CLINICAL AND EXPERIMENTAL PHARMACOLOGY AND PHYSIOLOGY, Issue 11 2006
Osamu Nishiyama
SUMMARY 1Although the clinical effects of the tulobuterol patch have been reported to include an increase in morning peak expiratory flow (PEF) values and a decrease of symptoms and the frequency of the rescue use of inhaled short-acting b2 -adrenoceptor agonists, no trials comparing the efficacy of the tulobuterol patch to other standard inhaled long-acting b2 -adrenoceptor agonists have yet been conducted. The aim of the present study was to compare the clinical effects of the patch formulation of tulobuterol with those of inhaled salmeterol in moderate to severe asthma. 2Fifty-four patients with moderate to severe asthma, whose conditions were suboptimally controlled despite receiving inhaled corticosteroids, were recruited. The study was a prospective, randomized trial of cross-over design comparing the effects of 4 weeks treatment with tulobuterol patch, 2 mg once daily, and salmeterol, 50 mg twice daily. The mean prebronchodilator morning PEF during the last 14 days of each treatment period and health-related quality of life (HRQoL) were the primary outcome variables. The HRQoL was assessed using the St George's Respiratory Questionnaire. 3Forty-four patients (81.5%) completed the trial and were included in the analysis. The mean morning PEF and HRQoL score were significantly improved in both the salmeterol (P < 0.0001 and P < 0.05, respectively) and the tulobuterol patch (P < 0.01 and P < 0.05, respectively) treatment periods compared with the run-in period. Although the mean morning PEF was significantly higher in the salmeterol-treated group than in the tulobuterol-treated group (P < 0.001), the HRQoL scores were comparable. 4The tulobuterol patch may be useful as a controller medication in addition to inhaled corticosteroids in moderate to severe asthma. [source]

Caregiver Depressive Symptoms and Observed Family Interaction in Low-Income Children with Persistent Asthma

FAMILY PROCESS, Issue 1 2008
MARIANNE CELANO PH.D.
This study examined the relationship between caregiver depressive symptoms and observed parenting behaviors and family processes during interactions among 101 urban, low-income Africtan American families with children with persistent asthma. Caregivers (primarily female) were assessed on four dimensions (i.e., warmth/involvement, hostility, consistent discipline, relationship quality) in three videotaped interaction tasks (loss, conflict, cohesion). The results indicated that increased depressive symptoms were significantly associated with lower warmth/involvement and synchrony scores and greater hostility scores during the loss and conflict tasks. In the total sample, the highest levels of hostility and the lowest levels of warmth/involvement were found for the conflict task; nevertheless, caregivers with moderate/severe depressive symptoms showed a significantly greater increase in hostility from the loss to the conflict task than caregivers with minimal/mild depressive symptoms. The findings highlight the salience of considering task content in family observational process research to expand our understanding of depressed and nondepressed caregivers' abilities to modulate appropriately their behaviors and affect across various family interactions. Implications for improving asthma management for low-income children with persistent asthma are discussed, including the utility of multidisciplinary interventions that combine asthma education with family therapy. RESUMEN Síntomas de depresión en los responsables de los niños e interacción familiar observada en niños de familias de bajos ingresos que padecen asma crónica Este estudio examinó la relación entre los síntomas de depresión de los responsables de los niños y los comportamientos paternos y dinámicas familiares observados durante interacciones entre 101 familias afronorteamericanas, urbanas y de bajos recursos, con niños que padecen asma crónica. Los responsables de los niños (la mayoría mujeres) fueron evaluados en base a cuatro criterios: calidez/implicación, hostilidad, disciplina constante, y calidad de la relación) en tres tareas de interacción grabadas en cinta de video (pérdida, conflicto y cohesión). Los resultados demostraron que el aumento de los síntomas de depresión estaban relacionados de forma significativa con una menor puntuación en calidez/implicación y comprensión mutua, y una mayor puntuación en hostilidad durante las tareas de pérdida y conflicto. En la muestra total, los mayores niveles de hostilidad y menores niveles de calidez/implicación se encontraron en la tarea de conflicto; sin embargo, los responsables con síntomas de depresión de moderados a severos mostraron un aumento mucho mayor de la hostilidad, de la tarea de pérdida a la de conflicto, que los responsables con síntomas de mínimos a leves. Los resultados enfatizan la importancia de considerar el contenido de la tarea en la investigación observacional de familias para aumentar nuestra comprensión de las habilidades de los responsables de los niños, con o sin depresión, con el fin de modular de una manera apropiada su comportamiento y afecto en diferentes interacciones familiares. Las medidas para mejorar el control del asma en niños que padecen asma crónica y provienen de familias de bajos ingresos están en debate, incluida la utilidad de intervenciones multidisciplinarias que combinen formación sobre el asma con terapia familiar. [source]

Testing the Biobehavioral Family Model in Pediatric Asthma: Pathways of Effect

FAMILY PROCESS, Issue 1 2008
BEATRICE L. WOOD PH.D.
This study uses a laboratory-based multiinformant, multimethod approach to test the hypothesis that a negative family emotional climate (NFEC) contributes to asthma disease severity by way of child depressive symptoms, and that parent-child relational insecurity mediates the effect. Children with asthma (n=199; aged 7,17; 55% male) reported parental conflict, parent-child relational security, and depressive symptoms. Parent(s) reported demographics, asthma history, and symptoms. Asthma diagnosis was confirmed by clinical evaluation and pulmonary function tests, with disease severity rated by an asthma clinician according to NHLBI guidelines. Family interactions were evoked using the Family Process Assessment Protocol, and rated using the Iowa Family Interaction Rating Scales. Path analysis indicated a good fit of data to the hypothesized model (,2[1]=.11, p=.74, NFI=.99, RMSEA=.00). Observed NFEC predicted child depression (,=.19, p<.01), which predicted asthma disease severity (,=.23, p<.01). Relational security inversely predicted depressive symptoms (,=,.40, p<.001), and was not a mediator as predicted, but rather an independent contributor. The findings are consistent with the Biobehavioral Family Model, which suggests a psychobiologic influence of specific family relational processes on asthma disease severity by way of child depressive symptoms. RESUMEN Prueba del Biobehavioral Family Model (Modelo familiar de biocomportamiento) en asma pediátrica: Factores desencadenantes Objetivo: Este estudio utiliza un método de laboratorio con varios informantes y distintos enfoques para probar la hipótesis de que un ambiente familiar negativo agrava la enfermedad del asma a través de síntomas de depresión infantil, y que la inseguridad en la relación entre padres e hijos influye en su efecto. Sujetos y métodos: Una serie de niños que padecen asma (n=199; edades entre 7 y 17; 55% varones) informaron sobre conflictos de pareja de sus padres, la seguridad en la relación con sus padres y síntomas de depresión. Los padres, por su parte, aportaron datos demográficos, antecedentes de asma e información acerca de los síntomas. El diagnóstico de asma fue confirmado por examen clínico y pruebas de pulmón, y un experto en asma determinó la gravedad de la enfermedad de acuerdo con las pautas del NHLBI (National Heart, Lung, and Blood Institute). La interacción en familia fue simulada mediante el método Family Process Assessment Protocol (protocolo de evaluación de dinámicas familiares) y estimada mediante el Iowa Family Interaction Rating Scales (escala Iowa de interacciones familiares). Resultados: El análisis de camino demostró que los datos encajaron bien con el modelo de la hipótesis (,2[1]=.11, p=.74, NFI=.99, RMSEA=.00). En las familias en las que se observó un ambiente emocional negativo se predijo la depresión del niño o de la niña (,=.19, p<.01), lo que, a su vez, predijo un agravamiento del asma (,=.23, p<.01). Por otra parte, las relaciones positivas predijeron síntomas de depresión de manera inversa (,=.40, p<.001), y no resultaron ser un mediador, como se había predicho, sino un contribuidor independiente. Conclusión: Las averiguaciones coinciden con el Biobehavioral Family Model (modelo familiar de biocomportamiento), que sugiere la existencia de una influencia psicobiológica de procesos de relaciones familiares específicos en la gravedad de la enfermedad del asma a través de síntomas de depresión infantil. [source]

A variant of the myosin light chain kinase gene is associated with severe asthma in African Americans

GENETIC EPIDEMIOLOGY, Issue 4 2007
Carlos Flores
Abstract Asthma is a complex phenotype influenced by environmental and genetic factors for which severe irreversible structural airway alterations are more frequently observed in African Americans. In addition to a multitude of factors contributing to its pathobiology, increased amounts of myosin light chain kinase (MLCK), the central regulator of cellular contraction, have been found in airway smooth muscle from asthmatics. The gene encoding MLCK (MYLK) is located in 3q21.1, a region noted by a number of genome-wide studies to show linkage with asthma and asthma-related phenotypes. We studied 17 MYLK genetic variants in European and African Americans with asthma and severe asthma and identified a single non-synonymous polymorphism (Pro147Ser) that was almost entirely restricted to African populations and which was associated with severe asthma in African Americans. These results remained highly significant after adjusting for proportions of ancestry estimated using 30 unlinked microsatellites (adjusted odds ratio: 1.76 [95% confidence interval, CI: 1.17,2.65], p = 0.005). Since all common HapMap polymorphisms in ,500,kb contiguous regions have low-to-moderate linkage disequilibrium with Pro147Ser, we speculate that this polymorphism is causally related to the severe asthma phenotype in African Americans. The association of this polymorphism, located in the N-terminal region of the non-muscle MLCK isoform, emphasizes the potential importance of the vascular endothelium, a tissue in which MLCK is centrally involved in multiple aspects of the inflammatory response, in the pathogenesis of severe asthma. This finding also offers a possible genetic explanation for some of the more severe asthma phenotype observed in African American asthmatics. Genet Epidemiol 2007. © 2007 Wiley-Liss, Inc. [source]

Is Headache Related to Asthma, Hay Fever, and Chronic Bronchitis?

HEADACHE, Issue 2 2007
The Head-HUNT Study
Objectives.,To examine the relationship between migraine and nonmigrainous headache and asthma, hay fever, and chronic bronchitis in a large cross-sectional population-based study. Background.,Associations between prevalence of migraine and asthma or allergy have been demonstrated in clinic-based and epidemiologic studies whereas studies on chronic bronchitis are scarce. Methods.,A total of 51,383 subjects completed a headache questionnaire and constituted the "Head-HUNT" Study. Of these 50,401 (98.1%) answered the questions about asthma and chronic bronchitis, and 47,029 (91.5%) answered the question about hay fever. Associations were assessed in multivariate analyses, estimating prevalence odds ratios (ORs) with 95% confidence intervals (CI). Results.,Both migraine and nonmigrainous headache were approximately 1.5 times more likely among those with current asthma, asthma related symptoms, hay fever, and chronic bronchitis than those without. The association increased with increasing headache frequency. Conclusions.,This large questionnaire-based study confirms that migraine and other headaches are associated with respiratory and allergic disorders. The magnitude of the association between headache and asthma, hay fever, and chronic bronchitis tended to be in the same order. Headache frequency seems to have a greater impact on the association with respiratory or allergic conditions than headache diagnoses. Whether it is a causal relationship is uncertain, but the results underline the importance of considering comorbid disorders among patients with frequent headache. [source]

Development and Validation of a Risk-Adjustment Tool in Acute Asthma

HEALTH SERVICES RESEARCH, Issue 5p1 2009
Chu-Lin Tsai
Objective. To develop and prospectively validate a risk-adjustment tool in acute asthma. Data Sources. Data were obtained from two large studies on acute asthma, the Multicenter Airway Research Collaboration (MARC) and the National Emergency Department Safety Study (NEDSS) cohorts. Both studies involved >60 emergency departments (EDs) and were performed during 1996,2001 and 2003,2006, respectively. Both included patients aged 18,54 years presenting to the ED with acute asthma. Study Design. Retrospective cohort studies. Data Collection. Clinical information was obtained from medical record review. The risk index was derived in the MARC cohort and then was prospectively validated in the NEDSS cohort. Principle Findings. There were 3,515 patients in the derivation cohort and 3,986 in the validation cohort. The risk index included nine variables (age, sex, current smoker, ever admitted for asthma, ever intubated for asthma, duration of symptoms, respiratory rate, peak expiratory flow, and number of beta-agonist treatments) and showed satisfactory discrimination (area under the receiver operating characteristic curve, 0.75) and calibration ( p=.30 for Hosmer,Lemeshow test) when applied to the validation cohort. Conclusions. We developed and validated a novel risk-adjustment tool in acute asthma. This tool can be used for health care provider profiling to identify outliers for quality improvement purposes. [source]

A Comparison of Clinically Important Differences in Health-Related Quality of Life for Patients with Chronic Lung Disease, Asthma, or Heart Disease

HEALTH SERVICES RESEARCH, Issue 2 2005
Kathleen W. Wyrwich
Objective. On the eight scales of the Medical Outcomes Study Short-Form 36-Item Health Survey (SF-36), Version 2, we compared the clinically important difference (CID) thresholds for change over time developed by three separate expert panels of physicians with experience in quality of life assessment among patients with chronic obstructive pulmonary disease (COPD), asthma, and heart disease. Study Design. We used a modified Delphi technique combined with a face-to-face panel meeting within each disease to organize and conduct the consensus process among the expert panelists, who were familiar with the assessment and evaluations of health-related quality of life (HRQL) measures among patients with the panel-specific disease. Principal Findings. Each of the expert panels first determined the magnitude of the smallest numerically possible change on each SF-36 scale, referred to as a state change, and then built their CIDs from this metric. All three panels attained consensus on the scale changes that constituted small, moderate, and large clinically important SF-36 change scores. The CIDs established by the heart disease panel were generally greater than the CIDs agreed on by the asthma and COPD panels. Conclusions. These panel-derived thresholds reflect possible differences in disease management among the represented panel-specific diseases, and are all greater than the minimal CID thresholds previously developed for the SF-36 scales among patients with arthritis. If confirmed among patients with the relevant diseases and those patients' physicians, these disease-specific CIDs could assist both researchers and practicing clinicians in the use and interpretation of HRQL changes over time. [source]

Asthma and respiratory symptoms in hospital workers related to dampness and biological contaminants

INDOOR AIR, Issue 4 2009
J. M. Cox-Ganser
Abstract, The National Institute for Occupational Safety and Health investigated respiratory symptoms and asthma in relation to damp indoor environments in employees of two hospitals. A cluster of six work-related asthma cases from one hospital department, whose symptoms arose during a time of significant water incursions, led us to conduct a survey of respiratory health in 1171/1834 employees working in the sentinel cases hospital and a nearby hospital without known indoor environmental concerns. We carried out observational assessment of dampness, air, chair, and floor dust sampling for biological contaminants, and investigation of exposure-response associations for about 500 participants. Many participants with post-hire onset asthma reported diagnosis dates in a period of water incursions and renovations. Post-hire asthma and work-related lower respiratory symptoms were positively associated with the dampness score. Work-related lower respiratory symptoms showed monotonically increasing odds ratios with ergosterol, a marker of fungal biomass. Other fungal and bacterial indices, particle counts, cat allergen and latex allergen were associated with respiratory symptoms. Our data imply new-onset of asthma in relation to water damage, and indicate that work-related respiratory symptoms in hospital workers may be associated with diverse biological contaminants. [source]

Psychosocial Care Needs of Children With Recent-Onset Asthma

JOURNAL FOR SPECIALISTS IN PEDIATRIC NURSING, Issue 1 2007
Angela M. McNelis
PURPOSE.,To examine psychosocial care needs of children with recent-onset asthma. DESIGN/METHODS.,Data were collected over 2 years from 63 children ages 8,14 years. RESULTS.,Children's need for attention to specific aspects of their asthma care remained high over the 2 years, as did their perceived needs for information and support and their concerns and fears. PRACTICE IMPLICATIONS.,Children have many needs, and healthcare professionals may not be providing care that addresses these needs. The Child Report of Psychosocial Care can be used as a quick tool to assess and guide interventions related to specific areas of need. [source]

Impoverished Children With Asthma: A Pilot Study of Urban Healthcare Access

JOURNAL FOR SPECIALISTS IN PEDIATRIC NURSING, Issue 2 2004
Andrea Wallace ND
ISSUES AND PURPOSE Using Andersen's Behavioral Model of Health Care Use, this pilot study was conducted to better understand the experiences of children with asthma as they access an urban healthcare system. DESIGN AND METHODS This descriptive study used a convenience sample of 34 families of pediatric asthma patients who participated in semistructured interviews and closed medical record review. RESULTS Only one patient reported having a written exacerbation management plan. Beliefs regarding medication addiction and side effects were frequently reported as barriers to medication adherence, and children seeking asthma care in primary care settings saw many care providers. PRACTICE IMPLICATIONS Exploring how expanded nursing roles can help address both family and system factors serving as barriers to health care ought to be a key priority for nursing. [source]

Lack of Relationship Between Acceptance and Knowledge of Asthma in School-Age Children and Early Adolescents

JOURNAL FOR SPECIALISTS IN PEDIATRIC NURSING, Issue 1 2004
Eileen Kae Kintner PhD
ISSUES AND PURPOSE Early adolescents diagnosed with asthma have difficulty accepting their condition. This study is part of an ongoing program of research designed to increase understanding of the adolescent process of coming to acceptance. The purpose was to explore relationships among variables in the Acceptance of Asthma Model. DESIGN AND METHODS A cross-sectional, theory-testing design with a sample of 94 students ages 9 to 14 years. RESULTS Acceptance was dependent on psychosocial influences and disease characteristics rather than knowledge of asthma. PRACTICE IMPLICATIONS Psychosocial interventions are needed to facilitate acceptance. [source]

Factors Associated With Self-Concept in Children With Asthma

JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING, Issue 2 2000
Angela M. McNelis PhD(C)
PURPOSE. To investigate the relationship of demographic asthma, family, and child factors with self-concept in children with asthma. METHODS. Data were collected twice approximately 4 years apart from both the afected children and their mothers (N = 134) via interviews and self-report questionnaire. FINDINGS. Children who demonstrated more negative attitudes toward their illness, had less satisfaction with family relationships, and used more negative coping behaviors had the poorest self-concepts. Over time, the greatest improvement in self-concept occurred in children whose attitudes and satisfaction with family relationships improved and whose use of negative coping behaviors decreased. CONCLUSIONS. Results suggest that some children with asthma, especially girls with severe asthma, appear to be at risk for poor self-concept [source]

A panel of multiple markers associated with chronic systemic inflammation and the risk of atherogenesis is detectable in asthma and chronic obstructive pulmonary disease

JOURNAL OF CLINICAL LABORATORY ANALYSIS, Issue 6 2007
Tsu-Lan Wu
Abstract Asthma and chronic obstructive pulmonary disease (COPD) are both lung diseases involving chronic inflammation of the airway. The injury is reversible in asthma whereas it is mostly irreversible in COPD. Both patients of asthma and COPD are known at risk for cardiovascular disease (CVD) and type 2 diabetes (T2DM), nephropathy, and cancer. We measured multiple risk markers for atherogenesis in 55 patients with asthma and 62 patients with COPD. We wanted to know whether risk markers for atherogenesis corresponding to sequence of events of chronic inflammation were also detectable in the airway inflammatory diseases. Elevation of almost all markers involving inflammation of the endothelial cells in the coronary artery were detectable in asthma and COPD involving the inflammation of the epithelial cell lining of the airway. Both the level and % elevation of all markers were found mostly higher in COPD, the more severe form of the lung disease. We believe that these markers are useful for predicting risk of developing clinical complications such as CVD. J. Clin. Lab. Anal. 21:367,371, 2007. © 2007 Wiley-Liss, Inc. [source]

TAP1 gene AccI polymorphism is associated with atopic bronchial asthma

JOURNAL OF CLINICAL LABORATORY ANALYSIS, Issue 2 2003
Liang-Wen Hang
Abstract Asthma is a hyperresponsive airway disease that may involve inflammation responses. A transporter associated with the antigen processing 1 gene (TAP1) is involved in antigen processing, and is therefore considered to play a role in the pathogenesis of bronchial asthma. The aim of this study was to test whether the polymorphisms of the TAP1 gene are a genetic marker for susceptibility to bronchial asthma. A normal control group comprised of 43 healthy people, and 116 patients with allergic asthma were examined in this study. The polymorphism was detected by polymerase chain reaction (PCR)-based restriction analysis. Associations between atopic bronchial asthma and TAP1 polymorphisms were evaluated. The results revealed no significant differences between normal individuals and asthmatics in regard to the TAP1 gene DpnII polymorphism (P=0.752). However, there was a significant difference between the control and asthma groups as regards the TAP1 gene AccI polymorphism (P=0.020). The odds ratio (OR) of GG homozygotes of the TAP1 AccI polymorphism was 229.8 compared with the AA homozygote group. The results show that the AccI polymorphism may be an indicator for atopic bronchial asthma. J. Clin. Lab. Anal. 17:57,60, 2003. © 2003 Wiley-Liss, Inc. [source]

Airway inflammation in subjects with gastro-oesophageal reflux and gastro-oesophageal reflux-related asthma

JOURNAL OF INTERNAL MEDICINE, Issue 3 2006
G. E. CARPAGNANO
Abstract. Study objectives., Asthma and gastro-oesophageal reflux (GER) are both characterized by airway inflammation. Design., The purposes of this work were (i) to study airway inflammation in patients troubled by gastro-oesophageal reflux (GER) and GER associated with asthma, (ii) to ascertain whether GER can aggravate asthma by exacerbating the pre-existing airway inflammation and oxidative stress and (iii) to establish the validity of analysing breath condensate and induced sputum when studying the airways of subjects affected by GER. Patient s and methods., We enrolled 14 patients affected by mild asthma associated with GER (40 ±12 years), nine with mild but persistent asthma (39 ± 13 years), eight with GER (35 ± 11 years) and 17 healthy subjects (37 ± 9 years). Sputum cell counts and concentrations of interleukin-4 (IL-4), IL-6 and 8-isoprostane were measured in breath condensate and supernatant. Measurements and results., GER-related asthma is characterized by an eosinophilic inflammation, as determined by elevated concentrations of IL-4 in breath condensate and sputum supernatant, and by sputum cell analysis. GER alone presents a neutrophilic pattern of inflammation when determined by elevated concentrations of IL-6 in sputum cell analysis. A concomitant increase has been found in 8-isoprostane in GER associated (or not associated) with asthma. Conclusions., We conclude that GER is characterized by a neutrophilic airway inflammation and by increased oxidative stress. GER does not however aggravate pre-existing airway inflammation in asthma patients. Determinations of inflammatory and oxidant markers in the breath condensate of subjects with GER reflect these measured in the induced sputum. [source]

Cross-sectional survey of risk factors for asthma in 6,7-year-old children in New Zealand: International Study of Asthma and Allergy in Childhood Phase Three

JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 6 2009
Edwin A Mitchell
Aim: To identify risk factors for asthma in primary school-aged children in New Zealand. Methods: A cross-sectional survey of 10 873 6,7-year-old children in Auckland, Bay of Plenty, Nelson and Christchurch (a response rate of 85.2%). A questionnaire was completed by the parent or care giver. Results: 22.2% of children wheezed in the last 12 months (current wheeze). Maori children were at greater risk of current wheeze compared with European children (adjusted odds ratio (adjOR) = 1.37; 95% confidence interval = 1.18,1.59). Antibiotics and paracetamol used in the first year of life were associated with an increased risk of current wheeze (adjOR = 1.78 (1.56,2.04) and adjOR = 1.31 (1.06,1.61), respectively). Watching television for 5 or more hours per day was associated with an increased risk of current wheeze (adjOR = 1.44 (1.13,1.83)). Milk and egg consumption in the last 12 months was associated with a reduced risk of current wheeze. Conclusions: This study has identified risk factors for asthma in children aged 6,7 years, although causal pathways cannot be established. These associations have important public health implications if causal. [source]

Piperine inhibits eosinophil infiltration and airway hyperresponsiveness by suppressing T cell activity and Th2 cytokine production in the ovalbumin-induced asthma model

JOURNAL OF PHARMACY AND PHARMACOLOGY: AN INTERNATI ONAL JOURNAL OF PHARMACEUTICAL SCIENCE, Issue 3 2009
Seung-Hyung Kim
Abstract Objectives This study aimed to investigate the effect of piperine on airway hyper-responsiveness, pulmonary eosinophilic infiltration, various immune cell phenotypes, Th2 cytokine production, immunoglobulin E and histamine production in a murine model of asthma. Methods Asthma was induced in Balb/c mice by ovalbumin sensitization and inhalation. Piperine (4.5 and 2.25 mg/kg) was orally administered 5 times a week for 8 weeks. At 1 day after the last ovalbumin exposure, airway hyperresponsiveness was determined and samples of bronchoalveolar lavage fluid, lung cells and serum were collected for further analysis. Key findings Piperine-treated groups had suppressed eosinophil infiltration, allergic airway inflammation and airway hyperresponsiveness, and these occurred by suppression of the production of interleukin-4, interleukin-5, immunoglobulin E and histamine. Moreover, polymerase chain reaction products for thymus and activation regulated chemokine from lung cell RNA preparations were decreased in the piperine-treated group compared with control groups, although transforming growth factor-, products were increased in the piperine-treated group. Conclusions The results suggest that the therapeutic mechanism by which piperine effectively treats asthma is based on a reduction of Th2 cytokines (interleukin-4, interleukin-5), eosinophil infiltration, and by marked reduction of thymus and activation regulated chemokine, eotaxin-2 and interleukin-13 mRNA expression (especially transcription of nuclear factor-, dependent genes) in lung tissue, as well as reduced interleukin-4, interleukin-5 and eotaxin levels in bronchoalveolar lavage fluid, and histamine and ovalbumin-specific immunoglobulin E production in serum. [source]

Introduction: Learning From Each Other About Managing Asthma in Schools

JOURNAL OF SCHOOL HEALTH, Issue 6 2006
Sarah L. Merkle
No abstract is available for this article. [source]

Using School Staff to Establish a Preventive Network of Care to Improve Elementary School Students' Control of Asthma

JOURNAL OF SCHOOL HEALTH, Issue 6 2006
Jean-Marie Bruzzese
To address these problems, Columbia University and the New York City Department of Education and the New York City Department of Health and Mental Hygiene undertook a randomized controlled trial to test the efficacy of a comprehensive school-based asthma program. In this intervention, school nurses were trained to facilitate the establishment of a preventive network of care for children with asthma by coordinating communications and fostering relationships between families, PCPs, and school personnel. PCPs also received training regarding asthma management. There was limited support for this model. While case detection helped nurses identify additional students with asthma and nurses increased the amount of time spent on asthma-related tasks, PCPs did not change their medical management of asthma. Few improvements in health outcomes were achieved. Relative to controls, 12-months posttest intervention students had a reduction in activity limitations due to asthma (,35% vs ,9%, p < .05) and days with symptoms (26% vs 39%, p = .06). The intervention had no impact on the use of urgent health care services, school attendance, or caregiver's quality of life. There were also no improvements at 24-months postintervention. We faced many challenges related to case detection, training, and implementing preventive care activities, which may have hindered our success. We present these challenges, describe how we coped with them, and discuss the lessons we learned. (J Sch Health. 2006;76(6):307-312) [source]

Is Recent Hospitalization a Marker for Moderate-Severe Persistent Asthma in School Children?

JOURNAL OF SCHOOL HEALTH, Issue 6 2004
Marina Reznik
No abstract is available for this article. [source]

Guidelines for Managing Life-Threatening Food Allergies in Massachusetts Schools

JOURNAL OF SCHOOL HEALTH, Issue 5 2004
Anne H. Sheetz
ABSTRACT: During the past decade, prevalence of food allergies among children increased. Caring for children with life-threatening food allergies has become a major challenge for school personnel. Prior to 2002, Massachusetts did not provide clear guidelines to assist schools in providing a safe environment for these children and preparing for an emergency response to unintended allergic reactions. In 2001, the Asthma and Allergy Foundation of America/New England Chapter, Massachusetts Department of Education, Massachusetts Department of Public Health, Massachusetts School Nurse Organization, parents, and other professional organizations forged a successful collaboration to develop guidelines for managing life- threatening food allergies in schools. The guidelines assist schools by providing information on food allergies and anaphylaxis, emphasizing the need for team planning and development of an individualized health care plan, giving guidance on strategies to prevent accidental exposure to specific allergens in school settings, and offering information on emergency responses should unintended exposures occur. The collaborative process for developing the guidelines, which continued during the distribution and implementation phases, set a tone for successful multidisciplinary teamwork in local schools. [source]

Environmental Allergens and Irritants in Schools: A Focus on Asthma

JOURNAL OF SCHOOL HEALTH, Issue 1 2002
Susan R. Tortolero
ABSTRACT: As part of the Partners in School Asthma Management Program, environmental data were collected from 385 rooms in 60 elementary schools in southeast Texas, using an Environmental Observation Checklist and a Q-TRAK Indoor Air Quality Monitor. Dust samples for allergen analysis were collected from floors, carpets, and area rugs in 80 classrooms in a subset of 20 schools. CO2 levels >1,000 ppm were found in 86% of rooms; 69% had indoor humidity above recommended levels. Der p I dust mite allergen levels >2,000 ng/g were present in 20% of rooms, but only 2.5% of rooms had Der f I mite allergen levels exceeding recommended tolerances. Detectable levels of cockroach allergen (Bla g II) were found in all schools (median 5.5 ng/g), with 10% of rooms over the recommended threshold. Almost two-thirds of classrooms had mold spore counts >10,000 col/g (median, 14,400 col/g; range, 2,000 , 52,000 col/g). [source]

Many asthma patients experience persistent symptoms despite appropriate clinical and guideline-based treatment with inhaled corticosteroids

JOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 9 2007
Joan Mogil MSN, NP-C (Nurse Practitioner)
Abstract Purpose: To review possible reasons for persistence of asthma symptoms despite appropriate use of clinical and guideline-based treatments, including the use of inhaled corticosteroids. Data sources: Review of the worldwide scientific literature on factors related to persistent symptoms in patients with asthma. Conclusions: Patients with asthma may not respond as expected to therapy because of factors that include poor adherence, improper inhaler technique, persistent exposure to symptom triggers, and limitations of current standard therapy, including steroid insensitivity or the steroid plateau effect. Persistent symptoms may also be associated with IgE-mediated airway inflammation, as current standard asthma therapies do not directly address the IgE-mediated component of the inflammatory cascade. Asthma is a complex disease and its treatment requires the full cooperation and participation of the patient. Implications for practice: Healthcare professionals can play a key role by educating patients and their family members about the nature of asthma and rationale for treatment, supporting the importance of strict adherence to prevention measures and the prescribed treatment regimen. [source]

Benefits of Swim Training for Children and Adolescents with Asthma

JOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 6 2003
Cherri Rosimini ARNP
PURPOSE To r eview scientific evidence related to the benefits of swimming and present an evidence-based approach to prescribing swim training for children and adolescents with asthma. DATA SOURCES Extensive literature review of all research that has been done on swim training in asthmatic children and adolescents, using the databases CINAHL, Medline, and ProQuest. CONCLUSIONS When swimming is compared to other sports in the scientific literature, it has been found to have a lower asthmogenicity. It has also been shown to decrease the severity of asthma symptoms. Swimming may be an effective nonpharma-cological intervention for the child or adolescent with asthma. IMPLICATIONS FOR PRACTICE Research findings are summarized regarding the benefits of swim training on children and adolescents with asthma, and a stepped three-level approach to swim prescription is outlined along with safety recommendations. [source]

A Bayesian model for longitudinal count data with non-ignorable dropout

JOURNAL OF THE ROYAL STATISTICAL SOCIETY: SERIES C (APPLIED STATISTICS), Issue 5 2008
Niko A. Kaciroti
Summary., Asthma is an important chronic disease of childhood. An intervention programme for managing asthma was designed on principles of self-regulation and was evaluated by a randomized longitudinal study. The study focused on several outcomes, and, typically, missing data remained a pervasive problem. We develop a pattern,mixture model to evaluate the outcome of intervention on the number of hospitalizations with non-ignorable dropouts. Pattern,mixture models are not generally identifiable as no data may be available to estimate a number of model parameters. Sensitivity analyses are performed by imposing structures on the unidentified parameters. We propose a parameterization which permits sensitivity analyses on clustered longitudinal count data that have missing values due to non-ignorable missing data mechanisms. This parameterization is expressed as ratios between event rates across missing data patterns and the observed data pattern and thus measures departures from an ignorable missing data mechanism. Sensitivity analyses are performed within a Bayesian framework by averaging over different prior distributions on the event ratios. This model has the advantage of providing an intuitive and flexible framework for incorporating the uncertainty of the missing data mechanism in the final analysis. [source]

Review article: respiratory manifestations of gastro-oesophageal reflux disease

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 6 2008
J. P. GALMICHE
Summary Background, Respiratory manifestations represent one of the most prevalent and difficult-to-manage extra-oesophageal syndromes of gastro-oesophageal reflux disease. Aims, To review the epidemiology, pathophysiological mechanisms and therapeutic outcomes of reflux-related respiratory disorders. Methods, Search of the literature published in English using PubMed database. Results, There is a discrepancy between the high prevalence of reflux in asthmatics and the limited efficacy of antireflux therapies. Asthma per se may cause reflux. Patients with difficult-to-treat asthma and/or nocturnal symptoms should be screened for reflux. Reflux can induce chronic cough through different mechanisms including micro-aspiration and both local and central reflexes. Cough and reflux may precipitate each other. A meta-analysis found no significant difference between placebo and proton pump inhibitors in the resolution of cough. Encouraging results have been reported, following antireflux surgery in patients selected on the basis of pH-impedance monitoring. Attention has been drawn to obstructive sleep apnoea syndrome. Conclusions, The role of gastro-oesophageal reflux disease in the pathogenesis of miscellaneous respiratory disorders has been discussed for decades and established in asthma and cough. However, no major therapeutic advances have been reported recently. Future trials should concentrate on patient selection and the control of efficacy using recently developed technologies, such as pH-impedance monitoring. [source]

Development and implementation of guidelines in allergic rhinitis , an ARIA-GA2LEN paper

ALLERGY, Issue 10 2010
J. Bousquet
To cite this article: Bousquet J, Schünemann HJ, Zuberbier T, Bachert C, Baena-Cagnani CE, Bousquet PJ, Brozek J, Canonica GW, Casale TB, Demoly P, Gerth van Wijk R, Ohta K, Bateman ED, Calderon M, Cruz AA, Dolen WK, Haughney J, Lockey RF, Lötvall J, O'Byrne P, Spranger O, Togias A, Bonini S, Boulet LP, Camargos P, Carlsen KH, Chavannes NH, Delgado L, Durham SR, Fokkens WJ, Fonseca J, Haahtela T, Kalayci O, Kowalski ML, Larenas-Linnemann D, Li J, Mohammad Y, Mullol J, Naclerio R, O'Hehir RE, Papadopoulos N, Passalacqua G, Rabe KF, Pawankar R, Ryan D, Samolinski B, Simons FER, Valovirta E, Yorgancioglu A, Yusuf OM, Agache I, Aït-Khaled N, Annesi-Maesano I, Beghe B, Ben Kheder A, Blaiss MS, Boakye DA, Bouchard J, Burney PG, Busse WW, Chan-Yeung M, Chen Y, Chuchalin AG, Costa DJ, Custovic A, Dahl R, Denburg J, Douagui H, Emuzyte R, Grouse L, Humbert M, Jackson C, Johnston SL, Kaliner MA, Keith PK, Kim YY, Klossek JM, Kuna P, Le LT, Lemiere C, Lipworth B, Mahboub B, Malo JL, Marshall GD, M vale-Manuel S, Meltzer EO, Morais-Almeida M, Motala C, Naspitz C, Nekam K, Niggemann B, Nizankowska-Mogilnicka E, Okamoto Y, Orru MP, Ouedraogo S, Palkonen S, Popov TA, Price D, Rosado-Pinto J, Scadding GK, Sooronbaev TM, Stoloff SW, Toskala E, van Cauwenberge P, Vandenplas O, van Weel C, Viegi G, Virchow JC, Wang DY, Wickman M, Williams D, Yawn BP, Zar HJ, Zernotti M, Zhong N, In collaboration with the WHO Collaborating Center of Asthma and Rhinitis (Montpellier). Development and implementation of guidelines in allergic rhinitis , an ARIA-GA2LEN paper. Allergy 2010; 65: 1212,1221. Abstract The links between asthma and rhinitis are well characterized. The Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines stress the importance of these links and provide guidance for their prevention and treatment. Despite effective treatments being available, too few patients receive appropriate medical care for both diseases. Most patients with rhinitis and asthma consult primary care physicians and therefore these physicians are encouraged to understand and use ARIA guidelines. Patients should also be informed about these guidelines to raise their awareness of optimal care and increase control of the two related diseases. To apply these guidelines, clinicians and patients need to understand how and why the recommendations were made. The goal of the ARIA guidelines is to provide recommendations about the best management options for most patients in most situations. These recommendations should be based on the best available evidence. Making recommendations requires the assessment of the quality of available evidence, deciding on the balance between benefits and downsides, consideration of patients' values and preferences, and, if applicable, resource implications. Guidelines must be updated as new management options become available or important new evidence emerges. Transparent reporting of guidelines facilitates understanding and acceptance, but implementation strategies need to be improved. [source]

Work-related stress, inability to relax after work and risk of adult asthma: a population-based cohort study

ALLERGY, Issue 10 2010
A. Loerbroks
To cite this article: Loerbroks A, Gadinger MC, Bosch JA, Stürmer T, Amelang M. Work-related stress, inability to relax after work and risk of adult asthma: a population-based cohort study. Allergy 2010; 65: 1298,1305. Abstract Background:, There is an extensive literature linking stressful work conditions to adverse health outcomes. Notwithstanding, the relationship with asthma has not been examined, although various other measures of psychological stress have been associated with asthma. Therefore, we aimed to investigate the relation between work stress and asthma prevalence and incidence. Methods:, We used data from a population-based cohort study (n = 5114 at baseline in 1992,1995 and n = 4010 at follow-up in 2002/2003). Asthma was measured by self-reports. Two scales that assessed psychologically adverse work conditions were extracted from a list of work-condition items by factor analysis (these scales were termed ,work stress' and ,inability to relax after work'). For each scale, the derived score was employed both as continuous z -score and as categorized variable in analyses. Associations with asthma were estimated by prevalence ratios (PRs) and risk ratios (RRs) using Poisson regression with a log-link function adjusting for demographics, health-related lifestyles, body mass index and family history of asthma. Analyses were restricted to those in employment (n = 3341). Results:, Work stress and inability to relax z -scores were positively associated with asthma prevalence (PR = 1.15, 95%CI = 0.97, 1.36 and PR = 1.43, 95%CI = 1.12, 1.83, respectively). Prospective analyses using z -scores showed that for each 1 standard deviation increase in work stress and inability to relax, the risk of asthma increased by approximately 40% (RR for work stress = 1.46, 95%CI = 1.06, 2.00; RR for inability to relax = 1.39, 95%CI = 1.01, 1.91). Similar patterns of associations were observed in analyses of categorized exposures. Conclusions:, This is the first study to show a cross-sectional and longitudinal association of work stress with asthma. [source]

Asthma prediction in school children; the value of combined IgE-antibodies and obstructive airways disease severity score,

ALLERGY, Issue 9 2010
K. C. Lødrup Carlsen
To cite this article: Lødrup Carlsen KC, Söderström L, Mowinckel P, Håland G, Pettersen M, Munthe Kaas MC, Devulapalli CS, Buchmann M, Ahlstedt S, Carlsen K-H. Asthma prediction in school children; the value of combined IgE-antibodies and obstructive airways disease severity score. Allergy 2010; 65: 1134,1140. Abstract Background:, Allergic sensitisation increases the risk for asthma development. In this prospective birth cohort (Environment and Childhood Asthma) study, we hypothesized that combining quantitative measures of IgE antibodies (,-IgE) and Severity score of obstructive airways disease (OAD) at 2 years of age (Severity score) is superior to predict current asthma (CA) at 10 years than either measure alone. Secondarily, we assessed if gender modified the prediction of CA. Methods:, A follow-up study at 10 years of age was performed in 371 2-year-old children with recurrent (n = 219) or no (n = 152) bronchial obstruction with available serum analysed for ,-IgE to common food and inhalant allergens through a panel test, Phadiatop Infant® (Phadia, Uppsala, Sweden). Clinical variables included allergic sensitisation and exercise testing to characterise children with CA vs not CA at 10 years and the Severity score (0,12, 0 indicating no OAD) was used to assess risk modification. Results:, Severity score alone explained 24% (Nagelkerke R2 = 0.24) of the variation in CA, whereas ,-IgE explained only 6% (R2 = 0.06). Combining the two increased the explanatory capacity to R2 = 0.30. Gender interacted significantly with ,-IgE; whereas Severity score predicted CA in both genders, the predictive capacity of ,-IgE for CA at 10 years was significant in boys only. Conclusion:, Combining ,-IgE to inhalant allergens and Severity score at 2 years was superior to predict asthma at 10 years than either alone. Severity score predicted CA in both genders, whereas ,-IgE significantly predicted CA in boys only. [source]