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Asthma Management (asthma + management)
Selected AbstractsA clinical pharmacological study of the potential beneficial effects of a propolis food product as an adjuvant in asthmatic patientsFUNDAMENTAL & CLINICAL PHARMACOLOGY, Issue 1 2003M. T. Khayyal Abstract The aqueous extract of propolis has been formulated as a nutritional food product and administered, as an adjuvant to therapy, to patients with mild to moderate asthma daily for 2 months in the framework of a comparative clinical study in parallel with a placebo preparation. The diagnosis of asthma was made according to the criteria of patient classification of the National Institutes of Health and Global Initiative for Asthma Management. At inclusion, the pulmonary forced expiratory volume in the first second (FEV1) as a percentage of the forced vital capacity (FVC) was more than 80% in mild persistent cases, and between 60 and 80% in moderate persistent cases, showing an increase in the degree of reversibility of >,15% in FEV1. All patients were on oral theophylline as controller therapy, none was receiving oral or inhaled corticosteroids, none had other comorbidities necessitating medical treatment, and all were from a middle-class community and had suffered from asthma for the last 2,5 years. Twenty-four patients received the placebo, with one drop-out during the study, while 22 received the propolis extract, with no drop-outs. The age range of the patients was 19,52 years; 36 were male and 10 female. The number of nocturnal attacks was recorded on a weekly basis, while pulmonary function tests were performed on all patients at the beginning of the trial, 1 month later and at the termination of the trial. Immunological parameters, including various cytokines and eicosanoids known to play a role in asthma, were measured in all patients at the beginning of the trial and 2 months later. Analysis of the results at the end of the clinical study revealed that patients receiving propolis showed a marked reduction in the incidence and severity of nocturnal attacks and improvement of ventilatory functions. The number of nocturnal attacks dropped from an average of 2.5 attacks per week to only 1. The improvement in pulmonary functions was manifested as a nearly 19% increase in FVC, a 29.5% increase in FEV1, a 30% increase in peak expiratory flow rate (PEFR), and a 41% increase in the forced expiratory flow rate between 25 and 75% of the vital capacity (FEF25-75). The clinical improvement was associated with decreases by 52, 65, 44 and 30%, respectively, of initial values for the pro-inflammatory cytokines tumor necrosis factor (TNF)-,, ICAM-1, interleukin (IL)-6 and IL-8, and a 3-fold increase in the ,protective' cytokine IL-10. The levels of prostaglandins E2 and F2, and leukotriene D4 were decreased significantly to 36, 39, and 28%, respectively, of initial values. Patients on the placebo preparation showed no significant improvement in ventilatory functions or in the levels of mediators. The findings suggest that the aqueous propolis extract tested is potentially effective as an adjuvant to therapy in asthmatic patients. The benefits may be related to the presence in the extract of caffeic acid derivatives and other active constituents. [source] Home Asthma Management for Rural FamiliesJOURNAL FOR SPECIALISTS IN PEDIATRIC NURSING, Issue 2 2003Sharon D. Horner ISSUES AND PURPOSE. To assess home asthma management among rural families with a school-age child who has asthma. DESIGN AND METHODS. Exploratory analysis of baseline data of a tri-ethnic sample of rural families with school-age children who have asthma. RESULTS. Parents and children enact a moderate amount of asthma management behaviors. Preventive behaviors were correlated with the Asthma Behavior Inventory and treatment behaviors were correlated with the child's asthma severity. Factors that could affect asthma management include no insurance, no visits to providers in 12 months, or no asthma medications. PRACTICE IMPLICATIONS. Nurses must use every contact with families to assess their asthma management and availability of resources, and to determine the fit between asthma severity and the asthma management plan. [source] How appropriate is asthma therapy in general practice?FUNDAMENTAL & CLINICAL PHARMACOLOGY, Issue 1 2005Laurent Laforest Abstract High association between burden of asthma and inadequate disease control make asthma management a major public health issue. We studied asthma management practices of general practitioners (GPs) in France to describe drug therapy and more specifically, to identify correlates of antibiotic prescriptions, a marker of inappropriate asthma management. Patients with persistent asthma aged 17,50 years were evaluated in a 12-month retrospective study using a computerized GPs database (Thales) and a patient survey, in which patients reported hospital contacts, use of oral corticosteroids and recent asthma symptoms. Therapy was described and the correlates of antibiotic prescriptions in the previous year were identified using multivariate logistic regression. During the study period, 16.4% of 1038 patients received one or more prescriptions of theophylline, 31.3% long-acting beta-agonists and 61.6% inhaled corticosteroids. Rates of prescription of antibiotics, expectorants, antihistamines, antitussives and nasal corticosteroids were 57.6, 42.0, 33.0, 19.9, and 14.4%, respectively. In parallel, 15% of patients reported at least one hospital contact for asthma and 43.1% used oral corticosteroids. Antibiotic prescriptions were more likely co-prescribed in patients using expectorants [odds ratio (OR) = 13.0, 95% confidence interval (CI) = 8.5,19.8] and antitussives (OR = 6.5, 95% CI =3.7,11.6). Moreover, patients using courses of oral corticosteroids, and often visiting their GP (more than four times) during the study period were more likely to receive antibiotics. The results were unchanged when analyses were restricted to non-smokers and younger patients (,40 years). Asthma management was sub-optimal among asthma patients treated by general practitioners in France. Antibiotics, expectorants, antihistamines, antitussives and nasal corticosteroids were commonly prescribed while asthma controllers were under-used. [source] An economic evaluation of NIOX MINO airway inflammation monitor in the United KingdomALLERGY, Issue 3 2009D. Price Background:, Fractional exhaled nitric oxide (FENO), a marker of eosinophilic airway inflammation, is easily measured by noninvasive means. The objective of this study was to determine the cost-effectiveness of FENO measurement using a hand-held monitor (NIOX MINO), at a reimbursement price of £23, for asthma diagnosis and management in the UK. Methods:, We constructed two decision trees to compare FENO measurement with standard diagnostic testing and guideline recommendations for management. For asthma diagnosis, we compared FENO measurement with lung function and reversibility testing, bronchial provocation and sputum eosinophil count. For asthma management, we evaluated the impact on asthma control, including inhaled corticosteroid use, exacerbations and hospitalizations, of monitoring with FENO measurement vs symptoms and lung function as in standard care. Resource use and health outcomes were evaluated over a 1-year time frame. Direct costs were calculated from a UK health-care payer perspective (2005 £). Results:, An asthma diagnosis using FENO measurement cost £43 less per patient as compared with standard diagnostic tests. Asthma management using FENO measurement instead of lung function testing resulted in annual cost-savings of £341 and 0.06 quality-adjusted life-years gained for patients with mild to severe asthma and cost-savings of £554 and 0.004 quality-adjusted life-years gained for those with moderate to severe asthma. Conclusions:, Asthma diagnosis based on FENO measurement with NIOX MINO alone is less costly and more accurate than standard diagnostic methods. Asthma management based on FENO measurement is less costly than asthma management based on standard guidelines and provides similar health benefits. [source] Asthma management: Reinventing the wheel in sickle cell disease,AMERICAN JOURNAL OF HEMATOLOGY, Issue 4 2009Claudia R. Morris Asthma is a common comorbidity in sickle cell disease (SCD) with a reported prevalence of 30,70%. The high frequency of asthma in this population cannot be attributed to genetic predisposition alone, and likely reflects in part, the contribution of overlapping mechanisms shared between these otherwise distinct disorders. There is accumulating evidence that dysregulated arginine metabolism and in particular, elevated arginase activity contributes to pulmonary complications in SCD. Derangements of arginine metabolism are also emerging as newly appreciated mechanism in both asthma and pulmonary hypertension independent of SCD. Patients with SCD may potentially be at risk for an asthma-like condition triggered or worsened by hemolysis-driven release of erythrocyte arginase and low nitric oxide bioavailability, in addition to classic familial asthma. Mechanisms that contributed to asthma are complex and multifactorial, influenced by genetic polymorphisms as well as environmental and infectious triggers. Given the association of asthma with inflammation, oxidative stress and hypoxemia, factors known to contribute to a vasculopathy in SCD, and the consequences of these factors on sickle erythrocytes, comorbid asthma would likely contribute to a vicious cycle of sickling and subsequent complications of SCD. Indeed a growing body of evidence documents what should come as no surprise: Asthma in SCD is associated with acute chest syndrome, stroke, pulmonary hypertension, and early mortality, and should therefore be aggressively managed based on established National Institutes of Health Guidelines for asthma management. Barriers to appropriate asthma management in SCD are discussed as well as strategies to overcome these obstacles in order to provide optimal care. Am. J. Hematol., 2009. © 2008 Wiley-Liss, Inc. [source] Asthma management in rural New South Wales: Perceptions of health care professionals and people with asthmaAUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 4 2009Biljana Cvetkovski Abstract Objective:,To investigate the perceptions and attitudes towards asthma management of general practitioners, pharmacists and people with asthma in a rural area. Design:,Qualitative semistructured interviews. Setting:,Small rural centre in New South Wales. Participants:,General practitioners, pharmacists and people with asthma in a rural area. Results:,General practitioners perceived that the patient provided a barrier to the implementation of optimal asthma services. They were aware that other health care professionals had a role in asthma management but were not aware of the details, particularly in relation to that of the pharmacist and would like to improve communication methods. Pharmacists also perceived the patient to be a barrier to the delivery of optimal asthma management services and would like to improve communication with the general practitioner. The impact of the rural environment for the health care professionals included workforce shortages, availability of support services and access to continuing education. People with asthma were satisfied with their asthma management and the service provided by the health care professionals and described the involvement of family members and ambulance officers in their overall asthma management. The rural environment was an issue with regards to distance to the hospital during an emergency. Conclusions:,General practitioners and pharmacists confirmed their existing roles in asthma management while expressing a desire to improve communication between the two professions to help overcome barriers and optimise the asthma service delivered to the patient. The patient described minimal barriers to optimising asthma management, which might suggest that they might not have great expectations of asthma care. [source] Caregiver Depressive Symptoms and Observed Family Interaction in Low-Income Children with Persistent AsthmaFAMILY PROCESS, Issue 1 2008MARIANNE 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] How appropriate is asthma therapy in general practice?FUNDAMENTAL & CLINICAL PHARMACOLOGY, Issue 1 2005Laurent Laforest Abstract High association between burden of asthma and inadequate disease control make asthma management a major public health issue. We studied asthma management practices of general practitioners (GPs) in France to describe drug therapy and more specifically, to identify correlates of antibiotic prescriptions, a marker of inappropriate asthma management. Patients with persistent asthma aged 17,50 years were evaluated in a 12-month retrospective study using a computerized GPs database (Thales) and a patient survey, in which patients reported hospital contacts, use of oral corticosteroids and recent asthma symptoms. Therapy was described and the correlates of antibiotic prescriptions in the previous year were identified using multivariate logistic regression. During the study period, 16.4% of 1038 patients received one or more prescriptions of theophylline, 31.3% long-acting beta-agonists and 61.6% inhaled corticosteroids. Rates of prescription of antibiotics, expectorants, antihistamines, antitussives and nasal corticosteroids were 57.6, 42.0, 33.0, 19.9, and 14.4%, respectively. In parallel, 15% of patients reported at least one hospital contact for asthma and 43.1% used oral corticosteroids. Antibiotic prescriptions were more likely co-prescribed in patients using expectorants [odds ratio (OR) = 13.0, 95% confidence interval (CI) = 8.5,19.8] and antitussives (OR = 6.5, 95% CI =3.7,11.6). Moreover, patients using courses of oral corticosteroids, and often visiting their GP (more than four times) during the study period were more likely to receive antibiotics. The results were unchanged when analyses were restricted to non-smokers and younger patients (,40 years). Asthma management was sub-optimal among asthma patients treated by general practitioners in France. Antibiotics, expectorants, antihistamines, antitussives and nasal corticosteroids were commonly prescribed while asthma controllers were under-used. [source] A comparison of budesonide/formoterol maintenance and reliever therapy vs. conventional best practice in asthma managementINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 10 2009R. Louis Summary Objective:, To study the effectiveness and safety of budesonide/formoterol (Symbicort®) Maintenance And Reliever Therapy (Symbicort SMART®, AstraZeneca, Södertalje, Sweden), a simplified management approach with one inhaler compared with conventional best practice (CBP) with multiple inhalers in patients with persistent asthma. Design:, Open-label randomised controlled parallel group trial, 6-month treatment. Participants:, A total of 908 patients , 12 years of age, with persistent asthma receiving treatment with inhaled corticosteroids (ICS), either alone or in conjunction with long-acting ,2 -agonist. Main outcome measures:, Time to first severe asthma exacerbation and number of severe asthma exacerbations. Results:, No difference between groups was seen in time to first severe exacerbation (p = 0.75). Exacerbation rates were low in both groups. A total of 12 patients in the Symbicort SMART® group experienced a total of 14 severe asthma exacerbations, and 19 patients in the CBP group experienced a total of 25 severe asthma exacerbations (annual rate 0.07 vs. 0.13 p = 0.09). The mean daily dose of ICS expressed in BDP equivalent was significantly lower in the Symbicort SMART® group (including as-needed use) vs. in the CBP group (749 ,g vs. 1059 ,g; p < 0.0001). Mean scores in Asthma Control Questionnaire, 5 question version improved significantly in the SMART group compared with the CBP group (p = 0.0026). Symbicort SMART and CBP were equally well tolerated. The mean drug cost/patient/month was significantly lower for the patients in the Symbicort SMART group compared with patients receiving CBP (51.3 , vs. 66.5 ,; p < 0.0001). Conclusions:, In Belgian patients, a simplified regimen using budesonide/formoterol maintenance and reliever therapy was at least as effective at improving clinical control compared with CBP with a significantly lower ICS dose and significantly lower drug costs. [source] Home Asthma Management for Rural FamiliesJOURNAL FOR SPECIALISTS IN PEDIATRIC NURSING, Issue 2 2003Sharon D. Horner ISSUES AND PURPOSE. To assess home asthma management among rural families with a school-age child who has asthma. DESIGN AND METHODS. Exploratory analysis of baseline data of a tri-ethnic sample of rural families with school-age children who have asthma. RESULTS. Parents and children enact a moderate amount of asthma management behaviors. Preventive behaviors were correlated with the Asthma Behavior Inventory and treatment behaviors were correlated with the child's asthma severity. Factors that could affect asthma management include no insurance, no visits to providers in 12 months, or no asthma medications. PRACTICE IMPLICATIONS. Nurses must use every contact with families to assess their asthma management and availability of resources, and to determine the fit between asthma severity and the asthma management plan. [source] Using School Staff to Establish a Preventive Network of Care to Improve Elementary School Students' Control of AsthmaJOURNAL OF SCHOOL HEALTH, Issue 6 2006Jean-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] The BreathmobileÔ: A Novel Comprehensive School-Based Mobile Asthma Care Clinic for Urban Underprivileged ChildrenJOURNAL OF SCHOOL HEALTH, Issue 6 2006Otto Liao Many school-based programs have been funded to improve asthma management, especially for these "high-risk" inner-city children with asthma. Here we report the outcomes of the Children's Hospital of Orange County Breathmobile program, which is a school-based asthma program that combines the use of a mobile clinic and a pediatric asthma specialist. Baseline evaluations included a detailed history and physical, skin prick test to common allergens, spirometry measurements, and asthma severity classification based on the current National Asthma Education and Prevention Program guidelines. From April 2002 to September 2005, a total of 1321 children were evaluated for asthma. Analysis of the 1112 (84%) children diagnosed with asthma showed a population mean age of 7.8 years, 81% Latino ethnicity, and 73% with persistent disease. At baseline, only 24% of children with persistent asthma were on daily anti-inflammatory medications, which increased to 78% by the first follow-up visit. In the year prior to entry into the program, 64% had school absenteeism related to asthma (38% >10 days), 45% had emergency room (ER) visits (28% >1), and 19% had hospitalizations (9% >1). There was a significant reduction (p < .001) in the annual rates of ER visits, hospitalizations, and school absenteeism when comparing pre- and postentry into the program. These data suggest that a mobile asthma van clinic at the school site with an asthma specialist could be an effective model in reducing morbidity in the underserved child with asthma. Further studies are necessary to determine whether this model is applicable to other inner-city settings. (J Sch Health. 2006;76(6):313-319) [source] Unawareness and undertreatment of asthma: follow-up in a different geographic area in DenmarkALLERGY, Issue 8 2009V. Backer Background:, Early detection and treatment of asthma is important to minimize morbidity and healthcare costs. The objective of this study was to investigate asthma awareness and management in a western society. Methods:, In a random sample of 10 400 subjects aged 14,44 years, 686 (6.6%) reported symptoms of asthma in a standardized screening questionnaire. All 686 were evaluated by respiratory specialists and diagnosed by history, symptoms, lung function tests, bronchial challenges and allergy testing. Of these 686 participants, 69 (10%) had asthma alone, 205 (30%) had rhinitis alone and 217 (32%) had both asthma and rhinitis; 195 (28%) had nonasthmatic respiratory reports. Results:, Awareness of asthma was found among 163 (57%) of the 286 asthmatics, and 204 (95%) had doctor-diagnosed rhinitis as well. In a multivariate regression analysis, comorbidity with rhinitis (, = 0.489, P < 0.001), smoking (, = ,0.116, P < 0.01), doctor-diagnosed bronchitis (, = 0.086, P < 0.05), and earlier emergency visits at hospital (, = 0.147, P < 0.001) was significantly associated with awareness. A difference in awareness was found between those who had asthma and rhinitis (62.2%) and those who had asthma alone (40.6%) (P < 0.01). Inhaled corticosteroids (ICS) were used by 27% of those with asthma, including 12% who used both ICS and long-acting beta-agonist. Conclusions:, More than half of the persons with asthma were aware of their disorder; and the awareness was more likely in those with comorbidity of rhinitis. In general, asthma management was inadequate. [source] Masitinib, a c-kit/PDGF receptor tyrosine kinase inhibitor, improves disease control in severe corticosteroid-dependent asthmaticsALLERGY, Issue 8 2009M. Humbert Background:, Masitinib is a tyrosine kinase inhibitor targeting stem cell factor receptor (c-kit) and platelet-derived growth factor (PDGF) receptor, which are expressed on several cell types including mast cells and bronchial structural cells, respectively. We hypothesized that c-kit and PDGF receptor inhibition may decrease bronchial inflammation and interfere with airway remodeling, which are crucial features of severe asthma. Objectives:, The primary endpoint was the percent change from baseline in oral corticosteroids after 16 weeks of treatment. Change in asthma control (asthma control questionnaire), exacerbation rate, pulmonary function tests, rescue medication requirement and safety were secondary endpoints. Methods:, A 16-week randomized, dose-ranging (3, 4.5, and 6 mg/kg/day), placebo-controlled study was undertaken in 44 patients with severe corticosteroid-dependent asthma who remained poorly controlled despite optimal asthma management. Results:, At 16 weeks of treatment, a comparable reduction in oral corticosteroids was achieved with masitinib and placebo (median reduction of 78% and 57% in the masitinib and placebo arms, respectively). Despite this similar reduction, the Asthma Control Questionnaire score was significantly better in the masitinib arm as compared to placebo with a reduction by 0.99 unit at week 16 (P < 0.001) vs 0.43 unit in the placebo arm. Masitinib therapy was associated with more transient skin rash and edema. Conclusions:, Masitinib, a c-kit and PDGF-receptor tyrosine kinase inhibitor, may represent an innovative avenue of treatment in corticosteroid-dependent asthma. These preliminary results warrant further long-term clinical studies in severe asthma (ClinicalTrials.gov Identifier: NCT00842270). [source] An economic evaluation of NIOX MINO airway inflammation monitor in the United KingdomALLERGY, Issue 3 2009D. Price Background:, Fractional exhaled nitric oxide (FENO), a marker of eosinophilic airway inflammation, is easily measured by noninvasive means. The objective of this study was to determine the cost-effectiveness of FENO measurement using a hand-held monitor (NIOX MINO), at a reimbursement price of £23, for asthma diagnosis and management in the UK. Methods:, We constructed two decision trees to compare FENO measurement with standard diagnostic testing and guideline recommendations for management. For asthma diagnosis, we compared FENO measurement with lung function and reversibility testing, bronchial provocation and sputum eosinophil count. For asthma management, we evaluated the impact on asthma control, including inhaled corticosteroid use, exacerbations and hospitalizations, of monitoring with FENO measurement vs symptoms and lung function as in standard care. Resource use and health outcomes were evaluated over a 1-year time frame. Direct costs were calculated from a UK health-care payer perspective (2005 £). Results:, An asthma diagnosis using FENO measurement cost £43 less per patient as compared with standard diagnostic tests. Asthma management using FENO measurement instead of lung function testing resulted in annual cost-savings of £341 and 0.06 quality-adjusted life-years gained for patients with mild to severe asthma and cost-savings of £554 and 0.004 quality-adjusted life-years gained for those with moderate to severe asthma. Conclusions:, Asthma diagnosis based on FENO measurement with NIOX MINO alone is less costly and more accurate than standard diagnostic methods. Asthma management based on FENO measurement is less costly than asthma management based on standard guidelines and provides similar health benefits. [source] The economic impact of severe asthma to low-income familiesALLERGY, Issue 3 2009R. Franco Background:, To estimate the direct and indirect costs of severe asthma and the economic impact of its management to low-income families in Salvador, Brazil. Methods:, One hundred and ninety-seven patients with severe asthma and referred to a state-funded asthma center providing free treatment were evaluated. At registration, they were asked about family cost-events in the previous year and had a baseline assessment of lung function, symptoms and quality of life. During the subsequent year, they were reassessed prospectively. Results:, One hundred-eighty patients concluded a 12-month follow-up. Eighty-four percent were female patients, and the median family income was US$ 2955/year. Forty-seven percent of family members had lost their jobs because of asthma. Total cost of asthma management took 29% of family income. After proper treatment, asthma control scores improved by 50% and quality of life by 74%. The income of the families increased by US$ 711/year, as their members went back to work. The total cost of asthma to the families was reduced by a median US$ 789/family/year. Consequently, an annual surplus of US$ 1500/family became available. Conclusions:, Family costs of severe asthma consumed over one-fourth of the family income of the underprivileged population in a middle-income country. Adequate management brings major economic benefit to individuals and families. [source] Validation of a questionnaire for assessment of asthma patient knowledge and behaviourALLERGY, Issue 1 2009F. Trebuchon Background:, For several years, educational programmes have been highlighted because care success depends on patient's knowledge and patient's asthma management. However, no tool is available to assess change in patient knowledge and behaviour before and after completing an educational programme. Objective:, To validate a questionnaire measuring the knowledge and behaviour of asthmatics participating in an educational programme and to gauge the benefit of such a programme. Methods:, The Asthma Behaviour Change (ABC) questionnaire was generated from literature, patient surveys and clinical situations. It was organized in eight dimensions assessing patient behaviour in seven different clinical situations and two assessing patient (pathophysiology and therapeutic) knowledge. A total of 139 asthmatics filled out the questionnaire before, during and after the educational programme. Results:, The principal component analysis confirmed the structure empirically made by clinical situations. Internal consistency analysis yielded high Cronbach's alpha values. Different dimensions and the two global scores were able to discriminate patients according to asthma severity. Finally, the effect size of difference before and after educational programme was at least 0.47, and was larger than 0.74 for both global behaviour and knowledge scores. The difference between visit 1 and 3 for global behaviour and knowledge scores reached 18.84 ± 20.83 (P < 0.001, 95% CI: 13.18,24.43) and 11.06 ± 14.98 (P < 0.001, 95% CI: 7.10,15.03), respectively. Conclusion:, ABC questionnaire is a valid tool to assess asthmatics' knowledge and behaviour. Furthermore, this study confirmed that educational programmes lead to better awareness of asthma by patients. [source] Budesonide/formoterol for maintenance and reliever therapy in the management of moderate to severe asthmaALLERGY, Issue 12 2008M. Humbert The Global Initiative for Asthma (GINA) guidelines aim at improving asthma control and preventing future risk. For patients with moderate to severe asthma an inhaled corticosteroid (ICS) or an ICS/long-acting ,2 -agonist (LABA) combination with a short-acting ,2 -agonist (SABA) as reliever is recommended. Despite the availability of effective maintenance therapies, a large proportion of patients still fail to achieve guideline-defined asthma control, and overuse of SABA reliever medication at the expense of ICS is commonly observed. New simplified treatment approaches may offer a solution and assist physicians to achieve overall asthma control. One such treatment approach, which is recommended in the GINA guidelines, is budesonide/formoterol for both maintenance and reliever therapy. This treatment strategy significantly reduces the rate of severe asthma exacerbations compared with ICS/LABA plus SABA and achieves equivalent daily symptom control compared with higher doses of ICS/LABA plus separate SABA for relief. These benefits are achieved at a lower overall steroid load, and budesonide/formoterol maintenance and reliever therapy is well tolerated in patients with moderate to severe asthma. This review discusses current asthma management in patients with moderate to severe disease and examines the evidence for alternative asthma management approaches. [source] Comparability of a hand-held nitric oxide analyser with online and offline chemiluminescence-based nitric oxide measurementPEDIATRIC ALLERGY AND IMMUNOLOGY, Issue 7 2009Barbara Schiller Practicability is crucial for successful implementation of fractional exhaled nitric oxide (FeNO) measurement into asthma management. The study aimed at comparing a conventional chemiluminescence NO analyser (EcoMedics®) with a hand-held device (NIOX MINO®) and offline FeNO measurement using a commercially available system in an unselected cohort of children aged 6,16 yr. A secondary objective was to confirm FeNO stability over time in 15 samples from adult volunteers obtained using the offline system. Sixty-six children (mean ± s.d. age 11.8 ± 3.0 yr) underwent single breath FeNO measurement in triplets with each device. Offline collected FeNO was measured after offline breath collection into a Mylar balloon and subsequent analysis using the chemiluminescence NO analyser. Variability and between-method agreement were assessed, and stability over time within the Mylar balloons was tested by repeated hourly measurements. FeNO levels ranged from 2 to 113 p.p.b. Intra-class correlation was excellent (r = 0.98, p < 0.001 for each pair). Bland,Altman plots and back-transformation of logarithmic mean differences revealed fair agreement between methods. Stability over time was confirmed over 10 h both at room temperature and when stored under cooling conditions. FeNO values obtained using the chemiluminescence NO analyser, the portable NIOX MINO® system and the offline collection technique show between-method agreement within clinically acceptable range. [source] Actual asthma control in a paediatric outpatient clinic population: Do patients perceive their actual level of control?PEDIATRIC ALLERGY AND IMMUNOLOGY, Issue 7 2008Sanne C Hammer Several epidemiological studies described poor asthma control in children. However, the diagnosis of childhood asthma in these studies is uncertain, and asthma control in children of an outpatient clinic population during treatment by a paediatrician is unknown. (1) to investigate the hypothesis that asthma control in a paediatric outpatient clinic population is better than epidemiological surveys suggest; (2) to find possible explanations for suboptimal asthma control. Asthmatic children aged 6,16 years, known for at least 6 months by a paediatrician at the outpatient clinic, were selected. During a normal visit, both the responsible physicians and parent/children completed a standardised questionnaire about asthma symptoms, limitation of daily activities, treatment, asthma attacks and emergency visits. Overall, excellent asthma control of 8.0% in this study was not significantly better than of 5.8% in the European AIR study (Chi-square, p = 0.24). Separate GINA goals like minimal chronic symptoms and no limitation of activities were better met in our study. Good to excellent controlled asthma was perceived by most children/parents (83%), but was less frequently indicated by the paediatrician (73%), or by objective criteria of control (45%) (chi-square, p = 0.0001). The agreement between patient-perceived and doctor assessed control was low, but improved in poorly controlled children. Patients were not able to perceive the difference between ,excellent asthma control' and ,good control' (p = 0.881). Too little children with uncontrolled disease got step-up of their asthma treatment. Although separate GINA goals like ,minimal chronic symptoms' and ,no limitation of activities' were significantly better in our study, overall, asthma control in this outpatient clinic population, treated by a paediatrician, was not significantly better than in the European AIR study. Poorly controlled disease was related to several aspects of asthma management, which are potentially accessible for improvements. [source] Association among lung function, exhaled nitric oxide, and the CAN questionnaire to assess asthma control in children,PEDIATRIC PULMONOLOGY, Issue 5 2010O. Sardón-Prado MD Abstract Background The aim of this study was to investigate the association among a validated symptom-based questionnaire for asthma control in children (CAN), forced expiratory volume in 1,sec (FEV1), and fractional exhaled nitric oxide (FENO). Methods Observational cross-sectional study was performed in a consecutive sample of asthmatic children aged between 7 and 14 years old from December 2007 to February 2008. FENO was measured with a portable electrochemical analyzer and forced spirometry was performed according to American Thoracic Society/European Respiratory Society. The CAN questionnaire was completed by the parents (aged <9 years old) or by the children (,9 years old). The strength of the association among FEV1, FENO, and CAN questionnaire was studied using Spearman's rho, and the degree of agreement for asthma control among FEV1, FENO, and CAN questionnaire, with classification of these variables according to values of normality, was studied using Pearson's ,2 test and Cohen's kappa (KC). Results We studied 268 children, mean age 9.7,±,2.1 years. Significant correlations were found between FENO and CAN (r,=,0.2), between FEV1 and CAN (r,=,,0.3), and between FENO and FEV1 (r,=,,0.12). On classifying the variables according to values of normality, no agreement was found to establish the degree of asthma control between FENO and CAN (KC,=,0.18, ,2 Pearson,=,9.63); between FEV1 and CAN (KC,=,0.29, ,2,=,38.5); or between FENO and FEV1 (KC,=,0.07, ,2,=,4.9). Conclusions The association among the three measurement instruments used to assess asthma control (FEV1, FENO, and CAN) was weak. These are instruments that quantify variables that influence asthma in different ways, in this sense, none can be used instead of another in asthma management although they are complementary. Pediatr Pulmonol. 2010; 45:434,439. © 2010 Wiley-Liss, Inc. [source] How pediatricians manage asthma in ThailandPEDIATRIC PULMONOLOGY, Issue 2 2001Pakit Vichyanond MD Abstract Currently, there is no existing information regarding prescribing practices for the management of childhood asthma among pediatricians in Thailand. In order to evaluate the management standards for childhood asthma in Thailand, 400 self-administered questionnaires were randomly mailed to nonacademic pediatricians throughout Thailand, asking questions about their preferences in the treatment of childhood asthma. One hundred and seventy-four of these 400 questionnaires were returned (a response rate of 43.5%). Data were analyzed using the descriptive module of the Epi-info 6 program. For acute asthma, 17% of the respondents used objective measures such as peak flow meters in assessing asthma severity and severity of acute asthma attacks. The drug of first choice for treating acute attacks was a nebulized beta-agonist q 20 min (81.8%). Although 93% indicated that they had used theophylline for treating acute attacks, most would reserve the drug for patients with severe symptoms. Corticosteroids were reserved for those with severe attacks (91.7% both for clinic and for in-hospital settings). Hydrocortisone was the most preferred corticosteroid preparation (59.8%). Ninety-seven percent used antibiotics in treating acute asthma, but only with appropriate indications. For chronic asthma, a strong preference was observed for oral beta-agonists as the bronchodilator of choice (88%). For moderately severe asthmatics, theophylline was still preferred by 41% of the responders. Among prophylactic agents, ketotifen was the most favored drug (90.4%), whereas inhaled steroids and cromolyn were chosen by 9.6% and 2.4%, respectively. Eighty-five percent indicated that they would prescribe prophylactic agents for 1 year or less. Forty-two percent never considered allergy evaluation as a part of a workup for childhood asthma. Certain prescribing practices of childhood asthma management in Thailand were observed among pediatricians, i.e., 1) low frequency of using objective measures in assessing asthma severity among pediatricians; 2) frequent use of theophylline and antibiotics in the treatment of acute asthma; 3) late introduction of corticosteroids in treating acute asthma; 4) preference for oral bronchodilators; and 5) preference of ketotifen as the prophylactic drug of choice. This survey provides baseline data and will aid in the evaluation of management guidelines for childhood asthma in Thailand. Pediatr Pulmonol. 2001; 32:109,114. © 2001 Wiley-Liss, Inc. [source] Behavioral issues in asthma managementPEDIATRIC PULMONOLOGY, Issue S21 2001Randall Brown MD Abstract Despite advances in drug treatment, outcomes in asthma remain unsatisfactory. Often overlooked in developing treatment strategies are important factors that affect outcomes in asthma, namely behavioral issues such as the low rate of patient adherence to the prescribed treatment regimen, inadequate physician-patient communication, and inconsistent implementation of evidenc-based treatment guidelines. The low adherence rates among asthma patients may be improved by education programs that emphasize both the potentially serious risks of this disease and a team approach to treatment that includes patients and their families in developing a treatment plan. Interactive physician education programs have been shown to improve guideline implementation and physician communication skills. Indeed, effective physician-patient communication may be the key to improving guideline implementation and patient adherence to treatment, resulting in meaningful decreases in asthma-related morbidity and mortality. Pediatr Pulmonol. 2001; Supplement 21:26,30. © 2001 Wiley-Liss, Inc. [source] Asthma management: Reinventing the wheel in sickle cell disease,AMERICAN JOURNAL OF HEMATOLOGY, Issue 4 2009Claudia R. Morris Asthma is a common comorbidity in sickle cell disease (SCD) with a reported prevalence of 30,70%. The high frequency of asthma in this population cannot be attributed to genetic predisposition alone, and likely reflects in part, the contribution of overlapping mechanisms shared between these otherwise distinct disorders. There is accumulating evidence that dysregulated arginine metabolism and in particular, elevated arginase activity contributes to pulmonary complications in SCD. Derangements of arginine metabolism are also emerging as newly appreciated mechanism in both asthma and pulmonary hypertension independent of SCD. Patients with SCD may potentially be at risk for an asthma-like condition triggered or worsened by hemolysis-driven release of erythrocyte arginase and low nitric oxide bioavailability, in addition to classic familial asthma. Mechanisms that contributed to asthma are complex and multifactorial, influenced by genetic polymorphisms as well as environmental and infectious triggers. Given the association of asthma with inflammation, oxidative stress and hypoxemia, factors known to contribute to a vasculopathy in SCD, and the consequences of these factors on sickle erythrocytes, comorbid asthma would likely contribute to a vicious cycle of sickling and subsequent complications of SCD. Indeed a growing body of evidence documents what should come as no surprise: Asthma in SCD is associated with acute chest syndrome, stroke, pulmonary hypertension, and early mortality, and should therefore be aggressively managed based on established National Institutes of Health Guidelines for asthma management. Barriers to appropriate asthma management in SCD are discussed as well as strategies to overcome these obstacles in order to provide optimal care. Am. J. Hematol., 2009. © 2008 Wiley-Liss, Inc. [source] Extended-stay hospitalization for childhood asthma in JapanPEDIATRICS INTERNATIONAL, Issue 4 2009Hidekazu Tani Abstract Background:, While recent advances in asthma management have enabled adequate control to be frequently achieved in outpatient settings, children whose asthma remains poorly controlled despite outpatient treatment are often referred to extended-stay hospitals. The aim of the present study was to examine trends concerning extended-stay hospitalization and to evaluate the present status of this approach. Methods:, A retrospective study was conducted to assess changes in the number of admissions among 408 children with extended stays at Kamiamakusa General Hospital between 1989 and 2005. Medical and laboratory data of 236 patients admitted since 1994 were obtained from clinical records. Results:, The number of children with extended-stay hospitalizations since 2000 declined dramatically compared with the early 1990s, while the percentage of patients with complications of childhood asthma, such as severe atopic dermatitis, school absenteeism, and obesity, have increased significantly in the recent past. Practical benefits of extended-stay hospitalization were demonstrated by significant improvement of exercise performance and measurement of pulmonary function parameters and serum IgE concentrations by time of discharge. In addition to improvement in asthmatic symptoms, maintenance drug requirements and frequency of school absenteeism were reduced. Conclusions:, The medical mission of extended-stay hospitalizations is currently limited due to the availability of improved pharmacotherapy. Some patients, however, with exceptionally severe asthma or psychological problems that interact with their medical condition still fare poorly under outpatient care and could benefit from group care. Further study is needed to identify the components of long-term programs essential to produce change. [source] Life Events, Chronic Stressors, and Depressive Symptoms in Low-Income Urban Mothers With Asthmatic ChildrenPUBLIC HEALTH NURSING, Issue 4 2009Joan Kub ABSTRACT Objective: This secondary data analysis study examines the relationship between maternal sociodemographic variables, life events, chronic stressors, including asthma control and management and environmental stressors, and maternal depression. Design: Cross-sectional descriptive design study consisting of baseline data from participants enrolled in a randomized asthma communication educational intervention trial. Sample: 201 mothers of children with asthma (ages 6,12), recruited from community pediatric practices and emergency departments of 2 urban university hospitals. Measurement: Life events were measured using standardized items. Chronic stressors were measured using items from the International Asthma and Allergies in Childhood study and maternal and child exposure to violence. Depressive symptoms were assessed with the Center for Epidemiologic Studies-Depression scale. Results: Close to 25% of the mothers had high depressive symptoms. In separate multiple logistic regression models, education (adjusted odds ratio [AOR]=2.62; 95% confidence interval [CI]=1.07, 6.39) or unemployment (AOR=2.38; 95% CI=1.16, 4.90) and the use of quick relief medications (AOR=2.74; 95% CI=1.33, 5.66) for asthma were positively associated with depressive symptoms. Conclusions: Implications include the need to assess maternal depressive symptoms of mothers of children with asthma, in order to improve asthma management for low-income urban children. [source] Asthma management in rural New South Wales: Perceptions of health care professionals and people with asthmaAUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 4 2009Biljana Cvetkovski Abstract Objective:,To investigate the perceptions and attitudes towards asthma management of general practitioners, pharmacists and people with asthma in a rural area. Design:,Qualitative semistructured interviews. Setting:,Small rural centre in New South Wales. Participants:,General practitioners, pharmacists and people with asthma in a rural area. Results:,General practitioners perceived that the patient provided a barrier to the implementation of optimal asthma services. They were aware that other health care professionals had a role in asthma management but were not aware of the details, particularly in relation to that of the pharmacist and would like to improve communication methods. Pharmacists also perceived the patient to be a barrier to the delivery of optimal asthma management services and would like to improve communication with the general practitioner. The impact of the rural environment for the health care professionals included workforce shortages, availability of support services and access to continuing education. People with asthma were satisfied with their asthma management and the service provided by the health care professionals and described the involvement of family members and ambulance officers in their overall asthma management. The rural environment was an issue with regards to distance to the hospital during an emergency. Conclusions:,General practitioners and pharmacists confirmed their existing roles in asthma management while expressing a desire to improve communication between the two professions to help overcome barriers and optimise the asthma service delivered to the patient. The patient described minimal barriers to optimising asthma management, which might suggest that they might not have great expectations of asthma care. [source] Maternal depressive symptoms and adherence to therapy in inner-city children with AsthmaCHILD: CARE, HEALTH AND DEVELOPMENT, Issue 4 2004Richard Reading Maternal depressive symptoms and adherence to therapy in inner-city children with Asthma . Bartlet, S.J., Krishnan, J.A., Riekert, K.A., Butz, A.M., Malveaux, F.J. & Rand, C.S. ( 2004 ) Pediatrics113 , 229 , 237 . Context Little is known about how depressive symptoms in mothers affects illness management in inner-city children with asthma. Objective The goal was to determine how maternal depressive symptoms influence child medication adherence, impact of the child's asthma on the mother, and maternal attitudes and beliefs. Methods Baseline and 6-month surveys were administered to 177 mothers of young minority children with asthma in inner-city Baltimore, MD and Washington, DC. Medication adherence, disruptiveness of asthma, and select attitudes toward illness and asthma therapy were measured. Six-month data (n = 158) were used to prospectively evaluate long-term symptom control and emergency department use. Independent variables included asthma morbidity, age, depressive symptoms and other psychosocial data. Results No difference in child asthma morbidity was observed between mothers high and low in depressive symptoms. However, mothers with high depressive symptoms reported significantly more problems with their child using inhalers properly [odds ratio (OR) 5.0, 95% confidence interval (CI) 1.3,18.9] and forgetting doses (OR 4.2, 95% CI 1.4,12.4). Depressive symptoms were also associated with greater emotional distress and interference with daily activities caused by the child's asthma, along with less confidence in asthma medications, ability to control asthma symptoms and self-efficacy to cope with acute asthma episodes. In addition, depressed mothers reported less understanding about their child's medications and use (OR 7.7, 95% CI 1.7,35.9). Baseline asthma morbidity, maternal depression scores and family income were independently associated with asthma symptoms 6 months later, whereas medication adherence was not predictive of subsequent asthma morbidity or emergency department use. Conclusions Maternal depressive symptoms were not associated with child asthma morbidity but were associated with a constellation of beliefs and attitudes that may significantly influence adherence to asthma medications and illness management. Identifying and addressing poor psychological adjustment in mothers is important when developing a child's asthma treatment and may facilitate parent,provider communication, medication adherence and asthma management among inner-city children. [source] A rapid test for detection of mite allergens in homesCLINICAL & EXPERIMENTAL ALLERGY, Issue 11 2002A. Tsay Summary Background International guidelines recommend allergen avoidance for asthma management, but do not include making assessments of allergen exposure. Mite allergen exposure cannot be assumed, especially in geographical regions where climatic conditions vary. Objective To develop a rapid test that would enable consumers to detect mite allergen in the home. Methods A lateral flow test using gold labelled antibody for mite group 2 allergen was developed as part of a detection kit incorporating the MITEST dust sampling device. Dust samples were assayed by ELISA for group 1 and group 2 allergens and by using the rapid test. The tests were compared as indices of mite allergen exposure. Results There was a good correlation between group 1 and group 2 levels by ELISA (n = 349, r = 0.60, P < 0.001). In a multi-centre study of 65 homes (263 dust samples) in five countries, there was a strong correlation between ELISA and the rapid test. Most samples with high scores in the test (43/48, 90%) contained > 1 µg/m2 group 2 allergen, whereas most low samples contained < 1 µg/m2 (50/64, 78%). Differences between mean group 2 levels of samples that scored low (0.28 µg/m2), medium (1.68 µg/m2) or high (3.18 µg/m2) on the test were highly significant (P 0.007 to < 0.001). Conclusions A simple rapid test has been developed that detects mite allergen in the home within 10 min. The mite screening test should educate consumers about allergen exposure and encourage compliance with allergen-avoidance procedures. This technology has applications for the detection of other common environmental allergens. [source] Natural history of asthma from childhood to adulthoodCLINICAL & EXPERIMENTAL ALLERGY REVIEWS, Issue 4 2002A. B. Kay Summary Asthma is a common and complex condition, with considerable heterogeneity both in phenotype and in the underlying pathophysiology. This paper aims to address some of the recent advances in the understanding of asthma, as well as indicating how these advances reveal potential new avenues for therapeutic intervention. Current drug treatments, although effective at alleviating inflammatory symptoms, do little to target the underlying causative factors. The onset of asthma is controlled by a combination of genetic and environmental factors, and a greater understanding of these has highlighted the importance of early-life infections, allergen avoidance and fetal and postnatal nutrition. An imbalance in the expression of T-cell phenotypes is thought to play an important role in the pathophysiology of asthma, and further elucidation of the underlying immune mechanisms has identified new ways of modulating the course of the disease. It is clear that there is also a need for new drug strategies that are aimed at the diverse factors that both trigger the disease and determine its course and severity, as well as the immune mechanisms contributing to its pathophysiology. Treatment plans that address this diversity are likely to provide a more effective means of asthma management and, combined with current knowledge of causative factors, might even act to modulate the course and severity of the disease. [source] | |||||||||||||