEV1: 41 (21-74)% predicted] were identified from medical records of an urban-based university hospital chest clinic, and their clinical outcomes studied at three months. Another 16 patients [50 (14-66) years; 48 (20-91)% predicted] of similar severity and treatment (i.e. Symbicort maintenance treatment plus short-acting beta2-agonist as reliever), but not on SMART, were used as comparator over the same assessment period. In addition, the patients were separately interviewed with standard questionnaire on their satisfaction and compliance to the SMART approach. In SMART group, rescue treatment requirement (p<0.001) and FEV1 [median difference = 2.5%, p=0.015; mean difference: 90 ml, p=0.013] showed significant improvement while in comparator, there was significant improvement only in the requirement for rescue treatment (p=0.023). Hospital admission rates were significantly reduced in SMART group compared to the other (p=0.039), but not in emergency treatment. Five patients asked to discontinue SMART while all others were satisfied, compliant and perceived improvement of their asthma with SMART. The maximum daily doses of inhaled budesonide and formoterol were 1400 microg and 31.5 microg respectively. Our preliminary findings suggest that SMART approach can be attempted as an effective and safe treatment option for patients with inadequately controlled moderate-to-severe asthma in Malaysian setting.

  16. What is the current status of management of the patient with exercise-induced asthma?

    PubMed

    Kobayashi, R H; Mellion, M B; Kobayashi, A L

    1994-07-01

    Exercise-induced asthma (EIA) is a very common and troublesome disease frequently impairing optimal athletic performance. Although described as early as the second century A.D. and widely known since 1972, EIA often goes unrecognized by both patient and physician. The goals of treatment are to minimize symptoms thus allowing the athlete to participate fully in a broad array of activities and to utilize the most effective pharmacologic drugs available. The recognition and treatment of exercise-induced asthma (EIA) have made significant progress since 1972 when United States swimmer, Rick Demont had his Olympic gold medal award rescinded because of traces of ephedrine were detected in his urine. Lessons from this episode paid dividends subsequently; in preparation for the 1984 Olympic games in Los Angeles, the U.S. Olympic Committee developed a screening program which identified 67 U.S. team members with EIA. Astoundingly, several of these world-class athletes did not realize they had asthma. Affected individuals were counseled on the prevention of asthma and also on the effective use of medications; 41 won medals in various competitions including track and field, wrestling, basketball, cycling, swimming and rowing. Despite this resounding success, many athletes at all levels of competition still suffer from unrecognized or under-treated EIA despite knowledge of the problem since the second century A.D.(ABSTRACT TRUNCATED AT 250 WORDS)

  17. Assessing patients' preferences for characteristics associated with homeopathic and conventional treatment of asthma: a conjoint analysis study

    PubMed Central

    Ratcliffe, J; Van Haselen, R; Buxton, M; Hardy, K; Colehan, J; Partridge, M

    2002-01-01

    Background: A study was undertaken to investigate the preferences of patients with asthma for attributes or characteristics associated with treatment for their asthma and to investigate the extent to which such preferences may differ between patient subgroups. Methods: The economic technique of conjoint analysis (CA) was used to investigate patients' strength of preference for several key attributes associated with services for the treatment of asthma. A CA questionnaire was administered to two groups of asthma outpatients aged 18 years or older, 150 receiving conventional treatment at Whipps Cross Hospital (WC) and 150 receiving homeopathic treatment at the Royal London Homoeopathic Hospital (RL). Results: An overall response rate of 47% (n=142) was achieved. Statistically significant attributes in influencing preferences for both the WC and RL respondents were (1) the extent to which the doctor gave sufficient time to listen to what the patient has to say, (2) the extent to which the treatment seemed to relieve symptoms, and (3) the travel costs of attending for an asthma consultation. The extent to which the doctor treated the patient as a whole person was also a statistically significant attribute for the RL respondents. Conclusions: This study has shown that aspects associated with the process of delivery of asthma services are important to patients in addition to treatment outcomes. The homeopathic respondents expressed stronger preferences for the doctor to treat them as a whole person than the patients receiving conventional treatment. Overall, the preferences for the attributes included in the study were similar for both groups. PMID:12037224

  18. Obstructive sleep apnea and asthma*

    PubMed Central

    Salles, Cristina; Terse-Ramos, Regina; Souza-Machado, Adelmir; Cruz, Álvaro A

    2013-01-01

    Symptoms of sleep-disordered breathing, especially obstructive sleep apnea syndrome (OSAS), are common in asthma patients and have been associated with asthma severity. It is known that asthma symptoms tend to be more severe at night and that asthma-related deaths are most likely to occur during the night or early morning. Nocturnal symptoms occur in 60-74% of asthma patients and are markers of inadequate control of the disease. Various pathophysiological mechanisms are related to the worsening of asthma symptoms, OSAS being one of the most important factors. In patients with asthma, OSAS should be investigated whenever there is inadequate control of symptoms of nocturnal asthma despite the treatment recommended by guidelines having been administered. There is evidence in the literature that the use of continuous positive airway pressure contributes to asthma control in asthma patients with obstructive sleep apnea and uncontrolled asthma. PMID:24310634

  19. Screening and Registering Patients with Asthma and Copd in Slovenian Primary Care: First Results

    PubMed Central

    POPLAS-SUSIČ, Tonka; ŠVAB, Igor; KLANČAR, Darinka; PETEK, Davorina; VODOPIVEC-JAMŠEK, Vlasta; BULC, Mateja; KERSNIK, Janko; PETROVSKI, Beáta Éva

    2015-01-01

    Aim This study aimed to evaluate a new project of the Slovene Ministry of Health – the Family Medicine Model Practices (MPs) Project in Slovenia, and to show its effectiveness in the management of asthma and COPD by family medicine practice teams, consisting of a family physician, a nurse practitioner and a practice nurse. Methods A total of 107 family practices with 203122 patients joined the project during the first year of its initiation. The effectiveness of the program in disease management was analysed in two phases according to the registration of family practices. The number of patients registered and the number of asthma and COPD patients (existing and newly detected) by model practice teams were being reported. Descriptive analyses were used to describe the study populations. Prevalence by diseases and phases was established after the initial round of data collection. Chi square (χ2) test was used to analyse the difference between the phases. Results The frequency of asthma was 2.12%, while the frequency of COPD was 1.15% throughout the study period. For both diseases, more than 30% of patients were newly diagnosed. Conclusions The project of implementing Family Medicine MPs in the area of COPD has given first positive results and the project is still ongoing to its full implementation. PMID:27646723

  20. The Wnt/β-catenin signaling pathway regulates the development of airway remodeling in patients with asthma.

    PubMed

    Kwak, Hyun Jung; Park, Dong Won; Seo, Ji-Young; Moon, Ji-Yong; Kim, Tae Hyung; Sohn, Jang Won; Shin, Dong Ho; Yoon, Ho Joo; Park, Sung Soo; Kim, Sang-Heon

    2015-12-11

    Airway remodeling is a key characteristic of chronic asthma, particularly in patients with a fixed airflow limitation. The mechanisms underlying airway remodeling are poorly understood, and no therapeutic option is available. The Wnt/β-catenin signaling pathway is involved in various physiological and pathological processes, including fibrosis and smooth muscle hypertrophy. In this study, we investigated the roles of Wnt/β-catenin signaling in airway remodeling in patients with asthma. Wnt7a mRNA expression was prominent in induced sputum from patients with asthma compared with that from healthy controls. Next, we induced a chronic asthma mouse model with airway remodeling features, including subepithelial fibrosis and airway smooth muscle hyperplasia. Higher expression of Wnt family proteins and β-catenin was detected in the lung tissue of mice with chronic asthma compared to control mice. Blocking β-catenin expression with a specific siRNA attenuated airway inflammation and airway remodeling. Decreased subepithelial fibrosis and collagen accumulation in the β-catenin siRNA-treated mice was accompanied by reduced expression of transforming growth factor-β. We further showed that suppressing β-catenin in the chronic asthma model inhibited smooth muscle hyperplasia by downregulating the tenascin C/platelet-derived growth factor receptor pathway. Taken together, these findings demonstrate that the Wnt/β-catenin signaling pathway is highly expressed and regulates the development of airway remodeling in chronic asthma.

  1. The Wnt/β-catenin signaling pathway regulates the development of airway remodeling in patients with asthma

    PubMed Central

    Kwak, Hyun Jung; Park, Dong Won; Seo, Ji-Young; Moon, Ji-Yong; Kim, Tae Hyung; Sohn, Jang Won; Shin, Dong Ho; Yoon, Ho Joo; Park, Sung Soo; Kim, Sang-Heon

    2015-01-01

    Airway remodeling is a key characteristic of chronic asthma, particularly in patients with a fixed airflow limitation. The mechanisms underlying airway remodeling are poorly understood, and no therapeutic option is available. The Wnt/β-catenin signaling pathway is involved in various physiological and pathological processes, including fibrosis and smooth muscle hypertrophy. In this study, we investigated the roles of Wnt/β-catenin signaling in airway remodeling in patients with asthma. Wnt7a mRNA expression was prominent in induced sputum from patients with asthma compared with that from healthy controls. Next, we induced a chronic asthma mouse model with airway remodeling features, including subepithelial fibrosis and airway smooth muscle hyperplasia. Higher expression of Wnt family proteins and β-catenin was detected in the lung tissue of mice with chronic asthma compared to control mice. Blocking β-catenin expression with a specific siRNA attenuated airway inflammation and airway remodeling. Decreased subepithelial fibrosis and collagen accumulation in the β-catenin siRNA-treated mice was accompanied by reduced expression of transforming growth factor-β. We further showed that suppressing β-catenin in the chronic asthma model inhibited smooth muscle hyperplasia by downregulating the tenascin C/platelet-derived growth factor receptor pathway. Taken together, these findings demonstrate that the Wnt/β-catenin signaling pathway is highly expressed and regulates the development of airway remodeling in chronic asthma. PMID:26655831

  2. Identifying asthma triggers.

    PubMed

    McCarty, Justin C; Ferguson, Berrylin J

    2014-02-01

    Asthma has many triggers including rhinosinusitis; allergy; irritants; medications (aspirin in aspirin-exacerbated respiratory disease); and obesity. Paradoxic vocal fold dysfunction mimics asthma and may be present along with asthma. This article reviews each of these triggers, outlining methods of recognizing the trigger and then its management. In many patients more than one trigger may be present. Full appreciation of the complexity of these relationships and targeted therapy to the trigger is needed to best care for the patient with asthma.

  3. Effect of high dose inhaled glucocorticoids on quality of life in patients with moderate to severe asthma.

    PubMed

    Choi, Jae-Sung; Jang, An-Soo; Lee, June-Hyuk; Park, Jong-Sook; Park, Sung-Woo; Kim, Do-Jin; Park, Choon-Sik

    2005-08-01

    Asthma is a chronic disorder that can place considerable restrictions on the physical, emotional, and social aspects of the lives of patients. Inhaled glucocorticoids (GCs) are the most effective controller therapy. The purpose of this study was to evaluate the effect of inhaled GCs on quality of life in patients with moderate to severe asthma. Patients completed the asthma quality of life questionnaire (AQLQ) and pulmonary function test at baseline and after 4 wks treatment of GCs. We enrolled 60 patients who had reversibility in FEV1 after 200 microgram of albuterol of 15% or more and/or positive methacholine provocation test, and initial FEV1% predicted less than 80%. All patients received inhaled GCs (fluticasone propionate 1,000 microgram/day) for 4 wks. The score of AQLQ was significantly improved following inhaled GCs (overall 51.9+/-14.3 vs. 67.5+/-12.1, p<0.05). The change from day 1 to day 28 in FEV1 following inhaled GCs was diversely ranged from -21.0% to 126.8%. The improvement of score of AQLQ was not different between at baseline and after treatment of GCs according to asthma severity and GCs responsiveness. Quality of life was improved after inhaled GCs regardless of asthma severity and GCs responsiveness in patients with moderate to severe asthma. PMID:16100448

  4. Lung Microbiome Analysis in Steroid-Naїve Asthma Patients by Using Whole Sputum

    PubMed Central

    Jung, Jae-Woo; Choi, Jae-Chol; Shin, Jong-Wook; Kim, Jae-Yeol; Park, In-Won; Choi, Byoung Whui; Park, Heung-Woo; Cho, Sang-Heon

    2016-01-01

    Background Although recent metagenomic approaches have characterized the distinguished microbial compositions in airways of asthmatics, these results did not reach a consensus due to the small sample size, non-standardization of specimens and medication status. We conducted a metagenomics approach by using terminal restriction fragment length polymorphism (T-RFLP) analysis of the induced whole sputum representing both the cellular and fluid phases in a relative large number of steroid naïve asthmatics. Methods Induced whole sputum samples obtained from 36 healthy subjects and 89 steroid-naїve asthma patients were analyzed through T-RFLP analysis. Results In contrast to previous reports about microbiota in the asthmatic airways, the diversity of microbial composition was not significantly different between the controls and asthma patients (p=0.937). In an analysis of similarities, the global R-value showed a statistically significant difference but a very low separation (0.148, p=0.002). The dissimilarity in the bacterial communities between groups was 28.74%, and operational taxonomic units (OTUs) contributing to this difference were as follows: OTU 789 (Lachnospiraceae), 517 (Comamonadaceae, Acetobacteraceae , and Chloroplast), 633 (Prevotella), 645 (Actinobacteria and Propionibacterium acnes), 607 (Lactobacillus buchneri, Lactobacillus otakiensis, Lactobacillus sunkii, and Rhodobacteraceae), and 661 (Acinetobacter, Pseudomonas, and Leptotrichiaceae), and they were significantly more prevalent in the sputum of asthma patients than in the sputum of the controls. Conclusion Before starting anti-asthmatic treatment, the microbiota in the whole sputum of patients with asthma showed a marginal difference from the microbiota in the whole sputum of the controls. PMID:27433177

  5. Meta-analysis of the efficacy and safety of bronchial thermoplasty in patients with moderate-to-severe persistent asthma.

    PubMed

    Wu, Q; Xing, Y; Zhou, X; Wang, D

    2011-01-01

    This meta-analysis assessed the efficacy and safety of a novel intervention for asthma, bronchial thermoplasty (BT), in patients with moderate-to-severe persistent asthma. An electronic literature search identified three randomized controlled trials (RCT) of BT that recruited 421 patients in total. Outcomes of interest were the Asthma Quality of Life Questionnaire (AQLQ) score, morning peak expiratory flow (PEF), tolerability and safety. Compared with standard medications and sham BT treatment, BT significantly improved AQLQ scores and PEF from baseline to the end of the trials. There were more respiratory adverse events and hospitalizations for adverse respiratory events with BT than with medications or sham treatment during the treatment period, but most events resolved, on average, within a week. This effect of BT treatment was not seen during the posttreatment period. Additional long-term RCT are required to confirm whether BT provides benefit to patients with moderate-to-severe persistent asthma.

  6. Comparison of Oral Montelukast and Intranasal Fluticasone in Patients with Asthma and Allergic Rhinitis

    PubMed Central

    Jindal, Apar; Sagadevan, Suresh; Narasimhan, Meenakshi; Shanmuganathan, Aruna; Vallabhaneni, Viswambhar; Rajalingam, Ragulan

    2016-01-01

    Introduction Even though the links between upper and lower airway had been of interest to clinicians since long back, it has not attracted the attention of the researchers till recent past. But the evidence is still far from conclusive, due to limited number of randomized controlled trials available on subjects with concomitant allergic rhinitis and asthma. This gap in the knowledge is even more conspicuous in Indian population. Aim The current study is conducted with an objective of comparing the efficacy and tolerability of intranasal Fluticasone and oral Montelukast in treatment of allergic rhinitis and bronchial asthma. Materials and Methods The study was a prospective randomized, single blinded, comparative, parallel group study, with two intervention groups conducted in a tertiary teaching hospital in Chennai, Southern India. One hundred and twenty patients diagnosed with concomitant diagnosis of allergic rhinitis and bronchial asthma was randomly allocated to either Fluticasone propionate aqueous nasal spray or oral Montelukast group. Results Out of total 120 subjects recruited, 108 subjects were included in the final analysis. The mean reduction in asthma and rhinitis symptom scores and improvement in PEFR was higher for Group A, compared to Group B during all the follow-up periods. No statistically significant difference was observed in proportion of subjects reporting exacerbations in the current study. Both the treatments were well tolerated. Conclusion Addition of intranasal Fluticasone propionate to Salmeterol plus Fluticasone is beneficial in improving asthma control, allergic rhinitis control and lung functions as compared to oral Montelukast. Thereby the use of intranasal Fluticasone Propionate in comparison to oral Montelukast in control of Allergic Rhinitis is justified as per the significant improvement in outcome measures. PMID:27656477

  7. Interaction effect of psychological distress and asthma control on productivity loss?

    PubMed

    Moullec, Grégory; FitzGerald, J Mark; Rousseau, Roxanne; Chen, Wenjia; Sadatsafavi, Mohsen

    2015-06-01

    Little is known about the potential synergistic effect of comorbid psychological distress (PD) and uncontrolled asthma (UA) on productivity loss. We estimated the productivity loss associated with the combination of these two potentially preventable conditions in employed adults with asthma. A population-based random sample of 300 adults with asthma in British Columbia, Canada, was prospectively recruited between Dec 2010 and Aug 2012. PD and productivity loss due to absenteeism and presenteeism was measured using validated instruments, and asthma control was ascertained using 2010 Global Initiative for Asthma management strategy. We used two-part regression models to study the contribution of UA and PD to productivity loss. Compared with reference group (controlled asthma (CA)+noPD), those with UA+noPD had CAD$286 (95%CI $276-297) weekly productivity loss, and those with CA+PD had CAD$465 ($445-485). Those with UA+PD had CAD$449 (437-462) in productivity loss. There was no significant interaction effect of PD with asthma control levels on productivity loss (p=0.22). In patients without PD, uncontrolled asthma was associated with a higher productivity loss than controlled asthma, but this was not the case in patients with PD. This finding can be explained by the fact that the contribution of PD to productivity loss is so large that there is no room for synergy with asthma control. Future studies should assess the impact of interventions that modify PD in patients with asthma.

  8. Psychological Factors in Asthma

    PubMed Central

    2008-01-01

    Asthma has long been considered a condition in which psychological factors have a role. As in many illnesses, psychological variables may affect outcome in asthma via their effects on treatment adherence and symptom reporting. Emerging evidence suggests that the relation between asthma and psychological factors may be more complex than that, however. Central cognitive processes may influence not only the interpretation of asthma symptoms but also the manifestation of measurable changes in immune and physiologic markers of asthma. Furthermore, asthma and major depressive disorder share several risk factors and have similar patterns of dysregulation in key biologic systems, including the neuroendocrine stress response, cytokines, and neuropeptides. Despite the evidence that depression is common in people with asthma and exerts a negative impact on outcome, few treatment studies have examined whether improving symptoms of depression do, in fact, result in better control of asthma symptoms or improved quality of life in patients with asthma. PMID:20525122

  9. Macrolide antibiotics for treatment of asthma in adults: a meta-analysis of 18 randomized controlled clinical studies.

    PubMed

    Tong, Xiang; Guo, Tingting; Liu, Sitong; Peng, Shifeng; Yan, Zhipeng; Yang, Xin; Zhang, Yonggang; Fan, Hong

    2015-04-01

    Mounting studies have been showed that long-term macrolides used in patients with asthma could improve the lung function and symptoms. However, a large number of studies have reported inconclusive results. The aim of this meta-analysis was to investigate the effect of macrolide antibiotics in patients with asthma. We have performed a search in PubMed, Embase, China National Knowledge Internet (CNKI), and Wanfang databases. The weighed mean difference (WMD) or standardized mean difference (SMD) was used to evaluate the pooled effect. Statistical analysis was performed by STATA 11.0 software. Totally 1306 patients were included in the meta-analysis. The overall results indicated that statistically significance of long-term macrolides therapy in patients with asthma on forced expiratory volume in 1 s (FEV1) (WMD: 0.11, P < 0.01), peak expiratory flow (PEF) (SMD: 0.25, P = 0.001), airway hyper-responsiveness (AHR) (SMD: 0.90, P = 0.04), forced vital capacity (FVC) (WMD: 0.18, P = 0.05) and FEV1/FVC (WMD: 1.93, P < 0.001), but no statistically significance on FEV1/predict, FVC/predict, symptom scores, quality of life scores (QOL), reliever inhaler puffs per 24 h, and cell counts in sputum and blood. The subgroup analysis indicated macrolides could increase FEV1 and PEF in Caucasian and Asian, decrease AHR in Caucasian, while cells counts of sputum improvement among Asian. Therefore, the study suggested that long-term marolides therapy in asthma may improved the FEV1, PEF, AHR, FVC, FEV1/FVC and cells counts in sputum, but it can't improve other lung function (FEV1/predict and FVC/predict) and clinical outcomes (such as symptom, quality of life etc.).

  10. Asthma Patients in US Overuse Quick-Relief Inhalers, Underuse Control Medications

    MedlinePlus

    American Academy of Allergy Asthma & Immunology Menu Search Main navigation Skip to content Conditions & Treatments Allergies Asthma Primary Immunodeficiency Disease Related Conditions Drug Guide Conditions Dictionary Just ...

  11. Acupuncture Treatment of a Patient with Persistent Allergic Rhinitis Complicated by Rhinosinusitis and Asthma

    PubMed Central

    Kim, Ae-Ran; Choi, Jun-Yong; Kim, Jong-In; Jung, So-Young; Choi, Sun-Mi

    2011-01-01

    A pathophysiologic relationship between allergic rhinitis and rhinosinusitis and asthma has long been suggested. However, few clinical studies of acupuncture have been conducted on these comorbid conditions. A 48-year-old male suffering from persistent allergic rhinitis with comorbid chronic rhinosinusitis and asthma since the age of 18 years was studied. He complained of nasal obstruction, sneezing, cough, rhinorrhea and moderate dyspnea. He occasionally visited local ear-nose-throat clinics for his nasal symptoms, but gained only periodic symptom relief. The patient was treated with acupuncture, infrared radiation to the face and electro-acupuncture. Needles were inserted at bilateral LI20, GV23, LI4 and EX-1 sites with De-qi. Electro-acupuncture was performed simultaneously at both LI20 sites and additional traditional Korean acupuncture treatments were performed. Each session lasted for 10 min and the sessions were carried out twice a week for 5 weeks. The patient's Mini-Rhinoconjunctivitis Quality-of-Life Questionnaire score decreased from 38, at the beginning of treatment, to 23, 3 weeks after the last treatment. The Total Nasal Symptom Score was reduced from six (baseline) to five, 3 weeks after the last treatment. There was significant clinical improvement in the forced expiratory volume in 1 s—from 3.01 to 3.50 l—with discontinuation of the inhaled corticosteroid, and no asthma-related complaints were reported. Further clinical studies investigating the effectiveness of acupuncture for the patients suffering from allergic rhinitis and/or rhinosinusitis with comorbid asthma are needed. PMID:21785632

  12. Similar activation state of neutrophils in sputum of asthma patients irrespective of sputum eosinophilia.

    PubMed

    Tak, T; Hilvering, B; Tesselaar, K; Koenderman, L

    2015-11-01

    Inflammatory phenotypes of asthma are associated with differences in disease characteristics. It is unknown whether these inflammatory phenotypes are reflected by the activation status of neutrophils in blood and sputum. We obtained peripheral blood and induced sputum from 21 asthma patients and stratified our samples based on sputum eosinophilia resulting in two groups (>3% eosinophils: n = 13, <3%: n = 8). Eosinophils and neutrophils from blood and sputum were analysed for expression of activation and degranulation markers by flow cytometry. Data were analysed by both classical, non-parametric statistics and a multi-dimensional approach, using principal component analysis (PCA). Patients with sputum eosinophilia were characterized by increased asthma control questionnaire (ACQ) scores and blood eosinophil counts. Both sputum neutrophils and eosinophils displayed an activated and degranulated phenotype compared to cells obtained from blood. Specifically, degranulation of all granule types was detected in sputum cells, combined with an increased expression of the activation markers (activated) Mac-1 (CD11b), programmed death ligand 1 (PD-L1) (CD274) and a decreased expression of CD62L. CD69 expression was only increased on sputum eosinophils. Surface marker expression of neutrophils was similar in the presence or absence of eosinophilia, either by single or multi-dimensional analysis. Sputum neutrophils were highly activated and degranulated irrespective of sputum eosinophilia. Therefore, we conclude that differences in granulocyte activation in sputum and/or blood are not associated with clinical differences in the two groups of asthma patients. The finding of PD-L1 expression on sputum granulocytes suggests an immunomodulatory role of these cells in the tissue.

  13. [The quality-of-life questionnaire with asthma patients: the Spanish version of the Asthma Quality of Life Questionnaire].

    PubMed

    Sanjuàs, C; Alonso, J; Sanchís, J; Casan, P; Broquetas, J M; Ferrie, P J; Juniper, E F; Antó, J M

    1995-05-01

    This paper describes the translation to Castilian and adaptation of a quality of life measurement instrument: the Asthma Quality of Life Questionnaire (AQLQ). The AQLQ, developed by Juniper et al, contains 32 items, 5 of which relate to habitual activities that the patient can choose from among a list of 26 possibilities. Answers are given on a scale of 7 points. To adapt this instrument for use in Spain, we subjected it to a process of translation/back translation by bilingual informants. The translated and original versions of each item, activity and answer option were evaluated as being totally equivalent (A), fairly equivalent but with some questionable wording (B), or of questionable equivalence (C). The naturalness and correctness of the Spanish version were also evaluated on a scale of 1 to 10. Three (9%) items and 1 (4%) activity were considered to be of questionable equivalence (C) and 12 (37%) items and 1 activity (4%) were considered to be of type B equivalence. The questionable aspects of types B and C equivalence were discussed in 2 meetings, along with expressions that were equivalent but unnatural or grammatically incorrect; the first meeting involved researchers and translators and the second was held with a group of 6 asthmatics. Consensus was finally obtained for each item and activity included in the second draft. That draft was then administered to another group of 7 patients in order to check comprehension and equivalence, after which a definitive version was produced by the researchers.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7788083

  14. Allergic sensitization to ornamental plants in patients with allergic rhinitis and asthma.

    PubMed

    Aydin, Ömür; Erkekol, Ferda Öner; Misirloigil, Zeynep; Demirel, Yavuz Selim; Mungan, Dilşad

    2014-01-01

    Ornamental plants (OPs) can lead to immediate-type sensitization and even asthma and rhinitis symptoms in some cases. This study aimed to evaluate sensitization to OPs in patients with asthma and/or allergic rhinitis and to determine the factors affecting the rate of sensitization to OPs. A total of 150 patients with asthma and/or allergic rhinitis and 20 healthy controls were enrolled in the study. Demographics and disease characteristics were recorded. Skin-prick tests were performed with a standardized inhalant allergen panel. Skin tests by "prick-to-prick" method with the leaves of 15 Ops, which are known to lead to allergenic sensitization, were performed. Skin tests with OPs were positive in 80 patients (47.1%). There was no significant difference between OP sensitized and nonsensitized patients in terms of gender, age, number of exposed OPs, and duration of exposure. Skin test positivity rate for OPs was significantly high in atopic subjects, patients with allergic rhinitis, food sensitivity, and indoor OP exposure, but not in patients with pollen and latex allergy. Most sensitizing OPs were Yucca elephantipes (52.5%), Dieffenbachia picta (50.8%), and Euphorbia pulcherrima (47.5%). There was significant correlation between having Saintpaulia ionantha, Croton, Pelargonium, Y. elephantipes, and positive skin test to these plants. Sensitivity to OPs was significantly higher in atopic subjects and patients with allergic rhinitis, food allergy, and indoor OP exposure. Furthermore, atopy and food sensitivity were found as risk factors for developing sensitization to indoor plants. Additional trials on the relationship between sensitization to OPs and allergic symptoms are needed. PMID:24717779

  15. [Efficiency of a combination of haloaerosols and helium-neon laser in the multimodality treatment of patients with bronchial asthma].

    PubMed

    Faradzheva, N A

    2007-01-01

    A hundred and thirty-eight patients with infection-dependent bronchial asthma, including 73 with moderate persistent asthma and 65 with severe persistent one, were examined. Four modes of a combination of traditional (drug) therapy (DT) and untraditional (halotherapy (HT) and endobronchial helium-neon laser irradiation (ELI) one were used. The efficiency of the treatment performed was evaluated, by determining the time course of clinical symptoms of the disease on the basis of scores of their magnitude and the patients' condition. The findings indicated that in moderate persistent asthma, both HT and ELI in combination with DT exerted an equal therapeutic effect, which provided a good and excellent condition in 83.3% of cases. In severe persistent asthma, such a condition was achieved in 93.75% of cases only when multimodality treatment involving DT, HT, and ELI had been performed. PMID:17915468

  16. [Melatonin production in thrombocytes and their functional activity in patients with aspirin asthma].

    PubMed

    Evsiukova, E V; Muraia, E V; Zubzhitskaia, L B; Kveshnoĭ, I M

    2007-01-01

    The aim of the investigation was to study melatonin production in thrombocytes and their functional activity in correlation with 6-sulfatoximelatonin (6-SOM) urinary excretion in patients with aspirin-induced bronchial asthma (AIBA). Forty-three patients with bronchial asthma (BA) were examined. The main group consisted of 26 AIBA patients; the comparison group consisted of 17 BA patients with no intolerance to aspirin or other non-steroidal anti-inflammatory drugs; 30 practically healthy individuals constituted the control group. The study found no melatonin production in thrombocytes of AIBA patients: only 13.0 +/- 1.3% of platelets expressed melatonin, while in healthy people 97.7 +/- 0.6% of the cells did. Besides, daytime urinary excretion of 6-SOM, the main melatonin metabolite, was lower in AIBA patients. Lower daytime and higher nighttime melatonin production in AIBA patients correlated with the acceleration of the 1st phase and increased intensity of thrombocyte aggregation, which evidences high thrombocyte reactivity to the inducing agent. The presence of a pathologic reaction of thrombocytes to exogenous melatonin, manifesting by changes in the 1st stage of aggregation, suggests the presence of pathology in thrombocyte membrane-receptor complex and the calcium homeostasis of the cell, which determines constant activation and the participation of thrombocytes in the development of asthmatic syndrome. PMID:18154178

  17. Prescription Acquired Acetaminophen Use and the Risk of Asthma in Adults: A Case Control Study

    PubMed Central

    Kelkar, Mugdha; Cleves, Mario A.; Foster, Howell R.; Hogan, William R.; James, Laura P.

    2013-01-01

    Background Studies have examined the association between acetaminophen (APAP) use and asthma; however, their interpretation is limited by a number of methodological issues. Objective We sought to investigate the association between recent and chronic prescription acquired acetaminophen use and asthma. Methods This was a retrospective case control study using a 10% random sample of the IMS LifeLink commercial claims data from 1997 to 2009. Cases had to have at least 1 incident claim of asthma. 3:1 controls matched on age, gender, and region were randomly chosen. APAP exposure, dose and duration were measured in the 7 and 30 days (recent) and in the 1-year (chronic) look-back period. Multivariable conditional logistic regression was used to estimate the risk of asthma associated with acetaminophen use adjusted for comorbidities, other drugs increasing asthma risk, and health system factors. Results There were 28,892 cases and 86,676 controls with mean age 42.7 years and 37.7% were males. 22.6% cases and 18.2% controls had APAP exposure in the pre-index year with mean cumulative doses of 78.7 gm and 59.8 gm respectively. There was no significant association between recent prescription APAP exposure and asthma (7 days: OR = 1.02, p = 0.74; 30 days: OR = 0.97, p = 0.38). Cumulative prescription APAP dose in the year prior increased asthma risk compared to APAP nonusers (<=1 kg: OR = 1.09, p <0.001 and >1 kg: OR = 1.60, p=0.02). Duration of prescription APAP use >30 days was associated with elevated asthma risk (OR = 1.39, p <0.001). Conclusion Chronic prescription-acquired APAP use was associated with an increased risk of asthma while recent use was not. However, over the counter APAP use was not captured in this study and further epidemiologic research with complete APAP exposure ascertainment and research on pathophysiological mechanisms is needed to confirm these relationships. PMID:23170033

  18. Early prediction of poor outcome in patients with acute asthma in the emergency room.

    PubMed

    Mallmann, F; Fernandes, A K; Avila, E M; Nogueira, F L; Steinhorst, A M P; Saucedo, D Z; Machado, F J; Raymundi, M G; Dalcin, P T R; Menna Barreto, S S

    2002-01-01

    Early identification of patients who need hospitalization or patients who should be discharged would be helpful for the management of acute asthma in the emergency room. The objective of the present study was to examine the clinical and pulmonary functional measures used during the first hour of assessment of acute asthma in the emergency room in order to predict the outcome. We evaluated 88 patients. The inclusion criteria were age between 12 and 55 years, forced expiratory volume in the first second below 50% of predicted value, and no history of chronic disease or pregnancy. After baseline evaluation, all patients were treated with 2.5 mg albuterol delivered by nebulization every 20 min in the first hour and 60 mg of intravenous methylprednisolone. Patients were reevaluated after 60 min of treatment. Sixty-five patients (73.9%) were successfully treated and discharged from the emergency room (good responders), and 23 (26.1%) were hospitalized or were treated and discharged with relapse within 10 days (poor responders). A predictive index was developed: peak expiratory flow rates after 1 h < or =0% of predicted values and accessory muscle use after 1 h. The index ranged from 0 to 2. An index of 1 or higher presented a sensitivity of 74.0, a specificity of 69.0, a positive predictive value of 46.0, and a negative predictive value of 88.0. It was possible to predict outcome in the first hour of management of acute asthma in the emergency room when the index score was 0 or 2.

  19. Switching patients with asthma from chlorofluorocarbon (CFC) albuterol to hydrofluoroalkane-134a (HFA) albuterol.

    PubMed

    Bronsky, E; Ekholm, B P; Klinger, N M; Colice, G L

    1999-01-01

    Chlorofluorocarbon (CFC) propellants deplete stratospheric ozone. Production and use of CFCs, except for certain critical exemptions, has been prohibited by the Montreal Protocol. Use of CFCs as propellants in metered-dose inhalers (MDIs) is still allowed, but the U.S. Food and Drug Administration is planning the transition to alternative propellants for use in MDIs. Hydrofluoroalkane-134a (HFA), a non-ozone-depleting propellant, has been used to reformulate albuterol (HFA albuterol). This study evaluates whether comparable safety and efficacy continues for 12 weeks after patients with asthma are switched from CFC albuterol to HFA albuterol. Patients with asthma stabilized on CFC albuterol during a 12-week safety and efficacy trial were randomized to either continue receiving CFC albuterol or to be switched to receive HFA albuterol in a yearlong safety and efficacy trial. Safety and efficacy were compared over the first 12 weeks of the yearlong trial between patients who had remained on CFC albuterol and those who had been switched to HFA albuterol. Bronchodilator efficacy was evaluated by serial spirometry for 6 hr after the patients self-administered the study drug in the clinic. Safety was assessed by measuring changes in pulse rate, blood pressure, and electrocardiogram (ECG) intervals after dosing with study drug, monitoring adverse events, and performing prestudy and poststudy laboratory testing and physical examinations. No significant differences in bronchodilator efficacy between the patients continuing to receive CFC albuterol and those switched to HFA albuterol were found in the 12 weeks after the switch. No differences between the two products were found for changes in pulse rate, blood pressure, and ECG intervals. Adverse event profiles were similar for the two products, except the patients remaining on CFC albuterol reported increased asthma symptoms and rhinitis significantly more often than the patients switched to HFA albuterol. No clinically

  20. Bronchial Hyperreactivity to Prostaglandin F2α and Histamine in Patients with Asthma

    PubMed Central

    Mathé, A. A.; Hedqvist, P.; Holmgren, A.; Svanborg, N.

    1973-01-01

    The influence on airway conductance of inhaled aerosols of prostaglandin F2α (PGF2α), histamine, and prostaglandin E2 (PGE2) was studied in 10 patients with spirometrically reversible bronchial asthma and in 10 healthy subjects with no history of lung disorder. Both groups responded with bronchoconstriction after inhalation of PGF2α but the asthmatic patients were about 8,000 times more sensitive to the compound than were the healthy controls. In the patients, but not in the controls, PGF2α often caused a long-standing decrease in airway conductance with symptoms resembling allergen-provoked asthmatic attacks. On the other hand, the patients showed less than a 10-fold increase in sensitivity to histamine, and the ratio of histamine: PGF2α doses causing a 50% decrease of airway conductance was 2·6:1 and 2,400:1 in controls and patients respectively. Inhalation of PGE2 while moderately but consistently increasing airway conductance in controls, had a variable—occasionally slight bronchoconstrictive—effect in patients. The decrease in airway conductance by a given dose of PGF2α was little modified by the simultaneous inhalation of a 100-times higher PGE2 dose. It is suggested that endogenous, locally formed PGF2α may play an important part in the pathogenesis of bronchial asthma. PMID:4686554

  1. Respiratory and cardiac effects of metoprolol and bevantolol in patients with asthma.

    PubMed

    Wilcox, P G; Ahmad, D; Darke, A C; Parsons, J; Carruthers, S G

    1986-01-01

    The effects on standing heart rate and respiratory function of two relatively selective beta 1-adrenoceptor antagonists, metoprolol and bevantolol, were compared in a double-blind, randomized, crossover study of 16 patients with asthma. After control observations on 2 separate days, the patients received approximately equivalent cardiac beta-adrenoceptor antagonist doses of metoprolol, 12.5, 25, 50, and 100 mg, and bevantolol, 18.75, 37.5, 75 and 150 mg, at intervals of 2 hours. Dosing was stopped if symptoms warranted or if there was a fall of greater than or equal to 20% in the forced expiratory volume in 1 second. In general, the cumulative dosing regimen proved a safe and effective means of assessing bronchial responsiveness to these beta-blockers in asthma, but one patient had to be dropped from the study because of severe bronchoconstriction after the first dose. Of the 15 patients studied who were taking both drugs, seven patients were withdrawn prematurely. In these seven patients, the average maximum tolerated cumulative doses were 45.5 mg bevantolol and 26.8 mg metoprolol, doses that are much lower than those usually required for therapeutic activity. The respiratory response to either drug could not be predicted.

  2. Nedocromil sodium and sodium cromoglycate in patients aged over 50 years with asthma.

    PubMed

    Boldy, D A; Ayres, J G

    1993-10-01

    We conducted a double-blind parallel-group study to compare the efficacy of inhaled nedocromil sodium and inhaled sodium cromogylcate in patients aged 50 years or over with asthma. Seventy-seven patients were randomized, 38 to receive nedocromil sodium (4 mg q.d.s.) and 39 to receive sodium cromoglycate (10 mg q.d.s.) over a 16-week period. Eight patients withdrew from the study. Both patient groups showed a reduction in inhaled bronchodilator usage during the treatment period. No statistically significant differences were seen in diary card PEF recordings or symptom scores. Both clinic PEF and FEV1 were significantly greater (P < 0.05) in the sodium cromoglycate group at week 12. Patients considered the treatment to be very or moderately effective in 59% of the nedocromil sodium group and 50% of the sodium cromoglycate group. Thus, the study suggests that there is no difference in response to nedocromil sodium or sodium cromoglycate in this older group of patients with asthma who are already on moderate doses of inhaled steroids.

  3. Protective effect of early prenatal stress on the induction of asthma in adult mice: Sex-specific differences.

    PubMed

    Vargas, Mauro Henrique Moraes; Campos, Natália Evangelista; de Souza, Rodrigo Godinho; da Cunha, Aline Andrea; Nuñez, Nailê Karine; Pitrez, Paulo Márcio; Donadio, Márcio Vinícius Fagundes

    2016-10-15

    Adversities faced during the prenatal period can be related to the onset of diseases in adulthood. However, little is known about the effects on the respiratory system. This study aimed to evaluate the effects of prenatal stress in two different time-points during pregnancy on pulmonary function and on the inflammatory profile of mice exposed to an asthma model. Male and female BALB/c mice were divided into 3 groups: control (CON), prenatal stress from the second week of pregnancy (PNS1) and prenatal stress on the last week of pregnancy (PNS2). Both PNS1 and PNS2 pregnant females were submitted to restraint stress. As adults, fear/anxiety behaviors were assessed, and animals were subjected to an asthma model induced by ovalbumin. Pulmonary function, inflammatory parameters in bronchoalveolar lavage (BAL) and histology were evaluated. There was a significant decrease in the number of entries and time spent in the central quadrant on the open field test for the PNS1 animals. Females (PNS1) showed improved pulmonary function (airway resistance, tissue damping and pulmonary elastance), significant increase in the percentage of neutrophils and lymphocytes and a decrease in eosinophils when compared to controls. There was a significant decrease in inflammatory cytokines in BAL of both males (IL-5 and IL-13) and females (IL-4, IL-5 and IL-13) from PNS1 and PNS2 when compared to the CON group. Prenatal stress starting from the beginning of pregnancy reduces the impact of asthma development in adult female mice, showing an improved pulmonary function and a lower inflammatory response in the lungs. PMID:27568231

  4. Protective effect of early prenatal stress on the induction of asthma in adult mice: Sex-specific differences.

    PubMed

    Vargas, Mauro Henrique Moraes; Campos, Natália Evangelista; de Souza, Rodrigo Godinho; da Cunha, Aline Andrea; Nuñez, Nailê Karine; Pitrez, Paulo Márcio; Donadio, Márcio Vinícius Fagundes

    2016-10-15

    Adversities faced during the prenatal period can be related to the onset of diseases in adulthood. However, little is known about the effects on the respiratory system. This study aimed to evaluate the effects of prenatal stress in two different time-points during pregnancy on pulmonary function and on the inflammatory profile of mice exposed to an asthma model. Male and female BALB/c mice were divided into 3 groups: control (CON), prenatal stress from the second week of pregnancy (PNS1) and prenatal stress on the last week of pregnancy (PNS2). Both PNS1 and PNS2 pregnant females were submitted to restraint stress. As adults, fear/anxiety behaviors were assessed, and animals were subjected to an asthma model induced by ovalbumin. Pulmonary function, inflammatory parameters in bronchoalveolar lavage (BAL) and histology were evaluated. There was a significant decrease in the number of entries and time spent in the central quadrant on the open field test for the PNS1 animals. Females (PNS1) showed improved pulmonary function (airway resistance, tissue damping and pulmonary elastance), significant increase in the percentage of neutrophils and lymphocytes and a decrease in eosinophils when compared to controls. There was a significant decrease in inflammatory cytokines in BAL of both males (IL-5 and IL-13) and females (IL-4, IL-5 and IL-13) from PNS1 and PNS2 when compared to the CON group. Prenatal stress starting from the beginning of pregnancy reduces the impact of asthma development in adult female mice, showing an improved pulmonary function and a lower inflammatory response in the lungs.

  5. Approach to Patients with Severe Asthma: a Consensus Statement from the Respiratory Care Experts’ Input Forum (RC-EIF), Iran

    PubMed Central

    Ansarin, Khalil; Attaran, Davood; Jamaati, Hamidreza; Masjedi, Mohammad Reza; Abtahi, Hamidreza; Alavi, Ali; Aliyali, Masoud; Asnaashari, Amir Mohammad Hashem; Farid-Hosseini, Reza; Ghayumi, Seyyed Mohammad Ali; Ghobadi, Hassan; Ghotb, Atabak; Halvani, Abolhassan; Nemati, Abbas; Rahimi Rad, Mohammad Hossein; Rahimian, Masoud; Sami, Ramin; Sohrabpour, Hamid; Tavana, Sasan; Vahedi, Parviz

    2015-01-01

    Challenges in the assessment, diagnosis and management of severe, difficult-to-control asthma are increasingly regarded as clinical needs yet unmet. The assessments required to determine asthma severity, comorbidities and confounding factors, disease phenotypes and optimal treatment are among the controversial issues in the field. The respiratory care experts’ input forum (RC-EIF), comprised of an Iranian panel of experts, reviewed the definition, appraised the available guidelines and provided a consensus for evaluation and treatment of severe asthma in adults. A systematic literature review followed by discussions during and after the forum, yielded the present consensus. The expert panel used the appraisal of guidelines for research and evaluation-II (AGREE-II) protocol to define an initial locally-adapted strategy for the management of severe asthma. Severe asthma is considered a heterogeneous condition with various phenotypes. Issues such as assessment of difficult-to-control asthma, phenotyping, the use of blood and sputum eosinophil count, exhaled nitric oxide to guide therapy, the position of anti-IgE antibody, methotrexate, macrolide antibiotics, antifungal agents and bronchial thermoplasty as well as the use of established, recently-developed and evolving treatment approaches were discussed and unanimously agreed upon in the panel. A systematic approach is required to ensure proper diagnosis, evaluate compliance, and to identify comorbidities and triggering factors in severe asthma. Phenotyping helps select optimized treatment. The treatment approach laid down by the Global Initiative for Asthma (GINA) needs to be followed, while the benefit of using biological therapies should be weighed against the cost and safety concerns. PMID:26528362

  6. Associations of Toll-like receptor 7 and 8 Polymorphisms with Asthma and Asthma-related Phenotypes in a Chinese Han Population.

    PubMed

    Zhang, Qian; Qian, Fen-Hong; Yin, Xiao-Wei; Cao, Qi; Bai, Jian-Ling; Du, Qiang; Shi, Yi

    2015-12-01

    Toll-like receptor (TLR) 7 and 8 mediate anti-virus immunity and are of particular relevance to asthma. However, very little information about genetic association on TLR7/8 and asthma are available. This study aimed to evaluate the effects of polymorphisms in TLR7 and 8 on asthma risk and asthma-related phenotypes in a Chinese Han population. We enrolled 462 unrelated adult asthmatic patients and 398 healthy volunteers. The genotypes of tagging single nucleotide polymorphisms (SNPs) in TLR7 and 8 genes were determined using multiplex SNaPshot SNP genotyping assay. We used case-control and case-only studies to assess any links with asthma and asthma-related phenotypes. There was no association between the variants in TLR7 and 8 and asthma susceptibility. However, our results revealed that the genetic variants in TLR7 and 8 were associated with asthma-related phenotypes, including eosinophil counts, serum immunoglobulin E levels, lung function, and asthma severity as well. Our study suggests that TLR7 and 8 polymorphisms may play a considerable role in the pathogenesis of asthma. It will help in better understanding the pathogenesis of asthma and development of more effective strategies for asthma prevention, prediction, and therapy.

  7. Endothelin-1 in exhaled breath condensate of allergic asthma patients with exercise-induced bronchoconstriction

    PubMed Central

    Zietkowski, Ziemowit; Skiepko, Roman; Tomasiak, Maria M; Bodzenta-Lukaszyk, Anna

    2007-01-01

    Background Exercise-induced bronchoconstriction (EIB) is a highly prevalent condition, whose pathophysiology is not well understood. Endothelins are proinflammatory, profibrotic, broncho- and vasoconstrictive peptides which play an important role in the development of airway inflammation and remodeling in asthma. The aim of the study was to evaluate the changes in endothelin-1 levels in exhaled breath condensate following intensive exercise in asthmatic patients. Methods The study was conducted in a group of 19 asthmatic patients (11 with EIB, 8 without EIB) and 7 healthy volunteers. Changes induced by intensive exercise in the concentrations of endothelin-1 (ET-1) in exhaled breath condensate (EBC) during 24 hours after an exercise challenge test were determined. Moreover, the possible correlations of these measurements with the results of other tests commonly associated with asthma and with the changes of airway inflammation after exercise were observed. Results In asthmatic patients with EIB a statistically significant increase in the concentration of ET-1 in EBC collected between 10 minutes and 6 hours after an exercise test was observed. The concentration of ET-1 had returned to its initial level 24 hours after exercise. No effects of the exercise test on changes in the concentrations of ET-1 in EBC in either asthmatic patients without EIB or healthy volunteers were observed. A statistically significant correlation between the maximum increase in ET-1 concentrations in EBC after exercise and either baseline FENO and the increase in FENO or BHR to histamine 24 hours after exercise in the groups of asthmatics with EIB was revealed. Conclusion The release of ET-1 from bronchial epithelium through the influence of many inflammatory cells essential in asthma and interactions with other cytokines, may play an important role in increase of airway inflammation which was observed after postexercise bronchoconstriction in asthmatic patients. PMID:17973986

  8. Nocturnal emergency department visits, duration of symptoms and risk of hospitalisation among adults with asthma exacerbations: a multicentre observational study

    PubMed Central

    Yasuda, Hideto; Hagiwara, Yusuke; Watase, Hiroko; Hasegawa, Kohei

    2016-01-01

    Objectives We sought to compare the characteristics of patients with asthma presenting to the emergency department (ED) during the night-time with those of patients presenting at other times of the day, and to determine whether the time of ED presentation is associated with the risk of hospitalisation. Design and setting A multicentre chart review study of 23 EDs across Japan. Participants Patients aged 18–54 years with a history of physician-diagnosed asthma, presented to the ED between January 2009 and December 2011 Outcome measures The outcome of interest was hospitalisation, including admissions to an observation unit, inpatient unit and intensive care unit. Results Among the 1354 patients (30.1% in the night-time group vs 69.9% in the other time group) included in this study, the median age was 34 years and ∼40% were male. Overall 145 patients (10.7%) were hospitalised. Patients in the night-time group were more likely to have a shorter duration of symptoms (≤3 hours) before ED presentation than those in the other time group (25.9% in night-time vs 13.4% in other times; p<0.001). In contrast, there were no significant differences in respiratory rate, initial peak expiratory flow or ED asthma treatment between the two groups (p>0.05). Similarly, the risk of hospitalisation did not differ between the two groups (11.3% in night-time vs 10.5% in other times; p=0.65). In a multivariable model adjusting for potential confounders, the risk of hospitalisation in the night-time group was not statistically different from the other time group (OR, 1.10; 95% CI 0.74 to 1.61; p=0.63). Conclusions This multicentre study in Japan demonstrated no significant difference in the risk of hospitalisations according to the time of ED presentation. PMID:27519919

  9. Serious Asthma Events with Budesonide plus Formoterol vs. Budesonide Alone.

    PubMed

    Peters, Stephen P; Bleecker, Eugene R; Canonica, Giorgio W; Park, Yong B; Ramirez, Ricardo; Hollis, Sally; Fjallbrant, Harald; Jorup, Carin; Martin, Ubaldo J

    2016-09-01

    Background Concerns remain about the safety of adding long-acting β2-agonists to inhaled glucocorticoids for the treatment of asthma. In a postmarketing safety study mandated by the Food and Drug Administration, we evaluated whether the addition of formoterol to budesonide maintenance therapy increased the risk of serious asthma-related events in patients with asthma. Methods In this multicenter, double-blind, 26-week study, we randomly assigned patients, 12 years of age or older, who had persistent asthma, were receiving daily asthma medication, and had had one to four asthma exacerbations in the previous year to receive budesonide-formoterol or budesonide alone. Patients with a history of life-threatening asthma were excluded. The primary end point was the first serious asthma-related event (a composite of adjudicated death, intubation, and hospitalization), as assessed in a time-to-event analysis. The noninferiority of budesonide-formoterol to budesonide was defined as an upper limit of the 95% confidence interval for the risk of the primary safety end point of less than 2.0. The primary efficacy end point was the first asthma exacerbation, as assessed in a time-to-event analysis. Results A total of 11,693 patients underwent randomization, of whom 5846 were assigned to receive budesonide-formoterol and 5847 to receive budesonide. A serious asthma-related event occurred in 43 patients who were receiving budesonide-formoterol and in 40 patients who were receiving budesonide (hazard ratio, 1.07; 95% confidence interval [CI], 0.70 to 1.65]); budesonide-formoterol was shown to be noninferior to budesonide alone. There were two asthma-related deaths, both in the budesonide-formoterol group; one of these patients had undergone an asthma-related intubation. The risk of an asthma exacerbation was 16.5% lower with budesonide-formoterol than with budesonide (hazard ratio, 0.84; 95% CI, 0.74 to 0.94; P=0.002). Conclusions Among adolescents and adults with predominantly

  10. Omalizumab Improves Quality of Life and Asthma Control in Chinese Patients With Moderate to Severe Asthma: A Randomized Phase III Study

    PubMed Central

    Li, Jing; Kang, Jian; Wang, Changzheng; Yang, Jing; Wang, Linda; Kottakis, Ioannis; Humphries, Michael

    2016-01-01

    Purpose Omalizumab is the preferred add-on therapy for patients with moderate-to-severe persistent allergic asthma and has demonstrated efficacy and safety in various ethnicities. This study evaluated the efficacy and safety of omalizumab in Chinese patients with moderate-to-severe allergic asthma. Methods This randomized, double-blind, parallel-group, placebo-controlled, phase III study assessed lung function, quality of life, asthma control, and safety of omalizumab after 24-week therapy in Chinese patients (18-75 years of age). Results A total of 616 patients were randomized (1:1) to omalizumab or placebo. The primary endpoint, least squares mean treatment difference (LSM-TD) in morning peak expiratory flow (PEF) (omalizumab vs placebo), at Weeks >20-24 was 8.85 L/min (Full analysis set; P=0.062). Per-protocol analysis set showed significant improvements with LSM-TD of 11.53 L/min in mean mPEF at Weeks >20-24 (P=0.022). The FEV1 % predicted was significantly improved with omalizumab vs placebo from 8 to 24 weeks (after 24-week treatment: LSM-TD=4.12%; P=0.001). At Week 24, a higher proportion of omalizumab-treated patients achieved clinically relevant improvements in standardized AQLQ (58.2% vs 39.3%; LSM=0.51 vs 0.10; P<0.001) and ACQ (49.5% vs 35.5%; LSM=-0.51 vs -0.34; P=0.002) scores vs placebo. Total and nighttime symptom scores reduced significantly with omalizumab vs placebo (LSM-TD=-0.21, P=0.048 and -0.12, P=0.011, respectively). Although the study was not powered to study differences in exacerbation rates (P=0.097), exacerbations in winter months were less frequent in the omalizumab vs placebo group (2 vs 21). Adverse event and severe adverse event rates were comparable between omalizumab and placebo. Conclusions Omalizumab improves lung function, quality of life, and asthma control in Chinese patients with moderate-to-severe persistent allergic asthma and has a good safety profile. PMID:27126725

  11. Twelve- and 52-week safety of albuterol multidose dry powder inhaler in patients with persistent asthma

    PubMed Central

    Raphael, Gordon; Taveras, Herminia; Iverson, Harald; O’Brien, Christopher; Miller, David

    2016-01-01

    Abstract Objective: Evaluate the safety of albuterol multidose dry powder inhaler (MDPI), a novel, inhalation-driven device that does not require coordination of actuation with inhalation, in patients with persistent asthma. Methods: We report pooled safety data from two 12-week, multicenter, randomized, double-blind, repeat-dose, parallel-group studies and the 12-week double-blind phase of a 52-week multicenter safety study as well as safety data from the 40-week open-label phase of the 52-week safety study. In each study, eligible patients aged ≥12 years with persistent asthma received placebo MDPI or albuterol MDPI 180 µg (2 inhalations × 90 µg/inhalation) 4 times/day for 12 weeks. In the 40-week open-label phase of the 52-week safety study, patients received albuterol MDPI 180 μg (2 inhalations × 90 μg/inhalation) as needed (PRN). Results: During both 12-week studies and the 12-week double-blind phase of the 52-week study, adverse events were more common with placebo MDPI (50%; n = 333) than albuterol MDPI (40%; n = 321); most frequent were upper respiratory tract infection (placebo MDPI 11%, albuterol MDPI 10%), nasopharyngitis (6%, 5%), and headache (6%, 4%). Incidences of β2-agonist-related events (excluding headache) during the pooled 12-week dosing periods were low (≤1%) in both groups. The safety profile with albuterol MDPI PRN during the 40-week open-label phase [most frequent adverse events: nasopharyngitis (12%), sinusitis (11%), upper respiratory tract infection (9%)] was similar to that observed during the 12-week pooled analysis. Conclusions: The safety profile of albuterol MDPI 180 μg in these studies was comparable with placebo MDPI and consistent with the well-characterized profile of albuterol in patients with asthma. PMID:26369589

  12. Paediatric asthma and obesity.

    PubMed

    Lucas, Sean R; Platts-Mills, Thomas A E

    2006-12-01

    None of the explanations proposed for the increase in paediatric asthma have been adequate. It is becoming apparent that the cause of the increase in asthma must be multi-factorial. Increasing attention has been focused on the role of lifestyle in the development of asthma. Lifestyle changes that have occurred in children are those in diet and decreased physical activity, with obesity being the product of these changes. The increase in asthma, obesity and a sedentary lifestyle have occurred together. However, a temporal relationship between asthma, obesity and decreased physical activity has not been determined in the paediatric literature. Limited data suggest that decreased physical activity could be playing a role in the aetiology of asthma independent of obesity. Furthermore, there has been substantial research on the benefits of exercise programmes for paediatric patients with asthma. Longitudinal trials monitoring physical activity, obesity and the development of asthma are needed. PMID:17098637

  13. Asthma remission in a patient with rheumatoid arthritis while on antiangiogenesis therapy during a rheumatoid arthritis trial demonstrated by forced oscillation and spirometry.

    PubMed

    Saadeh, Charles; Saadeh, Constantine

    2007-05-01

    Asthma is a chronic inflammatory condition. An integral part of the inflammation is angiogenesis (neovascularization). This report describes a patient with rheumatoid arthritis (RA) and moderately severe asthma despite maintenance on inhaled corticosteroids (ics) and intermittent systemic steroids (ss). While enrolled in a clinical trial for RA employing MEDI-522 (Vitaxin), her asthma symptoms remitted substantially, with significant improvement in spirometry and airflow resistance measured by forced oscillation. The patient was able to discontinue ics and required no ss while taking MEDI-522. After termination of the clinical trial, the patient's asthma symptoms again increased and required reinstitution of ics for control. PMID:17530526

  14. Diagnosis of Adult Patients with Cystic Fibrosis.

    PubMed

    Nick, Jerry A; Nichols, David P

    2016-03-01

    The diagnosis of cystic fibrosis (CF) is being made with increasing frequency in adults. Patients with CF diagnosed in adulthood typically present with respiratory complaints, and often have recurrent or chronic airway infection. At the time of initial presentation individuals may appear to have clinical manifestation limited to a single organ, but with subclinical involvement of the respiratory tract. Adult-diagnosed patients have a good response to CF center care, and newly available cystic fibrosis transmembrane receptor-modulating therapies are promising for the treatment of residual function mutation, thus increasing the importance of the diagnosis in adults with unexplained bronchiectasis.

  15. Insights into early treatment of mild asthma: do inhaled corticosteroids make a difference?

    PubMed

    Tan, Wan C

    2007-01-01

    Approaches to the management of moderate-to-severe persistent asthma in both children and adults are widely accepted but the treatment of mild persistent asthma remains controversial because of the lack of agreement on what constitutes mild asthma and whether regular treatment is required at all. Recent evidence indicates that 'mild asthma' may not be as benign a condition as was widely believed and should be treated to improve asthma control and to prevent the significant burden of exacerbation and progression of disease. This is supported by compelling evidence from histologic and clinical studies that have attributed irreversible pathologic and functional airway changes to consequences of persistent airway inflammation and under-treated asthma. This article focuses on the rationale of early treatment of mild persistent asthma, and discusses the various findings from the largest randomized, early-intervention trial with inhaled corticosteroids as regular treatment in patients with asthma of recent onset--the START (inhaled Steroid Treatment As Regular Therapy in early asthma) study. A brief review of the background of the natural history of asthma, the findings from key longitudinal epidemiologic studies on disease progression in children and adults, and the effect of inhaled corticosteroids on this progression are included, to provide further insight into the impact of early treatment on asthma management guidelines.

  16. Analysis of the impact of selected socio-demographic factors on quality of life of asthma patients

    PubMed Central

    Filanowicz, Małgorzata; Graczyk, Małgorzata; Cegła, Bernadeta; Jabłońska, Renata; Napiórkowska-Baran, Katarzyna; Bartuzi, Zbigniew

    2013-01-01

    Aim To evaluate the influence of selected socio-demographic factors on quality of life of patients with different degrees of asthma severity. Material and methods The study was conducted in 2009–2010 in the Clinic of Allergology, Clinical Immunology and Internal Diseases in Dr J. Biziel University Hospital No. 2 in Bydgoszcz. Patients were divided into a tested group (126) and a control group (86). The criterion for the division was the degree of asthma control according to GINA 2006. The following tools were used: the author's questionnaire containing questions about socio-demographic and clinical data, and the WHOQOL-100. Results In the tested group, a statistically significant correlation was observed between quality of life and age (p < 0.002 for the entire population), education (p < 0.05 in the group with controlled asthma, p = 0.0005 for the entire population), professional activity (p < 0.003 in the group with partially controlled asthma, p < 0.05 with uncontrolled asthma and p < 0.0001 in the entire population), marital status (p = 0.025 for the entire population) and financial situation (p < 0.0001; p < 0.0002; p < 0.009 in all groups; p < 0.0001 in the entire population). There was no significant difference between quality of life, and sex and the place of residence of the respondents. Conclusions Age, education, professional activity, marital status and financial situation affect the assessment of quality of life in patients with asthma. Socio-demographic factors such as sex and the place of residence do not influence the assessment of quality of life in patients with asthma. PMID:24278078

  17. Viral diversity in asthma

    PubMed Central

    McErlean, Peter; Greiman, Alyssa; Favoreto, Silvio; Avila, Pedro C.

    2010-01-01

    Synopsis Asthma exacerbations are precipitated primarily by respiratory virus infection and frequently require immediate medical intervention. Studies of childhood and adult asthma have implicated a wide variety of respiratory viruses in exacerbations. By focusing on both RNA and DNA respiratory viruses and some newly identified viruses, this review illustrates the diversity and highlights some of the uncertainties that exist in our understanding of virus-related asthma exacerbations. PMID:21029933

  18. Sensitisation to mites in a group of patients with asthma in Yaounde, Cameroon: a cross-sectional study

    PubMed Central

    Pefura-Yone, Eric Walter; Kengne, André Pascal; Kuaban, Christopher

    2014-01-01

    Objectives Sensitisation of asthmatic patients to mites in sub-Saharan Africa has been less described. The aim of this study was to assess the prevalence and determinants of sensitisation to mites in asthmatic adolescents and adults in Yaounde, Cameroon. Design This was a cross-sectional study. Logistic regression models were employed to investigate the determinants of sensitisation to mites. Setting This study was carried out at the Jamot Hospital and CEDIMER private centre, in Yaounde, capital city of Cameroon. Participants All asthmatic patients received in consultations from January 2012 to June 2013 and in whom prick-skin tests for perennial aeroallergens were performed were included. Outcome measures Prevalence of sensitisation to mites and associated factors. Results In total, 201 patients (132 being women, 65.7%), with a median age of 36 (25th–75th centiles: 20–54) years were included, with 135 (67.2%) having a positive skin test for mites. Sensitisation to Dermatophagoïdes pteronyssinus, Dermatophagoides farinae and Blomia tropicalis was found in 53.2%, 49.8% and 47.8% of the patients, respectively. Intermittent rhinitis (16.3% vs 7.6%) and persistent rhinitis (43.0% vs 22.7%) were more frequent in sensitised patients than in the non-sensitised ones (p<0.010). Independent allergological determinants of sensitisation to mites were sensitisation to Alternaria alternata (adjusted OR 14.98 (95% CIs 1.96 to 114.4)) and sensitisation to Blattella germanica (3.48 (1.34 to 9.00)). Conclusions Sensitisation to mites was found in about two-thirds of asthmatic patients in this setting, with a frequent multiple sensitisations to A alternata and Blattella germanica. Systematically investigating asthmatic patients for mites' sensitisation and determinants will help optimising the care in this setting by combining the aetiological treatment for the allergy with symptomatic treatment for asthma, in order to modify the natural course of the disease. PMID:24390384

  19. AB031. Validation of claims approach to identify asthma and COPD overlap syndrome patients in the United States

    PubMed Central

    Ding, Bo; De Pietro, Michael; Wu, Bingcao; Tunceli, Ozgur; Turner, Ralph

    2016-01-01

    Background With the increasing recognition of asthma and chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) and its significant disease and economic burden, knowledge about real-world patient characteristics and how they are treated is needed to aid in better understanding this phenotype. However, ACOS patient identification is challenging. Currently, there is no validated claims-based ACOS patient selection algorithm available to assist this type of research. To assess the validity of a retrospective claims-based algorithm to identify high likelihood ACOS patients using patient medical records as the criterion. Methods Patients were identified from the US based HealthCore Integrated Research Database (HIRD) between January 1, 2006 and October 31, 2014. A claims-based algorithm to identify high likelihood ACOS patients was based on the following inclusion criteria: age ≥40 years, ≥2 ICD-9 diagnoses (≥30 days apart) for asthma, (ICD-9 CM: 493.xx), ≥2 diagnoses (≥30 days apart) for COPD (ICD-9 CM: 491.xx, 492.xx, and 496.xx), ≥2 ICD-9 procedure, Current Procedural Terminology (CPT), or Healthcare Common Procedure Coding System (HCPCS) codes (≥30 days apart) for COPD-related procedures, ≥3 prescription fills (≥30 days apart) for asthma/COPD medication, and ≥2 CPT codes for spirometry test. Patients were indexed on the earliest date when all of the inclusion criteria were met. Patients diagnosed with cancer (ICD-9 CM: 140.xx–209.3x, 230.xx–234.xx) during the 12-month pre-index period were excluded. Outpatient medical records closest to (before or after) the index date were abstracted. Based on the chart review, at least 2 features (positive history of allergic rhinitis, chronic sinusitis, eczema, positive skin test to environmental allergens or desensitization to environmental allergens, diagnosis of asthma or past medical history for asthma before 40 years of age, or family history of asthma) were needed to confirm the asthma

  20. Inflammatory Pattern of the Bronchial Mucosa in Patients with Asthma with Airway Hyperresponsiveness to Hypoosmotic Stimulus.

    PubMed

    Pirogov, A B; Prikhod'ko, A G; Perelman, Yu M; Zinovyev, S V; Afanasyeva, E Yu; Kolosov, V P

    2016-08-01

    Positive reaction of the bronchi to distilled water inhalation in asthmatics is associated with significant stimulation of the respiratory epithelium desquamation against the background of increased content of eosinophilic and neutrophilic leukocytes in induced sputum, predomination of eosinophil and neutrophil cytolysis, and lower activity of myeloperoxidase in leukocyte granules (in comparison with the parameter in patients with a negative response to bronchostimulation). Enhanced cytolysis and destruction of leukocytes and high myeloperoxidase concentration in the extracellular space are essential for the development of bronchial hyperresponsiveness to hypoosmotic stimulus in asthma. PMID:27591875

  1. Strategies in managing asthma.

    PubMed Central

    Barker, A F

    1989-01-01

    The management of adult asthma involves a concerted effort to identify and remove or mollify inciting or triggering stimuli such as respiratory tract infections, gastric reflux, aspirin, beta-antagonists, and environmental agents; educate patients, using written treatment plans and pulmonary function monitoring; and properly use the antiasthmatic medications including beta-agonists, theophylline, anticholinergics, and corticosteroids, with an emphasis on aerosol delivery and the use of corticosteroids during exacerbations. This strategy is summarized with suggestions on therapy in emergency departments, during the transition from hospital to ambulatory care, before exercise, and during pregnancy. PMID:2660411

  2. Spirometry for Asthma - When You Need It and Why

    MedlinePlus

    ... Search Patient Resources Spirometry for Asthma Spirometry for Asthma When you need the test—and why DOWNLOAD ... ADVICE FROM CONSUMER REPORTS How should you manage asthma? The following steps can help to control asthma: ...

  3. Summary of the 2008 BTS/SIGN British Guideline on the management of asthma.

    PubMed

    Levy, Mark L; Thomas, Mike; Small, Iain; Pearce, Linda; Pinnock, Hilary; Stephenson, Paul

    2009-01-01

    The 2008 BTS/SIGN British Guideline on the management of asthma provides comprehensive updated evidence-based guidance on asthma management for healthcare professionals. This primary care-focussed summary has been produced to aid dissemination and implementation of the key guideline messages into primary care. The section on diagnosis emphasises the new integrated symptom-based approach with clinicians using their deductive skills to determine the probability that the patient has asthma. The various tools used for monitoring asthma are discussed. There are sections on both non-pharmacological and pharmacological management of chronic asthma in adults and children. Treatment options for children are subdivided into the under-5s and children aged 5-12 years. Poor asthma control is manifested by exacerbations and acute asthma. Personalised asthma action plans for guided self management should be provided and used when levels of asthma control change. There are sections on difficult asthma and the treatment of exacerbations and acute severe asthma. Various outcome measures for auditing the quality of asthma care are discussed.

  4. Assessment of satisfaction with different dry powder inhalation devices in Greek patients with COPD and asthma: the ANASA study

    PubMed Central

    Zervas, Eleftherios; Samitas, Konstantinos; Gaga, Mina

    2016-01-01

    Background Poor adherence to inhaled therapy is common in patients with asthma and COPD. An inhaler selection based on patients’ preference could be beneficial to adherence and treatment effectiveness. Properly designed questionnaires can assess patients’ satisfaction with their medication devices. The aim of this study was to estimate, using the Feeling of Satisfaction with Inhaler (FSI-10) questionnaire, the ease of use and satisfaction of patients regarding three different marketed dry powder inhalers (DPIs): Diskus® (DK), Elpenhaler® (EH), and Turbuhaler® (TH). The FSI-10 is a self-completed questionnaire to assess patients’ opinions regarding ease of use, portability, and usability of devices, irrespective of the drug used. Patients and methods We performed a 4-week, open, noninterventional, multicenter, parallel clinical study in 560 asthmatic and 561 COPD patients. During the first visit, patients were classified into three groups according to the DPI they were already using. Patients were regularly receiving their treatments (Seretide DK, Rolenium EH, and Symbicort TH) and agreed to complete the FSI-10 questionnaire in the second visit. Results A total of 517 COPD and 523 asthma patients completed the study. All DPIs tested received satisfactory results, while the EH obtained consistently higher scores in the FSI-10 in both COPD and asthma patients (44.7 and 44.1 vs 41.5 and 43 for TH, 40.8 and 41.4 for DK, P<0.001 and P<0.01, respectively). TH was rated better than DK by asthma patients. Patients suffering with severe COPD tended to express higher feeling of satisfaction than those with moderate or mild disease, irrespective of the device used. Conclusion All DPIs tested were highly acceptable by asthma and COPD patients of different ages; nevertheless, EH received significantly higher ratings in most of the questionnaire domains. COPD patients in advanced stages of the disease generally expressed higher level of satisfaction with their devices

  5. [Respiratory rehabilitation in patients with bronchial asthma and chronic obstructive pulmonary disease (COPD) in Kinshasa].

    PubMed

    Muzembo Ndundu, J; Nkakudulu Bikuku, H; Frans, A

    2001-06-01

    A number of studies in western countries have shown that respiratory and physical rehabilitation of patients with chronic obstructive pulmonary disease (COPD) only has a minimal effect on respiratory function but can significantly improve physical capacity. The aim of our study was to apply these methods to patients in Kinshasa, Democratic Republic of Congo. We treated 38 patients (20 women) who had bronchial asthma (n=14) or COPD (n=24). These ambulatory patients were treated in two different hospitals in Kinshasa, the university hospital and the general hospital, three times per week for twelve weeks. The patients were treated with kinestherapy and inhaled bronchodilator drugs (salbutamol, and/or ipratropium bromide with a boreal nebulizer) as well as bronchial hygiene and performed breathing exercises on a Bodyguard Ergometer 990 with walking, running and climbing steps until exhaustion. After the rehabilitation program FEV1 increased from 1.37 +/- 0.62 (50% expected) to 1.54 +/- 0.69 (56% expected) (p<0.01). The same trend was observed for walking distance (from 644 +/- 459 m to 1213 +/- 569 m, p<0.001) and for maximal power developed on the cycloergometer (from 45 +/- 20 w to 73 +/- 37 w, p<0.001). In contrast, the maximal work load performed during climbing steps (from 106 +/- 44 w to 115 +/- 23 w) did not improve significantly. COPD patients improved their FEV1 significantly compared with asthma patients. Our study show that pulmonary rehabilitaion increase the level of spontaneous physical activity. The pulmonary rehabilitation program changes the quality of life of COPD patients who are able to move about better for longer periods of time, have a longer walking distance, and improved physical activity level. PMID:11416804

  6. A double-blind study of the efficacy of nedocromil sodium in the management of asthma in patients using high doses of bronchodilators.

    PubMed

    Fink, J N; Forman, S; Silvers, W S; Soifer, M M; Tashkin, D P; Wilson, A F

    1994-09-01

    The effects of nedocromil sodium were assessed in 110 patients with asthma who experienced asthma symptoms despite the use of high doses of inhaled bronchodilators. During the baseline period, antiinflammatory agents were not permitted, and patients were treated with inhaled beta-agonists on an as-needed basis. Patients who required 12 or more puffs of albuterol and experienced continuing asthma symptoms for 7 of the 14 baseline days were randomized to treatment groups. Subjects received either nedocromil sodium (4 mg) or placebo four times a day for 10 weeks. Statistically significant (p < 0.05) between-treatment differences (weeks 3 to 10), favoring nedocromil sodium, were determined for the asthma summary score, daytime asthma severity, asthmatic cough, morning peak flow rates, reduction of as-needed bronchodilator use, physician's assessment of asthma severity, and patient and physician opinions of treatment effectiveness. By trial end (week 10), sleep difficulty caused by asthma decreased 29% in the nedocromil sodium group and 4% in the placebo group (p = 0.006). Nedocromil sodium was well tolerated and improved asthma control while reducing the inhaled bronchodilator load of these patients with moderately severe asthma.

  7. Association between media alerts of air quality index and change of outdoor activity among adult asthma in six states, BRFSS, 2005.

    PubMed

    Wen, Xiao-Jun; Balluz, Lina; Mokdad, Ali

    2009-02-01

    Media alerts of air quality index (AQI) were designed to inform the public the need to avoid harmful air pollution by changing their outdoor activities. The relationship between AQI media alerts and change in outdoor activities among people with asthma is unknown. Our objective is to examine this relationship. Data were analyzed in a cross-sectional study from 33,888 adults, in six states, who responded to the questions in the 2005 Behavioral Risk Factor Surveillance System (BRFSS) about reductions/changes in outdoor activity. The prevalence of change in outdoor activity due to media alerts was 31% among adults with lifetime asthma and 16% without asthma. The prevalence of outdoor activity change increased to 75% among those with lifetime asthma and to 68% without asthma, when the combined the effects of media alerts and individual perception were examined. The odds of activity change based on the media alerts was 2.30 (Adjusted odds ratio [aOR] = 2.16, 95% Confidence interval [CI]: 1.61, 2.90) among those with lifetime asthma and 1.72 (aO R = 1.72, 95% CI: 1.50, 1.98) without asthma, compared to those unaware of media alerts, after adjustment for demographic variables and covariates. This study shows that awareness of media alerts as well as health professional advice may be associated with reported changes in outdoor activities. Therefore, along with consistent efforts to improve the air quality, government agencies, health professionals, and community leaders should implement measures to effectively inform the public about air quality and educate them to take appropriate actions accordingly.

  8. FOXP3+ associated with the pro-inflammatory regulatory T and T helper 17 effector cells in asthma patients

    PubMed Central

    Zhang, Jian-Guo; Chen, Xiao-Juan; Liu, Tao; Jiang, Shu-Juan

    2016-01-01

    Asthma is a chronic bronchial inflammation that results to reversible incidence of airway obstruction and shortness of breath. Under normal circumstances, the lung immune system is maintained in a state of controlled inflammation, where balance exists between protective immunity mediated by effector cells and tolerance mediated by cells with regulatory function. Therefore, the inflammation observed in asthma patients may be caused by an imbalance between regulatory T (Treg) cells (CD4-positive with high expression of CD25 surface markers) and forkhead box P3 (FOXP3)-positive pro-inflammatory T helper 17 (Th17) cells. The aim of the present study was to evaluate whether reduced Treg cells and increased Th17 cells could be observed in the peripheral blood samples of asthma patients. As important markers of Treg cells, the expression levels of FOXP3 and interleukin (IL)-17a were analyzed via reverse trancription-quantitative polymerase chain reaction. The results indicated that the levels of cytokines that promote Th17 cells, including IL-6, IL-23 and TGF-β, were found to increase in the bronchoalveolar lavage fluid sample of asthma patients. However, the IL-10 level in the corresponding sample was much lower compared with that in control individuals. In conclusion, these results suggest that asthma associated with a reduced proportion of Treg and Th17 cells in the blood is characterized by the expression of pro-inflammatory cytokines that may be beneficial for the continuous generation of Th17 cells. PMID:27703517

  9. [Severe asthma].

    PubMed

    González, Claudio D

    2016-01-01

    The objectives of this work were to investigate the frequency of severe asthma (SA) according to WHO definition and to compare SA patients' characteristics with those of non-severe asthma (NSA); secondly, to investigate the level of control reached throughout a period of regular treatment. Between 1-1-2005 and 12-31-2014, 471 medical records from patients with bronchial asthma assisted in Buenos Aires City were analyzed. SA frequency was 40.1% (189/471), being significantly higher among patients from the public health system (47.7%, 108/226 vs. 33%, 81/245, p = 0.001). SA patients were older than NSA ones (51.3 ± 17.4 vs. 42.6 ± 17.1 years, p = 0.000), presented longer time since onset of the disease (median 30 vs. 20 years, p = 0.000), lower educational levels (secondary level or higher 41.7% vs. 58.1%, p = 0.000), lower frequency of rhinitis (47% vs. 60.6%, p = 0.004), more severe levels of airway obstruction (FEV% 50.2 ± 13.7 vs. 77.7 ± 12.4, p = 0.000), more frequent antecedents of Near Fatal Asthma (11.1% vs. 2.8%, p = 0.000), higher levels of serum IgE (median of 410 vs. 279 UI/l, p = 0.01) and higher demand of systemic steroids requirements and hospitalizations (68.7% vs. 50.7%, p = 0.000 and 37.5% vs. 15.9%, p = 0.000, respectively). A 30.6% of SA patients (58/189) reached a follow-up period of 12 months, 13 (22.5%) of whom reached the controlled asthma level. The frequency of SA found seems to be considerable. Multicenter studies to investigate the levels of control reached by SA patients with access to proper treatment are recommended.

  10. An Internet Intervention to Improve Asthma Management: Rationale and Protocol of a Randomized Controlled Trial

    PubMed Central

    Lau, Annie YS; Dennis, Sarah; Liaw, Siaw-Teng; Coiera, Enrico

    2013-01-01

    Background Many studies have shown the effectiveness of self-management for patients with asthma. In particular, possession and use of a written asthma action plan provided by a doctor has shown to significantly improve patients’ asthma control. Yet, uptake of a written asthma action plan and preventative asthma management is low in the community, especially amongst adults. Objective A Web-based personally controlled health management system (PCHMS) called Healthy.me will be evaluated in a 2010 CONSORT-compliant 2-group (static websites verse PCHMS) parallel randomized controlled trial (RCT) (allocation ratio 1:1). Methods The PCHMS integrates an untethered personal health record with consumer care pathways and social forums. After eligibility assessment, a sample of 300 adult patients with moderate persistent asthma will be randomly assigned to one of these arms. After 12 months of using either Healthy.me or information websites (usual care arm), a post-study assessment will be conducted. Results The primary outcome measure is possession of or revision of an asthma action plan during the study. Secondary outcome measures include: (1) adherence to the asthma action plan, (2) rate of planned and unplanned visits to healthcare providers for asthma issues, (3) usage patterns of Healthy.me and attrition rates, (4) asthma control and asthma exacerbation scores, and (5) impact of asthma on life and competing demands, and days lost from work. Conclusions This RCT will provide insights into whether access to an online PCHMS will improve uptake of a written asthma action plan and preventative asthma actions. Trial Registration Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12612000716864; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=362714 (Archived by WebCite at http://www.webcitation.org/6IYBJGRnW). PMID:23942523

  11. [Occupational asthma].

    PubMed

    Pérez, Padilla Alfredo

    2009-01-01

    The work-related asthma is a disease that is frequently reported in other countries, but little recognized in our own despite the large number of workers at risk. The lack of knowledge about its etiology at work involves a mishandling and poor outcome of the patient, because its treatment requires the removal of worker of exposure at work or at least this fall. The definitive diagnosis involves specialized medical procedures that are difficult to access and workplace studies that establish at first line the diagnosis of asthma and the work as cause of the disease or its aggravation. Health workers surveillance and compliance with work regulations are strategies that should be promoted prevention of asthma at work. PMID:20873063

  12. Suppression of leukotriene B4 generation by ex-vivo neutrophils isolated from asthma patients on dietary supplementation with gammalinolenic acid-containing borage oil: possible implication in asthma.

    PubMed

    Ziboh, Vincent A; Naguwa, Stanley; Vang, Kao; Wineinger, Julie; Morrissey, Brian M; Watnik, Mitchell; Gershwin, M Eric

    2004-03-01

    Dietary gammalinolenic acid (GLA), a potent inhibitor of 5-lipoxygenase (5-LOX) and suppressor of leukotriene B4 (LTB4), can attenuate the clinical course of rheumatoid arthritics, with negligible side effects. Since Zileuton, also an inhibitor of 5-LOX, attenuates asthma but with an undesirable side effect, we investigated whether dietary GLA would suppress biosynthesis of PMN-LTB4 isolated from asthma patients and attenuate asthma. Twenty-four mild-moderate asthma patients (16-75 years) were randomized to receive either 2.0 g daily GLA (borage oil) or corn oil (placebo) for 12 months. Blood drawn at 3 months intervals was used to prepare sera for fatty acid analysis, PMNs for determining phospholipid fatty acids and for LTB4 generation. Patients were monitored by daily asthma scores, pulmonary function, and exhaled NO. Ingestion of daily GLA (i) increased DGLA (GLA metabolite) in PMN-phospholipids; (ii) increased generation of PMN-15-HETrE (5-LOX metabolite of DGLA). Increased PMN-DGLA/15-HETrE paralleled the decreased PMN generation of proinflammatory LTB4. However, the suppression of PMN-LTB4 did not reveal statistically significant suppression of the asthma scores evaluated. Nonetheless, the study demonstrated dietary fatty acid modulation of endogenous inflammatory mediators without side effects and thus warrant further explorations into the roles of GLA at higher doses, leukotrienes and asthma. PMID:15154607

  13. Suppression of leukotriene B4 generation by ex-vivo neutrophils isolated from asthma patients on dietary supplementation with gammalinolenic acid-containing borage oil: possible implication in asthma.

    PubMed

    Ziboh, Vincent A; Naguwa, Stanley; Vang, Kao; Wineinger, Julie; Morrissey, Brian M; Watnik, Mitchell; Gershwin, M Eric

    2004-03-01

    Dietary gammalinolenic acid (GLA), a potent inhibitor of 5-lipoxygenase (5-LOX) and suppressor of leukotriene B4 (LTB4), can attenuate the clinical course of rheumatoid arthritics, with negligible side effects. Since Zileuton, also an inhibitor of 5-LOX, attenuates asthma but with an undesirable side effect, we investigated whether dietary GLA would suppress biosynthesis of PMN-LTB4 isolated from asthma patients and attenuate asthma. Twenty-four mild-moderate asthma patients (16-75 years) were randomized to receive either 2.0 g daily GLA (borage oil) or corn oil (placebo) for 12 months. Blood drawn at 3 months intervals was used to prepare sera for fatty acid analysis, PMNs for determining phospholipid fatty acids and for LTB4 generation. Patients were monitored by daily asthma scores, pulmonary function, and exhaled NO. Ingestion of daily GLA (i) increased DGLA (GLA metabolite) in PMN-phospholipids; (ii) increased generation of PMN-15-HETrE (5-LOX metabolite of DGLA). Increased PMN-DGLA/15-HETrE paralleled the decreased PMN generation of proinflammatory LTB4. However, the suppression of PMN-LTB4 did not reveal statistically significant suppression of the asthma scores evaluated. Nonetheless, the study demonstrated dietary fatty acid modulation of endogenous inflammatory mediators without side effects and thus warrant further explorations into the roles of GLA at higher doses, leukotrienes and asthma.

  14. IL-33 promotes the migration and proliferation of circulating fibrocytes from patients with allergen-exacerbated asthma

    SciTech Connect

    Bianchetti, Lorenza; Marini, Maurizio A.; Isgro, Mirko; Bellini, Alberto; Schmidt, Matthias; Mattoli, Sabrina

    2012-09-14

    Highlights: Black-Right-Pointing-Pointer IL-33 is considered a new therapeutic target for reducing inflammation in asthma. Black-Right-Pointing-Pointer This study shows that IL-33 is a potent chemoattractant for fibrocytes in asthma. Black-Right-Pointing-Pointer IL-33 also promotes fibrocyte proliferation without reducing collagen production. Black-Right-Pointing-Pointer The study uncovers a novel non-inflammatory, profibrotic function of IL-33. -- Abstract: The release of IL-33 increases in the bronchial mucosa of asthmatic patients in relation to disease severity and several studies have demonstrated that IL-33 may enhance airway inflammation in asthma. This study tested the hypothesis that IL-33 may also contribute to the development of irreversible structural changes in asthma by favoring the airway recruitment and profibrotic function of circulating fibrocytes during episodes of allergen-induced asthma exacerbation. The circulating fibrocytes from patients with allergen-exacerbated asthma (PwAA) showed increased expression of the specific IL-33 receptor component ST2L in comparison with the cells from non-asthmatic individuals (NAI). Recombinant IL-33 induced the migration of circulating fibrocytes from PwAA at clinically relevant concentrations and stimulated their proliferation in a concentration-dependent manner between 0.1 and 10 ng/ml, without affecting the constitutive release of type I collagen. The recombinant protein did not induce similar responses in circulating fibrocytes from NAI. This study uncovers an important mechanism through which fibrocytes may accumulate in the airways of allergic asthmatics when their disease is not adequately controlled by current treatment and provides novel information on the function of IL-33 in asthma.

  15. Canadian asthma consensus report, 1999

    PubMed Central

    Boulet, L P; Becker, A; Bérubé, D; Beveridge, R; Ernst, P

    1999-01-01

    OBJECTIVES: To provide physicians with current guidelines for the diagnosis and optimal management of asthma in children and adults, including pregnant women and the elderly, in office, emergency department, hospital and clinic settings. OPTIONS: The consensus group considered the roles of education, avoidance of provocative environmental and other factors, diverse pharmacotherapies, delivery devices and emergency and in-hospital management of asthma. OUTCOMES: Provision of the best control of asthma by confirmation of the diagnosis using objective measures, rapid achievement and maintenance of control and regular follow-up. EVIDENCE: The key diagnostic and therapeutic recommendations are based on the 1995 Canadian guidelines and a critical review of the literature by small groups before a full meeting of the consensus group. Recommendations are graded according to 5 levels of evidence. Differences of opinion were resolved by consensus following discussion. VALUES: Respirologists, immunoallergists, pediatricians and emergency and family physicians gave prime consideration to the achievement and maintenance of optimal control of asthma through avoidance of environmental inciters, education of patients and the lowest effective regime of pharmacotherapy to reduce morbidity and mortality. BENEFITS, HARMS AND COSTS: Adherence to the guidelines should be accompanied by significant reduction in patients' symptoms, reduced morbidity and mortality, fewer emergency and hospital admissions, fewer adverse side-effects from medications, better quality of life for patients and reduced costs. RECOMMENDATIONS: Recommendations are included in each section of the report. In summary, after a diagnosis of asthma is made based on clinical evaluation, including demonstration of variable airflow obstruction, and contributing factors are identified, a treatment plan is established to obtain and maintain optimal asthma control. The main components of treatment are patient education

  16. Response of the Adrenergic System After Provoked Bronchoconstriction in Patients with Bronchial Asthma

    PubMed Central

    Islami, Hilmi; Ilazi, Ali; Gashi, Nijazi; Mustafa, Lirim; Maloku, Halit; Jashanica, Adelina

    2014-01-01

    Objective: In this paper, effect of the Tolazoline as antagonist of the alpha-2 adrenergic receptors in patients with bronchial asthma and chronic obstructive bronchitis was studied, and also the effect of stimulation with Hexoprenaline of beta-2 adrenergic receptor after bronchi-constriction caused with Propranolol, and Acetylcholine. Methods: Lung function parameters are determined with Body plethysmography. In patients with bronchial asthma and chronic obstructive bronchitis was registered resistance (Raw), was determined the amount of intrathoracic gas volume (ITGV), and specific resistance was calculated as well (SRaw). Aerosolization was done with standard aerosolizing machine-Asema. Results: The study included a total of 21 patients. Two hours after the inhalation of Propranolol, in experimental group, it was applied the blocker of alpha-2 adrenergic receptors (Tolazoline 20 mg / ml with inhalator ways), which did not cause changes in bronchomotor tonus of tracheobronchial system (p > 1.0). Meanwhile, at the same patient, stimulation of beta-2 adrenergic receptor with Hexoprenaline (2 inh x 0.2 mg) is associated with a significant decrease of the specific resistance of airways (SRaw, p < 0.01). Control group results show that after bronchi-constriction caused by Propranolol-aerosol (20 mg / ml) in patients with bronchial asthma and chronic obstructive bronchitis, an increase of specific resistance in airways was caused (SRaw, p < 0.01), which confirms the presence of hyper-reactive bronco-constrictor effects intermediated by vagal ways. Two hours after Propranolol, inhaled Hexorenaline has blocked the action of Propranolol, but not entirely. Furthermore, two hours after acetylcholine-aerosol (1 mg /ml) was applied, inhaled Ipratropium (2 inh x 1 mg) has fully blocked the action of chemical bronchoconstrictor mediators, causing a decline of specific resistance in the airways (SRaw; p < 0.01). Conclusion: This suggests that primary mechanism, which would cause

  17. Systemic and local eosinophil inflammation during the birch pollen season in allergic patients with predominant rhinitis or asthma

    PubMed Central

    Kämpe, Mary; Stålenheim, Gunnemar; Janson, Christer; Stolt, Ingrid; Carlson, Marie

    2007-01-01

    Background The aim of the study was to investigate inflammation during the birch pollen season in patients with rhinitis or asthma. Methods Subjects with birch pollen asthma (n = 7) or rhinitis (n = 9) and controls (n = 5) were studied before and during pollen seasons. Eosinophils (Eos), eosinophil cationic protein (ECP) and human neutrophil lipocalin were analysed. Results Allergic asthmatics had a larger decline in FEV1 after inhaling hypertonic saline than patients with rhinitis (median) (-7.0 vs.-0.4%, p = 0.02). The asthmatics had a lower sesonal PEFR than the rhinitis group. The seasonal increase in B-Eos was higher among patients with asthma (+0.17 × 109/L) and rhinitis (+0.27 × 109/L) than among controls (+0.01 × 109/L, p = 0.01). Allergic asthmatics and patients with rhinitis had a larger increase in sputum ECP (+2180 and +310 μg/L) than the controls (-146 μg/L, p = 0.02). No significant differences in inflammatory parameters were found between the two groups of allergic patients. Conclusion Patients with allergic asthma and rhinitis have the same degree of eosinophil inflammation. Despite this, only the asthmatic group experienced an impairment in lung function during the pollen season. PMID:17967188

  18. Work-related asthma: diagnosis and prognosis of immunological occupational asthma and work-exacerbated asthma.

    PubMed

    Muñoz, X; Cruz, M J; Bustamante, V; Lopez-Campos, J L; Barreiro, E

    2014-01-01

    The incidence and prevalence of asthma are increasing. One reason for this trend is the rise in adult-onset asthma, especially occupational asthma, which is 1 of the 2 forms of work-related asthma. Occupational asthma is defined as asthma caused by agents that are present exclusively in the workplace. The presence of pre-existing asthma does not rule out the possibility of developing occupational asthma. A distinction has traditionally been made between immunological occupational asthma (whether IgE-mediated or not) and nonimmunological occupational asthma caused by irritants, the most characteristic example of which is reactive airway dysfunction syndrome. The other form of work-related asthma is known as work-exacerbated asthma, which affects persons with pre-existing or concurrent asthma that is worsened by work-related factors. It is important to differentiate between the 2 entities because their treatment, prognosis, and medical and social repercussions can differ widely. In this review, we discuss diagnostic methods, treatment, and avoidance/nonavoidance of the antigen in immunological occupational asthma and work-exacerbated asthma. Key words: Specific inhalation challenge. Peak expiratory flow. Workplace. Irritants.

  19. Economic analysis of temperature-controlled laminar airflow (TLA) for the treatment of patients with severe persistent allergic asthma

    PubMed Central

    Brazier, Peter; Schauer, Uwe; Hamelmann, Eckard; Holmes, Steve; Pritchard, Clive; Warner, John O

    2016-01-01

    Introduction Chronic asthma is a significant burden for individual sufferers, adversely impacting their quality of working and social life, as well as being a major cost to the National Health Service (NHS). Temperature-controlled laminar airflow (TLA) therapy provides asthma patients at BTS/SIGN step 4/5 an add-on treatment option that is non-invasive and has been shown in clinical studies to improve quality of life for patients with poorly controlled allergic asthma. The objective of this study was to quantify the cost-effectiveness of TLA (Airsonett AB) technology as an add-on to standard asthma management drug therapy in the UK. Methods The main performance measure of interest is the incremental cost per quality-adjusted life year (QALY) for patients using TLA in addition to usual care versus usual care alone. The incremental cost of TLA use is based on an observational clinical study monitoring the incidence of exacerbations with treatment valued using NHS cost data. The clinical effectiveness, used to derive the incremental QALY data, is based on a randomised double-blind placebo-controlled clinical trial comprising participants with an equivalent asthma condition. Results For a clinical cohort of asthma patients as a whole, the incremental cost-effectiveness ratio (ICER) is £8998 per QALY gained, that is, within the £20 000/QALY cost-effectiveness benchmark used by the National Institute for Health and Care Excellence (NICE). Sensitivity analysis indicates that ICER values range from £18 883/QALY for the least severe patients through to TLA being dominant, that is, cost saving as well as improving quality of life, for individuals with the most severe and poorly controlled asthma. Conclusions Based on our results, Airsonett TLA is a cost-effective addition to treatment options for stage 4/5 patients. For high-risk individuals with more severe and less well controlled asthma, the use of TLA therapy to reduce incidence of hospitalisation would be a cost

  20. Sternomastoid muscle fatigue and twitch maximum relaxation rate in patients with steroid dependent asthma.

    PubMed Central

    Mak, V. H.; Bugler, J. R.; Spiro, S. G.

    1993-01-01

    BACKGROUND--Long term oral corticosteroid treatment is a cause of myopathy of the skeletal muscles. The effect of long term treatment with oral corticosteroids on the respiratory muscles is uncertain. Respiratory muscle function and fatigue in sternomastoid muscle were investigated in a group of patients with chronic severe asthma who were taking oral corticosteroids. The results were compared with those from a group of patients with chronic airflow limitation who were not taking oral steroids. METHODS--Twelve patients with chronic severe asthma, taking a mean daily dosage of 8 mg of prednisolone for a mean (SD) of 16.8 (9.1) years, were compared with patients with chronic airflow limitation and individually matched for sex, age, and severity of airflow limitation. Lung function tests, maximal mouth pressures, and quadriceps and sternomastoid muscle strength were measured. The sternomastoid muscle was fatigued by maximal headlift exercise to 70% of initial headlift force and the endurance time noted. Sternomastoid fatigue was assessed by twitch maximum relaxation rate (TMRR) measured in the fresh state and for 30 minutes after exercise. RESULTS--There was no significant difference between the control group and the corticosteroid group for maximal mouth pressures, fresh state TMRR, and quadriceps and sternomastoid strength. The control group had a significantly longer mean (SD) endurance time than the corticosteroid group (121 (47) s v 86 (24) s), and also had significantly less slowing and faster recovery of the TMRR after exercise. The slowing and recovery of the TMRR in the corticosteroid group, however, was similar to that previously reported for normal subjects. CONCLUSION--Respiratory muscle weakness does not occur more often in patients taking oral corticosteroids. The corticosteroid group was more prone to fatigue than the control group, but was similar to normal subjects. This suggests that chronic airflow limitation may produce a training effect on the

  1. Activin A is associated with asthma in underweight and overweight patients.

    PubMed

    Zhang, L L; Liu, C T

    2015-01-01

    There are limited data regarding the effects of activin A on underweight, normal weight, and overweight patients with asthma. We determined serum levels of activin A in asthmatic patients in relation to body mass index. The study protocol included questionnaires, measurement of exhaled nitric oxide, blood sampling for inflammatory biomarkers, and high-resolution computed tomography of the lungs to identify bronchial wall thickening. Serum and sputum activin A levels were measured using an enzyme-linked immunosorbent assay in 94 asthmatic patients. Mean serum levels of activin A were significantly (P = 0.001) higher in underweight (1781 ± 327.3 pg/mL) than in normal weight and overweight asthmatic patients, regardless of gender. After stratification by gender, significantly higher mean values of activin A were observed in females compared to males in the normal and underweight groups (P = 0.003 and P = 0.0002, respectively). Significant differences between groups were found in airway wall area (%) (P < 0.0001). We also observed a much higher percentage of sputum lymphocytes in the underweight group compared to the other groups (P < 0.0001). Correlations between bronchial wall thickness and activin A were found in the underweight (r = 0.67, P = 0.48) and normal weight groups (r = 0.51, P = 0.042). Correlations between fractional of exhaled nitric oxide, forced expiratory volume in 1 s, delayed treatment years, and activin A in different groups were also observed. Increased serum level of activin A indicates its role in the pathogenesis of asthma, particularly in underweight and overweight patients.

  2. Inhalation errors due to device switch in patients with chronic obstructive pulmonary disease and asthma: critical health and economic issues

    PubMed Central

    Roggeri, Alessandro; Micheletto, Claudio; Roggeri, Daniela Paola

    2016-01-01

    Background Different inhalation devices are characterized by different techniques of use. The untrained switching of device in chronic obstructive pulmonary disease (COPD) and asthma patients may be associated with inadequate inhalation technique and, consequently, could lead to a reduction in adherence to treatment and limit control of the disease. The aim of this analysis was to estimate the potential economic impact related to errors in inhalation in patients switching device without adequate training. Methods An Italian real-practice study conducted in patients affected by COPD and asthma has shown an increase in health care resource consumption associated with misuse of inhalers. Particularly, significantly higher rates of hospitalizations, emergency room visits (ER), and pharmacological treatments (steroids and antimicrobials) were observed. In this analysis, those differences in resource consumption were monetized considering the Italian National Health Service (INHS) perspective. Results Comparing a hypothetical cohort of 100 COPD patients with at least a critical error in inhalation vs 100 COPD patients without errors in inhalation, a yearly excess of 11.5 hospitalizations, 13 ER visits, 19.5 antimicrobial courses, and 47 corticosteroid courses for the first population were revealed. In the same way, considering 100 asthma patients with at least a critical error in inhalation vs 100 asthma patients without errors in inhalation, the first population is associated with a yearly excess of 19 hospitalizations, 26.5 ER visits, 4.5 antimicrobial courses, and 21.5 corticosteroid courses. These differences in resource consumption could be associated with an increase in health care expenditure for INHS, due to inhalation errors, of €23,444/yr in COPD and €44,104/yr in asthma for the considered cohorts of 100 patients. Conclusion This evaluation highlights that misuse of inhaler devices, due to inadequate training or nonconsented switch of inhaled medications

  3. The increasing challenge of discovering asthma drugs.

    PubMed

    Mullane, Kevin

    2011-09-15

    The prevalence of asthma continues to rise. Current drugs provide symptomatic relief to some, but not all, patients. Despite the need for new therapeutics, and a huge research effort, only four novel agents from two classes of drugs - the antileukotrienes and an anti-IgE antibody - have been approved in the last 30 years. This review highlights three particular issues that contribute to the challenge of identifying new therapeutics. First is an over-reliance on animal models of allergy to define targets and expectations of efficacy that has met with poor translation to the clinical setting. While sensitivity to particular aeroallergens is one key risk factor for asthma, atopy and asthma are not synonymous, and while about half of adult asthmatics are atopic the incidence of allergic asthma is probably <50%. The second issue is a fundamental disconnect between the directions of basic research and clinical research. Basic research has developed a detailed, reductive, unifying mechanism of antigen-induced, T helper type 2 cell-mediated airway inflammation as the root cause of asthma. In contrast, clinical research has started to identify multiple asthma phenotypes with differing cellular components, mediators and sensitivities to asthma drugs, and probably varying underlying factors including susceptibility genes. Finally, different features of asthma - bronchoconstriction, symptoms, and exacerbations - respond diversely to treatment; effects that are not captured in animal models which do not develop asthma per se, but utilize unvalidated surrogate markers. Basic research needs to better integrate and utilize the clinical research findings to improve its relevance to drug discovery efforts. PMID:21745459

  4. High-dose inhaled corticosteroids or addition of theophylline in patients with poorly controlled asthma?

    PubMed

    Celis, Pilar; Rada, Gabriel

    2015-08-19

    There are several management strategies for patients with poorly controlled asthma despite usual treatment. Increasing doses of inhaled corticosteroids or adding theophylline are among the therapeutic alternatives. However, the latter is associated with important adverse effects. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified only one systematic review including four pertinent randomized controlled trials. We combined the evidence using meta-analysis and generated a summary of findings following the GRADE approach. We concluded it is not clear whether theophylline or high-dose inhaled corticosteroids constitute a better alternative for symptomatic control or reduction in exacerbations in poorly controlled asthmatic patients because the certainty of the evidence is very low.

  5. Post-Inhaled Corticosteroid Pulmonary Tuberculosis Increases Lung Cancer in Patients with Asthma

    PubMed Central

    Lin, Frank Cheau-Feng; Nfor, Oswald Ndi; Jhang, Kai-Ming; Ku, Wen-Yuan; Ho, Chien-Chang; Lung, Chia-Chi; Pan, Hui-Hsien; Wu, Min-Chen; Wu, Ming-Fang; Liaw, Yung-Po

    2016-01-01

    Purpose To evaluate the association between post-inhaled corticosteroid (ICS) pulmonary tuberculosis (TB), pneumonia and lung cancer in patients with asthma. Methods The study samples were collected from the National Health Insurance Database. Asthmatic patients who were first-time users of ICS between 2003 and 2005 were identified as cases. For each case, 4 control individuals were randomly matched for sex, age and date of ICS use. Cases and matched controls were followed up until the end of 2010. Cox proportional hazard regression was used to determine the hazard ratio for pulmonary infections and lung cancer risk in the ICS users and non-users. Results A total of 10,904 first-time users of ICS were matched with 43,616 controls. The hazard ratios for lung cancer were: 2.52 (95% confidence interval [CI], 1.22–5.22; p = 0.012) for individuals with post-ICS TB, 1.28 (95%CI, 0.73–2.26; p = 0.389) for post-ICS pneumonia, 2.31(95%CI, 0.84–6.38; p = 0.105) for post-ICS pneumonia+TB, 1.08 (95%CI, 0.57–2.03; p = 0.815) for TB, 0.99 (95%CI, 0.63–1.55; p = 0.970) for pneumonia, and 0.32 (95%CI, 0.05–2.32; p = 0.261) for pneumonia+ TB, respectively. Conclusions Post-ICS TB increased lung cancer risk in patients with asthma. Because of the high mortality associated with lung cancer, screening tests are recommended for patients with post-ICS TB. PMID:27448321

  6. Pharmacological Management of Elderly Patients with Asthma-Chronic Obstructive Pulmonary Disease Overlap Syndrome: Room for Speculation?

    PubMed

    Castiglia, Daniela; Battaglia, Salvatore; Benfante, Alida; Sorino, Claudio; Scichilone, Nicola

    2016-06-01

    Asthma and chronic obstructive pulmonary disease (COPD) are two distinct diseases that share a condition of chronic inflammation of the airways and bronchial obstruction. In clinical settings, it is not rare to come across patients who present with clinical and functional features of both diseases, posing a diagnostic dilemma. The overlap condition has been termed asthma-COPD overlap syndrome (ACOS), and mainly occurs in individuals with long-standing asthma, especially if they are also current or former smokers. Patients with ACOS have poorer health-related quality of life and a higher exacerbation rate than subjects with asthma or COPD alone. Whether ACOS is a distinct nosological entity with genetic variants or rather a condition of concomitant diseases that overlap is still a matter of debate. However, there is no doubt that extended life expectancy has increased the prevalence of asthma and COPD in older ages, and thus the probability that overlap conditions occur in clinical settings. In addition, age-associated changes of the lung create the basis for the two entities to converge on the same subject. ACOS patients may benefit from a stepwise treatment similar to that of asthma and COPD; however, the proposed therapeutic algorithms are only speculative and extrapolated from studies that are not representative of the ACOS population. Inhaled corticosteroids are the mainstay of therapy, and always in conjunction with long-acting bronchodilators. The potential heterogeneity of the overlap syndrome in terms of inflammatory features (T helper-1 vs. T helper-2 pathways) may be responsible for the different responses to treatments. The interaction between respiratory drugs and concomitant diseases should be carefully evaluated. Similarly, the effect of non-respiratory drugs, such as aspirin, statins, and β-blockers, on lung function needs to be properly assessed. PMID:27138954

  7. Lung penetration and patient adherence considerations in the management of asthma: role of extra-fine formulations

    PubMed Central

    Scichilone, Nicola; Spatafora, Mario; Battaglia, Salvatore; Arrigo, Rita; Benfante, Alida; Bellia, Vincenzo

    2013-01-01

    The mainstay of management in asthma is inhalation therapy at the target site, with direct delivery of the aerosolized drug into the airways to treat inflammation and relieve obstruction. Abundant evidence is available to support the concept that inflammatory and functional changes at the level of the most peripheral airways strongly contribute to the complexity and heterogeneous manifestations of asthma. It is now largely accepted that there is a wide range of clinical phenotypes of the disease, characterized primarily by small airways involvement. Thus, an appropriate diagnostic algorithm cannot exclude biological and functional assessment of the peripheral airways. Similarly, achievement of optimal control of the disease and appropriate management of specific phenotypes of asthma should be based on drugs (and delivery options) able to distribute uniformly along the bronchial tree and to reach the most peripheral airways. Products developed with the Modulite® technology platform have been demonstrated to meet these aims. Recent real-life studies have shown clearly that extra-fine fixed-combination inhaled therapy provides better asthma control than non-extra-fine formulations, thus translating the activity of the drugs into greater effectiveness in clinical practice. We suggest that in patients with incomplete asthma control despite good lung function, involvement of the peripheral airways should always be suspected. When this is the case, treatments targeting both the large and small airways should be used to improve asthma control. Above all, it is emphasized that patient adherence with prescribed medications can contribute to clinical success, and clinicians should always be aware of the role played by patients themselves in determining the success or failure of treatment. PMID:23378776

  8. The role of molds in the relation between indoor environment and atopy in asthma patients

    PubMed Central

    Ceylan, Emel; Doruk, Sibel; Genc, Sebahat; Ozkutuk, Ayşe Aydan; Karadag, Fisun; Ergor, Gul; Itil, Bahriye Oya; Cımrın, Arif Hikmet

    2013-01-01

    Background: The effect of mold fungi to allergic sensitization is not well-known. We aimed to evaluate the role of molds in the relation between indoor environment and atopy in asthmatics. Materials and Methods: The air samples obtained from 66 stable asthmatics and 35 control subject's houses were sprayed into Sabouraud dextrose agar. Allergy skin testing were performed in both groups. The temperature and humidity of each house were measured. Results: The incidence of atopy was similar in cases (59.1%) and controls (51.4%). The average amount of mold was 35.9 CFU/m3 and 34.3 CFU/m3, respectively. The number of household residents was positively correlated with the amount of molds. There was no difference in the amount of mold with respect to dosage of inhaler corticosteroids as well as symptom levels in asthmatics. The most frequently encountered allergens were Dermatophagoides farinae/Dermatophagoides pteronyssinus, grass/weeds and molds. Spending childhood in a village was more common among atopics. Conclusion: Living environment during the childhood might affect atopy and asthma. Based on the identification of molds as the second most frequent allergen after mites in our study population, assessment of mold sensitization as well as in forming patients about ways to avoid them seem likely to contribute to the effective management of uncontrolled asthma. PMID:24523798

  9. Stepping down inhaled corticosteroids in asthma: randomised controlled trial

    PubMed Central

    Hawkins, Gillian; McMahon, Alex D; Twaddle, Sara; Wood, Stuart F; Ford, Ian; Thomson, Neil C

    2003-01-01

    Objectives To determine whether the dose of inhaled corticosteroids can be stepped down in patients with chronic stable asthma while maintaining control. Design One year, randomised controlled, double blind, parallel group trial. Setting General practices throughout western and central Scotland. Participants 259 adult patients with asthma receiving regular treatment with inhaled corticosteroids at high dose (mean dose 1430 μg beclomethasone dipropionate). Interventions Participants were allocated to receive either no alteration to their dose of inhaled corticosteroid (control) or a 50% reduction in their dose if they met criteria for stable asthma (stepdown). Main outcome measures Comparison of asthma exacerbation rates, asthma related visits to general practice and hospital, health status measures, and corticosteroid dosage between the two groups. Results The proportions of subjects with asthma exacerbations were not significantly different (stepdown 31%, control 26%, P=0.354). Similarly, the numbers of visits to general practice or hospital and the disease specific and generic measures of health status over the one year period were not significantly different. On average the stepdown group received 348 μg (95% confidence interval 202 μgto494 μg) of beclomethasone dipropionate less per day than the controls (a difference of 25%), with no difference in the annual dose of oral corticosteroids between the two treatment regimens. Conclusions By adopting a stepdown approach to the use of inhaled steroids at high doses in asthma a reduction in the dose can be achieved without compromising asthma control. PMID:12763981

  10. [Gustatory sensitivity to sodium chloride and potassium chloride and certain parameters of sodium metabolism in patients with bronchial asthma].

    PubMed

    Mineev, V N; Suparnovich, I Iu

    2008-01-01

    The aim of the study was to determine threshold gustatory sensitivity (TGS) to sodium chloride and potassium chloride in patients with bronchial asthma (BA) taking into account a number of factors responsible for the enhanced risk of development and progress of this disease. Forty five practically healthy subjects were compared with 139 asthmatic patients; a separate group comprised patients treated permanently with oral glucocorticoids and those having non-pulmonary allergy. Chemically pure solutions of sodium and potassium chlorides were used in the dripping test to assess TGS. Asthmatic patients had enhanced TGS to sodium chloride compared with healthy subjects. TGS values were especially high in non-allergic bronchial asthma and minimal in allergic asthma when they were unrelated to the phase of the disease. TGS to potassium chloride in asthmatic patients also differed from that in healthy subjects; more patients were bitter-insensitive or sensitive only to high concentrations of potassium chloride. Patients treated with systemic glucocorticoids had the highest TGS to sodium chloride. Patients with non-pulmonary allergy and allergic BA had very similar TGS to potassium chloride. TGS to sodium chloride in the former was lower than in healthy subjects and patients with allergic BA. Asthmatic patients had a higher sodium ion concentration in erythrocytes than normal subjects; it reached maximum values in persons used to add salt to fully cooked food.

  11. Immunoglobulin G Subclass Deficiencies in Adult Patients with Chronic Airway Diseases

    PubMed Central

    2016-01-01

    Immunoglobulin G subclass deficiency (IgGSCD) is a relatively common primary immunodeficiency disease (PI) in adults. The biological significance of IgGSCD in patients with chronic airway diseases is controversial. We conducted a retrospective study to characterize the clinical features of IgGSCD in this population. This study examined the medical charts from 59 adult patients with IgGSCD who had bronchial asthma or chronic obstructive pulmonary disease (COPD) from January 2007 to December 2012. Subjects were classified according to the 10 warning signs developed by the Jeffrey Modell Foundation (JMF) and divided into two patient groups: group I (n = 17) met ≥ two JMF criteria, whereas group II (n = 42) met none. IgG3 deficiency was the most common subclass deficiency (88.1%), followed by IgG4 (15.3%). The most common infectious complication was pneumonia, followed by recurrent bronchitis, and rhinosinusitis. The numbers of infections, hospitalizations, and exacerbations of asthma or COPD per year were significantly higher in group I than in group II (P < 0.001, P = 0.012, and P < 0.001, respectively). The follow-up mean forced expiratory volume (FEV1) level in group I was significantly lower than it was at baseline despite treatment of asthma or COPD (P = 0.036). In conclusion, IgGSCD is an important PI in the subset of patients with chronic airway diseases who had recurrent upper and lower respiratory infections as they presented with exacerbation-prone phenotypes, decline in lung function, and subsequently poor prognosis. PMID:27550483

  12. 326 Lung Age/Chronological Age Index as Indicator of Clinical Improvement or Severity in Asthma Patients

    PubMed Central

    Castrejon-Vázquez, Isabel; Vargas, Maria Eugenia; Sabido, Raúl Cicero; Tapía, Jorge Galicia

    2012-01-01

    Background Spirometry is a very useful clinical test to evaluate pulmonary function in asthma. However pulmonary function could be affected by the sex, time of clinical evolution, lung age (LA) and chronological age (CA). The aim of this study was to evaluate LA/CA as index of clinical improvement or severity in asthma patients. Methods The tenets of the Declaration of Helsinki were followed, and all patients gave their informed consent to participate in this study. Asthma severity was evaluated according with GINA classification. Spirometry was performed at the beginning of this study, at 46 days, 96 days, 192 days and after 8 months. Statistical analysis was performed using t test, 2-way ANOVA test, correlation and multiple regression models as well as ROC curves were also performed, a P < 0.05 was considered as significant. Results 70 asthma patients were included (22 male and 48 female), mean CA was 35-years old; mean LA was 48-years with a LA/CA index = 1.4, time of clinical evolution was 13 years. A LA/CA index = 1 (range 0.5 to 0.9) was observed in asymptomatic patients. LA/CA index over 1 were related with airway inflammation, and a LA/CA index more than 2 correlated with GINA step 3. Interestingly when we analyzed CA and LA, we observed that in female group more than 10 years of difference between CA and LA, (GINA Step2 and 3); while in male we observed (GINA Step1, Step2 and Step3). LA/CA index ≤ 1 was considered as normal. Conclusions LA/CA index is a good as clinical indicator of clinical improvement or severity in asthma patients in with excellent correlation of pulmonary function and age.

  13. Impact of fluticasone propionate powder on health-related quality of life in patients with moderate asthma.

    PubMed

    Mahajan, P; Okamoto, L J; Schaberg, A; Kellerman, D; Schoenwetter, W F

    1997-01-01

    Because biological indicators alone do not adequately represent the comprehensive health status of a patient with asthma, we also assessed patients' health-related quality of life (HRQOL) in a randomized, double-blind, placebo-controlled study of the effects of the inhaled corticosteroid fluticasone propionate (FP). A total of 342 patients with moderate asthma were treated twice daily for 12 weeks with FP powder (50, 100, or 250 micrograms) or placebo. At regular intervals, patients completed the Medical Outcomes Study Short Form-36, acute version (SF-36A), a general health status questionnaire measuring eight dimensions of HRQOL; the 20-item Living with Asthma (LWA-20) questionnaire, a disease-specific instrument measuring HRQOL; and three additional questions related to sleep loss and number of nighttime awakenings. Each of the three FP groups compared with placebo had significantly higher scores at study endpoint on the Physical Functioning (p < 0.001) and Role-Physical (p < or = 0.0001) dimensions of the SF-36A; the FP 100- or 250-micrograms groups compared with placebo also had significantly higher scores on General Health Perceptions (p < 0.03), Vitality (p < 0.007), and Mental Health (p < 0.02). At endpoint, all three FP groups compared with placebo had significantly better scores on the LWA questionnaire (p < 0.05) and on the sleep-related items (p < 0.0001). These data, collected using both a general health status questionnaire and an asthma-specific questionnaire, demonstrate that fluticasone propionate powder can improve HRQOL in patients with mild-to-moderate asthma. PMID:9168850

  14. Do Panic Symptoms Affect the Quality of Life and Add to the Disability in Patients with Bronchial Asthma?

    PubMed

    Faye, A D; Gawande, S; Tadke, R; Kirpekar, V C; Bhave, S H; Pakhare, A P; Tayade, B

    2015-01-01

    Background. Anxiety and panic are known to be associated with bronchial asthma with variety of impact on clinical presentation, treatment outcome, comorbidities, quality of life, and functional disability in patients with asthma. This study aims to explore the pattern of panic symptoms, prevalence and severity of panic disorder (PD), quality of life, and disability in them. Methods. Sixty consecutive patients of bronchial asthma were interviewed using semistructured proforma, Panic and Agoraphobia scale, WHO Quality of life (QOL) BREF scale, and WHO disability schedule II (WHODAS II). Results. Though 60% of the participants had panic symptoms, only 46.7% had diagnosable panic attacks according to DSM IV TR diagnostic criteria and 33.3% had PD. Most common symptoms were "sensations of shortness of breath or smothering," "feeling of choking," and "fear of dying" found in 83.3% of the participants. 73.3% of the participants had poor quality of life which was most impaired in physical and environmental domains. 55% of the participants had disability score more than a mean (18.1). Conclusion. One-third of the participants had panic disorder with significant effect on physical and environmental domains of quality of life. Patients with more severe PD and bronchial asthma had more disability. PMID:26425540

  15. Viral infections in asthma and COPD.

    PubMed

    Matsumoto, Koichiro; Inoue, Hiromasa

    2014-03-01

    Airway viral infections are associated with the pathogenesis of asthma and COPD. It has been argued that respiratory syncytial virus (RSV) infection in infancy is a probable causal factor in the development of pediatric asthma. RSV infections tend to induce Th2-biased immune responses in the host airways. RSV infection, atopy, and low pulmonary function in neonates may work synergistically toward the development of pediatric asthma. Human rhinovirus (HRV) is a representative virus associated with the exacerbation of asthma in both children and adults. Viral infections trigger innate immune responses including granulocytic inflammation and worsen the underlying inflammation due to asthma and COPD. The innate immune responses involve type-I and -III interferon (IFN) production, which plays an important role in anti-viral responses, and the airway epithelia of asthmatics reportedly exhibit defects in the virus-induced IFN responses, which renders these individuals more susceptible to viral infection. A similarly impaired IFN response is seen in COPD, and several investigators propose that latent adenoviral infection may be involved in COPD development. Persistent RSV infections were detected in a sub-population of patients with COPD and were associated with the accelerated decline of lung function. The virus-induced upregulation of co-inhibitory molecules in the airway epithelium partly accounts for the persistent infections. Experimental animal models for virus-asthma/COPD interactions have shed light on the underlying immune mechanisms and are expected to help develop novel approaches to treat respiratory diseases.

  16. Maximum Time of the Effect of Antileukotriene - Zileuton in Treatment of Patients with Bronchial Asthma

    PubMed Central

    Morina, Naim; Boçari, Gëzim; Iljazi, Ali; Hyseini, Kadir; Halac, Gunay

    2016-01-01

    Objective: Maximum time of the effect of antileukotriene substances - Zileuton in the treatment of patients with bronchial asthma and increased bronchial reactivity and of the salbutamol as agonist of the beta2 adrenergic receptor studied in this work. Methods: Parameters of the lung function are determined with Body plethysmography. Raw and ITGV were registered and specific resistance (SRaw) was calculated. Zileuton (Zyflo, tbl. 600 mg), producer Cornerstone Therapeutics, USA was used in the research. Results: Results of this research, in patients with bronchial asthma, indicate that antileukotriene substances–Zileuton administered in a dose of 600 mg first day (oral route of administration 4 × 1 tbl.) has not caused significant decrease of the specific resistance of the airways (SRaw) (p value 0.1 > Alpha 0.05), whereas Zileuton administered two days in a row, in a dose of 600 mg (4 × 1 tbl. a day), has caused significant decrease of the specific resistance of the airways (SRaw) (P value 0.03 < Alpha 0.05). Effect of the control with salbutamol (beta2-adrenergic receptor agonist) is efficient in the removal of the increased bronchomotor tone, causing significant decrease of the resistance (Raw), respectively of the specific resistance (SRaw), (p value 0.05 = Alpha 0.05). Conclusion: Formation of leukotrienes depends on the lypoxygenation of the arachidonic acid by 5-lypoxygenase. Zileuton is an active and powerful inhibitor of the activity of 5- lypoxygenase and as such inhibits generation of its products. Consequently, besides inhibition of cys-LTs’, zileuton also inhibits the formation of leukotriene B4 (LTB4), which is a powerful chemotactic of other eicosanoids too, which depend on the synthesis of lekotriene A4 (LTA4). This suggests that the effect of antileukotrienes (Zileuton) is not immediate after oral administration, but the powerful effect of the Zileuton seen only after two days of inhibition of cys-LTs’, and inhibition of leukotriene B4 (LTB4

  17. Influence of TRPV4 gene polymorphisms on the development of osmotic airway hyperresponsiveness in patients with bronchial asthma.

    PubMed

    Naumov, D E; Kolosov, V P; Perelman, J M; Prikhodko, A G

    2016-07-01

    The effect of single nucleotide polymorphisms (SNP) of TRPV4 gene on the development of airway hyperresponsiveness (39.7% of cases) in response to the decrease in osmolarity under inspiration of distilled water aerosol was studies in 189 patients with uncontrolled bronchial asthma. rs6606743 SNP was found to significantly contribute to the development of osmotic airway hyperresponsiveness. Analysis of the dominant genetic model revealed substantial prevalence of AG + GG genotype frequency in the group of patients with asthma with osmotic hyperresponsiveness in comparison with the patients who had negative response to bronchoprovocation. In addition, carriers of GG or AG genotypes had significantly more profound decrease of lung function parameters in relation to A homozygous patients. PMID:27599507

  18. Implementation of a 12-week disease management program improved clinical outcomes and quality of life in adults with asthma in a rural district hospital: pre- and post-intervention study.

    PubMed

    Chamnan, Parinya; Boonlert, Kittipa; Pasi, Wanit; Yodsiri, Songkran; Pong-on, Sirinya; Khansa, Bhoonsab; Yongkulwanitchanan, Pichapat

    2010-03-01

    Despite the availability of effective medical treatment and disease management guidelines, asthma remains a poorly controlled disease in developing countries. There is little evidence of the effectiveness of disease management guidelines in rural clinical practice. The effect of disease management guidelines on clinical outcomes and quality of life in asthmatic patients in a rural community hospital was examined. Fifty-seven patients aged > or = 16 years with physician-diagnosed asthma from a hospital outpatient clinic in Ubon-ratchathani, Thailand, were recruited. Asthma diagnosis was confirmed by reviewing clinical records. We implemented a 12-week disease management program, including the use of written asthma treatment plan and asthma action plan tailored to individual patients. Using one-group pre- and post-intervention design, we compared the average number of emergency visits and hospitalizations from acute asthmatic attacks before and after the implementation of interventions using the Wilcoxon matched-pairs signed-rank test. We also compared patient's asthma quality of life (AQL) scores, measured using the 7-point scaled Mini Asthma Quality of Life Questionnaire. It was found that among the 57 patients, 38 (67%) were women, and the mean age (SD) of the patients was 47.6 (17.0) years. Sixteen patients (28%) had a family history of asthma. Emergency visits decreased from 0.48 (SD = 0.83) per patient before implementation of interventions to 0.11 (0.37) per patient after implementation of interventions (p = 0.003). Hospitalizations with acute asthma attacks reduced from 0.14 (0.35) per patient to 0.04 (0.27) per patient (p = 0.034). Overall AQL scores increased significantly from 3.7 to 5.4 (p < 0.001), with most improvement observed in symptoms and emotions. It was concluded that implementation of a 12-week asthma disease management program could reduce emergency visits and hospitalizations, and improve patients' quality of life in a rural practice setting.

  19. A national census of those attending UK accident and emergency departments with asthma. The UK National Asthma Task Force.

    PubMed Central

    Partridge, M R; Latouche, D; Trako, E; Thurston, J G

    1997-01-01

    OBJECTIVE: To obtain a representative national picture of the type of people with asthma attending accident and emergency (A&E) departments in the UK, the reasons why they attend, and to determine the proportion admitted to hospital. DESIGN: A national census involving questionnaires. SETTING: 100 A&E departments throughout the UK. SUBJECTS: All those with asthma attending because of asthma during a one week period in September 1994. RESULTS: Details were obtained about 1292 attendances. About half of all attendances were by adults and half by children, and 87.8% were previously diagnosed asthmatics; 18.8% of adult attenders were unemployed. Perceived severity of asthma was the reason for attendance in 65.5%, but 11.5% reported non-availability, or perceived non-availability, of the general practitioner (GP) as the reason for attending. One fifth of adults had been kept awake by their asthma for over three nights before attendance. 425 of the 1292 attenders (32.9%) had been admitted to hospital in the previous 12 months and 316 (24.5%) had attended the A&E department in the previous three months. Only 24.6% of attenders had had contact with their general practitioner in the previous 24 h. 61.6% of under-5 attenders (n = 341) were admitted to hospital; the figures for those aged 5-15 and 15+ years and above were 265 (41.4%) and 665 (38.7%). CONCLUSIONS: Many people with asthma attend A&E departments without first having seen their GP. In many adult cases the asthma, while severe, is not acute, but a high proportion of both adults and children are admitted to hospital. Many of these attendances and admissions are repeat attendances. To enhance the quality of care provided to those with asthma may require easier access to primary care, enhanced patient education, or enhanced health professional education. Further study is needed of a variety of potential interventions. PMID:9023616

  20. Association of peroxisome proliferator-activated receptor-gamma gene polymorphisms and gene-gene interaction with asthma risk in a Chinese adults population

    PubMed Central

    Li, Wancheng; Dai, Wenjing; Sun, Jian; Zhang, Wei; Jiang, Yi; Ma, Chunlan; Wang, Chunmao; He, Jie

    2015-01-01

    Aims: To investigate the association between single nucleotide polymorphism (SNP) of peroxisome proliferator-activated receptors γ (PPAR γ) and additional gene-gene interactions on asthma risk. Methods: A total of 882 subjects (602 males, 280 females), with a mean age of 61.3±14.8 years old, including 430 asthma patients and 452 normal subjects were selected in this study, including the genotyping of polymorphisms. Logistic regression was performed to investigate association between SNP and asthma. Generalized MDR (GMDR) was used to analysis the interaction among four SNP. Results: Asthma risk was significantly lower in carriers of Ala allele of the rs1805192 polymorphism than those with Pro/Pro (Pro/Ala+ Ala/Ala versus Pro/Pro, adjusted OR (95% CI)=0.70 (0.51-0.94). In addition, we also found a significant association between rs10865710 and asthma, asthma risk was significantly lower in carriers of G allele of the rs10865710 polymorphism than those with CC (CG+ GG versus CC, adjusted OR (95% CI)=0.68 (0.55-0.95). There was a significant three-locus model (P=0.0107) involving rs1805192, rs10865710 and rs709158, indicating a potential gene-gene interaction among rs1805192, rs10865710 and rs709158. Overall, the three-locus models had a cross-validation consistency of 10 of 10, and had the testing accuracy of 60.72% after covariates adjustment. Conclusions: Our results support an important association of rs1805192 and rs10865710 with asthma, and additional interaction among rs1805192, rs10865710 and rs709158. PMID:26770574

  1. Concise guidance: diagnosis, management and prevention of occupational asthma.

    PubMed

    Nicholson, Paul J; Cullinan, Paul; Burge, Sherwood

    2012-04-01

    This concise guidance, prepared for physicians, summarises the British Occupational Health Research Foundation guideline for the prevention, identification and management of occupational asthma. Approximately one in six people of working age who develop asthma have work-related asthma, where work has either caused or aggravated their disease. Physicians who assess working adults with asthma need to ask the patient about their job and the materials they work with, and be aware of those that carry particular risks; they should also ask whether symptoms improve regularly on days away from work. A diagnosis of occupational asthma (ie asthma caused by work) should not be made on the basis of history alone, but be supported by immunological and physiological investigations of proven diagnostic benefit. Following a validated diagnosis of occupational asthma, physicians should recommend early avoidance of further exposure, because this offers the best chance of complete recovery. If appropriate and timely interventions are not taken, the prognosis of occupational asthma is poor, with only approximately one-third of workers achieving full symptomatic recovery.

  2. Different effects of long-term exposures to SO2 and NO2 air pollutants on asthma severity in young adults.

    PubMed

    Greenberg, Nili; Carel, Rafael S; Derazne, Estela; Bibi, Haim; Shpriz, Manor; Tzur, Dorit; Portnov, Boris A

    2016-01-01

    Numerous studies demonstrated that exposure to ambient air pollutants contributes to severity and frequency of asthma exacerbations. However, whether common air pollutants, such as nitrogen dioxide (NO2) and sulfur dioxide (SO2), exert differential effects on asthma occurrence and severity is unclear. The aim of this investigation was to determine whether exposure to NO2 and/or SO2 may initiate different long-term effects on prevalence and severity of asthma in young adults. Medical records of 137,040 males, 17 years old, who underwent standard premilitary service health examinations during 1999-2008 were examined. Air-pollution data for NO2 and SO2 were linked to the place of residence of each subject. The influence of specific air pollutants on asthma prevalence and severity was evaluated using bivariate logistic regression, controlling for individuals' sociodemographic attributes. For both ambient air pollutants, there was a significant dose-response effect on severity of asthma at ambient concentrations below the current National Ambient Air Quality Standards. However, in residential areas with high levels of SO2 (13.3-592.7µg/m(3)) and high levels of NO2 (27.2-43.2µg/m(3)) the risk of asthma occurrence was significantly higher than that in residential areas with high levels of NO2 (27.2-43.2 µg/m(3)) and intermediate levels (6.7-13.3 µg/m(3)) of SO2 pollution. The effects of exposure to SO2 and NO2 air pollutants on the respiratory airways system appear to differ, with possible implications regarding medical management, even in cases of exposure to mixtures of these pollutants.

  3. Safety and Tolerability of an Antiasthma Herbal Formula (ASHMI™) in Adult Subjects with Asthma: A Randomized, Double-Blinded, Placebo-Controlled, Dose-Escalation Phase I Study

    PubMed Central

    Kelly-Pieper, Kristin; Patil, Sangita P.; Busse, Paula; Yang, Nan; Sampson, Hugh; Li, Xiu-Min; Kattan, Meyer

    2009-01-01

    Abstract Background Complementary and alternative medicines are increasingly used for the treatment of asthma in Western countries. A novel three-herb antiasthma herbal medicine intervention (ASHMI™; Sino-Lion Pharmaceutical Company; Shan Dong China) was demonstrated to be effective and safe in a murine model of asthma and in a preliminary clinical study in China. Objective The objective of this study was to evaluate the safety and tolerability of ASHMI in adult subjects with allergic asthma. Design Randomized, double-blind, placebo-controlled, dose escalation, phase I trial aimed at developing a botanical drug under the United States Food and Drug Administration Investigational New Drug title. Interventions Subjects received one of three doses of ASHMI or placebo: 600 mg (2 capsules); 1200 mg (4 capsules); or 1800 mg (6 capsules) twice daily for 1 week. Four (4) ASHMI and 2 placebo subjects were treated at each dose level. Subjects continued to use their conventional asthma medications for the duration of the study. Outcome measures Vital signs, physical examination, laboratory data, and electrocardiogram data were monitored throughout the study to assess occurrence of adverse events (AEs). Immunomodulatory studies were performed to evaluate the effect of ASHMI on cytokine, chemokine, and growth factor levels. Results Twenty (20) nonsmoking, allergic subjects with asthma were included in the study. Eight (8) subjects (4 ASHMI and 4 placebo) reported mild gastrointestinal symptoms. No grade 3 AEs were observed during the study period. Vital signs, electrocardiogram findings, and laboratory results obtained at pre- and post-treatment visits remained within normal range. No abnormal immunologic alterations were detected. Conclusion In this phase I study, ASHMI appeared to be safe and well tolerated by subjects with asthma. These findings allowed initiation of a larger phase II study to assess the efficacy of ASHMI. PMID:19586409

  4. Different effects of long-term exposures to SO2 and NO2 air pollutants on asthma severity in young adults.

    PubMed

    Greenberg, Nili; Carel, Rafael S; Derazne, Estela; Bibi, Haim; Shpriz, Manor; Tzur, Dorit; Portnov, Boris A

    2016-01-01

    Numerous studies demonstrated that exposure to ambient air pollutants contributes to severity and frequency of asthma exacerbations. However, whether common air pollutants, such as nitrogen dioxide (NO2) and sulfur dioxide (SO2), exert differential effects on asthma occurrence and severity is unclear. The aim of this investigation was to determine whether exposure to NO2 and/or SO2 may initiate different long-term effects on prevalence and severity of asthma in young adults. Medical records of 137,040 males, 17 years old, who underwent standard premilitary service health examinations during 1999-2008 were examined. Air-pollution data for NO2 and SO2 were linked to the place of residence of each subject. The influence of specific air pollutants on asthma prevalence and severity was evaluated using bivariate logistic regression, controlling for individuals' sociodemographic attributes. For both ambient air pollutants, there was a significant dose-response effect on severity of asthma at ambient concentrations below the current National Ambient Air Quality Standards. However, in residential areas with high levels of SO2 (13.3-592.7µg/m(3)) and high levels of NO2 (27.2-43.2µg/m(3)) the risk of asthma occurrence was significantly higher than that in residential areas with high levels of NO2 (27.2-43.2 µg/m(3)) and intermediate levels (6.7-13.3 µg/m(3)) of SO2 pollution. The effects of exposure to SO2 and NO2 air pollutants on the respiratory airways system appear to differ, with possible implications regarding medical management, even in cases of exposure to mixtures of these pollutants. PMID:27092440

  5. Local adverse effects associated with the use of inhaled corticosteroids in patients with moderate or severe asthma*

    PubMed Central

    Pinto, Charleston Ribeiro; Almeida, Natalie Rios; Marques, Thamy Santana; Yamamura, Laira Lorena Lima; Costa, Lindemberg Assunção; Souza-Machado, Adelmir

    2013-01-01

    OBJECTIVE: To describe and characterize local adverse effects (in the oral cavity, pharynx, and larynx) associated with the use of inhaled corticosteroids (ICSs) in patients with moderate or severe asthma. METHODS: This was a cross-sectional study involving a convenience sample of 200 asthma patients followed in the Department of Pharmaceutical Care of the Bahia State Asthma and Allergic Rhinitis Control Program Referral Center, located in the city of Salvador, Brazil. The patients were ≥ 18 years of age and had been using ICSs regularly for at least 6 months. Local adverse effects (irritation, pain, dry throat, throat clearing, hoarseness, reduced vocal intensity, loss of voice, sensation of thirst, cough during ICS use, altered sense of taste, and presence of oral candidiasis) were assessed using a 30-day recall questionnaire. RESULTS: Of the 200 patients studied, 159 (79.5%) were women. The mean age was 50.7 ± 14.4 years. In this sample, 55 patients (27.5%) were using high doses of ICS, with a median treatment duration of 38 months. Regarding the symptoms, 163 patients (81.5%) reported at least one adverse effect, and 131 (65.5%) had a daily perception of at least one symptom. Vocal and pharyngeal symptoms were identified in 57 (28.5%) and 154 (77.0%) of the patients, respectively. The most commonly reported adverse effects were dry throat, throat clearing, sensation of thirst, and hoarseness. CONCLUSIONS: Self-reported adverse effects related to ICS use were common among the asthma patients evaluated here. PMID:24068261

  6. Asthma Quiz

    MedlinePlus

    ... Asthma is a chronic disease that requires ongoing management. Personalized plans for treatment may include medications, an asthma action plan, and environmental control measures to avoid your child's asthma triggers. ...

  7. Hypersensitivity to acetylsalicylic acid (ASA) and tartrazine in patients with asthma.

    PubMed

    Stenius, B S; Lemola, M

    1976-03-01

    One-hundred and forty asthmatics were tested perorally with acetylsalicylic acid (ASA), and/or with the azo-colour tartrazine; a fall in PEF of more than 20% was accepted as a positive result. About one quarter of the patients displayed a positive reaction to one of the two tested agents. No significant correlation was found between the reactions of these, and the presence of atopy, nasal polyposis, sinusitis, rhinitis, sensitivity to cold air, the age at onset, duration of asthma, or history of sensitivity to alcoholic drinks. The history suggested sensitivity to ingested, possibly coloured, food and drink, in only about one third of the tartrazine-positive cases. The ASA provocation tests were mainly applied to patients with doubtful or negative histories of sensitivity to ASA-containing drugs. The frequency of cross-reactivity between the two tested agents was statistically significant; patients reacting to tartrazine were for the most part, also sensitive to ASA. Tests for sensitivity to analgesics and food additives should be conducted as a routine measure in asthmatics, and sensitive patients should be given information on suitable medication and dietary control. PMID:1277437

  8. [Functional activity of alveolar macrophages in patients with bronchial asthma and gastroesophageal reflux disease].

    PubMed

    Maev, I V; Liamina, S V; Kalish, S V; Malysheva, E V; Iurenev, G L; Malyshev, I Iu

    2013-01-01

    Combination of bronchial asthma (BA) and gastroesophageal reflux disease (GERD) is a widespread clinical situation. The two pathologies are known to influence each other leading to disturbances in immune responsiveness. We studied phenotypes and phenotypic plasticity of immune cells (alveolar macrophages) in patients with BA and GERD. It was shown that BA and GERD are largely associated with AM of proinflammatory M2 and anti-inflammatory M1 phenotypes respectively. Population of AM with MI phenotype increases in patients having both BA and GERD compared with that in BA alone. In vitro experiments showed that acidic milieu promotes shifting the phenotype toward the predominance of M1, i.e. simulates the situation characteristic of GERD. Combination of BA and GERD narrows the interval within which AM can change MI phenotype (i.e. makes them more "rigid") but broadens the range in which they can change M2 phenotype. Also, GERD promotes the development of morphological rigidity of AM. Patients with BA given steroid therapy undergo inversion of phenotypic plasticity of AM. These data characterize the immunological component of BA and/or GERD pathogenesis. They help to better understand mechanisms of development of broncho-pulmonary pathology in GERD patients and can be used to work out new methods for the treatment of these diseases. PMID:24417067

  9. [Clinical and morphological peculiarities of the clinical course of duodenal ulcer in patients with bronchial asthma].

    PubMed

    Cherniaevskaia, G M; Maksimenko, G V; Beloborodova, É I; Ustiuzhanina, E A; Denisova, O A

    2014-01-01

    This work was aimed to study clinical features of H. pylori-associated duodenal ulcer (DU) and elucidate morphological features of gastric mucosa (GM) in patients with bronchial asthma (BA). Simultaneous prospective examination of 118 patients aged 18-64 yr included clinical and endoscopic study of the gastroduodenal region with the assessment of gastroenterological symptoms and morphological analysis of GM and duodenal biopsies by histological, histochemical, and morphometric methods. It was shown that GM inflammation in patients with DU and BA is associated not only with H. pylori infection but also with the phase of BA. Structural changes of GM in the patients with DU and BA, unlike those with DU without BA, were apparent not only in the antrum but also in the fundus. Growing density of eosinophil, neutrophil and mast cell infiltration of fundal and antral GM as well as increased total number of cells in the antrum reflects active immune-mediated inflammation in GM lamina propria. It is concluded that negative effect of uncontrolled BA on the clinical course of DU is not restricted to the association of DU exacerbation with the absence of BA control; it is also responsible for enhanced activity of gastritis. One of the possible factors determining combination of H. pylori-associated duodenal ulcer with BA is chronic hyperergic inflammation and marked structural changes in GM. PMID:25269182

  10. Validation of the ‘Test of the Adherence to Inhalers’ (TAI) for Asthma and COPD Patients

    PubMed Central

    Fernández-Rodríguez, Concepción; Melero, Carlos; Cosío, Borja G.; Entrenas, Luís Manuel; de Llano, Luis Pérez; Gutiérrez-Pereyra, Fernando; Tarragona, Eduard; Palomino, Rosa; López-Viña, Antolín

    2016-01-01

    Abstract Background: To validate the ‘Test of Adherence to Inhalers’ (TAI), a 12-item questionnaire designed to assess the adherence to inhalers in patients with COPD or asthma. Methods: A total of 1009 patients with asthma or COPD participated in a cross-sectional multicenter study. Patients with electronic adherence ≥80% were defined as adherents. Construct validity, internal validity, and criterion validity were evaluated. Self-reported adherence was compared with the Morisky-Green questionnaire. Results: Factor analysis study demonstrated two factors, factor 1 was coincident with TAI patient domain (items 1 to 10) and factor 2 with TAI health-care professional domain (items 11 and 12). The Cronbach's alpha was 0.860 and the test-retest reliability 0.883. TAI scores correlated with electronic adherence (ρ=0.293, p=0.01). According to the best cut-off for 10 items (score 50, area under the ROC curve 0.7), 569 (62.5%) patients were classified as non-adherents. The non-adherence behavior pattern was: erratic 527 (57.9%), deliberate 375 (41.2%), and unwitting 242 (26.6%) patients. As compared to Morisky-Green test, TAI showed better psychometric properties. Conclusions: The TAI is a reliable and homogeneous questionnaire to identify easily non-adherence and to classify from a clinical perspective the barriers related to the use of inhalers in asthma and COPD. PMID:26230150

  11. Interleukin-10 and interleukin-5 balance in patients with active asthma, those in remission, and healthy controls

    PubMed Central

    Tomiita, Minako; Campos-Alberto, Eduardo; Shima, Masayuki; Namiki, Masanobu; Sugimoto, Kazuo; Kojima, Hiroyuki; Watanabe, Hiroko; Sekine, Kunio; Nishimuta, Toshiyuki; Kohno, Yoichi

    2015-01-01

    Background The immunological mechanisms of asthma remission remain unclear although several reports have suggested that balance between T helper (Th) 2 cytokines and regulatory cytokines is related. Objective To study the balance between interleukin (IL) 10 and IL-5 in asthma clinical remission. Methods We measured the numbers of IL-5 and IL-10 producing cells in peripheral blood mononuclear cells stimulated with mite antigen obtained from patients with active asthma (group A, n = 18), patients in clinical remission (group R, n = 15) and nonatopic healthy controls (group H, n = 14). Results The numbers of IL-5 producing cells in groups A and R were significantly higher than in group H. The number of IL-5 producing cells was lower in group R than in group A, although the difference was not statistically significant. The number of IL-10 producing cells was higher in group R than in group A, although again the difference was not statistically significant. There was a significant difference in the number of IL-10 producing cells between groups A and H but not between groups R and H. The ratio of the number of IL-10 to IL-5 producing cells was highest in group H followed by groups R and A, and the differences were statistically significant for each pair of groups. Conclusion Our study suggests that the IL-10/IL-5 balance is related to clinical asthma. The balance differs between patients in clinical remission and healthy controls, suggesting that allergic inflammation may continue even after clinical asthma remission. PMID:26539403

  12. Montelukast and fluticasone compared with salmeterol and fluticasone in protecting against asthma exacerbation in adults: one year, double blind, randomised, comparative trial

    PubMed Central

    Bjermer, Leif; Bisgaard, Hans; Bousquet, Jean; Fabbri, Leonardo M; Greening, Andrew P; Haahtela, Tari; Holgate, Stephen T; Picado, Cesar; Menten, Joris; Dass, S Balachandra; Leff, Jonathan A; Polos, Peter G

    2003-01-01

    Objectives To assess the effect of montelukast versus salmeterol added to inhaled fluticasone propionate on asthma exacerbation in patients whose symptoms are inadequately controlled with fluticasone alone. Design and setting A 52 week, two period, double blind, multicentre trial during which patients whose symptoms remained uncontrolled by inhaled corticosteroids were randomised to add montelukast or salmeterol. Participants Patients (15-72 years; n = 1490) had a clinical history of chronic asthma for ≥ 1 year, a baseline forced expiratory volume in one second (FEV1) value 50-90% predicted, and a β agonist improvement of ≥ 12% in FEV1. Main outcome measures The primary end point was the percentage of patients with at least one asthma exacerbation. Results 20.1% of the patients in the group receiving montelukast and fluticasone had an asthma exacerbation compared with 19.1% in the group receiving salmeterol and fluticasone; the difference was 1% (95% confidence interval -3.1% to 5.0%). With a risk ratio (montelukast-fluticasone/salmeterol-fluticasone) of 1.05 (0.86 to 1.29), treatment with montelukast and fluticasone was shown to be non-inferior to treatment with salmeterol and fluticasone. Salmeterol and fluticasone significantly increased FEV1 before a β agonist was used and morning peak expiratory flow compared with montelukast and fluticasone (P ≤ 0.001), whereas FEV1 after a β agonist was used and improvements in asthma specific quality of life and nocturnal awakenings were similar between the groups. Montelukast and fluticasone significantly (P = 0.011) reduced peripheral blood eosinophil counts compared with salmeterol and fluticasone. Both treatments were generally well tolerated. Conclusion The addition of montelukast in patients whose symptoms remain uncontrolled by inhaled fluticasone could provide equivalent clinical control to salmeterol. PMID:14563743

  13. Biomarkers in Severe Asthma.

    PubMed

    Wan, Xiao Chloe; Woodruff, Prescott G

    2016-08-01

    Biomarkers have been critical for studies of disease pathogenesis and the development of new therapies in severe asthma. In particular, biomarkers of type 2 inflammation have proven valuable for endotyping and targeting new biological agents. Because of these successes in understanding and marking type 2 inflammation, lack of knowledge regarding non-type 2 inflammatory mechanisms in asthma will soon be the major obstacle to the development of new treatments and management strategies in severe asthma. Biomarkers can play a role in these investigations as well by providing insight into the underlying biology in human studies of patients with severe asthma. PMID:27401625

  14. Safety of inhaled corticosteroids in the treatment of persistent asthma.

    PubMed Central

    Peters, Stephen P.

    2006-01-01

    OBJECTIVE: Inhaled corticosteroids (ICSs) are the most effective medications available for patients with persistent asthma of all severities and currently are recommended as the preferred asthma controller therapy by the National Heart, Lung and Blood Institute. Nevertheless, lingering concerns about potential adverse systemic effects of ICSs contribute to their underuse. This review discusses the safety of ICSs with respect to potential systemic effects of most concern to physicians and patients. METHODS: Articles reporting on the safety of ICSs in children and adults with persistent asthma were identified from the Medline database from January 1966 through December 2003, reference lists of review articles and international respiratory meetings. RESULTS: Ocular effects of ICSs and ICS effects on bone mineral density and adrenal function are minimal in patients maintained on recommended ICS doses. One-year growth studies in children have shown decreased growth velocity with ICSs, but long-term studies with inhaled budesonide and beclomethasone show no effect on final adult height, suggesting that these effects are transient. In addition, extensive data from the Swedish Medical Birth Registry show no increased risk of adverse perinatal outcomes when inhaled budesonide is administered to pregnant women with asthma. CONCLUSIONS: ICSs have minimal systemic effects in most patients when taken at recommended doses. The benefits of ICS therapy clearly outweigh the risks of uncontrolled asthma, and ICSs should be prescribed routinely as first-line therapy for children and adults with persistent disease. PMID:16775906

  15. Omalizumab therapy for children and adolescents with severe allergic asthma.

    PubMed

    Romano, Ciro

    2015-01-01

    Omalizumab, a therapeutic humanized monoclonal antibody specific for human IgE, was introduced in clinical practice more than a decade ago as an add-on therapy for moderate-to-severe allergic asthma in patients aged ≥12 years. Omalizumab has been demonstrated to be effective in adults with uncontrolled persistent asthma, with an excellent safety profile. In simple terms, omalizumab works by inhibiting the allergic cascade, that is, by neutralization of the circulating free IgE. This leads to reduction in the quantity of cell-bound IgE, downregulation of high-affinity IgE receptors, and, eventually, prevention of mediator release from effector cells. Evidence is far less abundant on the role of omalizumab in pediatric asthma. Although efficacy and safety of omalizumab in children and adolescents with uncontrolled, persistent allergic asthma has been recognized as well, further studies are needed to clarify a number of open questions in this specific patient population.

  16. Asthma - control drugs

    MedlinePlus

    Asthma - inhaled corticosteroids; Asthma - long-acting beta-agonists; Asthma - leukotriene modifiers; Asthma - cromolyn; Bronchial asthma-control drugs; Wheezing - control drugs; Reactive airway disease - control drugs

  17. Asthma and the diver.

    PubMed

    Davies, Michael J; Fisher, Laura H; Chegini, Soheil; Craig, Timothy J

    2005-10-01

    Self-contained underwater breathing apparatus (scuba) diving has grown in popularity, with nearly 9 million sport divers in the United States alone. Approximately 7% of the population has been diagnosed with asthma, which is similar to the percentage of divers admitting they have asthma. Numerous concerns exist regarding subjects with asthma who choose to participate in recreational diving. Among these concerns are pulmonary barotrauma, pneumomediastinum, pneumothorax, arterial gas embolism, ear barotrauma, sinus barotrauma, and dental barotrauma. Despite these concerns, a paucity of information exists linking asthma to increased risk of diving complications. However, it has long been the norm to discourage individuals with asthma from participating in recreational scuba diving. This article examines the currently available literature to allow for a more informed decision regarding the possible risks associated with diving and asthma. It examines the underlying physiological principles associated with diving, including Henry's law and Boyle's law, to provide a more intimate understanding on physiological changes occurring in the respiratory system under compressive stress. Finally, this article offers a framework for guiding the patient with asthma who is interested in scuba diving. Under the right circumstances, the patient with asthma can safely participate in recreational diving without apparent increased risk of an asthma-related event. PMID:16251767

  18. Asthma and the diver.

    PubMed

    Davies, Michael J; Fisher, Laura H; Chegini, Soheil; Craig, Timothy J

    2005-10-01

    Self-contained underwater breathing apparatus (scuba) diving has grown in popularity, with nearly 9 million sport divers in the United States alone. Approximately 7% of the population has been diagnosed with asthma, which is similar to the percentage of divers admitting they have asthma. Numerous concerns exist regarding subjects with asthma who choose to participate in recreational diving. Among these concerns are pulmonary barotrauma, pneumomediastinum, pneumothorax, arterial gas embolism, ear barotrauma, sinus barotrauma, and dental barotrauma. Despite these concerns, a paucity of information exists linking asthma to increased risk of diving complications. However, it has long been the norm to discourage individuals with asthma from participating in recreational scuba diving. This article examines the currently available literature to allow for a more informed decision regarding the possible risks associated with diving and asthma. It examines the underlying physiological principles associated with diving, including Henry's law and Boyle's law, to provide a more intimate understanding on physiological changes occurring in the respiratory system under compressive stress. Finally, this article offers a framework for guiding the patient with asthma who is interested in scuba diving. Under the right circumstances, the patient with asthma can safely participate in recreational diving without apparent increased risk of an asthma-related event.

  19. Long-term Study of Disodium Cromoglycate in Treatment of Severe Extrinsic or Intrinsic Bronchial Asthma in Adults

    PubMed Central

    1972-01-01

    The results are reported here of a long-term double-blind controlled clinical trial of disodium cromoglycate (D.S.C.G.) and isoprenaline, D.S.C.G. alone, isoprenaline alone, and a placebo given as a powder for inhalation in the treatment of severe bronchial asthma. At the end of one year 16 out of 20 patients on D.S.C.G.-isoprenaline remained on the allocated capsules, compared with 10 out of 15 on D.S.C.G., 5 out of 20 on isoprenaline, and 3 out of 19 taking the placebo. The differences between each of the D.S.C.G.-isoprenaline and D.S.C.G. regimens compared with the isoprenaline and placebo regimens were statistically significant. After eight weeks on four capsules a day the patients in each group were allocated at random so that half continued on full dosage and half on a reducing regimen. At the end of the year there was no significant difference in the failure rate between patients allocated the full dosage and the patients on the reducing dosage. The capsules were well tolerated and toxicity to D.S.C.G. was not observed. PMID:4629183

  20. The level of emotional intelligence for patients with bronchial asthma and a group psychotherapy plan in 7 steps.

    PubMed

    Ropoteanu, Andreea-Corina

    2011-01-01

    Strong emotions, either positive or negative, as well as vulnerability to stress are often major factors in triggering, maintaining and emphasizing the symptoms of bronchial asthma. On a group of 99 patients suffering from moderately and severely persistent allergic bronchial asthma for more than 2 years, I applied a situational test of emotional intelligence, the NEO PI-R personality test provided by D&D Consultants and I also elaborated a psychosocial test form of asthma by which I evaluated the frequency of physical symptoms, the intensity of negative emotional symptoms arisen during or subsequent to the crisis and the level of the patients' quality of life. I have presumed first that if the level of the emotional intelligence grew, this fact would have a significant positive influence on controlling the negative emotional symptoms arisen during or subsequent to the crisis and on patients' quality of life. This was invalidated, the correlations between the mentioned variables being insignificant. Secondly, I have presumed the existence of positive significant correlations between the emotional intelligence coefficient and the personality dimensions: extraversion, openness, conscientiousness and a negative significant correlation between the emotional intelligence coefficient and the dimension neuroticism. This presumption was totally confirmed. Finally, we proposed a group psychotherapy plan in 7 steps for asthmatic patients that has as main objectives to improve symptoms and therefore the patients' quality of life.

  1. Dyspnoea at rest and at the end of different exercises in patients with near-fatal asthma.

    PubMed

    Barreiro, E; Gea, J; Sanjuás, C; Marcos, R; Broquetas, J; Milic-Emili, J

    2004-08-01

    Blunted perception of dyspnoea under resistive loading has been observed in patients with a history of near-fatal asthma (NFA). The perception of dyspnoea at rest and at the end point of various exercises was assessed in such patients. Respiratory function and exercise capacity (6-min walking distance, incremental cycloergometry and inspiratory threshold loading) were assessed in seven NFA and eight non-NFA patients. Dyspnoea (Borg scale) was measured at rest and at the end point of the various exercises. Dyspnoea at rest was significantly lower in NFA patients. Although exercise tolerance was similarly reduced in both the NFA and non-NFA groups, dyspnoea at peak cycle exercise was significantly lower in the former (2.6+/-2 versus 6.1+/-3.8 (Borg scale; mean+/-SD)), who mainly (86%) stopped because of leg discomfort. A similar trend was observed in the 6-min walking distance and inspiratory threshold loading tests. Dyspnoea at peak exercise was the best indicator of the NFA condition, with a sensitivity of 100% and specificity of 63% for a Borg scale score of < or = 6. Perception of dyspnoea is blunted in near-fatal asthma patients at both rest and the end point of various forms of exercise. Dyspnoea at peak exercise is the best indicator of the near-fatal asthma condition. PMID:15332388

  2. Serum Magnesium and Vitamin D Levels as Indicators of Asthma Severity

    PubMed Central

    Malapati, Brahma Reddy; Gokani, Ruchi; Patel, Bhavita; Chatriwala, Mitul

    2016-01-01

    Background. Serum magnesium levels affect the concentration of circulating vitamin D in blood and subsequently it affects the immunity; thus it plays significant role in the pathogenesis of asthma. Asthma, in adults, is less studied and hypomagnesemia along with vitamin D deficiency and insufficiency is common in asthmatic individuals, which causes frequent asthma attacks, respiratory infections, severe exacerbations, and poor response to bronchodilators. Objective. To detect the magnitude of vitamin D insufficiency and deficiency and serum magnesium levels among asthmatic patients and to correlate them with the severity of asthma. Materials and Methods. This is a cross-sectional case-control study which includes 60 patients of chronic stable asthma and 60 healthy controls. After taking clinical history and systemic examination, pulmonary function test was done. Serum levels of magnesium, 25-hydroxycholecalciferol [25(OH)D], and calcium were measured in all the subjects. Results. Significant correlation was found between vitamin D deficiency, hypomagnesemia, and asthma severity. Serum calcium levels were unaffected by that. Conclusion. Vitamin D and serum magnesium deficiency are highly prevalent in patients with asthma. Increased asthma severity, frequency of attacks, and exacerbation are associated with lower levels of one or both. Serum 25(OH)D and magnesium levels may serve as important markers of asthma severity.

  3. Diagnostic work-up in patients with possible asthma referred to a university hospital

    PubMed Central

    Backer, Vibeke; Sverrild, Asger; Ulrik, Charlotte Suppli; Bødtger, Uffe; Seersholm, Niels; Porsbjerg, Celeste

    2015-01-01

    Objective The best strategy for diagnosing asthma remains unclear. Accordingly, the aim of this study was to evaluate diagnostic strategies in individuals with possible asthma referred to a respiratory outpatient clinic at a university hospital. Methods All individuals with symptoms suggestive of asthma referred over 12 months underwent spirometry, bronchodilator reversibility test, Peak expiratory flow rate (PEF) registration, and bronchial challenge test with methacholine and mannitol on three separate days. The results of these tests were compared against an asthma diagnosis based on symptoms, presence of atopy and baseline spirometry made by a panel of three independent respiratory specialists. Results Of the 190 individuals examined, 63% (n=122) were classified as having asthma. Reversibility to β2-agonist had the lowest sensitivity of 13%, whereas airway hyperresponsiveness to methacholine had the highest (69%). In contrast, specificity was the highest for reversibility testing (93%), whereas methacholine had the lowest specificity (57%). The combination of reversibility, peak-flow variability, and methacholine yielded a cumulative sensitivity of 78%, albeit a specificity of 41%. In comparison, a combination of reversibility and mannitol resulted in a specificity of 82% and a sensitivity of 42%. Conclusion In this real-life population, different diagnostic test combinations were required to achieve a high specificity for diagnosing asthma and a high sensitivity, respectively: Our findings suggest that the diagnostic test approach should be based on whether the aim is to exclude asthma (high sensitivity required) or confirm a diagnosis of asthma (high specificity required). PMID:26557251

  4. [Physiopathology of aspirin intolerant asthma].

    PubMed

    Carsin, A; Bienvenu, J; Pacheco, Y; Devouassoux, G

    2012-02-01

    Aspirin-exacerbated respiratory disease (AERD) refers to the development of bronchoconstriction in individuals with asthma following the ingestion of aspirin. AERD affects up to 20 % of adults with asthma. At present, no reliable in vitro test is available to confirm the diagnosis. The confirmation of the diagnosis of AERD therefore depends on the response to challenge testing with aspirin. The pathogenesis of AERD is linked to abnormalities in arachidonic acid metabolism. Prior to exposure to aspirin, respiratory mucosal inflammation is the result of a cell infiltration, an overproduction of leukotrienes, prostaglandins D2, 5-oxo-eicosatetraenoic acid and an underproduction of lipoxins. After aspirin ingestion, patients with AERD synthesize excessive amounts of cysteinyl leukotrienes and prostaglandin metabolites involved in bronchoconstriction. New hypotheses concerning AERD pathogenesis have been added to the initial cyclooxygenase theory. These propose that AERD may be linked to the complement system, adenosine metabolism or angiotensin converting enzyme gene and IgE receptor gene polymorphisms. PMID:22405107

  5. Characteristics of reversible and nonreversible COPD and asthma and COPD overlap syndrome patients: an analysis of salbutamol Easyhaler data.

    PubMed

    Müller, Veronika; Gálffy, Gabriella; Orosz, Márta; Kováts, Zsuzsanna; Odler, Balázs; Selroos, Olof; Tamási, Lilla

    2016-01-01

    The choice of inhaler device for bronchodilator reversibility is crucial since suboptimal inhalation technique may influence the result. On the other hand, bronchodilator response also varies from time to time and may depend on patient characteristics. In this study, patients with airway obstruction (forced expiratory volume in 1 second [FEV1]/forced vital capacity [FVC] ratio <70% in chronic obstructive pulmonary disease [COPD]; <80% in asthma) were included (n=121, age: 57.8±17.3 years). Bronchodilator reversibility (American Thoracic Society/European Respiratory Society criteria) was tested in patients with COPD (n=63) and asthma and COPD overlap syndrome (ACOS; n=12). Forty-six asthmatics served as controls. Reversibility was tested with 400 µg salbutamol dry powder inhaler (Buventol Easyhaler, Orion Pharma Ltd, Espoo, Finland). Demographic data and patients' perceptions of Easyhaler compared with β2-agonist pressurized metered dose inhalers (pMDIs) were analyzed. American Thoracic Society/European Respiratory Society guideline defined reversibility was found in 21 out of 63 COPD patients and in two out of 12 ACOS patients. Airway obstruction was more severe in COPD patients as compared with controls (mean FEV1 and FEV1% predicted both P<0.0001). Average response to salbutamol was significantly lower in COPD patients compared with asthma controls (P<0.0001). Reversibility was equally often found in smokers as in never-smokers (33% vs 34%). Nonreversible COPD patients had higher mean weight, body mass index, and FEV1/FVC compared with reversible COPD patients. Most patients preferred Easyhaler and defined its use as simpler and more effective than use of a pMDI. Never-smokers and patients with asthma experienced Easy-haler somewhat easier to use than smokers and patients with COPD. In conclusion, a substantial part of patients with COPD or ACOS showed reversibility to salbutamol dry powder inhaler. Nonreversible patients with COPD were characterized by higher

  6. Exposure to daily ambient particulate polycyclic aromatic hydrocarbons and cough occurrence in adult chronic cough patients: A longitudinal study

    NASA Astrophysics Data System (ADS)

    Anyenda, Enoch Olando; Higashi, Tomomi; Kambayashi, Yasuhiro; Thao, Nguyen Thi Thu; Michigami, Yoshimasa; Fujimura, Masaki; Hara, Johsuke; Tsujiguchi, Hiromasa; Kitaoka, Masami; Asakura, Hiroki; Hori, Daisuke; Yamada, Yohei; Hayashi, Koichiro; Hayakawa, Kazuichi; Nakamura, Hiroyuki

    2016-09-01

    The specific components of airborne particulates responsible for adverse health effects have not been conclusively identified. We conducted a longitudinal study on 88 adult patients with chronic cough to evaluate whether exposure to daily ambient levels of particulate polycyclic aromatic hydrocarbons (PAH) has relationship with cough occurrence. Study participants were recruited at Kanazawa University Hospital, Japan and were physician-diagnosed to at least have asthma, cough variant asthma and/or atopic cough during 4th January to 30th June 2011. Daily cough symptoms were collected by use of cough diaries and simultaneously, particulate PAH content in daily total suspended particles collected on glass fiber filters were determined by high performance liquid chromatography coupled with fluorescence detector. Population averaged estimates of association between PAH exposure and cough occurrence for entire patients and subgroups according to doctor's diagnosis were performed using generalized estimating equations. Selected adjusted odds ratios for cough occurrence were 1.088 (95% confidence interval (CI): 1.031, 1.147); 1.209 (95% CI: 1.060, 1.379) per 1 ng/m3 increase for 2-day lag and 6-day moving average PAH exposure respectively. Likewise, 5 ring PAH had higher odds in comparison to 4 ring PAH. On the basis of doctor's diagnosis, non-asthma group had slightly higher odds ratio 1.127 (95% CI: 1.033, 1.228) per 1 ng/m3 increase in 2-day lag PAH exposure. Our findings suggest that ambient PAH exposure is associated with cough occurrence in adult chronic cough patients. The association may be stronger in non-asthma patients and even at low levels although there is need for further study with a larger sample size of respective diagnosis and inclusion of co-pollutants.

  7. Increased Protease-Activated Receptor-2 (PAR-2) Expression on CD14++CD16+ Peripheral Blood Monocytes of Patients with Severe Asthma

    PubMed Central

    Shrestha Palikhe, Nami; Nahirney, Drew; Laratta, Cheryl; Gandhi, Vivek Dipak; Vethanayagam, Dilini; Bhutani, Mohit; Mayers, Irvin

    2015-01-01

    Background Protease-Activated Receptor-2 (PAR-2), a G protein coupled receptor activated by serine proteases, is widely expressed in humans and is involved in inflammation. PAR-2 activation in the airways plays an important role in the development of allergic airway inflammation. PAR-2 expression is known to be upregulated in the epithelium of asthmatic subjects, but its expression on immune and inflammatory cells in patients with asthma has not been studied. Methods We recruited 12 severe and 24 mild/moderate asthmatics from the University of Alberta Hospital Asthma Clinics and collected baseline demographic information, medication use and parameters of asthma severity. PAR-2 expression on blood inflammatory cells was analyzed by flow cytometry. Results Subjects with severe asthma had higher PAR-2 expression on CD14++CD16+ monocytes (intermediate monocytes) and also higher percentage of CD14++CD16+PAR-2+ monocytes (intermediate monocytes expressing PAR-2) in blood compared to subjects with mild/moderate asthma. Receiver operating characteristics (ROC) curve analysis showed that the percent of CD14++CD16+PAR-2+ in peripheral blood was able to discriminate between patients with severe and those with mild/moderate asthma with high sensitivity and specificity. In addition, among the whole populations, subjects with a history of asthma exacerbations over the last year had higher percent of CD14++CD16+ PAR-2+ cells in peripheral blood compared to subjects without exacerbations. Conclusions PAR-2 expression is increased on CD14++CD16+ monocytes in the peripheral blood of subjects with severe asthma and may be a biomarker of asthma severity. Our data suggest that PAR-2 -mediated activation of CD14++CD16+ monocytes may play a role in the pathogenesis of severe asthma. PMID:26658828

  8. Ab Interno Trabeculectomy in the Adult Patient

    PubMed Central

    SooHoo, Jeffrey R.; Seibold, Leonard K.; Kahook, Malik Y.

    2015-01-01

    Glaucoma is a potentially blinding disease that affects millions of people worldwide. The mainstay of treatment is lowering of intraocular pressure (IOP) through the use of medications, laser and/or incisional surgery. The trabecular meshwork (TM) is thought to be the site of significant resistance to aqueous outflow in open angle glaucoma. Theoretically, an incision through TM or TM removal should decrease this resistance and lead to a significant reduction in IOP. This approach, commonly referred to as goniotomy or trabeculotomy, has been validated in the pediatric population and has been associated with long-term IOP control. In adults, however, removal of TM tissue has been historically associated with more limited and short-lived success. More recent evidence, reveals that even adult patients may benefit significantly from removal of diseased TM tissue and can lead to a significant reduction in IOP that is long-lasting and safe. In this review, we discuss current evidence and techniques for ab interno trabeculectomy using various devices in the adult patient. PMID:25624670

  9. Ab interno trabeculectomy in the adult patient.

    PubMed

    SooHoo, Jeffrey R; Seibold, Leonard K; Kahook, Malik Y

    2015-01-01

    Glaucoma is a potentially blinding disease that affects millions of people worldwide. The mainstay of treatment is lowering of intraocular pressure (IOP) through the use of medications, laser and/or incisional surgery. The trabecular meshwork (TM) is thought to be the site of significant resistance to aqueous outflow in open angle glaucoma. Theoretically, an incision through TM or TM removal should decrease this resistance and lead to a significant reduction in IOP. This approach, commonly referred to as goniotomy or trabeculotomy, has been validated in the pediatric population and has been associated with long-term IOP control. In adults, however, removal of TM tissue has been historically associated with more limited and short-lived success. More recent evidence, reveals that even adult patients may benefit significantly from removal of diseased TM tissue and can lead to a significant reduction in IOP that is long-lasting and safe. In this review, we discuss current evidence and techniques for ab interno trabeculectomy using various devices in the adult patient.

  10. [COPD and Asthma: same same but different].

    PubMed

    Rothe, T

    2012-02-15

    In clinical practice, differentiation of COPD and asthma is difficult. A case report of an asthma patient with a drifter type of asthma imitating COPD is presented. In this context differences and similarities of both diseases are high-lighted. The definitions of asthma and COPD in international guidelines leave some space to misdiagnosing.

  11. The effect of house design and environment on fungal movement in homes of bronchial asthma patients.

    PubMed

    Takatori, K; Saito, A; Yasueda, H; Akiyama, K

    2001-01-01

    The effect of house building design and environment on the fungal movement in the houses of 41 bronchial asthma (BA) patients has been investigated by examining house dust. The presence and composition of fungi were determined and compared in relation to building structure, house age, size of living room, main flooring material, presence of a living-room rug or air purifier, and frequency of vacuum cleaning. Among these elements, fungal CFU apparently varied only between building structure: wooden-board houses had significantly higher numbers of fungi than reinforced concrete houses (p < 0.01), and wooden mortar or iron-framed prefabricated houses had significantly higher numbers of fungi than reinforced concrete houses (p < 0.05). Classification of the types of fungi present in the house dust of BA patients showed that, regardless of the building designs, there were high levels of osmophilic fungi (group A) and fungi that survive at relatively dry conditions (group B), whereas fungi that survive in very wet conditions (group D) were present at low frequency. PMID:11694095

  12. A smart spirometry device for asthma diagnosis.

    PubMed

    Kassem, A; Hamad, M; El Moucary, C

    2015-08-01

    In this paper an innovative prototype for smart asthma spirometry device to be used by doctors and asthma patients is presented. The novelty in this prototype relies in the fact that it is destined to subtend not only adults but offers an efficient and attractive manner to accommodate children patients as well thus, making it efficient for doctors, patients and parents to detect and monitor such intricate cases at stages as early as six years old. Moreover, the apparatus used enables us to integrate a vital parameter representing the Forced Expiratory Volume to the final diagnosis. Besides, the presented device will automatically diagnose those patients, assess their asthma condition, and schedule their medication process without excessive visits to medical centers whilst providing doctors with accurate and pertinent and comprehensive medical data in a chronological fashion. Zooming into under the hood of the device, a fully reliable hardware digital system lies along with a flowmeter detector and a Bluetooth emitter to interface with a user-friendly GUI-based application installed on smartphones which incorporates appealing animated graphics to encourage children to take the test. Furthermore, the device offers the capability of storing chronological data and a relevant resourceful display for accurate tracking of patients' medical record, the evolvement of their asthma condition, and the administered medication. Finally, the entire device is aligned with the medical requirements as per doctors' and telemedicine specialists' recommendations; the experiments carried out demonstrated the effectiveness and sustainable use of such device. PMID:26736587

  13. Evolution of asthma through childhood.

    PubMed

    Sears, M R

    1998-11-01

    The greatest incidence of childhood asthma is among males under 5 years, with decreasing numbers of new cases with age. Many young children wheeze, but remission is common especially in non-atopic children without a family history of allergy or asthma, whose wheezing relates more to infections and environmental tobacco smoke exposure. The prognosis of childhood asthma is best established from population studies, in which some two-thirds of wheezy children become symptom-free as adults, whereas follow-up studies of wheezing children seen in office or specialty clinic practice, who generally have more severe asthma, show a much greater likelihood (60-80%) of persistence of asthma into adulthood. Factors predisposing to persistence of childhood asthma include a positive family history, development of atopy, environmental exposures to allergens and cigarette smoke, markers of severity of childhood asthma, and female gender.

  14. Comparison of the process of care of acute severe asthma in adults admitted to hospital before and 1 yr after the publication of national guidelines.

    PubMed

    Pearson, M G; Ryland, I; Harrison, B D

    1996-10-01

    This study set out to assess the effect of publication of the British Guidelines on Asthma Management on the processes and outcomes of the inpatient care of acute severe asthma in the U.K. A criterion-based audit of all acute asthma admissions during August and September 1990 (immediately before) and in 1991 (1 yr after publication of the Guidelines) using eight criteria of process and outcome was performed. Thirty-six teaching and district general hospitals in England, Scotland and Wales took part. In total, 766 patients admitted in 1990, and 900 patients admitted in 1991, were studied. The 1990 and 1991 cohorts were very similar demographically and had asthma of comparable severity. Respiratory physicians achieved similar high performance rates of between 75 and 91% for seven of the eight criteria for both years. Respiratory physicians were significantly more likely to provide patients with a written management plan in 1991. General physicians' performance was significantly lower in both years, but overall there was a very small, but just significant, improvement in their performance in 1991. Some hospitals performed consistently well in both years. It is concluded that respiratory physicians consistently provide better asthma care than general physicians. Though statistically significant, the small degree of improvement was disappointing. Possible reasons include: insufficient time for the Guidelines to be incorporated into practice; inaccessibility of the Guidelines to general physicians; failure to accept responsibility for implementing the good practice reflected in the Guidelines; and an explicit need for strategies to implement the Guidelines beyond publication in a widely-read general medical journal.

  15. National trends in the morbidity and mortality of asthma in the US. Prevalence, hospitalization and death from asthma over two decades: 1965-1984.

    PubMed

    Evans, R; Mullally, D I; Wilson, R W; Gergen, P J; Rosenberg, H M; Grauman, J S; Chevarley, F M; Feinleib, M

    1987-06-01

    National population-based data systems of the National Center for Health Statistics (NCHS) were used to study the epidemiology of asthma in the United States over the last 20 years. Asthma is more prevalent among males, those living below the poverty level, persons living in the South and West, and blacks; however, this difference did not attain statistical significance. Death rates from asthma among the older age groups probably increased between 1968 and 1982, with a substantial increase since 1979. For children, the evidence is less clear, but the death rate has increased for children over five years of age during the period from 1979 to 1982. Between 1964 and 1980, asthma has become more prevalent in children under 17 years of age, but this does not reflect an increase in the severity of asthma over this same time period. Hospitalization rates for asthma between 1965 and 1983 increased by 50 percent in adults and by over 200 percent in children. Rates for black patients are 50 percent higher in adults and 150 percent greater in children. It is concluded that there has been a marked increase in hospitalization rates for asthma, a moderate increase in death rates from asthma and a smaller increase in overall prevalence of the disease in the United States.

  16. The association between asthma control, health care costs, and quality of life in France and Spain

    PubMed Central

    2013-01-01

    Background Current asthma management guidelines are based on the level of asthma control. The impact of asthma control on health care resources and quality of life (QoL) is insufficiently studied. EUCOAST study was designed to describe costs and QoL in adult patients according to level of asthma control in France and Spain. Methods An observational cost of illness study was conducted simultaneously in both countries among patients age greater or equal to 18 with a diagnosis of asthma for at least 12 months. Patients were recruited prospectively by GPs in 2010 in four waves to avoid a seasonal bias. Health care resources utilization of the three months before the inclusion was collected through physician questionnaires. Asthma control was evaluated using 2009 GINA criteria over a 3-month period. QoL was assessed using EQ-5D-3L®. Results 2,671 patients (France: 1,154; Spain: 1,517) were enrolled. Asthma was controlled in 40.6% [95% CI: 37.7% - 43.4%] and 29.9% [95% CI: 27.6% - 32.3%] of French and Spanish patients respectively. For all types of costs, the percentage of patients using health care resources varied significantly according to the level of asthma control. The average cost (euros/3-months/patient) of controlled asthma was €85.4 (SD: 153.5) in France compared with €314.0 (SD: 2,160.4) for partially controlled asthma and €537.9 (SD: 2,355.7) for uncontrolled asthma (p<0.0001). In Spain, the corresponding figures were €152.6 (SD: 162.1), €241.2 (SD: 266.8), and €556.8 (SD: 762.4). EQ-5D-3L® score was higher (p<0.0001) in patients with controlled asthma compared to partially controlled and uncontrolled asthma in both countries (respectively 0.88; 0.78; 0.63 in France and 0.89; 0.82; 0.69 in Spain). Conclusions In both countries, patients presenting with uncontrolled asthma had a significantly higher asthma costs and lower scores of Qol compared to the others. PMID:23517484

  17. Characteristics of patients making serious inhaler errors with a dry powder inhaler and association with asthma-related events in a primary care setting

    PubMed Central

    Westerik, Janine A. M.; Carter, Victoria; Chrystyn, Henry; Burden, Anne; Thompson, Samantha L.; Ryan, Dermot; Gruffydd-Jones, Kevin; Haughney, John; Roche, Nicolas; Lavorini, Federico; Papi, Alberto; Infantino, Antonio; Roman-Rodriguez, Miguel; Bosnic-Anticevich, Sinthia; Lisspers, Karin; Ställberg, Björn; Henrichsen, Svein Høegh; van der Molen, Thys; Hutton, Catherine; Price, David B.

    2016-01-01

    Abstract Objective: Correct inhaler technique is central to effective delivery of asthma therapy. The study aim was to identify factors associated with serious inhaler technique errors and their prevalence among primary care patients with asthma using the Diskus dry powder inhaler (DPI). Methods: This was a historical, multinational, cross-sectional study (2011–2013) using the iHARP database, an international initiative that includes patient- and healthcare provider-reported questionnaires from eight countries. Patients with asthma were observed for serious inhaler errors by trained healthcare providers as predefined by the iHARP steering committee. Multivariable logistic regression, stepwise reduced, was used to identify clinical characteristics and asthma-related outcomes associated with ≥1 serious errors. Results: Of 3681 patients with asthma, 623 (17%) were using a Diskus (mean [SD] age, 51 [14]; 61% women). A total of 341 (55%) patients made ≥1 serious errors. The most common errors were the failure to exhale before inhalation, insufficient breath-hold at the end of inhalation, and inhalation that was not forceful from the start. Factors significantly associated with ≥1 serious errors included asthma-related hospitalization the previous year (odds ratio [OR] 2.07; 95% confidence interval [CI], 1.26–3.40); obesity (OR 1.75; 1.17–2.63); poor asthma control the previous 4 weeks (OR 1.57; 1.04–2.36); female sex (OR 1.51; 1.08–2.10); and no inhaler technique review during the previous year (OR 1.45; 1.04–2.02). Conclusions: Patients with evidence of poor asthma control should be targeted for a review of their inhaler technique even when using a device thought to have a low error rate. PMID:26810934

  18. Retrospective Observations on the Ability to Diagnose and Manage Patients with Asthma through the Use of Impulse Oscillometry: Comparison with Spirometry and Overview of the Literature

    PubMed Central

    Saadeh, Charles; Gaylor, Michael

    2014-01-01

    Objective. Impulse oscillometry (IOS) is an evolving technology for the diagnosis and followup of patients with asthma. Our objective is to review the findings on patients who underwent both spirometry and IOS during clinical evaluations of their asthma. The goal was to retrospectively evaluate IOS during the initial diagnosis and followup of patients with asthma in comparison with spirometry. Methods. We routinely perform IOS and spirometry evaluation in patients with suspected asthma during baseline visits and at followup. We reviewed the data on 39 patients over the age of 13 with asthma at baseline and following treatment with inhaled corticosteroids. IOS and spirometry were both done at baseline, following short acting bronchodilator administration, and at followup after at least three months of inhaled corticosteroid treatment. Results. IOS showed improvement in airway function both initially, following short acting bronchodilator introduction, and later after initiation of long term inhaled corticosteroid treatment, even when the spirometry did not reveal improvement. We noted the IOS improvement in the reactance or AX as well as the resistance in smaller airways or R5. Conclusion. IOS may provide a useful measure towards identifying an asthma diagnosis and followup without inducing the extra respiratory effort spirometry requires. PMID:24665365

  19. Chlamydia pneumoniae and asthma

    PubMed Central

    Cook, P; Davies, P; Tunnicliffe, W; Ayres, J; Honeybourne, D; Wise, R

    1998-01-01

    BACKGROUND—This study was designed to test the association of Chlamydia pneumoniae infection with asthma in a multiracial population, after adjustments for several potential confounding variables.
METHODS—Antibodies to C pneumoniae were measured by microimmunofluorescence in 123 patients with acute asthma, 1518 control subjects admitted to the same hospital with various non-cardiovascular, non-pulmonary disorders, and 46 patients with severe chronic asthma, including some with "brittle" asthma. Acute infection or reinfection was defined by titres of IgG of ⩾512 or IgM ⩾8 or a fourfold rise in IgG, and previous infection by IgG 64-256 or IgA ⩾8. Logistic regression was used to control for likely confounders, including ethnic origin, age, sex, smoking habit, steroid medication, diabetes mellitus and social deprivation, on antibody levels.
RESULTS—Antibody titres consistent with acute C pneumoniae infection were found in 5.7% of patients with acute asthma and 5.7% of control patients, while 14.6% of patients with acute asthma and 12.7% of control patients had titres suggesting previous infection. These two groups did not differ significantly. However, titres suggesting previous infection were found in 34.8% of patients with severe chronic asthma: the difference between this group and the control group was statistically significant with an adjusted odds ratio of 3.99 (95% confidence interval 1.60 to 9.97).
CONCLUSIONS—These data raise important questions about the previously demonstrated association of C pneumoniae infection with asthma, and suggest that future studies of this association should give particular attention to the presence or absence of a history of severe chronic asthma.

 PMID:9741366

  20. Cotinine level is associated with asthma severity in passive smoker children.

    PubMed

    Hassanzad, Maryam; Khalilzadeh, Soheila; Eslampanah Nobari, Shabnam; Bloursaz, Mohammadreza; Sharifi, Hooman; Mohajerani, Seyed Amir; Tashayoie Nejad, Sabereh; Velayati, Ali Akbar

    2015-02-01

    Asthma environmental triggers play important roles in severity of disease. Passive smoking could exacerbate asthma symptoms and enhance the decrease in lung function. Cotinine levels could be a reflection of passive exposure to the cigarette both in adults and pediatrics. The aim of this study was to determine degree of association of asthma severity and cotinine level as a marker of passive smoking. In a cross-sectional study, 100 pediatric patients (under 10 years old) with asthma were enrolled, 50 of whom, had been exposed to passive smoking and 50 others included as controls. A complete clinical history, lab exam, and spirometry were performed. A sample of urine, serum and saliva was collected from all attendant patients and controls in the study after confirmation of diagnosis and determination of severity of asthma. The results revealed that age, sex, age of onset of asthma, family history and allergic history were not significantly different between two groups of patients. According to GINA classification, percentage of patients with severe asthma was significantly higher in passive smoker group (p=0.001). Cotinine was significantly higher in passive smoker group compared to control group in serum (p=001), saliva (p=0.001), and urine (p=0.0014). In passive smoker group, cotinine levels were significantly higher in serum (p=0.001), urine (p=0.007), and saliva (p=0.01) of patients with severe asthma than moderate and mild asthma. Serum cotinine (OR: 1.81, 95% CI: 1.35-2.32, p=0.024), urine cotinine (OR: 3.56,95% CI = 1.29-5.53, p=0.01) and saliva cotinine (OR: 1.66, 95% CI: 1.23-1.98, p=0.031) were also significantly associated with higher risk of severe asthma. Cotinine levels were higher in passive smokers compared to non-passive smokers. Besides, cotinine was a predictive risk factor for severe asthma.

  1. Aberrant expression of regulatory cytokine IL-35 and pattern recognition receptor NOD2 in patients with allergic asthma.

    PubMed

    Wong, Chun Kwok; Leung, Ting Fan; Chu, Ida Miu Ting; Dong, Jie; Lam, Yvonne Yi On; Lam, Christopher Wai Kei

    2015-02-01

    We investigated the plasma concentration of the novel regulatory cytokine IL-35 and intracytosolic pattern recognition receptors nucleotide-binding oligomerization domain (NOD)-like receptors in granulocytes and explored their potential implication in disease severity monitoring of allergic asthma. The expression of circulating IL-35 and other pro-inflammatory mediators in asthmatic patients or control subjects were evaluated using enzyme-linked immunosorbent assay (ELISA). The intracellular expressions of NOD1 and NOD2 in CCR3+ granulocytes were assessed using flow cytometry. Plasma concentrations of IL-35, IL-17A, basophil activation marker basogranulin, and eosinophilic airway inflammation biomarker periostin were significantly elevated in allergic asthmatic patients compared to non-atopic control subjects (all probability (p) <0.05). Both granulocyte markers exhibited significant and positive correlation with plasma IL-35 concentration in asthmatic patients (all p < 0.05). Significant positive correlation was also identified between plasma concentrations of IL-35 and periostin with disease severity score in asthmatic patients (both p < 0.05). The basophil activation allergenicity test was positive in allergic asthmatic patients but not in control subjects. Despite significantly elevated eosinophil count in allergic asthmatic patients, downregulation of NOD2 in CCR3+ granulocytes was observed in these patients (both p < 0.05). A negative correlation between plasma concentrations of tumor necrosis factor family member LIGHT and soluble herpesvirus entry mediator was observed in patients with elevated plasma concentration of IL-35 (p < 0.05). Aberrant expression of NOD2 in granulocytes may be contributed to the impaired innate immunity predisposing allergic asthma. IL-35 may serve as a potential surrogate biomarker for disease severity of allergic asthma.

  2. Carboplatin dosing for adult Japanese patients.

    PubMed

    Ando, Yuichi; Shimokata, Tomoya; Yasuda, Yoshinari; Hasegawa, Yoshinori

    2014-02-01

    Carboplatin is a platinum-based anticancer drug that has been long used to treat many types of solid cancer. Because the clearance of carboplatin strongly correlates with the glomerular filtration rate (GFR), its dosage is calculated with the Calvert formula on the basis of the patient's GFR to achieve the target area under the plasma drug concentration-time curve (AUC) for each patient. However, many lines of evidence from previous clinical studies should be interpreted with caution because different methods were used to estimate drug clearance and derive the dosage of carboplatin. There is a particularly high risk of carboplatin overdosing when the dosage is determined on the basis of standardized serum creatinine values. When deciding the dose of carboplatin for adult Japanese patients, preferred methods to assess renal function instead of directly measuring GFR include (1) 24-h urinary collection-based creatinine clearance adjusted by adding 0.2 mg/dl to the serum creatinine concentration measured by standardized methods, and (2) equation-based GFR (eGFR) with a back calculation to units of ml/min per subject. Given the limitations of serum creatinine-based GFR estimations, the GFR or creatinine clearance should be directly measured in each patient whenever possible. To ensure patient safety and facilitate a medical-team approach, the single most appropriate method available at each institute or medical team should be consistently used to calculate the dose of carboplatin with the Calvert formula.

  3. The distribution of dust mite allergen in the houses of patients with asthma

    SciTech Connect

    Tovey, E.R.; Chapman, M.D.; Wells, C.W.; Platts-Mills, T.A.

    1981-11-01

    Using an inhibition radioimmunoassay for the major allergen from Dermatophagoides pteronyssinus (antigen P1), we studied the distribution of this dust allergen in the houses of patients with asthma. Both bed and floor dust samples contained a wide range of antigen P1, 100 to 100,000 ng/g of fine dust, and this concentration correlated well with the number of mite bodies (r . 0.81, p less than 0.001). We were unable to detect antigen P1 in the air of undisturbed rooms. However, during domestic activity, between 1 and 30 ng were collected on a filter than sampled air for 45 min at 17 L/min. Using a cascade impactor it was shown that greater than 80% of the airborne antigen P1 was associated with particles greater than 10 mu in diameter. Some of the particles containing allergen could be identified because they formed precipitin rings when impacted onto agarose containing rabbit antimite antiserum. These particles had the physical appearance of mite feces, which are the major source of antigen P1 in mite cultures. The results suggested that natural exposure to this dust allergen allows occasional fecal particles to enter the lungs and that these particles contain very concentrated allergen.

  4. The threat of Asian dust storms on asthma patients: a population-based study in Taiwan.

    PubMed

    Wang, Chien-Ho; Chen, Chin-Shyan; Lin, Chung-Liang

    2014-01-01

    This study explores the relationship between Asian dust storms (ADSs), asthma hospital admissions and average medical cost discharge. We adopt the hospitalisation data from the Taiwan National Health Insurance research database covering the period from 2000 to 2009. The autoregressive integrated moving average with exogenous variables (ARIMAX) analyses were performed to explore the relationship between ADS and asthma hospital admissions, adjusting for temperature, air pollutants and season dummy. The results show that ADS events do generate a critical influence upon the occurrences of asthma on post-ADS events from days 1 through 3, with an average of 17-20 more hospitalised admissions, and have stronger effects on preschool children, middle-aged people and the elderly. From the perspective of medical expenses, the cost of hospitalised admissions for asthma substantially rises daily, on average, by NT$634,698 to NT$787,407 during ADS event days. This study suggests that government should establish a forecast and alert system and release warnings about dust storms, so that the individuals predisposed to asthma can take precautionary measures to reduce their outdoor exposure. Consequently, personal risk and medical expenditure could be reduced significantly, especially for preschool children, middle-aged people and the elderly with asthma. PMID:25186129

  5. Atlantoaxial Rotatory Fixation in Adults Patient

    PubMed Central

    Jeon, Sei Woong; Moon, Seung Myung; Choi, Sun Kil

    2009-01-01

    Atlantoaxial rotatory fixation (AARF) in adult is a rare disorder that occurs followed by a trauma. The patients were presented with painful torticollis and a typical 'cock robin' position of the head. The clinical diagnosis is generally difficult and often made in the late stage. In some cases, an irreducible or chronic fixation develops. We reported a case of AARF in adult patient which was treated by immobilization with conservative treatment. A 25-year-old female was presented with a posterior neck pain and limitation of motion of cervical spine after a traffic accident. She had no neurological deficit but suffered from severe defect on the scalp and multiple thoracic compression fractures. Plain radiographs demonstrated torticollis, lateral shift of odontoid process to one side and widening of one side of C1-C2 joint space. Immobilization with a Holter traction were performed and analgesics and muscle relaxants were given. Posterior neck pain and limitation of the cervical spine's motion were resolved. Plain cervical radiographs taken at one month after the injury showed that torticollis disappeared and the dens were in the midline position. The authors reported a case of type I post-traumatic AARF that was successfully treated by immobilization alone. PMID:19444353

  6. The future of asthma.

    PubMed Central

    Hall, I. P.

    1997-01-01

    Reports in the media describing the discovery of "the asthma gene" or "a new vaccine for asthma" may be inaccurate and often raise patients' hopes unjustifiably. This article is a personal view of key areas in current asthma research, and it examines how they may impinge on the care of asthmatic patients in the next decade. I have tried to explain the thinking behind some of the approaches under study. I discuss the potential contributions of genetic studies, immunological approaches, and new therapeutic approaches. PMID:9001482

  7. Dietary antioxidants and magnesium in type 1 brittle asthma: a case control study

    PubMed Central

    Baker, J; Tunnicliffe, W; Duncanson, R; Ayres, J

    1999-01-01

    BACKGROUND—Type 1 brittle asthma is a rare form of asthma. Atopy, psychosocial factors and diet may contribute to this condition. As increased dietary magnesium has a beneficial effect on lung function and selenium, vitamins A, C and E have antioxidant properties, a study was undertaken to test the hypothesis that patients with brittle asthma have diets deficient in these nutrients compared with subjects with non-brittle asthma and healthy adults.
METHODS—A case control study of the dietary intakes of 20 subjects with brittle asthma, 20 with non-brittle asthma, and 20 healthy adults was performed using five day weighed dietary records. Intake of magnesium was the primary outcome measure with selenium and vitamins A, C and E as secondary outcomes. Serum levels were measured at the same time as the dietary assessment.
RESULTS—Sixty subjects (27 men) of mean age 49.5 years were recruited and completed the study. Subjects with brittle asthma had statistically lower median dietary intakes of vitamins A and E than the other groups (vitamin A: brittle asthma 522.5 µg/day, non-brittle asthma 869.5 µg/day, healthy adults 806.5 µg/day; vitamin E: brittle asthma 4.3 mg/day, non-brittle asthma 4.6 mg/day, healthy adults 4.5 mg/day). Median dietary intakes for the other nutrients were not significantly different between groups. Serum levels were within normal ranges for each nutrient in all subjects. Intakes less than the reference nutrient intake (RNI) for magnesium and vitamins A and C, and less than the safe intake (SI) for vitamin E were more likely in patients with brittle asthma than in those with non-brittle asthma.
CONCLUSION—Nutrient deficiency and reduced antioxidant activity may contribute to disease activity in type 1 brittle asthma, although a prospective study of replacement therapy will be needed to confirm this hypothesis.

 PMID:10325914

  8. Indoor Dust Allergen Levels in the Homes of Patients with Childhood Asthma: An Experience From Southwestern Iran.

    PubMed

    Moghtaderi, Mozhgan; Farjadian, Shirin; Fereidouni, Mohammad; Nasiri, Mahboubeh; Nejat, Arsalan

    2016-04-01

    Exposure to indoor allergens plays an important role in the etiology of asthma. This study was designed to quantify indoor allergens from homes of families that had at least one case of childhood asthma at home in a southwestern city of Iran. The relationship between the indoor allergen levels and home characteristics was also investigated. Dust samples were collected from the bedrooms and the kitchens of 35 homes where children with persistent asthma were living. The levels of indoor allergens were measured by enzyme linked immunosorbent assay (ELISA). Detectable amounts of mite, mouse and cockroach allergens were found in all evaluated places. None of our patients were exposed to a threshold concentration of indoor allergen for sensitizing at home. Regarding of mite allergens, the levels of Der f1 were significantly higher than Der p1 and a direct correlation was observed between living in an apartment and Der f1 levels. Moreover, Fel d1 (cat) and Bla g1 (cockroach) allergens were found in the children's bedrooms more frequently than those in the kitchens. In this study, direct associations were obtained between Bla g1 allergen and the duration of occupancy and between Fel d1 and average home size. A total of 34.2% of the patients showed positive skin reactions to at least one of the tested allergens as 17.1% of them showed reactivity to D. pteronyssinus. Proper controlling of cockroaches and mice by public health officials would be a practical approach to avoid inducing asthma or worsening the symptoms.

  9. Indoor Dust Allergen Levels in the Homes of Patients with Childhood Asthma: An Experience From Southwestern Iran.

    PubMed

    Moghtaderi, Mozhgan; Farjadian, Shirin; Fereidouni, Mohammad; Nasiri, Mahboubeh; Nejat, Arsalan

    2016-04-01

    Exposure to indoor allergens plays an important role in the etiology of asthma. This study was designed to quantify indoor allergens from homes of families that had at least one case of childhood asthma at home in a southwestern city of Iran. The relationship between the indoor allergen levels and home characteristics was also investigated. Dust samples were collected from the bedrooms and the kitchens of 35 homes where children with persistent asthma were living. The levels of indoor allergens were measured by enzyme linked immunosorbent assay (ELISA). Detectable amounts of mite, mouse and cockroach allergens were found in all evaluated places. None of our patients were exposed to a threshold concentration of indoor allergen for sensitizing at home. Regarding of mite allergens, the levels of Der f1 were significantly higher than Der p1 and a direct correlation was observed between living in an apartment and Der f1 levels. Moreover, Fel d1 (cat) and Bla g1 (cockroach) allergens were found in the children's bedrooms more frequently than those in the kitchens. In this study, direct associations were obtained between Bla g1 allergen and the duration of occupancy and between Fel d1 and average home size. A total of 34.2% of the patients showed positive skin reactions to at least one of the tested allergens as 17.1% of them showed reactivity to D. pteronyssinus. Proper controlling of cockroaches and mice by public health officials would be a practical approach to avoid inducing asthma or worsening the symptoms. PMID:27090366

  10. [Distinguishing asthma from COPD].

    PubMed

    Ohara, Kouhei; Samukawa, Takuya; Inoue, Hiromasa

    2016-05-01

    Asthma and chronic obstructive pulmonary disease (COPD) are major public health burdens. Asthma is characterized by airway inflammation, airway narrowing with reversibility, and hyperresponsiveness of airways. COPD has been associated with smoking and exposure to environmental fumes, which typically characterized by persistent airflow limitation and chronic inflammation of the airways. These differences are most apparent when young non-smoker with asthma and older smokers with COPD are compared. However, it would be difficult to differentiate asthma from COPD, especially in elderly who currently smoke or have a significant history of smoking. Furthermore, some patients exhibit characteristics of both diseases, this may represent a phenotype known as asthma-COPD overlap syndrome (ACOS). Therefore, the precise understanding of these diseases is important.

  11. Evolving Concepts of Asthma.

    PubMed

    Gauthier, Marc; Ray, Anuradha; Wenzel, Sally E

    2015-09-15

    Our understanding of asthma has evolved over time from a singular disease to a complex of various phenotypes, with varied natural histories, physiologies, and responses to treatment. Early therapies treated most patients with asthma similarly, with bronchodilators and corticosteroids, but these therapies had varying degrees of success. Similarly, despite initial studies that identified an underlying type 2 inflammation in the airways of patients with asthma, biologic therapies targeted toward these type 2 pathways were unsuccessful in all patients. These observations led to increased interest in phenotyping asthma. Clinical approaches, both biased and later unbiased/statistical approaches to large asthma patient cohorts, identified a variety of patient characteristics, but they also consistently identified the importance of age of onset of disease and the presence of eosinophils in determining clinically relevant phenotypes. These paralleled molecular approaches to phenotyping that developed an understanding that not all patients share a type 2 inflammatory pattern. Using biomarkers to select patients with type 2 inflammation, repeated trials of biologics directed toward type 2 cytokine pathways saw newfound success, confirming the importance of phenotyping in asthma. Further research is needed to clarify additional clinical and molecular phenotypes, validate predictive biomarkers, and identify new areas for possible interventions.

  12. Asthma: Not Just a Childhood Condition.

    ERIC Educational Resources Information Center

    Strauss, Kandra

    2002-01-01

    Asthma has grown to epidemic proportions among school-age children, and nearly 10 million U.S. adults suffer from it. This paper describes asthma and its triggers and explains how to take measures to manage asthma symptoms within the school (e.g., dusting regularly and keeping medications available). A sidebar presents tips on controlling asthma…

  13. Predicting asthma outcomes.

    PubMed

    Sears, Malcolm R

    2015-10-01

    This review addresses predictors of remission or persistence of wheezing and asthma from early childhood through adulthood. Early childhood wheezing is common, but predicting who will remit or have persistent childhood asthma remains difficult. By adding parental history of asthma and selected infant biomarkers to the history of recurrent wheezing, the Asthma Predictive Index and its subsequent modifications provide better predictions of persistence than simply the observation of recurrent wheeze. Sensitization, especially to multiple allergens, increases the likelihood of development of classic childhood asthma. Remission is more likely in male subjects and those with milder disease (less frequent and less severe symptoms), less atopic sensitization, a lesser degree of airway hyperresponsiveness, and no concomitant allergic disease. Conversely, persistence is linked strongly to allergic sensitization, greater frequency and severity of symptoms, abnormal lung function, and a greater degree of airway hyperresponsiveness. A genetic risk score might predict persistence more accurately than family history. Remission of established adult asthma is substantially less common than remission during childhood and adolescence. Loss of lung function can begin early in life and tracks through childhood and adolescence. Despite therapy which controls symptoms and exacerbations, the outcomes of asthma appear largely resistant to pharmacologic therapy.

  14. Asthma in childhood.

    PubMed

    de Benedictis, Fernando Maria; Attanasi, Marina

    2016-03-01

    Several topics on childhood asthma were addressed in the Paediatric Clinical Year in Review session at the 2015 European Respiratory Society International Congress. With regard to the relationship between lower respiratory tract infections and asthma, it emerges that is the number of respiratory episodes in the first years of life, but not the particular viral trigger, to be associated with later asthma development. Understanding which characteristics of individual patients are associated with an increased risk for asthma exacerbation is a critical step to implement strategies preventing these seasonal events. Recent data suggest the possibility that exhaled volatile organic compounds may qualify as biomarkers in detecting early signs of asthma. Adding information of exhaled volatile organic compounds and expression of inflammation genes to a clinical tool significantly improves asthma prediction in preschool wheezy children. Personal communication with children and adolescents is likely more important than the tools actually used for monitoring asthma. Systemic corticosteroids do not affect the long-term prognosis in children with first viral-induced wheezing episode and should be used cautiously during acute episodes. Finally, stress and a polymorphism upstream of a specific gene are both associated with reduced bronchodilator response in children with asthma.

  15. The costs of asthma.

    PubMed

    Barnes, P J; Jonsson, B; Klim, J B

    1996-04-01

    At present, asthma represents a substantial burden on health care resources in all countries so far studied. The costs of asthma are largely due to uncontrolled disease, and are likely to rise as its prevalence and severity increase. Costs could be significantly reduced if disease control is improved. A large proportion of the total cost of illness is derived from treating the consequences of poor asthma control-direct costs, such as emergency room use and hospitalizations. Indirect costs, which include time off work or school and early retirement, are incurred when the disease is not fully controlled and becomes severe enough to have an effect on daily life. In addition, quality of life assessments show that asthma has a significant socioeconomic impact, not only on the patients themselves, but on the whole family. Underuse of prescribed therapy, which includes poor compliance, significantly contributes towards the poor control of asthma. The consequences of poor compliance in asthma include increased morbidity and sometimes mortality, and increased health care expenditure. To improve asthma management, international guidelines have been introduced which recommend an increase in the use of prophylactic therapy. The resulting improvements in the control of asthma will reduce the number of hospitalizations associated with asthma, and may ultimately produce a shift within direct costs, with subsequent reductions in indirect costs. In addition, costs may be reduced by improving therapeutic interventions and through effective patient education programmes. This paper reviews current literature on the costs of asthma to assess how effectively money is spent and, by estimating the proportion of the cost attributable to uncontrolled disease, will identify where financial savings might be made. PMID:8726924

  16. Comparison between objective measures of smoking and self-reported smoking status in patients with asthma or COPD: are our patients telling us the truth?*

    PubMed Central

    Stelmach, Rafael; Fernandes, Frederico Leon Arrabal; Carvalho-Pinto, Regina Maria; Athanazio, Rodrigo Abensur; Rached, Samia Zahi; Prado, Gustavo Faibischew; Cukier, Alberto

    2015-01-01

    OBJECTIVE: Smoking prevalence is frequently estimated on the basis of self-reported smoking status. That can lead to an underestimation of smoking rates. The aim of this study was to evaluate the difference between self-reported smoking status and that determined through the use of objective measures of smoking at a pulmonary outpatient clinic. METHODS: This was a cross-sectional study involving 144 individuals: 51 asthma patients, 53 COPD patients, 20 current smokers, and 20 never-smokers. Smoking status was determined on the basis of self-reports obtained in interviews, as well as through tests of exhaled carbon monoxide (eCO) and urinary cotinine. RESULTS: All of the asthma patients and COPD patients declared they were not current smokers. In the COPD and asthma patients, the median urinary cotinine concentration was 167 ng/mL (range, 2-5,348 ng/mL) and 47 ng/mL (range, 5-2,735 ng/mL), respectively (p < 0.0001), whereas the median eCO level was 8 ppm (range, 0-31 ppm) and 5 ppm (range, 2-45 ppm), respectively (p < 0.05). In 40 (38%) of the patients with asthma or COPD (n = 104), there was disagreement between the self-reported smoking status and that determined on the basis of the urinary cotinine concentration, a concentration > 200 ng/mL being considered indicative of current smoking. In 48 (46%) of those 104 patients, the self-reported non-smoking status was refuted by an eCO level > 6 ppm, which is also considered indicative of current smoking. In 30 (29%) of the patients with asthma or COPD, the urinary cotinine concentration and the eCO level both belied the patient claims of not being current smokers. CONCLUSIONS: Our findings suggest that high proportions of smoking pulmonary patients with lung disease falsely declare themselves to be nonsmokers. The accurate classification of smoking status is pivotal to the treatment of lung diseases. Objective measures of smoking could be helpful in improving clinical management and counseling. PMID:25972966

  17. A randomized, controlled, crossover study in patients with mild and moderate asthma undergoing treatment with traditional Chinese acupuncture

    PubMed Central

    Pai, Hong Jin; Azevedo, Raymundo Soares; Braga, Alfésio Luís Ferreira; Martins, Lourdes Conceição; Saraiva-Romanholo, Beatriz M; de Arruda Martins, Milton; Lin, Chin An

    2015-01-01

    OBJECTIVES: This study sought to verify the effects of acupuncture as an adjuvant treatment for the control of asthma. METHODS: This was a randomized, controlled, crossover trial conducted at the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. A total of 74 patients with mild/moderate, persistent asthma were randomized into two therapeutic groups: Group A – 31 patients underwent 10 real weekly acupuncture sessions, followed by a 3-week washout period and 10 sham weekly acupuncture sessions; and Group B - 43 patients underwent 10 sham weekly acupuncture sessions, followed by a 3-week washout period and 10 real weekly acupuncture sessions. Patients used short- and long-acting β-2 agonists and inhaled corticosteroids when necessary. Prior to treatment and after each period of 10 treatment sessions, the patients were evaluated for spirometry, induced sputum cell count, exhaled nitric oxide (NO) and with the Short Form 36 (SF-36) and Questionnaire on Quality of Life-Asthma (QQLA) questionnaires. Daily peak flow and symptom diaries were registered. The level of significance adopted was 5% (α=0.05). RESULTS: In Group B, after real acupuncture, there was a decrease in eosinophils (p=0.035) and neutrophils (p=0.047), an increase in macrophages (p=0.001) and an improvement in peak flow (p=0.01). After sham acupuncture treatment, patients experienced less coughing (p=0.037), wheezing (p=0.013) and dyspnea (p=0.014); similarly, after real acupuncture, patients reported less coughing (p=0.040), wheezing (p=0.012), dyspnea (p<0.001) and nocturnal awakening episodes (p=0.009). In Group A, there was less use of rescue medication (p=0.043). After the sham procedure, patients in Group A experienced less coughing (p=0.007), wheezing (p=0.037), dyspnea (p<0.001) and use of rescue medication (p<0.001) and after real acupuncture, these patients showed improvements in functional capacity (p=0.004), physical aspects (p=0.002), general health status (p<0

  18. Childhood Asthma

    MedlinePlus

    ... Share your child's asthma management plan with the school nurse and any coaches who oversee your child. With the approval of physicians and parents, school-age children with asthma should be allowed to ...

  19. Improvement in symptoms and pulmonary function of asthmatic patients due to their treatment according to the Global Strategy for Asthma Management (GINA)

    PubMed Central

    Boskabady, Mohammad H; Rezaeitalab, Fariba; Rahimi, Najmah; Dehnavi, Damon

    2008-01-01

    Background Global Initiative Strategy for Asthma Management (GINA) is poorly applied in undeveloped and developing countries. The current study examined the effects of applying GINA guidelines on treatment efficacy in asthmatic patients in Iran. Methods Twenty four asthmatic patients (usual care group) were treated as usual and 26 patients (intervention group) according to the GINA for 2 months. Asthma symptom score, asthma severity, frequency of symptoms/week and wheezing were recorded at the beginning (first visit), one month after treatment (second visit), and at the end of the study (third visit). Pulmonary function tests (PFTs) were performed by spirometry, and the patients' use of asthma drugs and their symptoms were evaluated, at each visit. Results Asthma symptoms, frequency of symptoms/week, chest wheezing, and PFT values were significantly improved in the intervention group at the second and third visits compared to first visit (p < 0.001 for all measures). In addition, exercise induced cough and wheeze were significant improved in the third visit compared to the second visit in this group (p < 0.01 for both measures). In the second and third visits all symptoms were significantly lower, and PFT values higher, in the intervention group compared to the usual care group (p < 0.005 to p < 0.001). In the usual care group, there were only small improvements in some parameters in just the second visit (p < 0.01 for all measures). The use of asthma drugs was unchanged in the usual care group and significantly reduced in the intervention group (p < 0.01) by the end of the study. Conclusion Adoption of GINA guidelines improves asthma symptoms and pulmonary function in asthmatic patients in Iran. PMID:19102753

  20. Psychiatric symptoms in patients with asthma causality, comorbidity, or shared genetic etiology.

    PubMed

    Mrazek, David A

    2003-07-01

    Despite the range of diverse studies that attempt to understand the comorbidity of asthma and psychiatric diagnoses, it is still not possible to provide a reliable quantitative estimate of the increased risk for anxiety and mood disorders in children with asthma. A new hypothesis for this comorbidity has evolved, however. It is likely that the stress of having a chronic illness increases the likelihood of the development of anxiety and depressive symptoms. If this were a sufficient etiologic explanation, however, increased comorbidities of psychiatric illnesses would be found in all chronic pediatric illnesses. More precise prevalence estimates of these comorbidities require the completion of large studies that use a longitudinal design and reliable and well-validated assessment instruments. The most promising direction for future research is the definition of underlying genetic vulnerabilities that reflect autonomic regulation, may contribute to the onset of some forms of asthma, and are associated with increased risk for anxiety and mood disorders.

  1. Patient- and Family-Centered Care as an approach to reducing disparities in asthma outcomes in urban African American children: A review of the literature

    PubMed Central

    Harper, Felicity W. K.; Eggly, Susan; Crider, Beverly; Kobayashi, Hitomi; Meert, Kathleen L.; Ball, Allison; Penner, Louis A.; Gray, Herman; Albrecht, Terrance L.

    2016-01-01

    Background Patient- and family-centered care (PFCC) has the potential to address disparities in access and quality of healthcare for African American pediatric asthma patients by accommodating and responding to the individual needs of patients and families. Study Objectives To identify and evaluate research on the impact of family–provider interventions that reflect elements of PFCC on reducing disparities in the provision, access, quality, and use of healthcare services for African American pediatric asthma patients. Methods Electronic searches were conducted using PubMed, CINAHL, and Psyclnfo databases. Inclusion criteria were peer-reviewed, English-language articles on family–provider interventions that (a) reflected one or more elements of PFCC and (b) addressed healthcare disparities in urban African American pediatric asthma patients (≤18years). Results Thirteen interventions or programs were identified and reviewed. Designs included randomized clinical trials, controlled clinical trials, pre-and post-interventions, and program evaluations. Conclusions Few interventions were identified as explicitly providing PFCC in d pediatric asthma context, possibly because of a Iack of consensus on what constitutes PFCC in practice. Some studies have demonstrated that PFCC improves satisfaction and communication during clinical interactions. More empirical research is needed to understand whether PFCC interventions reduce care disparities and improve the provision, access, and quality of asthma healthcare for urban African American children. Electronic databases used PubMed, CINAHL, and Psyclnfo PMID:27269485

  2. Food sensitivity reported by patients with asthma and hay fever. A relationship between food sensitivity and birch pollen-allergy and between food sensitivity and acetylsalicylic acid intolerance.

    PubMed

    Eriksson, N E

    1978-08-01

    Among adult patients with bronchial asthma and/or allergic rhinitis undergoing allergological investigation with skin test, nasal provocation test and RAST, 1129 answered a questionaire regarding food sensitivity (FS). 276 (24%) of the patients reported some kind of allergic symptoms on eating or handling various foods, of which hazel nut, apple and shell fish were the most often named. Females reported FS more often than males. A correlation was found between birch pollen allergy and FS with nuts, apple, peach, cherry, pear, plum, carrot and new potato. The higher the degree of birch pollen allergy, according to skin test, RAST or provocation test, the higher the frequency of FS. A correlation was found too between acetylsalicylic acid intolerance and FS with some foods, e.g. nuts, strawberry, almond, green pepper, hip, chocolate, egg, cabbage, milk and wine. The connection between birch pollen allergy and FS is probably explained by the structural relationship between birch pollen allergen and some allergens of the foodstuffs, whereas the high incidence of FS in acetylsalicylic acid-intolerant patients is probably explained by additives in foods as well as salicylates or benzoates naturally occurring in some food. PMID:717703

  3. [Investigation of the presence of human metapneumovirus in patients with chronic obstructive pulmonary disease and asthma and its relationship with the attacks].

    PubMed

    Ilvan, Ahmet; Aslan, Gönül; Serin, Mehmet Sami; Calıkoğlu, Mukadder; Yılmaz, Fatma Mehtap; Tezcan, Seda; Taş, Dilaver; Ayrık, Cüneyt; Uygungül, Evren; Sezer, Ogün; Emekdaş, Gürol

    2013-10-01

    Human metapneumovirus (hMPV), an enveloped RNA virus classified in Paramyxoviridae family, was first characterized in 2001 from children with acute respiratory tract infection. Recent studies have suggested hMPV to play a role in chronic obstructive pulmonary disease (COPD) and asthma attacks. The aims of this study were to investigate the frequency of hMPV in patients with COPD and asthma, its effects on the severity of the attacks and the relationship between demographical and clinical factors. A total of 123 patients, including 66 with COPD (45 were in attack and 21 were stable) and 57 with asthma (33 were in attack and 24 were under control) diagnosed according to the criteria of Global Initiative for Chronic Obstructive Lung Disease and the Global Strategy for Asthma Management and Prevention, respectively, were included in the study. Nasopharyngeal lavage samples collected from all of the patients have been evaluated for the presence of hMPV-RNA by using a reverse transcriptase-polymerase chain reaction (RT-PCR) targeting F gene region of the virus. hMPV-RNA positivity rates in patients with COPD and asthma were observed as 30.3% (20/66) and 31.6% (18/57), respectively, and the difference between the groups were not statistically significant (p= 1.00). When patients were compared according to their disease status, hMPV was detected in 31.1% (14/45) of patients with COPD attack and 28.6% of stable patients (p> 0.05). These rates were found as 36.4% (12/33) and 25% (6/24) in patients with asthma attack and controlled asthma, respectively (p> 0.05). Although the virus detection rates in patients with COPD and asthma attacks (26/78; 33.3%) were higher than the patients with stable/controlled disease (12/45; 26.7%), the difference was not found as statistically significant (p= 0.57). The detection rate of hMPV-RNA was 26.1% in patients who can be treated at home and hospital without any need of intensive care and mechanical ventilation, while this rate was 36

  4. Allergy and Asthma Health Magazine

    MedlinePlus

    Contact Us Home > Healthy Living Font: Aerosol Delivery Oxygen Resources Immunizations Pollution Nutrition Exercise Coming Of Age Older Adults Allergy and Asthma Health Magazine Women Infant, Children and Teenagers Living ...

  5. Comparison of Glucocorticoid (Budesonide) and Antileukotriene (Montelukast) Effect in Patients with Bronchial Asthma Determined with Body Plethysmography

    PubMed Central

    Lajqi, Njomza; Ilazi, Ali; Kastrati, Bashkim; Islami, Hilmi

    2015-01-01

    Objective: Effect of glucocorticoids-budesonide and antileukotriene–montelukast in patients with bronchial asthma and bronchial increased reactivity was studied in this work. Methods: Parameters of the lung function are determined with Body plethysmography. Raw and ITGV were registered and specific resistance (SRaw) was also calculated. Results: Results of this research, in patients with bronchial asthma, indicate that glucocorticoids – budesonide (Pulmicort; 2 × 2 mg inh) has significant action (p< 0.01) on reduction of the specific resistance (SRaw) of airways, applied to the same patients 3 days after administration of montelukast, at home (2 × 10 mg). Three days after administration of the montelukast, antileukotriene medicine, at home, on the fourth day same patients administered a capsule of montelukast, 10 mg dose per os, and significantly (p < 0.05) reduced the increased bronchomotor tonus; and the effect of the control with salbutamol (beta2-adrenergic agonist) is effective in removal of the increased bronchomotor tonus, causing significant decrease of the resistance (Raw), respectively of the specific resistance (SRaw), (p < 0, 01). Conclusion: This suggests that the bronchodilator effect of glucocorticoids is more powerful than of the leukotriene, because glucocorticoids terminate the early stage of chemical mediator release (prostaglandins PgD2, SRS, and leukotriene LTC4, LTD4, LTE4 and Cytokinins also etc.) as powerful bronchoconstriction substances, whilst antileukotriene substances does not have this feature. PMID:26862243

  6. Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma-Summary Report 2007.

    PubMed

    2007-11-01

    Highlights of the National Asthma Education and Prevention Program's Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma-Full Report 2007 are presented in this EPR-3 summary report. The updated guidelines emphasize the importance of asthma control. Asthma control is the degree to which the manifestations of asthma are minimized by therapeutic intervention and the goals of therapy are met. Because asthma is highly variable, the level of control must be monitored on a periodic basis to determine whether therapy should be maintained or adjusted (stepped up if necessary, stepped down if possible). On the other hand, asthma severity is the intrinsic intensity of the disease process, most easily and directly measured in a patient not receiving long-term control therapy. For managing asthma, the recommendation is to assess severity to initiate therapy and assess control to adjust therapy. Recommendations for managing asthma include an expanded section on childhood asthma with addition of an age group 5 to 11 years old (earlier guidelines combined this group with adults). The guidelines provide new recommendations on patient education in settings beyond the physician's office, and new advice for controlling environmental factors that can cause asthma symptoms. The concepts of current impairment (frequency and intensity of symptoms, low lung function, and limitations of daily activities) and future risk (likelihood of exacerbations, progressive loss of lung function, or adverse side effects from medications) support a new approach to assessing and monitoring the patient's level of asthma control through use of multiple measures. The guidelines stress that some patients can still be at high risk for frequent exacerbations even if they have few day-to-day effects of asthma.Moreover, EPR-3 confirms the importance of teaching patients skills to self-monitor and manage asthma and to use a written asthma action plan, which should include

  7. Diagnostic value of symptoms and laboratory data for pertussis in adolescent and adult patients

    PubMed Central

    2013-01-01

    Background Several symptoms are classically thought to be suggestive of pertussis in children, but the diagnostic value of these symptoms in adolescent and adult patients is unclear. We evaluated the accuracy of the clinical findings for the early presumptive diagnosis of pertussis in adolescent and adult patients. Furthermore, we measured fractional exhaled nitric oxide (FeNO) with regard to whether we could distinguish eosinophilic inflammation of the airway and pertussis. FeNO is not expected to be associated with pertussis. Methods We compared 183 cases with laboratory-confirmed pertussis using serology and polymerase chain reaction and 1,132 cases without laboratory-confirmed pertussis. Results Among pertussis patients, paroxysmal cough was common with 90% sensitivity, but the specificity was low (25%). Posttussive vomiting and whoop were less common (sensitivity 25% and 19%, respectively), but both showed greater specificity for pertussis (80% and 86%, respectively). Posttussive gagging was observed with intermediate frequency and provided greater specificity (49% and 77%, respectively). Pertussis cases were most frequent between May and August with a peak in June. The mean FeNO value for the pertussis patients was 18.2 ± 9.2 ppb, which was significantly lower than that in asthma patients (56.9 ± 20.3 ppb, p <0.001). The most useful definition was posttussive vomiting and/or gagging, and a plus normal FeNO value, which had a sensitivity of 72% and a specificity of 70%. Conclusions Clinical symptoms and laboratory data are of limited value in making the diagnosis of pertussis, and it was clinically difficult to differentiate adolescent and adult patients with or without pertussis. However, pertussis should be considered if patients have posttussive vomiting and/or gagging and a normal FeNO concentration. PMID:23496900

  8. Is asthma prevalence still increasing?

    PubMed

    Lundbäck, Bo; Backman, Helena; Lötvall, Jan; Rönmark, Eva

    2016-01-01

    Increased awareness of asthma in society and altered diagnostic practices makes evaluation of data on prevalence change difficult. In most parts of the world the asthma prevalence seems to still be increasing. The increase is associated with urbanization and has been documented particularly among children and teenagers in urban areas of middle- and low-level income countries. Use of validated questionnaires has enabled comparisons of studies. Among adults there are few studies based on representative samples of the general population which allow evaluation of time trends of prevalence. This review focuses mainly on studies of asthma prevalence and symptoms among adults. Parallel with increased urbanization, we can assume that the increase in asthma prevalence in most areas of the world will continue. However, in Australia and North-West Europe studies performed, particularly among children and adolescents, indicate that the increase in asthma prevalence may now be leveling off. PMID:26610152

  9. Getting control of uncontrolled asthma.

    PubMed

    Wechsler, Michael E

    2014-11-01

    Despite various treatment modalities, a large proportion of patients have asthma that remains uncontrolled. These patients remain at an increased risk of developing severe exacerbations, have a poor quality of life, and pose a high economic healthcare burden, with an estimated mean annual cost more than double that of patients with good symptom control. It is therefore important to accurately diagnose asthma and continually assess asthma control. Several validated tools are available to do this, including questionnaires, biomarker analysis, and bronchoscopy. Current guidelines advise physicians to establish a self-management program for the patient to assess and monitor asthma control. A further recommendation is the establishment of an educational action plan to increase treatment adherence and to improve asthma control. National and international guidelines provide long-term management strategies for these patients and recommend a stepwise approach for achieving and maintaining asthma control. Despite availability of a wide range of controller and reliever therapies, uncontrolled asthma remains a challenge and reflects the need for new therapeutic options. This review discusses current global guidelines for the assessment and management of asthma control and summarizes the broad spectrum of novel therapeutic agents currently under development for the treatment of asthma, including anticholinergics, chemoattractant receptor-homologous molecules expressed on T-helper 2 lymphocyte antagonists, and anti-interleukin (IL)-5, anti-IL-13, and anti-IL-4 agents. PMID:24844737

  10. The disease management approach to controlling asthma.

    PubMed

    Haahtela, T

    2002-02-01

    Asthma has become an important public health issue worldwide and certain groups, such as children, are at particular risk of the disease. Often asthma remains under-diagnosed and under-treated. Despite these worrying trends, the disease management approach to asthma control can help most asthma patients achieve a 'normal' way of life. The increased prevalence and greater diagnostic awareness of asthma have placed increased demands on healthcare resources, but effective asthma control can minimize the personal, social and economic burdens of asthma. Early diagnosis and immediate anti-inflammatory treatment is the first step in gaining control of symptoms. A stepwise approach is then used to classify asthma severity and treatment, with the number and frequency of medications increasing (step up) as asthma severity increases and decreasing (step down) when asthma is under control. This stepwise approach to asthma management necessitates regular review of treatment once asthma is under control. However, effective asthma management is dependent on successful patient education, adherence to prescribed medication and good doctor patient partnerships. Current treatment guidelines recommend the use of a written asthma management plan that should be agreed between the doctor and patient. These plans should cover all aspects of asthma treatment, including prevention steps for long-term control and action steps to stop attacks once a worsening in asthma has been recognized. This comprehensive approach to asthma management increases the likelihood of achieving asthma control, which in turn reduces the need for emergency visits to the hospital or clinic and reduces the limitations on physical activity previously imposed by the condition.

  11. Occupational Asthma

    PubMed Central

    Sheppard, Dean

    1982-01-01

    Bronchospasm is a common cause of morbidity in the workplace. More than 100 agents are now recognized as occupational causes of asthma and numerous agents can cause exacerbations of preexisting asthma. Because of the large number of potential causative agents and the complexity of modern industrial processes, knowledge of the characteristic clinical features of occupational asthma is the key to recognizing this disease. Early diagnosis of occupational asthma is important in preventing long-term morbidity. Present evidence that prolonged exposure to some work-encountered agents can cause asthma that persists for years after the end of exposure suggests that avoidance is the only acceptable countermeasure against this disease. PMID:7164429

  12. Intravenous magnesium for acute asthma?

    PubMed

    2003-10-01

    Each year in the UK, around 1,500 people die from asthma. Standard treatment has been based on bronchodilators (e.g. beta 2-stimulants) and anti-inflammatory drugs (corticosteroids). The recently revised British Guideline on the Management of Asthma suggests also using a single dose of i.v. magnesium sulphate in patients with acute severe asthma, an unlicensed indication. Here we discuss the rationale for giving i.v. magnesium and whether it offers any advantage for patients with acute severe asthma.

  13. Transcendental meditation and asthma.

    PubMed

    Wilson, A F; Honsberger, R; Chiu, J T; Novey, H S

    1975-01-01

    A 6-month study with crossover at 3 months was designed to evaluate the possible beneficial effects of transcendental meditation upon bronchial asthma. 21 patients kept daily diaries of symptoms and medications and answered questionnaires at the end of the study and 6 months later. Other measurements included physician evaluation, pulmonary function testing, and galvanic skin resistance. The results indicated that transcendental meditation is a useful adjunct in treating asthma.

  14. Relvar Ellipta for asthma.

    PubMed

    2014-08-01

    ▼Relvar Ellipta (GSK) is a dry powder inhaler that contains a corticosteroid (fluticasone furoate) and a long-acting beta2 agonist (vilanterol trifenatate). It is licensed for once-daily use as maintenance therapy for chronic obstructive pulmonary disease (COPD) and asthma. In a previous article we considered its use in the management of COPD.1 Here we review the evidence for Relvar Ellipta in the treatment of patients with asthma.

  15. Assessing the Validity of the RAND Negative Impact of Asthma on Quality of Life Short-Forms

    PubMed Central

    Sherbourne, Cathy D.; Stucky, Brian D.; Edelen, Maria Orlando; Eberhart, Nicole K.; Kleerup, Eric; Lara, Marielena

    2014-01-01

    Background In response to recommendations from the 2010 NIH Asthma Outcomes Workshop, we developed a system for measuring the negative impact of asthma on Quality of Life (QoL), referred to as the RAND Negative Impact of Asthma on Quality of Life (RAND-IAQL) item bank. The bank contains 65 items that focus on the patient’s perception of the impact or bother of asthma on his or her life. Objective Evidence for the validity of two short-forms, The RAND-IAQL-4 and 12, from the bank is presented. Methods Using a sample of 2032 adults with asthma, we validated our short-forms against the Marks Asthma Quality of Life Questionnaire (M-AQLQ); The Asthma Control Test; and generic measures of QoL developed by PROMIS®. Discriminant validity was examined by comparing scores of respondents who differed according to multiple health indicators. Results Our sample ranged in age from 18–99 (mean of 43), 14% of whom were Hispanic, 11% Asian, 19% African American and 56% non-Hispanic White. Men had significantly worse impact of asthma on QoL than women. Impact of asthma on QoL was greatest in African Americans and Hispanics compared to non-Hispanic Whites. Our measures correlated highly with Marks AQLQ and more strongly with the PROMIS® global physical than mental scale. They differentiated between adults with asthma according to their perceived severity, level of control, presence or absence of exacerbations and physical comorbidity. Conclusion The RAND-IAQL item bank, measuring the impact of asthma on QoL, will complement other patient-reported outcomes such as measures of asthma symptoms, functioning and control. PMID:24746752

  16. Effect of particle size of bronchodilator aerosols on lung distribution and pulmonary function in patients with chronic asthma.

    PubMed

    Mitchell, D M; Solomon, M A; Tolfree, S E; Short, M; Spiro, S G

    1987-06-01

    The particle size of bronchodilator aerosols may be important in determining the site of deposition in the lung and their therapeutic effect. The distribution of aerosols (labelled with technetium-99m diethylene triamine pentacetic acid) of two different particle sizes has been studied by gamma camera imaging. The particles had mass median aerodynamic diameters (geometric standard deviations) of 1.4 (1.4) and 5.5 (2.3) micron, and they were administered from a jet nebuliser to eight patients with chronic severe stable asthma. There was no significant difference in peripheral lung deposition with the two aerosols in any patient. The bronchodilator effect of the two aerosols was determined from cumulative dose-response studies. To avoid large doses that might mask possible differences in effect due to aerosol size, small, precisely determined incremental amounts of salbutamol (25-250 micrograms total lung dose) were used. The two doses were given via a nebuliser on separate occasions and the bronchodilator response was measured from FEV1, forced vital capacity, and peak expiratory flow 30 minutes after each dose. Bronchodilatation was similar with the two aerosols at each dose of salbutamol. There was therefore no difference in distribution within the lung or any difference in bronchodilator effect between an aerosol of small (1.4 micron) particle size and an aerosol of 5.5 microns in patients with severe but stable asthma. PMID:3660305

  17. Long-term falls in antibodies to dust mite and pollen allergens in patients with asthma or hay fever.

    PubMed

    Rawle, F C; Burr, M L; Platts-Mills, T A

    1983-09-01

    'Spontaneous' improvement in, or alteration of, allergic symptoms is a common occurrence, and the immunological basis is of interest in attempts to develop effective specific therapy. In the present study we measured levels of serum antibodies to Dermatophagoides pteronyssinus in patients diagnosed as having house-dust-allergic asthma up to 40 years previously. The results show a progressive fall in both IgG and IgE antibodies to antigen P1 and RAST binding to crude D. pteronyssinus extract. By contrast changes in total serum IgE were not marked. Within each of the groups of patients diagnosed 20, 30 and 40 years previously, 70% no longer suffered severe symptoms. However, the absence of detectable IgE antibody in serum was neither a necessary nor a sufficient condition for loss of symptoms. A group of patients who had spontaneously recovered from hay fever had significantly lower IgG and IgE antibody for the major grass pollen allergen Rye I and also lower total IgE than current hay fever sufferers. In neither hay fever nor asthma was there evidence to link spontaneous improvement in symptoms with an increase in IgG antibodies.

  18. Asthma management programs in managed care organizations.

    PubMed

    Hartmann, Christine W; Maio, Vittorio; Goldfarb, Neil I; Cobb, Nicole; Nash, David B

    2005-12-01

    The aim of this work was to investigate how managed care organizations (MCOs) currently approach asthma treatment and management and to determine factors affecting asthma outcomes. A Web-based survey was administered to a national sample of 351 medical directors of MCOs to investigate the asthma management program components in their organizations as well as gaps and barriers in the management of patients with asthma. All 134 (38.2%) responding medical directors reported that their organizations monitor asthma patients. Plans use a variety of asthma management activities, including general member education (90%), member education by mail (87%), self-management education (85%), and provider education (82%). Educational resources (89%) and telephone advice nurse (77%) were the most common self-management strategies offered. Among factors impeding the provision of effective asthma care, noncompliance with asthma treatment, the inappropriate use of medications, and the need for multiple medications were cited by virtually all respondents. Health plans rely on an array of strategies to manage asthma patients. Education encouraging patient self-management is a key component of asthma management programs. However, a considerable number of treatment approach barriers are impeding the achievement of proper asthma care. Without innovative approaches to care, it appears that current MCOs' asthma management efforts may not result in substantial improvements in asthma outcomes.

  19. AB013. Inappropriate asthma therapy: a tale of two countries

    PubMed Central

    Nibber, Anjan; Belhassen, Manon; Van Ganse, Eric; Ryan, Dermot; Langlois, Carole; Appiagyei, Francis; Skinner, Derek; Laforest, Laurent; Soriano, Joan B.; Price, David

    2016-01-01

    Background Inappropriate prescribing and misuse of asthma medication, have been identified as potentially preventable factors linked to asthma exacerbations and deaths. A recent report by the National Review of Asthma Deaths drew attention to the excessive prescribing of reliever medication, and under-prescribing of controlled medication in the United-Kingdom (UK). The inappropriate prescribing of long-acting beta agonist (LABA) bronchodilator inhalers, as either a monotherapy or without inhaled corticosteroids (ICS) has been highlighted as a major preventable factor of asthma exacerbations and deaths. To determine whether the prevalence of inappropriate LABA therapy use in asthma in the UK and in France has changed over time. Methods Two interval, parallel, population-based cohorts (2007 and 2013), were developed in each country, utilising the UK Optimum Patient Care Research Database and the French Permanent Beneficiaries Sample database. Following inclusion, patients aged 6–40 years were studied over a 12-month period. The use of LABAs without ICS, and ≥2-fold higher use of LABA compared with ICS were investigated. Analyses were stratified by age groups: children (6–13 years) and adults (14–40 years). Results Overall, 39,743 UK and 4,910 French patients were included in 2007 and 14,036 and 5,657 in 2013. In 2013, LABA use without ICS occurred in 0.1% and 1.5% of UK and French adults respectively. This was a marked reduction from 2007 UK and French figures of 0.4% and 2.6% respectively (P<0.05 for both). Excessive use of LABA relative to ICS occurred in 0.2% of UK adults and in 0.7% of French adults in 2013. These percentages represented a decrease from the 2007 figures of 0.6% and 1.4% for UK (P=0.29) and France (P=0.003), respectively. In 2007, LABA inappropriate use was more frequent in French than UK asthmatic children (P<0.0001), but showed a downward trend by time in both countries (0.1% in 2013 in both countries). Conclusions Our study suggests

  20. Six-minute walk test and respiratory muscle strength in patients with uncontrolled severe asthma: a pilot study*

    PubMed Central

    Pereira, Luiz Fernando Ferreira; Mancuzo, Eliane Viana; Rezende, Camila Farnese; Côrrea, Ricardo de Amorim

    2015-01-01

    OBJECTIVE: To evaluate respiratory muscle strength and six-minute walk test (6MWT) variables in patients with uncontrolled severe asthma (UCSA). METHODS: This was a cross-sectional study involving UCSA patients followed at a university hospital. The patients underwent 6MWT, spirometry, and measurements of respiratory muscle strength, as well as completing the Asthma Control Test (ACT). The Mann-Whitney test was used in order to analyze 6MWT variables, whereas the Kruskal-Wallis test was used to determine whether there was an association between the use of oral corticosteroids and respiratory muscle strength. RESULTS: We included 25 patients. Mean FEV1 was 58.8 ± 21.8% of predicted, and mean ACT score was 14.0 ± 3.9 points. No significant difference was found between the median six-minute walk distance recorded for the UCSA patients and that predicted for healthy Brazilians (512 m and 534 m, respectively; p = 0.14). During the 6MWT, there was no significant drop in SpO2. Mean MIP and MEP were normal (72.9 ± 15.2% and 67.6 ± 22.2%, respectively). Comparing the patients treated with at least four courses of oral corticosteroids per year and those treated with three or fewer, we found no significant differences in MIP (p = 0.15) or MEP (p = 0.45). CONCLUSIONS: Our findings suggest that UCSA patients are similar to normal subjects in terms of 6MWT variables and respiratory muscle strength. The use of oral corticosteroids has no apparent impact on respiratory muscle strength. PMID:26176518

  1. Influence of circulating alpha adrenoceptor agonists on lung function in patients with exercise induced asthma and healthy subjects.

    PubMed Central

    Larsson, K; Martinsson, A; Hjemdahl, P

    1986-01-01

    The influence of circulating noradrenaline (in this context primarily a non-selective alpha agonist) and the alpha 1 selective agonist phenylephrine on bronchial tone, blood pressure, and heart rate was studied in eight patients with exercise induced asthma and eight age and sex matched controls. All subjects refrained from taking treatment for at least one week before the trial. The agonists were infused intravenously in stepwise increasing doses of 0.04, 0.085, 0.17, and 0.34 micrograms/kg a minute for noradrenaline and 0.5, 1.0, 2.0, and 4.0 micrograms/kg a minute for phenylephrine. At the highest dose the plasma concentration of noradrenaline was about 30 nmol/l, resembling the concentrations found during intense exercise, and that of phenylephrine was about 400 nmol/l. Both agonists caused dose dependent and similar increases in blood pressure in the two groups. Despite clearcut cardiovascular effects (systolic and diastolic blood pressure increased by about 40-50/25-30 mm Hg), neither agonist altered lung function, as assessed by measurements of specific airway compliance (sGaw), peak expiratory flow (PEF), or end expiratory flow rate, in either group. It is concluded that circulating alpha agonists, whether alpha 1 selective (phenylephrine) or non-selective (noradrenaline), fail to alter basal bronchial tone in patients with exercise induced asthma or in healthy subjects. PMID:3787535

  2. Precipitating factors of asthma.

    PubMed

    Lee, T H

    1992-01-01

    Asthma is characterised by bronchial hyperresponsiveness. This feature of the asthmatic diathesis predisposes patients to wheezing in response to a number of different factors. These precipitating factors include specific allergen acting via sensitised mediator cells through an IgE-dependent mechanism. There are irritants which may work through a non-specific manner, or stimuli such as exercise and hyperventilation, which probably also act through mediator release via a non-IgE-dependent manner. The mechanism whereby physical stimuli such as exercise induce bronchoconstriction is of interest, because it increases the context in which the mast cell may participate in acute asthmatic bronchoconstriction. Respiratory infections also commonly provoke asthma, especially in infants and may, indeed, precipitate the asthmatic state itself. Finally, drugs can often trigger asthma attacks and the mechanisms of asthma precipitated by non-steroidal anti-inflammatory drugs such as aspirin have been the subject of recent research.

  3. [Bacterial parotitis in an immunocompromised patient in adult ICU].

    PubMed

    Vassal, O; Bernet, C; Wallet, F; Friggeri, A; Piriou, V

    2013-09-01

    Bacterial parotitis is a common childhood disease with a favorable outcome. Staphylococcus aureus is the most frequently involved pathogen. Clinical presentation in adult patients can be misleading, Onset occurs in patients with multiple comorbidities, making diagnosis difficult--particularly in ICU. Different pathogens are found in adults with worse outcomes observed. We report here the case of a critically ill patient and discuss diagnosis and management of bacterial parotitis.

  4. Breathe easy at home: a web-based referral system linking clinical sites with housing code enforcement for patients with asthma.

    PubMed

    Reid, Margaret; Fiffer, Melissa; Gunturi, Nivedita; Ali, Amanda; Irish, Dion; Sandel, Megan

    2014-03-01

    Asthma, the most significant cause of pediatric morbidity and mortality, is exacerbated by adverse environmental conditions, especially substandard housing. The clinical care provider is often unable to address housing and environmental trigger issues. In Boston, Massachusetts, a web-based referral system called Breathe Easy At Home has been put in place, through which clinicians can refer patients to have their homes inspected for housing code violations that may be contributing to their asthma. Violations will then be brought to the attention of the landlord, who then has the option of redressing the issue or be taken to housing court. By bringing the local public health department, the city's inspectional services department, and the clinical care provider together with the help of a program coordinator, Breathe Easy At Home is able to provide comprehensive care to asthma patients. This program also serves as a replicable model for other cities and jurisdictions to follow.

  5. A systematic review of complementary and alternative medicine for asthma self-management.

    PubMed

    George, Maureen; Topaz, Maxim

    2013-03-01

    This article is a systematic review of complementary and alternative medicine use for pediatric and adult asthma self-management. The aim of the review was to summarize the existing body of research regarding the types and patterns of, adverse events and risky behaviors associated with, and patient-provider communication about complementary therapies in asthma. This evidence serves as the basis for a series of recommendations in support of patient-centered care, which addresses both patient preferences for integrated treatment and patient safety.

  6. Adolescent Asthma Self-Management: Patient and Parent-Caregiver Perspectives on Using Social Media to Improve Care

    ERIC Educational Resources Information Center

    Panzera, Anthony D.; Schneider, Tali K.; Martinasek, Mary P.; Lindenberger, James H.; Couluris, Marisa; Bryant, Carol A.; McDermott, Robert J.

    2013-01-01

    Background: Self-management of asthma can now leverage new media technologies. To optimize implementation they must employ a consumer-oriented developmental approach. This study explored benefits of and barriers to improved asthma self-management and identified key elements for the development of a digital media tool to enhance asthma control.…

  7. Evaluation of quality of life according to asthma control and asthma severity in children and adolescents

    PubMed Central

    Matsunaga, Natasha Yumi; Ribeiro, Maria Angela Gonçalves de Oliveira; Saad, Ivete Alonso Bredda; Morcillo, André Moreno; Ribeiro, José Dirceu; Toro, Adyléia Aparecida Dalbo Contrera

    2015-01-01

    ABSTRACT OBJECTIVE: To evaluate quality of life according to the level of asthma control and degree of asthma severity in children and adolescents. METHODS: We selected children and adolescents with asthma (7-17 years of age) from the Pediatric Pulmonology Outpatient Clinic of the State University of Campinas Hospital de Clínicas, located in the city of Campinas, Brazil. Asthma control and asthma severity were assessed by the Asthma Control Test and by the questionnaire based on the Global Initiative for Asthma, respectively. The patients also completed the Paediatric Asthma Quality of Life Questionnaire (PAQLQ), validated for use in Brazil, in order to evaluate their quality of life. RESULTS: The mean age of the patients was 11.22 ± 2.91 years, with a median of 11.20 (7.00-17.60) years. We selected 100 patients, of whom 27, 33, and 40 were classified as having controlled asthma (CA), partially controlled asthma (PCA), and uncontrolled asthma (UA), respectively. As for asthma severity, 34, 19, and 47 were classified as having mild asthma (MiA), moderate asthma (MoA), and severe asthma (SA), respectively. The CA and the PCA groups, when compared with the NCA group, showed higher values for the overall PAQLQ score and all PAQLQ domains (activity limitation, symptoms, and emotional function; p < 0.001 for all). The MiA group showed higher scores for all of the PAQLQ components than did the MoA and SA groups. CONCLUSIONS: Quality of life appears to be directly related to asthma control and asthma severity in children and adolescents, being better when asthma is well controlled and asthma severity is lower. PMID:26785958

  8. Pharmacogenomic test that predicts response to inhaled corticosteroids in adults with asthma likely to be cost-saving

    PubMed Central

    Wu, Ann Chen; Gay, Charlene; Rett, Melisa D; Stout, Natasha; Weiss, Scott T; Fuhlbrigge, Anne L

    2015-01-01

    Aim To identify the clinical and economic circumstances under which a pharmacogenomic test that predicts response to inhaled corticosteroids might be a cost-effective option for individuals with asthma. Materials & methods We synthesized published data on clinical and economic outcomes to project 10-year costs, quality-adjusted life-years and cost–effectiveness of pharmacogenomic testing for inhaled corticosteroid response. We assumed the pharmacogenomic test cost was $500 with a sensitivity and specificity of 84 and 98%, respectively. These were varied in sensitivity analyses. Results Both strategies, pharmacogenomic testing for inhaled corticosteroid response and no testing conferred 7.1 quality-adjusted life-years. Compared with no testing, pharmacogenomic testing costs less. Conclusion Pharmacogenomic testing for asthma is cost-saving and noninferior in improving health. PMID:25880024

  9. Physical and psychosocial challenges in adult hemophilia patients with inhibitors

    PubMed Central

    duTreil, Sue

    2014-01-01

    Numerous challenges confront adult hemophilia patients with inhibitors, including difficulty in controlling bleeding episodes, deterioration of joints, arthritic pain, physical disability, emotional turmoil, and social issues. High-intensity treatment regimens often used in the treatment of patients with inhibitors also impose significant scheduling, economic, and emotional demands on patients and their families or primary caregivers. A comprehensive multidisciplinary assessment of the physical, emotional, and social status of adult hemophilia patients with inhibitors is essential for the development of treatment strategies that can be individualized to address the complex needs of these patients. PMID:25093002

  10. Asthma, Allergy and Eczema among Adults in Multifamily Houses in Stockholm (3-HE Study) - Associations with Building Characteristics, Home Environment and Energy Use for Heating

    PubMed Central

    Norbäck, Dan; Lampa, Erik; Engvall, Karin

    2014-01-01

    Risk factors for asthma, allergy and eczema were studied in a stratified random sample of adults in Stockholm. In 2005, 472 multifamily buildings (10,506 dwellings) were invited (one subject/dwelling) and 7,554 participated (73%). Associations were analyzed by multiple logistic regression, adjusting for gender, age, smoking, country of birth, income and years in the dwelling. In total, 11% had doctor's diagnosed asthma, 22% doctor's diagnosed allergy, 23% pollen allergy and 23% eczema. Doctor's diagnosed asthma was more common in dwellings with humid air (OR = 1.74) and mould odour (OR = 1.79). Doctor's diagnosed allergy was more common in buildings with supply exhaust air ventilation as compared to exhaust air only (OR = 1.45) and was associated with redecoration (OR = 1.48) and mould odour (OR = 2.35). Pollen allergy was less common in buildings using more energy for heating (OR = 0.75) and was associated with humid air (OR = 1.76) and mould odour (OR = 2.36). Eczema was more common in larger buildings (OR 1.07) and less common in buildings using more energy for heating (OR = 0.85) and was associated with water damage (OR = 1.47), humid air (OR = 1.73) and mould odour (OR = 2.01). Doctor's diagnosed allergy was less common in buildings with management accessibility both in the neighbourhood and in larger administrative divisions, as compared to management in the neighbourhood only (OR = 0.49; 95% CI 0.29–0.82). Pollen allergy was less common if the building maintenance was outsourced (OR = 0.67; 95% CI 0.51–0.88). Eczema was more common when management accessibility was only at the division level (OR = 1.49; 95% CI 1.06–2.11). In conclusions, asthma, allergy or eczema were more common in buildings using less energy for heating, in larger buildings and in dwellings with redecorations, mould odour, dampness and humid air. There is a need to reduce indoor chemical emissions and to control dampness

  11. Asthma, allergy and eczema among adults in multifamily houses in Stockholm (3-HE study)--associations with building characteristics, home environment and energy use for heating.

    PubMed

    Norbäck, Dan; Lampa, Erik; Engvall, Karin

    2014-01-01

    Risk factors for asthma, allergy and eczema were studied in a stratified random sample of adults in Stockholm. In 2005, 472 multifamily buildings (10,506 dwellings) were invited (one subject/dwelling) and 7,554 participated (73%). Associations were analyzed by multiple logistic regression, adjusting for gender, age, smoking, country of birth, income and years in the dwelling. In total, 11% had doctor's diagnosed asthma, 22% doctor's diagnosed allergy, 23% pollen allergy and 23% eczema. Doctor's diagnosed asthma was more common in dwellings with humid air (OR = 1.74) and mould odour (OR = 1.79). Doctor's diagnosed allergy was more common in buildings with supply exhaust air ventilation as compared to exhaust air only (OR = 1.45) and was associated with redecoration (OR = 1.48) and mould odour (OR = 2.35). Pollen allergy was less common in buildings using more energy for heating (OR = 0.75) and was associated with humid air (OR = 1.76) and mould odour (OR = 2.36). Eczema was more common in larger buildings (OR 1.07) and less common in buildings using more energy for heating (OR = 0.85) and was associated with water damage (OR = 1.47), humid air (OR = 1.73) and mould odour (OR = 2.01). Doctor's diagnosed allergy was less common in buildings with management accessibility both in the neighbourhood and in larger administrative divisions, as compared to management in the neighbourhood only (OR = 0.49; 95% CI 0.29-0.82). Pollen allergy was less common if the building maintenance was outsourced (OR = 0.67; 95% CI 0.51-0.88). Eczema was more common when management accessibility was only at the division level (OR = 1.49; 95% CI 1.06-2.11). In conclusions, asthma, allergy or eczema were more common in buildings using less energy for heating, in larger buildings and in dwellings with redecorations, mould odour, dampness and humid air. There is a need to reduce indoor chemical emissions and to control dampness. Energy saving may have consequences for allergy and eczema. More

  12. [Effect of nedocromil sodium on clinical course and histamine airway responsiveness in patients with pollen induced bronchial asthma].

    PubMed

    Grzelewska-Rzymowska, I; Grabski, W; Kroczyńska-Bednarek, J; Zieba, M; Rozniecki, J

    1995-01-01

    Nedocromil sodium is a non-steroidal prophylactic agent for the management of asthma. We assessed the effect of inhaled of nedocromil sodium 8 mg/24 h in a double blind, placebo controlled study in 14 patients suffering from seasonal (grass-pollen) asthma. Symptom scores for dyspnoe, cough, rhinitis and airway responsiveness to histamine (PC20H) according to Cockcroft et al were estimated before the grass-pollen season and at the end of 14-day placebo treatment and 21-day nedocromil sodium treatment. During placebo period the significant decrease in PC20H from 1.81 mg/ml to 0.54 mg/ml (p < 0.01) was observed. Nedocromil sodium did not have the effect on nonspecific bronchial responsiveness, PC20 - 0.74 mg/ml (p = 0.25). Subjective global assessment scores were significantly better with nedocromil sodium (31.15 mean 2.23) than with placebo (10.5 mean 0.7) p < 0.05.

  13. Approximate Quantification in Young, Healthy Older Adults', and Alzheimer Patients

    ERIC Educational Resources Information Center

    Gandini, Delphine; Lemaire, Patrick; Michel, Bernard Francois

    2009-01-01

    Forty young adults, 40 healthy older adults, and 39 probable AD patients were asked to estimate small (e.g., 25) and large (e.g., 60) collections of dots in a choice condition and in two no-choice conditions. Participants could choose between benchmark and anchoring strategies on each collection of dots in the choice condition and were required to…

  14. [Exercise-induced asthma].

    PubMed

    Dinh Xuan, A T; Marsac, J; Lockhart, A

    1988-12-10

    Exercise-induced asthma only differs from common asthma in its causative factor. It is a typical asthmatic attack which follows a strenuous and continuous physical exercise lasting 5 to 10 minutes, most often in cold and dry weather. The prevalence of exercise-induced asthma has not yet been firmly established; its pathophysiological mechanisms are still debated, and the respective roles of heat and water losses by the airways are not clearly defined. However, the influence of the type of exercise as a precipitating factor of exercise-induced asthma is now well-known. All things being equal, swimming generates less asthma than running and cycling. This enables the subjects to be directed towards the most suitable sports and encouraged to improve their physical fitness. Drug treatment of exercise-induced asthma must preferentially be preventive; it relies on cromoglycate and beta-2 adrenergic agonists, the latter being also capable of treating acute exercise-induced bronchial obstruction. Education of the patients and their family is also important.

  15. Asthma in inner cities.

    PubMed Central

    LeNoir, M. A.

    1999-01-01

    While the management of asthma has improved over the past two decades, the incidence of asthma in the inner city has not. The inner city, comprising a disproportionate number of people who live close to or below the poverty line, shows increased rates of morbidity and mortality from asthma. African Americans and Hispanic Americans are two to six times more likely to die from asthma than their white counterparts. When federally funded programs have targeted reducing morbidity and mortality in children from these populations, they have succeeded, but in a national study only 18 states had initiatives targeting asthma in low-income populations. This is tantamount to a public health crisis. Patients are not always properly diagnosed and are often without a regular source of health care, and symptoms are seen only in an acute context. Living conditions for the inner-city child have significant allergen triggers associated with house dust, cockroaches, cigarette smoke, chemical pollutants, and particulate matter. Viral infections, such as those caused by respiratory syncytial virus, are worse in crowded living conditions. The desirability of an increased public awareness of the seriousness of the disease and the need for chronic health care are issues that should be raised, through culturally relevant public means and in the knowledge that visual information is most effective. Physicians must understand the proper use of rescue and controller drugs, and asthma education must expand beyond doctors and nurses in their offices. The National Medical Association is committed to doing this aggressively, and community organizations, alliances, and coalitions must also aggressively follow. Public agencies must be lobbied to set high standards for proper asthma care and resources. With organizations acting in concert, the mortality and morbidity from asthma can be substantially prevented in the inner city. PMID:12653387

  16. HelpDesk answers: is it safe to add long-acting β-2 agonists to inhaled corticosteroids in patients with persistent asthma?

    PubMed

    Townsend, Laurie; Madlon-Kay, Diane J

    2015-06-01

    Possibly. Long-acting β-2 agonists (LABAs) used in combination with inhaled corticosteroids (ICS) don't appear to increase all-cause mortality or serious adverse events in patients with persistent asthma compared with ICS alone. Studies showing an increase in catastrophic events had serious methodologic issues. A large surveillance study is ongoing.

  17. An Angiotensin I Convert