Asthma

Childhood exposure to microbiological agents may influence the development of allergic and respiratory diseases. Apart from home, children spend most of their time at school, which represents an environment of significant exposure to indoor air microbes. Therefore, we aimed to assess how the prevalence of allergic sensitization and asthma in schoolchildren is affected by microbiological exposure within classrooms. Spirometry with bronchodilation, exhaled nitric oxide measurements and skin-prick tests data were retrieved from 858 children aged 8 to 10 years old attending 71 classrooms in 20 primary schools. Air samples were collected in all classrooms using a single-stage microbiological air impactor through agar plates. Gram-negative endotoxins were collected using flow control pumps and analysed by limulus amebocyte lysate assay. Diversity scores were established as the number of different fungal species found in each classroom. Classrooms with increased diversity scores showed a s...

Background Asthma is an important cause of morbidity and mortality worldwide. Education is a critical component in the management of asthma. Objective This study sought to assess the impact of pharmacist-led educational interventions on asthma control and adherence. Setting Tertiary Hospitals in Nigeria Method This was a single-blind, three-arm, prospective, randomised, controlled, parallel-group study conducted in the Respiratory Units of the University of Nigeria Teaching Hospital, Enugu State and the Lagos University Teaching Hospital, Lagos State between March 2016 and September 2017. The three arms were: Usual Care, Individual Intervention, Caregiver-assisted Intervention (1:1:1 ratio). The Intervention arms received education for 6 months while the Usual Care arm received no education. The Asthma Control Test and the 8-item Morisky Medication Adherence Scale were filled at baseline, 3 months, and 6 months after baseline. Data were analyzed using the IBM SPSS Version 25.0 with statistical significance set as P  < 0.05. Main outcome measure Asthma control and adherence. Results Seventy-eight (78) asthma patients participated; thirty-nine (39) per hospital; thirteen (13) in each arm. The Individual Intervention arm possessed significantly better asthma control compared to Usual Care at 3 months (21.42 Vs. 18.85; P  = 0.004, t  = 3.124, df = 25, 95% confidence interval = 0.88 − 4.28) and 6 months (21.81 Vs. 19.58; P  = 0.003, t  = 3.259, df = 25, 95% confidence interval = 0.82 − 3.64). The Individual Intervention arm also possessed significantly better adherence compared to Usual Care at 3 months (6.81 Vs. 4.94; P  = 0.001, t  = 3.706, df = 25, 95% confidence interval = 0.83 − 2.90) and 6 months (7.28 Vs. 5.13; P  < 0.001, t  = 4.094, df = 25, 95% confidence interval = 1.07 −3.24). The Caregiver-assisted Interventions had no significant improvement in asthma control and adherence. Conclusion The individualized educational interventions produced better improvements in asthma control and adherence.

Background: Spirometry is vital in screening, diagnosing and monitoring of patients in clinical respiratory medicine. The interpretations of these results depend on comparison with reference values derived from a pool of normal healthy population, which are age, weight, height, gender and ethnicity dependant. Objectives: To establish normative data of lung function indices (FVC, FEV1, FEV1/FVC, PEFR and MVV) of healthy adult persons and to find correlation of these data, if any, with age, height, weight and BMI. Methods: Participants (n=174, mean age 19.60±1.177 yrs, height 161.87±8.572 cm, weight 58.65±11.190 kg and BMI 22.28±3.159 kg/m2) were recruited from KIST medical college. Spriometry was performed and data were grouped according to age, height, weight, BMI and gender. Results: The mean FVC, FEV1, PEFR and MVV of males (3.58 ±0.7241 L, 3.34±0.61L, 8.41±1.20L/sec and 141.45±18.54L/min respectively) were significantly higher than that of females (2.52±0.50L, 2.44±0.44L, 6.72±0....

In this study we evaluated how the quality of life in subjects with asthma was affected by a history of non-infectious rhinitis. The study comprised 180 persons with asthma and 156 controls, who answered the Short Form 36 quality of life questionnaire. Both the asthma subjects and the controls were stratified according to a history of non-infectious rhinitis (NIR). The global physical quality of life score (PCS) was significantly lower for all the asthma subjects regardless of their previous history of NIR compared to controls (NIR positive asthma, -8, p=O,001, NIR negative asthma, -9, p=0, 001). The subjects with asthma and a positive history of NIR obtained significantly lower scores for their global mental quality of life (MCS) than the controls (46 vs 51, p=0.004). The subjects with asthma and a negative history of NIR obtained MCS scores that were similar to those of the controls (50 and 51, p=0.9). In this population based study, the physical Qol of the subjects with asthma wa...

Background: Asthma is one of the most common persistent inflammatory respiratory disorders. Comorbidities are relatively common in asthma. The aim of this review study was to find comorbid disorders in children with asthma.
Methods: For the purpose of this review, we searched databases including Scopus, Google scholar, PubMed, SID, Irandoc and up-to-date. Key words for the search included children asthma, comorbidity and pediatric asthma. There were no time limitations for the search. Full text articles in English language were included in this study.
Results: Neuropsychiatric comorbidities were Attention-deficit/hyperactivity disorder (ADHD) (11.5%), oppositional defiant disorder (ODD) (10.7%), separation anxiety disorder (6.1%), social anxiety disorder (3.8%), specific phobias (2.3%), agoraphobia without panic (1.5%), (mild) manic episodes (1.1%), major depressive episodes (MDE) (0.8%), movement (tic) disorder (0.8%) and dysthymia (0.4%). The prevalence of sinusitis was 13% in children with asthma (17). Prevalence of asthma in chronic rhinosinusitis with polyposis (CRSwP) is 26-48%, but the prevalence of CRSwP in asthmatic patients is only 7%. Asthma was prevalent in 25-35% patients with allergic rhinitis, and rhinitis symptoms were present in 75-90% of asthmatic patients. Asthma and obstructive sleep apnea (OSA) commonly coexist. Snoring (49.5%), gastro-esophageal reflux disease (GERD) (46.3%), atopic dermatitis (27.3%), allergic sinusitis (20%) and food allergy (10.5%) were common in children with asthma.
Conclusions: Our review has revealed that allergic rhinitis, gastroesophageal reflux, obesity, food allergy, obstructive sleep apnea, allergic conjunctivitis, chronic rhinosinusitis and psychological abnormalities are common comorbidities in children with asthma.

Background Subcutaneous immunotherapy is effective for the treatment of respiratory allergy, and it is largely used in Italy, but no systematic safety assessment has been carried out so far.Objective To assess prospectively the safety of injection immunotherapy in a multicentre, real-life survey.Methods Eleven Italian allergy departments recorded the clinical characteristics of systemic reactions (SRs) due to immunotherapy. Vaccines were prescribed according to guidelines; only standardized depot extracts were used. SRs were graded according to the EAACI recommendations, and were classified as immediate or delayed.Results One thousand seven hundred and thirty-eight patients (847 males, age range 5–71) received immunotherapy from eight different manufacturers, for a total of 2038 courses (300 patients received two extracts). A total of 60 785 injections were given over a mean immunotherapy duration of 3 years. Overall, 95 reactions were observed in 57 patients (3.28%), corresponding to 4.7% of the courses and 1.56/1000 injections. Twenty-five patients experienced more than one adverse event. There were 34 grade 2, 60 grade 3 and one grade 4 reactions and no fatality. SRs occurred more frequently in patients with asthma than in patients with rhinitis alone (4.1% vs. 1.1%), and were equally distributed between the build-up and the maintenance phase. Ragweed and grass extracts caused significantly more side effects than other allergens.Conclusion In this large prospective study, the rate of SRs was low, thus confirming that injection immunotherapy has an acceptable risk/benefit ratio when prescribed and carried out according to recommendations.

Information on sCD200 (OX-2), 25-Hydroxyvitamin-D(25(OH)D), homocysteine (hcy), eosinophil cationic peptid (ECP), d-dimer (DD), CXCL8, fractional exhale nitric oxide concentrations (FeNO) status all together among patients with allergy in mediterranean region in comparison of climatic conditions have not been well established yet. Blood samples were taken on May and June during the highest air pollination. Hence, this study was undertaken to compare these serum biomolecules’ levels in allergic patients and matched controls, to evaluate disease characteristics. The study participants (n=129) included 25 healthy individuals (controls) and 104 allergic patients. Consecutive patients with allergic disease (Group II,III,IV,V) above the age of 18 years, managed. In the control group there was a significant positive correlation between ECP and BMI. Positive correlations between ECP, IgE and OX-2 were detected in group IV. For group V patients, positive correlations between age and IgE and ...

To test the ability of an automated telephone outreach intervention to reduce acute healthcare utilization and improve quality of life among adult asthma patients in a large managed care organization. Randomized clinical trial. Patients with persistent asthma were randomly assigned to telephone outreach (automated = 3389, live caller = 192) or usual care (n = 3367). Intervention participants received 3 outreach calls over a 10-month period. The intervention provided brief, supportive information and flagged individuals with poor asthma control for follow-up by a provider. A survey was mailed to 792 intervention participants and 236 providers after the intervention. Additional feedback was obtained as part of the final intervention contact. The intent-to-treat analysis found no significant differences between the intervention and usual-care groups for medication use, healthcare utilization, asthma control, or quality of life. Post hoc analyses found that, compared with the control gr...

Pulmonary rehabilitation programmes are often costly and dependent on the infrastructure of specialised centres. We developed a modular, outpatient-based rehabilitation programme, which is inexpensive and can be implemented in a variety of settings. The aim of this study was to determine the effects and feasibility of this programme. Thirteen patients with COPD and 7 patients with asthma were enrolled by their primary care physician because of dyspnoea. Initial assessment included cardiopulmonary exercise testing, six-minute walking distance, lung function testing and multiple questionnaires addressing dyspnoea, depression and quality of life issues. The training consisted of 36 sessions of high intensity training of 2 hours duration to improve exercise tolerance, including 30 minutes of stationary cycling at the anaerobic threshold. Another complete assessment was done on completion of the study at 3 months. The six-minute walking distance improved significantly from 401 to 551 m (...

It is difficult to put research findings into clinical practice by either guidelines or prescription feedback. To study the effect on the quality of prescribing by a combined intervention of providing individual feedback and deriving quality criteria using guideline recommendations in peer review groups. 199 general practitioners in 32 groups were randomised to participate in peer review meetings related to either asthma or urinary tract infections. The dispensing by the participating doctors of antiasthmatic drugs and antibiotics during the year before the intervention period provided the basis for prescription feedback. The intervention feedback was designed to describe the treatment given in relation to recommendations in the national guidelines. In each group the doctors agreed on quality criteria for their own treatment of the corresponding diseases based on these recommendations. Comparison of their prescription feedback with their own quality criteria gave each doctor the pro...

Gaps exist in inpatient asthma care. Our aims were to assess the impact of an evidence-based care process model (EB-CPM) 5 years after implementation at Primary Children's Hospital (PCH), a tertiary care facility, and after its dissemination to 7 community hospitals. Participants included asthmatics 2 to 17 years admitted at 8 hospitals between 2003 and 2013. The EB-CPM was implemented at PCH between January 2008 and March 2009, then disseminated to 7 community hospitals between January and June 2011. We measured compliance using a composite score (CS) for 8 quality measures. Outcomes were compared between preimplementation and postimplementation periods. Confounding was addressed through multivariable regression analyses. At PCH, the CS increased and remained at >90% for 5 years after implementation. We observed sustained reductions in asthma readmissions (P = .026) and length of stay (P < .001), a trend toward reduced costs (P = .094), and no change in hospital resource ...

The aim of the current study was to determine the impact and interaction of important influencing factors on the fraction of exhaled nitric oxide (FeNO). FeNO was measured in a population-based sample of 1250 middle-aged subjects from the KORA F4 cohort (Augsburg, Germany). Analysis of covariance models was performed including the factors age, height, FVC, FEV(1), sex, current smoking status, recent respiratory tract infection, and respiratory allergy. Geometric mean (SD as factor; 95% confidence interval as factor) FeNO was 13.9 (1.9; 1.033) ppb. FeNO significantly depended on age, height, smoking, infection and allergy. Smoking reduced FeNO by 21%, while infection and allergy led to increases by 9 and 11%, respectively. Increases in age by 10 years and in height by 10 cm were associated with increases of FeNO by 15 and 10%, respectively. Non-smokers demonstrated independent multiplicative superposition of factors affecting FeNO while the effect of allergy was virtually eliminated ...

Modern  guidelines for the treatment  of asthma and COPD emphasize the use of inhalational    therapy.    Administration of drug directly to the airway offers several advantages  to both patients and their physicians.    Most  evident to patients with asthma  is  the  speed of response when  using inhaled  bronchodilating  agents  as compared  to  oral  agents.    Bronchodilitation  occurs  within  minutes  rather  than hours  so that  bronchodilators may be used  on an intermittent  as-needed  basis. Moreover,  drugs delivered  directly to the airway  can produce  much of their effect directly  with  fewer  associated  systemic side-effects.    Orally  administered  betas agonists,  for  example, produce  considerably more  tremor  and  tachycardia  than inhaled beta, agonists at equipotent bronchodilating doses.    The reduced  systemic toxicity  of inhaled  agents is pivotal  in  our current use of corticosteroids  for  the management  of  asthma.    Control  of airway  irritability  with  oral  steroids  is associated with considerable risk of systemic toxicity including immunosuppression, osteoporosis and cataract formation.    The same effect may be achieved with  little or no risk by using inhaled, topically-active corticosteroids.    This combination of advantages. has lead to flexible patient self-management schemes.    Physicians can gauge the  severity of disease by quantifying the patients need for inhaled bronchodilator  therapy.    A variety of delivery systems is  available ranging  from the  traditional  metered-dose  inhaler  to  breath-actuated  dry  powder  inhalers. Holding chambers may be used to augment the delivery of drug via metered-dose inhaler.    this flexibility requires that physicians become familiar with a variety of delivery systems so that they may properly instruct their patients.