WorldWideScience

Sample records for asthma rationale study

  1. Predicting asthma in preschool children with asthma symptoms: study rationale and design

    Directory of Open Access Journals (Sweden)

    Hafkamp-de Groen Esther

    2012-10-01

    Full Text Available Abstract Background In well-child care it is difficult to determine whether preschool children with asthma symptoms actually have or will develop asthma at school age. The PIAMA (Prevention and Incidence of Asthma and Mite Allergy Risk Score has been proposed as an instrument that predicts asthma at school age, using eight easy obtainable parameters, assessed at the time of first asthma symptoms at preschool age. The aim of this study is to present the rationale and design of a study 1 to externally validate and update the PIAMA Risk Score, 2 to develop an Asthma Risk Appraisal Tool to predict asthma at school age in (specific subgroups of preschool children with asthma symptoms and 3 to test implementation of the Asthma Risk Appraisal Tool in well-child care. Methods and design The study will be performed within the framework of Generation R, a prospective multi-ethnic cohort study. In total, consent for postnatal follow-up was obtained from 7893 children, born between 2002 and 2006. At preschool age the PIAMA Risk Score will be assessed and used to predict asthma at school age. Discrimination (C-index and calibration will be assessed for the external validation. We will study whether the predictive ability of the PIAMA Risk Score can be improved by removing or adding predictors (e.g. preterm birth. The (updated PIAMA Risk Score will be converted to the Asthma Risk Appraisal Tool- to predict asthma at school age in preschool children with asthma symptoms. Additionally, we will conduct a pilot study to test implementation of the Asthma Risk Appraisal Tool in well-child care. Discussion Application of the Asthma Risk Appraisal Tool in well-child care will help to distinguish preschool children at high- and low-risk of developing asthma at school age when asthma symptoms appear. This study will increase knowledge about the validity of the PIAMA risk score and might improve risk assessment of developing asthma at school age in (specific subgroups

  2. Predicting asthma in preschool children with asthma symptoms: study rationale and design

    NARCIS (Netherlands)

    E.H.D. Hafkamp-De Groen (Esther); H.F. Lingsma (Hester); D. Caudri (Daan); A.H. Wijga (Alet); V.W.V. Jaddoe (Vincent); E.W. Steyerberg (Ewout); J.C. de Jongste (Johan); H. Raat (Hein)

    2012-01-01

    textabstractBackground: In well-child care it is difficult to determine whether preschool children with asthma symptoms actually have or will develop asthma at school age. The PIAMA (Prevention and Incidence of Asthma and Mite Allergy) Risk Score has been proposed as an instrument that predicts

  3. Early markers of airways inflammation and occupational asthma: Rationale, study design and follow-up rates among bakery, pastry and hairdressing apprentices

    Directory of Open Access Journals (Sweden)

    Hannhart Bernard

    2009-04-01

    Full Text Available Abstract Background Occupational asthma is a common type of asthma caused by a specific agent in the workplace. The basic alteration of occupational asthma is airways inflammation. Although most patients with occupational asthma are mature adults, there is evidence that airways inflammation starts soon after inception of exposure, including during apprenticeship. Airways hyper responsiveness to methacholine is a valid surrogate marker of airways inflammation, which has proved useful in occupational epidemiology. But it is time-consuming, requires active subject's cooperation and is not readily feasible. Other non-invasive and potentially more useful tests include the forced oscillation technique, measurement of fraction exhaled nitric oxide, and eosinophils count in nasal lavage fluid. Methods and design This study aims to investigate early development of airways inflammation and asthma-like symptoms in apprentice bakers, pastry-makers and hairdressers, three populations at risk of occupational asthma whose work-related exposures involve agents of different nature. The objectives are to (i examine the performance of the non-invasive tests cited above in detecting early airways inflammation that might eventually develop into occupational asthma; and (ii evaluate whether, and how, constitutional (e.g. atopy and behavioural (e.g. smoking risk factors for occupational asthma modulate the effects of allergenic and/or irritative substances involved in these occupations. This paper presents the study rationale and detailed protocol. Discussion Among 441 volunteers included at the first visit, 354 attended the fourth one. Drop outs were investigated and showed unrelated to the study outcome. Sample size and follow-up participation rates suggest that the data collected in this study will allow it to meet its objectives.

  4. Early markers of airways inflammation and occupational asthma: rationale, study design and follow-up rates among bakery, pastry and hairdressing apprentices.

    Science.gov (United States)

    Tossa, Paul; Bohadana, Abraham; Demange, Valérie; Wild, Pascal; Michaely, Jean-Pierre; Hannhart, Bernard; Paris, Christophe; Zmirou-Navier, Denis

    2009-04-23

    Occupational asthma is a common type of asthma caused by a specific agent in the workplace. The basic alteration of occupational asthma is airways inflammation. Although most patients with occupational asthma are mature adults, there is evidence that airways inflammation starts soon after inception of exposure, including during apprenticeship. Airways hyper responsiveness to methacholine is a valid surrogate marker of airways inflammation, which has proved useful in occupational epidemiology. But it is time-consuming, requires active subject's cooperation and is not readily feasible. Other non-invasive and potentially more useful tests include the forced oscillation technique, measurement of fraction exhaled nitric oxide, and eosinophils count in nasal lavage fluid. This study aims to investigate early development of airways inflammation and asthma-like symptoms in apprentice bakers, pastry-makers and hairdressers, three populations at risk of occupational asthma whose work-related exposures involve agents of different nature. The objectives are to (i) examine the performance of the non-invasive tests cited above in detecting early airways inflammation that might eventually develop into occupational asthma; and (ii) evaluate whether, and how, constitutional (e.g. atopy) and behavioural (e.g. smoking) risk factors for occupational asthma modulate the effects of allergenic and/or irritative substances involved in these occupations. This paper presents the study rationale and detailed protocol. Among 441 volunteers included at the first visit, 354 attended the fourth one. Drop outs were investigated and showed unrelated to the study outcome. Sample size and follow-up participation rates suggest that the data collected in this study will allow it to meet its objectives.

  5. Establishing a birth cohort to investigate the course and aetiology of asthma and allergies across three generations - rationale, design, and methods of the ACROSSOLAR study.

    Science.gov (United States)

    Weinmann, Tobias; Gerlich, Jessica; Heinrich, Sabine; Nowak, Dennis; Gerdes, Jennifer; Schlichtiger, Jenny; von Mutius, Erika; Schaub, Bianca; Vogelberg, Christian; Roller, Diana; Radon, Katja

    2015-12-04

    Atopic diseases are a major burden of disease on a global scale. Regarding their aetiology, the early years of life are assumed to play a crucial role. In addition, there is growing evidence that elucidating the impact of cross-generational effects and epigenetic mechanisms such as DNA methylation can substantially widen the scientific knowledge of the occurrence and progression of these diseases. We are thus aiming at following the course of asthma, allergies, and potential risk factors for their occurrence across three generations by establishing a birth cohort in the offspring of an existing population-based cohort. 2051 young adults who have been recruited in 1995 for Phase II of the International Study of Asthma and Allergies in Childhood (ISAAC) and who have subsequently been followed-up by the Study on Occupational Allergy Risks (SOLAR) are asked bi-annually since 2009 if they conceived a child in the meantime. If parenthood is reported, parents are invited to enrol along with their children in the ACROSSOLAR cohort. Participation involves completing a questionnaire assessing general and health-related information about the course of the pregnancy and the first year of life of their children. Subsequently, the children are followed up until primary school age when asthma and allergies can be diagnosed reliably. In addition, DNA for epigenetic analysis will be collected and analysed. Longitudinal data analysis techniques will then be used to assess potential associations between early-life exposures and onset of childhood asthma and allergies taking into account epigenetics. Birth cohorts are especially suited to elucidate the impact of genetic predisposition, epigenetics, exposures during the first years of life, and gene-environment interactions on the occurrence and progression of asthma and allergies. By building upon an existing cohort, ACROSSOLAR offers a unique and cost-effective opportunity to investigate the aetiology of atopic disease in a

  6. Use of mobile devices and the internet for multimedia informed consent delivery and data entry in a pediatric asthma trial: Study design and rationale.

    Science.gov (United States)

    Blake, Kathryn; Holbrook, Janet T; Antal, Holly; Shade, David; Bunnell, H Timothy; McCahan, Suzanne M; Wise, Robert A; Pennington, Chris; Garfinkel, Paul; Wysocki, Tim

    2015-05-01

    Phase III/IV clinical trials are expensive and time consuming and often suffer from poor enrollment and retention rates. Pediatric trials are particularly difficult because scheduling around the parent, participant and potentially other sibling schedules can be burdensome. We are evaluating using the internet and mobile devices to conduct the consent process and study visits in a streamlined pediatric asthma trial. Our hypothesis is that these study processes will be non-inferior and will be less expensive compared to a traditional pediatric asthma trial. Parents and participants, aged 12 through 17 years, complete the informed consent process by viewing a multi-media website containing a consent video and study material in the streamlined trial. Participants are provided an iPad with WiFi and EasyOne spirometer for use during FaceTime visits and online twice daily symptom reporting during an 8-week run-in followed by a 12-week study period. Outcomes are compared with participants completing a similarly designed traditional trial comparing the same treatments within the same pediatric health-system. After 8 weeks of open-label Advair 250/50 twice daily, participants in both trial types are randomized to Advair 250/50, Flovent 250, or Advair 100/50 given 1 inhalation twice daily. Study staff track time spent to determine study costs. Participants have been enrolled in the streamlined and traditional trials and recruitment is ongoing. This project will provide important information on both clinical and economic outcomes for a novel method of conducting clinical trials. The results will be broadly applicable to trials of other diseases. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Chronic obstructive pulmonary disease, bronchial asthma and allergic rhinitis in the adult population within the commonwealth of independent states: rationale and design of the CORE study.

    Science.gov (United States)

    Feshchenko, Yuriy; Iashyna, Liudmyla; Nugmanova, Damilya; Gyrina, Olga; Polianska, Maryna; Markov, Alexander; Moibenko, Maryna; Makarova, Janina; Tariq, Luqman; Pereira, Marcelo Horacio S; Mammadbayov, Eljan; Akhundova, Irada; Vasylyev, Averyan

    2017-10-10

    Main treatable Chronic Respiratory Diseases (CRDs) like Chronic Obstructive Pulmonary Disease (COPD), Bronchial Asthma (BA) and Allergic Rhinitis (AR) are underdiagnosed and undertreated worldwide. CORE study was aimed to assess the point prevalence of COPD, BA and AR in the adult population of major cities of Commonwealth of Independent States (CIS) countries - Azerbaijan, Kazakhstan, and Ukraine based on study questionnaires and/or spirometry, and to document risk factors, characterize the COPD, BA and AR population to provide a clearer "epidemiological data". A descriptive, cross-sectional, population-based epidemiological study conducted from 2013 to 2015 with two-stage cluster geographical randomization. Interviewers conducted face-to-face visits at respondent's household after informed consent and eligibility assessment including interviews, anthropometry, spirometry (with bronchodilator test) and completion of disease-specific questionnaires. Two thousand eight hundred forty-two respondents (Ukraine: 964 from Ukraine; 945 from Kazakhstan; 933 Azerbaijan) were enrolled. Mean age was 40-42 years and males were 37%-42% across three countries. In Kazakhstan 62.8% were Asians, but in Ukraine and in Azerbaijan 99.7% and 100.0%, respectively, were Caucasians. Manual labourers constituted 40.5% in Ukraine, 22.8% in Kazakhstan and 22.0% in Azerbaijan, while office workers were 16.1%, 31.6% and 36.8% respectively. 51.3% respondents in Ukraine, 64.9% in Kazakhstan and 69.7% in Azerbaijan were married. CORE study collected information that can be supportive for health policy decision makers in allocating healthcare resources in order to improve diagnosis and management of CRDs. The detailed findings will be described in future publications. Study Protocol Summary is disclosed at GlaxoSmithKline Clinical Study Register on Jun 06, 2013, study ID 116757 .

  8. Rationale and design of the multiethnic Pharmacogenomics in Childhood Asthma consortium

    DEFF Research Database (Denmark)

    Farzan, Niloufar; Vijverberg, Susanne J; Andiappan, Anand K

    2017-01-01

    AIM: International collaboration is needed to enable large-scale pharmacogenomics studies in childhood asthma. Here, we describe the design of the Pharmacogenomics in Childhood Asthma (PiCA) consortium. MATERIALS & METHODS: Investigators of each study participating in PiCA provided data...... corticosteroid users. Among patients from 13 studies with available data on asthma exacerbations, a third reported exacerbations despite inhaled corticosteroid use. In the future pharmacogenomics studies within the consortium, the pharmacogenomics analyses will be performed separately in each center...

  9. Defining asthma in genetic studies

    NARCIS (Netherlands)

    Koppelman, GH; Postma, DS; Meijer, G.

    1999-01-01

    Genetic studies have been hampered by the lack of a gold standard to diagnose asthma. The complex nature of asthma makes it more difficult to identify asthma genes. Therefore, approaches to define phenotypes, which have been successful in other genetically complex diseases, may be applied to define

  10. The Jamaica asthma and allergies national prevalence survey: rationale and methods

    Directory of Open Access Journals (Sweden)

    Edwards Nancy C

    2010-04-01

    Full Text Available Abstract Background Asthma is a significant public health problem in the Caribbean. Prevalence surveys using standardized measures of asthma provide valid prevalence estimates to facilitate regional and international comparisons and monitoring of trends. This paper describes methods used in the Jamaica Asthma and Allergies National Prevalence Survey, challenges associated with this survey and strategies used to overcome these challenges. Methods/Design An island wide, cross-sectional, community-based survey of asthma, asthma symptoms and allergies was done among adults and children using the European Community Respiratory Health Survey Questionnaire for adults and the International Study of Asthma and Allergies in Children. Stratified multi-stage cluster sampling was used to select 2, 163 adults aged 18 years and older and 2, 017 children aged 2-17 years for the survey. The Kish selection table was used to select one adult and one child per household. Data analysis accounted for sampling design and prevalence estimates were weighted to produce national estimates. Discussion The Jamaica Asthma and Allergies National Prevalence Survey is the first population- based survey in the Caribbean to determine the prevalence of asthma and allergies both in adults and children using standardized methods. With response rates exceeding 80% in both groups, this approach facilitated cost-effective gathering of high quality asthma prevalence data that will facilitate international and regional comparison and monitoring of asthma prevalence trends. Another unique feature of this study was the partnership with the Ministry of Health in Jamaica, which ensured the collection of data relevant for decision-making to facilitate the uptake of research evidence. The findings of this study will provide important data on the burden of asthma and allergies in Jamaica and contribute to evidence-informed planning of comprehensive asthma management and education programs.

  11. Rationale and design of the multiethnic Pharmacogenomics in Childhood Asthma consortium

    NARCIS (Netherlands)

    Farzan, Niloufar; Vijverberg, Susanne J.; Andiappan, Anand K.; Arianto, Lambang; Berce, Vojko; Blanca-López, Natalia; Bisgaard, Hans; Bønnelykke, Klaus; Burchard, Esteban G.; Campo, Paloma; Canino, Glorisa; Carleton, Bruce; Celedón, Juan C.; Chew, Fook Tim; Chiang, Wen Chin; Cloutier, Michelle M.; Daley, Denis; den Dekker, Herman T.; Dijk, F. Nicole; Duijts, Liesbeth; Flores, Carlos; Forno, Erick; Hawcutt, Daniel B.; Hernandez-Pacheco, Natalia; de Jongste, Johan C.; Kabesch, Michael; Koppelman, Gerard H.; Manolopoulos, Vangelis G.; Melén, Erik; Mukhopadhyay, Somnath; Nilsson, Sara; Palmer, Colin N.; Pino-Yanes, Maria; Pirmohamed, Munir; Potočnik, Uros; Raaijmakers, Jan A.; Repnik, Katja; Schieck, Maximilian; Sio, Yang Yie; Smyth, Rosalind L.; Szalai, Csaba; Tantisira, Kelan G.; Turner, Steve; van der Schee, Marc P.; Verhamme, Katia M.; Maitland-van der Zee, Anke H.

    2017-01-01

    Aim: International collaboration is needed to enable large-scale pharmacogenomics studies in childhood asthma. Here, we describe the design of the Pharmacogenomics in Childhood Asthma (PiCA) consortium. Materials & methods: Investigators of each study participating in PiCA provided data on the study

  12. Rationale and design of the multiethnic Pharmacogenomics in Childhood Asthma consortium

    NARCIS (Netherlands)

    Farzan, Niloufar; Vijverberg, Susanne J.; Andiappan, Anand K.; Arianto, Lambang; Berce, Vojko; Blanca-Lopez, Natalia; Bisgaard, Hans; Bonnelykke, Klaus; Burchard, Esteban G.; Campo, Paloma; Canino, Glorisa; Carleton, Bruce; Celedon, Juan C.; Chew, Fook Tim; Chiang, Wen Chin; Cloutier, Michelle M.; Daley, Denis; Den Dekker, Herman T.; Dijk, Nicole F.; Duijts, Liesbeth; Flores, Carlos; Forno, Erick; Hawcutt, Daniel B.; Hernandez-Pacheco, Natalia; de Jongste, Johan C.; Kabesch, Michael; Koppelman, Gerard H.; Manolopoulos, Vangelis G.; Melen, Erik; Mukhopadhyay, Somnath; Nilsson, Sara; Palmer, Colin N.; Pino-Yanes, Maria; Pirmohamed, Munir; Potocnki, Uros; Raaijmakers, Jan A.; Repnik, Katja; Schieck, Maximilian; Sio, Yang Yie; Smyth, Rosalind L.; Szalai, Csaba; Tantisira, Kelan G.; Turner, Steve; van der Schee, Marc P.; Verhamme, Katia M.; Maitland-van der Zee, Anke H.

    2017-01-01

    Aim: International collaboration is needed to enable large-scale pharmacogenomics studies in childhood asthma. Here, we describe the design of the Pharmacogenomics in Childhood Asthma (PiCA) consortium.  Materials & methods: Investigators of each study participating in PiCA provided data on the

  13. Studies on provoked asthma

    International Nuclear Information System (INIS)

    Munkner, L.; Bundgaard, A.

    1982-01-01

    A group of adult patients with perennial bronchial asthma has been studied as to lung perfusion and alveolar ventilation (81m-Kr) at rest and after provocation of an acute attack. Asthma was provoked by exercise and by histamine inhalation. After provocation the peak expiratory flow values were reduced to less than 80% of the base line values. Perfusion was often deranged. Regional ventilation changed rapidly after provocation and not always in the same fashion after exercise and histamine. During attacks lung volume increased. The expansion decreased (in parallel with increased peak expiratory flow) after inhalator of a #betta#-2 agonist (terbutaline). 81m-Kr offers unique opportunities for studying acute regional changes in alveolar ventilation. (Author)

  14. Current situation of asthma-COPD overlap syndrome (ACOS) in Chinese patients older than 40 years with airflow limitation: rationale and design for a multicenter, cross-sectional trial (study protocol).

    Science.gov (United States)

    Kang, Jian; Yao, Wanzhen; Cai, Baiqiang; Chen, Ping; Ling, Xia; Shang, Hongyan

    2016-12-01

    Asthma and chronic obstructive pulmonary disease (COPD) are the frequently occurring chronic airway diseases, and the overlapping syndrome observed in the majority of patients has been recently defined as asthma-COPD overlap syndrome (ACOS) by the Global Initiative for Chronic Obstructive Lung (GOLD, 2014) and Global initiative for Asthma (GINA, 2015). The proportion, features, and clinical practice of ACOS still remain elusive in China. We are conducting this multicenter, cross-sectional, observational study (NCT02600221) to investigate the distributions of chronic obstructive diseases in patients >40 years of age with chronic airflow limitation in China along with determination of the main clinical practice and features of these diseases. The study will also explore the factors that may influence the exacerbations and severity of ACOS in Chinese patients (>40 years of age). A total of 2,000 patients (age, ≥40 years; either sex) who are clinically diagnosed as having asthma, COPD/chronic bronchitis/emphysema, or ACOS for at least 12 months with airflow limitation [post-bronchodilator forced expiratory volume in 1 second/forced vital capacity (FEV 1 /FVC): current situation, main clinical practice, and features of ACOS, asthma, and COPD conditions in Chinese patients. The insights will be helpful in designing optimal management strategies for ACOS and redefining the healthcare development programs.

  15. RATIONALE FOR A SPECIFIC THERAPY OF CYTOMEGALOVIRUS INFECTION IN CHILDREN WITH BRONCHIAL ASTHMA

    Directory of Open Access Journals (Sweden)

    E. N. Suprun

    2013-01-01

    Full Text Available Abstract. We propose a protocol of treatment in cases of bronchial asthma with cytomegalovirus (CMV persistence. This basic therapy is administered depending on the disease severity, according to the National Programme 2009. The treatment includes administration of human immunoglobulin, with dosage according on CMV antibodies titers. The study has revealed that such regimen of antibody administration based on the content of anti-CMV antibodies in bronchial asthma treatment stops active CMV replication in bronchial mucous membrane, alleviates clinical course of the disease, diminishes changes of immune system typical to children suffering from bronchial asthma and CMV reactivation, thus allowing to reduce the volume of basic therapy, along with maintaining control of asthma control.

  16. The need for precision medicine clinical trials in childhood asthma : rationale and design of the PUFFIN trial

    NARCIS (Netherlands)

    Vijverberg, Susanne J. H.; Pijnenburg, Marielle W.; Hovels, Anke M.; Koppelman, Gerard H.; Maitland-van der Zee, Anke-Hilse

    A `one-size fits all'-approach does not fit all pediatric asthma patients. Current evidence suggests that in children with persistent asthma, ADRB2 genotype-guided treatment can improve treatment outcomes, yet this evidence is mainly derived from observational and genotype-stratified studies.

  17. The need for precision medicine clinical trials in childhood asthma: rationale and design of the PUFFIN trial

    NARCIS (Netherlands)

    Vijverberg, Susanne Jh; Pijnenburg, Mariëlle W.; Hövels, Anke M.; Koppelman, Gerard H.; Maitland-van der Zee, Anke-Hilse

    2017-01-01

    A 'one-size fits all'-approach does not fit all pediatric asthma patients. Current evidence suggests that in children with persistent asthma, ADRB2 genotype-guided treatment can improve treatment outcomes, yet this evidence is mainly derived from observational and genotype-stratified studies.

  18. ALLERGIC ASTHMA AND THE DEVELOPING IMMUNE SYSTEM: A PILOT STUDY

    Science.gov (United States)

    Rationale: The predisposition towards atopic disease begins early in life, and that the risk of developing asthma is heightened following prenatal exposure to some compounds. Nonetheless, the effect of gestational aeroallergen exposure on the developing immune system is unclear....

  19. Is there a rationale and role for long-acting anticholinergic bronchodilators in asthma?

    NARCIS (Netherlands)

    Price, David; Fromer, Leonard; Kaplan, Alan; van der Molen, Thys; Roman-Rodriguez, Miguel

    2014-01-01

    Despite current guidelines and the range of available treatments, over a half of patients with asthma continue to suffer from poor symptomatic control and remain at risk of future worsening. Although a number of non-pharmacological measures are crucial for good clinical management of asthma, new

  20. Characteristics and Prognosis of Never-Smokers and Smokers with Asthma in the Copenhagen General Population Study. A Prospective Cohort Study

    DEFF Research Database (Denmark)

    Çolak, Yunus; Afzal, Shoaib; Nordestgaard, Børge G

    2015-01-01

    RATIONALE: Asthma is associated with complications, cardiovascular comorbidities, and higher mortality in some individuals. OBJECTIVES: To test the hypothesis that, among individuals with asthma, never-smokers have different characteristics and a better prognosis than smokers. METHODS: We recruited...... 94,079 individuals aged 20-100 years from the Copenhagen General Population Study, a prospective cohort study. Among these individuals, 5,691 (6%) had self-reported asthma (2,304 never-smokers, 2,467 former smokers, and 920 current smokers). We examined respiratory symptoms, lung function, and levels......-up. MEASUREMENTS AND MAIN RESULTS: Compared with never-smokers without asthma, individuals with asthma had more respiratory symptoms and airflow limitation and higher levels of inflammatory and allergic biomarkers, which were most pronounced in smokers. Among individuals with asthma compared with never-smokers...

  1. Asthma

    Directory of Open Access Journals (Sweden)

    Kim Harold

    2011-11-01

    Full Text Available Abstract Asthma is the most common respiratory disorder in Canada. Despite significant improvement in the diagnosis and management of this disorder, the majority of Canadians with asthma remain poorly controlled. In most patients, however, control can be achieved through the use of avoidance measures and appropriate pharmacological interventions. Inhaled corticosteroids (ICSs represent the standard of care for the majority of patients. Combination ICS/long-acting beta2-agonists (LABA inhalers are preferred for most adults who fail to achieve control with ICS therapy. Allergen-specific immunotherapy represents a potentially disease-modifying therapy for many patients with asthma, but should only be prescribed by physicians with appropriate training in allergy. Regular monitoring of asthma control, adherence to therapy and inhaler technique are also essential components of asthma management. This article provides a review of current literature and guidelines for the appropriate diagnosis and management of asthma.

  2. Genomewide Association Studies: History, Rationale, and Prospects for Psychiatric Disorders

    NARCIS (Netherlands)

    Cichon, S.; Craddock, N.; Daly, M.J.; Faraone, S.V.; Gejman, P.V.; Kelsoe, J.; Lehner, T.; Levinson, D.F.; Moran, A.P.; Sklar, P.; Sullivan, P.F.; Boomsma, D.I.; de Geus, E.J.C.; Posthuma, D.; Willemsen, G.

    2009-01-01

    Objective: The authors conducted a review of the history and empirical basis of genomewide association studies (GWAS), the rationale for GWAS of psychiatric disorders, results to date, limitations, and plans for GWAS meta-analyses. Method: A literature review was carried out, power and other issues

  3. Genomewide association studies: history, rationale, and prospects for psychiatric disorders.

    NARCIS (Netherlands)

    Franke, B.; Buitelaar, J.K.; Cichon, S.; Craddock, N.; Daly, M.; Faraone, S.V.; Gejman, P.V.; Kelsoe, J.; Lehner, T.; Levinson, D.F.; Moran, A.; Sklar, P.; Sullivan, P.F.

    2009-01-01

    OBJECTIVE: The authors conducted a review of the history and empirical basis of genomewide association studies (GWAS), the rationale for GWAS of psychiatric disorders, results to date, limitations, and plans for GWAS meta-analyses. METHOD: A literature review was carried out, power and other issues

  4. Association between asthma and dysphonia: A population-based study.

    Science.gov (United States)

    Park, Bumjung; Choi, Hyo Geun

    2016-09-01

    We investigated whether asthma predisposes patients to organic laryngeal lesions or increases dysphonia in those without organic laryngeal lesions. We performed a cross-sectional study with data from the Korea National Health and Nutrition Examination Survey; 19,330 subjects from 2008 through 2011 were included. The associations of asthma with organic laryngeal lesions and dysphonia were analyzed using a simple/multiple logistic regression analysis with complex sampling while adjusting for confounding factors (age, sex, smoking status, stress level, and body mass index) that could contribute to dysphonia. Compared with non-asthma participants, the asthma patients tended to be older and female and to have higher stress levels. These factors were associated with dysphonia (Age, AOR = 1.20, 95% CI = 1.14 = 1.23, P dysphonia. Compared with non-asthma participants, asthma patients who had not taken asthma medication recently showed a higher AOR (1.62; 95% CI = 1.0-2.42) for dysphonia, and asthma patients who had taken asthma medication recently showed the highest adjusted odds ratio for dysphonia (AOR = 1.97; 95% confidence interval, CI = 1.28-3.02, P = 0.001). On multiple logistic regression analysis, vocal nodules, laryngeal polyps, and laryngitis were not associated with asthma (all P > 0.05). Asthma patients are predisposed to subjective dysphonia due to demographic and clinical characteristics (older age, female, and higher stress level) as well as to asthma itself. However, asthma was not associated with organic laryngeal lesions in this study.

  5. Mechanistic Indicators of Childhood Asthma (MICA) Study

    Science.gov (United States)

    The Mechanistic Indicators of Childhood Asthma (MICA) Study has been designed to incorporate state-of-the-art technologies to examine the physiological and environmental factors that interact to increase the risk of asthmatic responses. MICA is primarily a clinically-bases obser...

  6. Sleep in children with asthma: results of the PIAMA study

    NARCIS (Netherlands)

    van Maanen, Annette; Wijga, Alet H.; Gehring, Ulrike; Postma, Dirkje S.; Smit, Henriëtte A.; Oort, Frans J.; Rodenburg, Roos; Meijer, Anne Marie

    2013-01-01

    Children with asthma are thought to have impaired sleep quality and quantity. In this study, we investigated which of the many sleep aspects are associated with asthma. Our sample consisted of 2529 children (aged 11 years) who participated in the Prevention and Incidence of Asthma and Mite Allergy

  7. Sleep in children with asthma : results of the PIAMA study

    NARCIS (Netherlands)

    van Maanen, Annette; Wijga, Alet H.; Gehring, Ulrike; Postma, Dirkje S.; Smit, Henriette A.; Oort, Frans J.; Rodenburg, Roos; Meijer, Anne Marie

    Children with asthma are thought to have impaired sleep quality and quantity. In this study, we investigated which of the many sleep aspects are associated with asthma. Our sample consisted of 2529 children (aged 11 years) who participated in the Prevention and Incidence of Asthma and Mite Allergy

  8. Epidemiological study of risk factors in pediatric asthma

    African Journals Online (AJOL)

    EL-HAKIM

    Methods: This cross sectional study involved 206 asthmatic children, 5 to 15 years old. They were enrolled from the School ... exercise-induced asthma while 64.6% stated that emotional stress triggered their symptoms. ... Keywords: asthma severity; asthma triggers; children; residence; risk factors; smoking; social status.

  9. Rationale and Design of the 'MITOCARE' Study

    DEFF Research Database (Denmark)

    Clemmensen, Peter

    2012-01-01

    resonance). The study is being financed under an EU-FP7 grant and conducted under the auspices of the MITOCARE research consortium, which includes experts from clinical and basic research centers, as well as commercial enterprises, throughout Europe. Results from this study will contribute to a better...

  10. Prevalence of childhood asthma in Korea: international study of asthma and allergies in childhood.

    Science.gov (United States)

    Lee, Sang-Il

    2010-04-01

    Childhood asthma is a major concern because it leads to more hospital visits and a heavy economic burden. Proper management and prevention strategies for childhood asthma must be based on correct evaluation of prevalence and risk factors for its development. In Korea, nationwide studies were conducted in 1995 and 2000 on students from 68 elementary schools (age, 6-12 years) and junior high schools (age, 12-15 years) by the Korean Academy of Pediatric Allergy and Respiratory Diseases. We used the Korean version of the International Study of Asthma and Allergies in Childhood (ISAAC) written and video questionnaires at the same schools during the same period (October-November). The prevalence of asthma in junior high school children seemed to increase over 5 years. However, in elementary school children, the prevalence of asthma symptoms decreased, although the prevalence of 'diagnosis of asthma, ever' and 'treatment of asthma, last 12 months' increased. In addition, it was found that various factors, such as obesity, passive smoking, dietary habits, raising pets at home, and fever/antibiotic use during infancy were associated with childhood asthma. When prevalence of asthma in Korea was compared with that in different regions, the prevalence changes in the 6-7 years age group did not seem to be consistent between regions, whereas similar trends were observed among children aged 13-14 years. To conduct another epidemiological study to evaluate the time trend over time, a third nationwide survey is planned in 2010, and we anticipate ISAAC Phase 3 will explore recent changes in the prevalence of childhood asthma and assess its risk factors in Korean children. On the basis of accurate data on the current status of childhood asthma in 2010, we will be able to establish proper management strategies.

  11. Randomized controlled study of CBT in bronchial asthma

    Directory of Open Access Journals (Sweden)

    Grover Naveen

    2007-01-01

    Full Text Available The aim of the present study was to find out efficacy of cognitive behavior therapy, as an adjunct to standard pharmacotherapy, in bronchial asthma. In a random-ized two-group design with pre-and post assessments, forty asthma patients were randomly allotted to two groups: self management group and cognitive behavior therapy group. Both groups were exposed to 6-8 weeks of intervention, asthma self management program and cognitive behavior therapy. Assessment measures used were-Semi structured interview schedule, Asthma Symptom Checklist, Asthma di-ary, Asthma Bother Profile, Hospital Anxiety & Depression Scale, AQLQ and Peak Expiratory Flow Rate. Within group comparison showed significant improvement in both groups at the post assessment. Between group comparisons showed that CBT group reported significantly greater change than that of SM group. Cognitive behavior therapy helps in improving the managment of asthma.

  12. Air pollution and asthma control in the Epidemiological study on the Genetics and Environment of Asthma

    Science.gov (United States)

    Jacquemin, Bénédicte; Kauffmann, Francine; Pin, Isabelle; Le Moual, Nicole; Bousquet, Jean; Gormand, Frédéric; Just, Jocelyne; Nadif, Rachel; Pison, Christophe; Vervloet, Daniel; Künzli, Nino; Siroux, Valérie

    2012-01-01

    Background The associations between exposure to air pollution and asthma control are not well known. The objective is to assess the association between long term exposure to NO2, O3 and PM10 and asthma control in the EGEA2 study (2003–2007). Methods Modeled outdoor NO2, O3 and PM10 estimates were linked to each residential address using the 4-km grid air pollutant surface developed by the French Institute of Environment for 2004. Asthma control was assessed in 481 subjects with current asthma using a multidimensional approach following the 2006–2009 GINA guidelines. Multinomial and ordinal logistic regressions were conducted adjusted on sex, age, BMI, education, smoking and use of inhaled corticosteroids. The association between air pollution and the three domains of asthma control (symptoms, exacerbations and lung function) was assessed. Odds Ratios (ORs) are reported per Inter Quartile Range (IQR). Results Median concentrations (μg.m−3) were 32(IQR 25–38) for NO2 (n=465), 46(41–52) for O3 and 21(18–21) for PM10 (n=481). In total, 44%, 29% and 27% had controlled, partly-controlled and uncontrolled asthma. The ordinal ORs for O3 and PM10 with asthma control were 1.69(95%CI 1.22–2.34) and 1.35(95%CI 1.13–1.64) respectively. When including both pollutants in the same model, both associations persisted. Associations were not modified by sex, smoking status, use of inhaled corticosteroids, atopy, season of examination or BMI. Both pollutants were associated with each of the three main domains of control. Conclusions The results suggest that long-term exposure to PM10 and O3 is associated with uncontrolled asthma in adults, defined by symptoms, exacerbations and lung function. Abstract Word count: 250 Key words: air pollution, asthma, asthma control PMID:21690606

  13. The integrated care of asthma in Switzerland (INCAS)-study: Patients' perspective of received asthma care and their interest in asthma education.

    Science.gov (United States)

    Dürr, Selina; Hersberger, Kurt E; Zeller, Andreas; Scheuzger, Jonas; Miedinger, David; Gregoriano, Claudia; Leuppi, Jörg D; Steurer-Stey, Claudia

    2016-11-01

    For successful long-term asthma care, self-management education is a cornerstone. Little is known about associations between patients' interest in education, asthma control and care delivery. We compared patients' characteristics, asthma control and patients' perspective about asthma care in subjects with and without interest in asthma education. Moreover, we assessed reasons, why patients denied participating in asthma education. Baseline data of 223 patients with asthma (age 43 ± 12 years, 38% male, 58% non-smokers, 13% current smokers), who participated in a multicentre longitudinal controlled study, are reported. At baseline, patients completed the Asthma Control Test (ACT), the Patient Assessment Chronic Illness Care questionnaire (PACIC 5A) and stated their interest in an asthma education programme. Overall, 34% of all participants showed uncontrolled asthma. One hundred and twenty-five (56%) patients were interested in education. Compared to patients without interest, they were characterised by male gender (p = 0.013), worse asthma control (p < 0.001), and perception of lower quality of chronic asthma care delivery, in particular lower self-management support (p < 0.001). Main reasons for rejecting asthma education were having sufficient asthma knowledge, having only mild asthma, receiving adequate medical support and lack of time. More than half of the patients were interested in asthma education. Interest was associated with worse asthma control and lower receipt of care according to the Chronic Care Model. Considering these aspects, this approach may help to improve care quality and allow targeting interventions to those patients who are interested in becoming active participants in their care and who might benefit most.

  14. Lung VITAL: Rationale, design, and baseline characteristics of an ancillary study evaluating the effects of vitamin D and/or marine omega-3 fatty acid supplements on acute exacerbations of chronic respiratory disease, asthma control, pneumonia and lung function in adults

    OpenAIRE

    Gold, Diane R; Litonjua, Augusto A.; Carey, Vincent J.; Manson, JoAnn E.; Buring, Julie E; Lee, I-Min; Gordon, David; Walter, Joseph; Friedenberg, Georgina; Hankinson, John L; Copeland, Trisha; Luttmann-Gibson, Heike

    2016-01-01

    Laboratory and observational research studies suggest that vitamin D and marine omega-3 fatty acids may reduce risk for pneumonia, acute exacerbations of respiratory diseases including chronic obstructive lung disease (COPD) or asthma, and decline of lung function, but prevention trials with adequate dosing, adequate power, and adequate time to follow-up are lacking. The ongoing Lung VITAL study is taking advantage of a large clinical trial?the VITamin D and OmegA-3 TriaL (VITAL)?to conduct t...

  15. Asthma

    Science.gov (United States)

    ... BS, Burks AW, et al, eds. Middleton's Allergy Principles and Practice . 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 55. Lugogo N, Que LG, Gilstrap DL, Kraft M. Asthma: clinical diagnosis and management. In: Broaddus VC, Mason RJ, Ernst JD, et ...

  16. Asthma

    Science.gov (United States)

    ... asthma worse. If so, try to limit time outdoors when the levels of these substances in the outdoor air are high. If animal fur triggers your ... have side effects. Most doctors agree that the benefits of taking inhaled ... have. Also, work with your health care team if you have any questions about ...

  17. The Integrated Care of Asthma in Switzerland (INCAS) Study: Changes in Asthma Control and Perception of Health Care through Asthma Education.

    Science.gov (United States)

    Dürr, Selina; Hersberger, Kurt E; Zeller, Andreas; Scheuzger, Jonas; Miedinger, David; Gregoriano, Claudia; Joos Zellweger, Ladina; Steurer-Stey, Claudia; Leuppi, Jörg Daniel

    2017-01-01

    Despite great efforts in establishing optimal asthma management, asthma may remain uncontrolled. To effectively manage chronic diseases, such as asthma, it is important to train patients in self-management skills. The aim of this study was to assess the potential benefit of standardised asthma education in Switzerland for asthma control and patients' perception of received asthma care and of self-management support. For this multicentre longitudinal controlled study, asthma patients were recruited in Switzerland. The Asthma Control Test (ACT) was used to assess asthma control. The Patient Assessment of Chronic Illness Care questionnaire (PACIC 5A) was applied to evaluate received health-care services and self-management support. Patients were offered the possibility to attend asthma education sessions conducted by the Swiss Lung League and Swiss Allergy Centre. After 1 year, attenders and non-attenders completed the questionnaires again. Changes in ACT and PACIC 5A scores were analysed using dependent t tests. Overall, 223 patients with asthma were investigated (mean age 43 ± 12 years, 38% male, 13% current smokers, 29% ex-smokers). Sixty-one (27%) patients attended education sessions. Both groups had improved asthma control at follow-up (attenders: t(56) = -3.2, r = 0.4 [medium effect size], p = 0.002; non-attenders: t(141) = -2.6, r = 0.2 [small effect size], p = 0.010). Attenders improved in PACIC and 5A sum scores (t(50) = -3.6, r = 0.5 [medium effect size], p = 0.001). A comprehensive self-management asthma education programme in Switzerland improved asthma control and patients' perception of received asthma care and of self-management support. Professionals should motivate patients to attend asthma education in order to become active partners in managing their disease. © 2017 S. Karger AG, Basel.

  18. A study of asthma severity in adult twins

    DEFF Research Database (Denmark)

    Thomsen, Simon Francis; van der Sluis, Sophie; Kyvik, Kirsten Ohm

    2012-01-01

    Introduction: The tendency to develop asthma runs in families, but whether the severity of asthma symptoms is inherited is not known. Objectives: The aim of this study was to examine whether genetic factors influence the variation in the severity of asthma. Methods: Of a sample of 21 133 adult......, and markers of airway impairment and allergy were measured. Results: After adjusting for confounders, genetic factors explained 24% (10%-37%), P = 0.0004, of the variation in overall asthma symptom severity, whereas non-shared environment accounted for the remaining 76% of the variation. A significant genetic...

  19. Multiancestry association study identifies new asthma risk loci that colocalize with immune-cell enhancer marks

    NARCIS (Netherlands)

    Demenais, Florence; Margaritte-Jeannin, Patricia; Barnes, Kathleen C; Cookson, William O C; Altmüller, Janine; Ang, Wei; Barr, R Graham; Beaty, Terri H; Becker, Allan B; Beilby, John; Bisgaard, Hans; Bjornsdottir, Unnur Steina; Bleecker, Eugene; Bønnelykke, Klaus; Boomsma, Dorret I; Bouzigon, Emmanuelle; Brightling, Christopher E; Brossard, Myriam; Brusselle, Guy G; Burchard, Esteban; Burkart, Kristin M; Bush, Andrew; Chan-Yeung, Moira; Chung, Kian Fan; Couto Alves, Alexessander; Curtin, John A; Custovic, Adnan; Daley, Denise; de Jongste, Johan C; Del-Rio-Navarro, Blanca E; Donohue, Kathleen M; Duijts, Liesbeth; Eng, Celeste; Eriksson, Johan G; Farrall, Martin; Fedorova, Yuliya; Feenstra, Bjarke; Ferreira, Manuel A; Freidin, Maxim B; Gajdos, Zofia; Gauderman, Jim; Gehring, Ulrike; Geller, Frank; Genuneit, Jon; Gharib, Sina A; Gilliland, Frank; Granell, Raquel; Graves, Penelope E; Gudbjartsson, Daniel F; Haahtela, Tari; Heckbert, Susan R; Heederik, Dick; Heinrich, Joachim; Heliövaara, Markku; Henderson, John; Himes, Blanca E; Hirose, Hiroshi; Hirschhorn, Joel N; Hofman, Albert; Holt, Patrick; Hottenga, Jouke; Hudson, Thomas J; Hui, Jennie; Imboden, Medea; Ivanov, Vladimir; Jaddoe, Vincent W V; James, Alan; Janson, Christer; Jarvelin, Marjo-Riitta; Jarvis, Deborah; Jones, Graham; Jonsdottir, Ingileif; Jousilahti, Pekka; Kabesch, Michael; Kähönen, Mika; Kantor, David B; Karunas, Alexandra S; Khusnutdinova, Elza; Koppelman, Gerard H; Kozyrskyj, Anita L; Kreiner, Eskil; Kubo, Michiaki; Kumar, Rajesh; Kumar, Ashish; Kuokkanen, Mikko; Lahousse, Lies; Laitinen, Tarja; Laprise, Catherine; Lathrop, Mark; Lau, Susanne; Lee, Young-Ae; Lehtimäki, Terho; Letort, Sébastien; Levin, Albert M; Li, Guo; Liang, Liming; Loehr, Laura R; London, Stephanie J; Loth, Daan W; Manichaikul, Ani; Marenholz, Ingo; Martinez, Fernando J; Matheson, Melanie C; Mathias, Rasika A; Matsumoto, Kenji; Mbarek, Hamdi; McArdle, Wendy L; Melbye, Mads; Melén, Erik; Meyers, Deborah; Michel, Sven; Mohamdi, Hamida; Musk, Arthur W; Myers, Rachel A; Nieuwenhuis, Maartje A E; Noguchi, Emiko; O'Connor, George T; Ogorodova, Ludmila M; Palmer, Cameron D; Palotie, Aarno; Park, Julie E; Pennell, Craig E; Pershagen, Göran; Polonikov, Alexey; Postma, Dirkje S; Probst-Hensch, Nicole; Puzyrev, Valery P; Raby, Benjamin A; Raitakari, Olli T; Ramasamy, Adaikalavan; Rich, Stephen S; Robertson, Colin F; Romieu, Isabelle; Salam, Muhammad T; Salomaa, Veikko; Schlünssen, Vivi; Scott, Robert; Selivanova, Polina A; Sigsgaard, Torben; Simpson, Angela; Siroux, Valérie; Smith, Lewis J; Solodilova, Maria; Standl, Marie; Stefansson, Kari; Strachan, David P; Stricker, Bruno H; Takahashi, Atsushi; Thompson, Philip J; Thorleifsson, Gudmar; Thorsteinsdottir, Unnur; Tiesler, Carla M T; Torgerson, Dara G; Tsunoda, Tatsuhiko; Uitterlinden, André G; van der Valk, Ralf J P; Vaysse, Amaury; Vedantam, Sailaja; von Berg, Andrea; von Mutius, Erika; Vonk, Judith M; Waage, Johannes; Wareham, Nick J; Weiss, Scott T; White, Wendy B; Wickman, Magnus; Widén, Elisabeth; Willemsen, Gonneke; Williams, L Keoki; Wouters, Inge M; Yang, James J; Zhao, Jing Hua; Moffatt, Miriam F; Ober, Carole; Nicolae, Dan L

    We examined common variation in asthma risk by conducting a meta-analysis of worldwide asthma genome-wide association studies (23,948 asthma cases, 118,538 controls) of individuals from ethnically diverse populations. We identified five new asthma loci, found two new associations at two known asthma

  20. A review of epidemiological studies of asthma in Ghana | Amoah ...

    African Journals Online (AJOL)

    Context/Background: The last few decades have witnessed a rise in the global prevalence of asthma with a number of risk factors being linked to this increase. Although there is insufficient data on the prevalence of asthma in Ghana, a few studies conducted in this country have shed light on the disease aetiology and ...

  1. Genome-wide association studies in asthma: progress and pitfalls

    Directory of Open Access Journals (Sweden)

    March ME

    2015-01-01

    Full Text Available Michael E March,1 Patrick MA Sleiman,1,2 Hakon Hakonarson1,2 1Center for Applied Genomics, Children's Hospital of Philadelphia Research Institute, 2Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA Abstract: Genetic studies of asthma have revealed that there is considerable heritability to the phenotype. An extensive history of candidate-gene studies has identified a long list of genes associated with immune function that are potentially involved in asthma pathogenesis. However, many of the results of candidate-gene studies have failed to be replicated, leaving in question the true impact of the implicated biological pathways on asthma. With the advent of genome-wide association studies, geneticists are able to examine the association of hundreds of thousands of genetic markers with a phenotype, allowing the hypothesis-free identification of variants associated with disease. Many such studies examining asthma or related phenotypes have been published, and several themes have begun to emerge regarding the biological pathways underpinning asthma. The results of many genome-wide association studies have currently not been replicated, and the large sample sizes required for this experimental strategy invoke difficulties with sample stratification and phenotypic heterogeneity. Recently, large collaborative groups of researchers have formed consortia focused on asthma, with the goals of sharing material and data and standardizing diagnosis and experimental methods. Additionally, research has begun to focus on genetic variants that affect the response to asthma medications and on the biology that generates the heterogeneity in the asthma phenotype. As this work progresses, it will move asthma patients closer to more specific, personalized medicine. Keywords: asthma, genetics, GWAS, pharmacogenetics, biomarkers

  2. The Danish Alzheimer Intervention Study: Rationale, Study Design and Baseline Characteristics of the Cohort

    DEFF Research Database (Denmark)

    Waldemar, G.; Waldorff, F.B.; Buss, D.V.

    2011-01-01

    There is a lack of appropriately designed trials investigating the efficacy of psychosocial interventions for patients with mild dementia and their family caregivers. This paper reports the rationale and design of the Danish Alzheimer Disease Intervention Study and baseline characteristics...

  3. Asthma control and productivity loss in those with work-related asthma: A population-based study.

    Science.gov (United States)

    Wong, Alyson; Tavakoli, Hamid; Sadatsafavi, Mohsen; Carlsten, Chris; FitzGerald, J Mark

    2017-06-01

    In Canada, asthma is the third leading cause of work loss, yet little is known about the associated productivity loss. The goal of this study was to look at the relationship between asthma control and productivity loss, particularly contrasting those with work-related asthma (WRA) and non-work-related asthma (NWRA). A population-based random sample of adults with asthma in British Columbia, Canada, was prospectively recruited. Asthma control was graded according to Global Initiative for Asthma classification, while productivity loss and presence of WRA was assessed using questionnaires. Ordinal regression models were then used to associate WRA with asthma control. Generalized linear models were applied to estimate the average productivity loss associated with different levels of asthma control among those with WRA and NWRA. The study included 300 employed adults. Sixty (20%) had WRA. The odds of being controlled were significantly lower in those with WRA (OR = 0.23, 95% CI: 0.09, 0.56; P asthma had a significant difference in productivity loss due to presenteeism ($659.1 [95% CI: 12.9, 1581.5; P = 0.04]), but not absenteeism ($88.7 [95% CI: -86.5, 279.6; P = 0.35]), when compared to those with NWRA and uncontrolled asthma. There was no significant difference when a similar comparison was made for those with controlled or partially controlled asthma. WRA is associated with worse asthma control and increased productivity loss. Presenteeism makes a significant contribution to productivity loss and should be considered when evaluating the overall economic burden of asthma, particularly WRA.

  4. Epidemiological study of school performance and asthma ...

    African Journals Online (AJOL)

    Ehab

    Original article. Background: Childhood asthma is a major health problem in Egypt and worldwide. ... and environmental barriers like indoor and outdoor air pollution, tobacco ..... medical therapy and its utilization for the benefit of the asthmatic ...

  5. Data book: Space station/base food system study. Book 3: Study selection rationale sheets

    Science.gov (United States)

    1970-01-01

    The supporting rationale sheets are presented which were utilized in the selection and support of the concepts considered in the final phase of the study. Each concept, conceived to fulfill a specific function of the food system, was assessed in terms of the eight critical factors depicted on the rationale sheet. When weighted and totaled, the resulting selection factor was used as a guide in making the final decision.

  6. Work stress, asthma control and asthma-specific quality of life: Initial evidence from a cross-sectional study.

    Science.gov (United States)

    Hartmann, Bettina; Leucht, Verena; Loerbroks, Adrian

    2017-03-01

    Research has suggested that psychological stress is positively associated with asthma morbidity. One major source of stress in adulthood is one's occupation. However, to date, potential links of work stress with asthma control or asthma-specific quality of life have not been examined. We aimed to address this knowledge gap. In 2014/2015, we conducted a cross-sectional study among adults with asthma in Germany (n = 362). For the current analyses that sample was restricted to participants in employment and reporting to have never been diagnosed with chronic obstructive pulmonary disease (n = 94). Work stress was operationalized by the 16-item effort-reward-imbalance (ERI) questionnaire, which measures the subcomponents "effort", "reward" and "overcommitment." Participants further completed the Asthma Control Test and the Asthma Quality of Life Questionnaire-Sydney. Multivariable associations were quantified by linear regression and logistic regression. Effort, reward and their ratio (i.e. ERI ratio) did not show meaningful associations with asthma morbidity. By contrast, increasing levels of overcommitment were associated with poorer asthma control and worse quality of life in both linear regression (ß = -0.26, p = 0.01 and ß = 0.44, p work-related overcommitment with asthma control and asthma-specific quality of life. Longitudinal studies with larger samples are needed to confirm our findings and to disentangle the potential causality of associations.

  7. The Living Donor Lost Wages Trial: Study Rationale and Protocol.

    Science.gov (United States)

    Rodrigue, James R; Fleishman, Aaron; Carroll, Michaela; Evenson, Amy R; Pavlakis, Martha; Mandelbrot, Didier A; Baliga, Prabhakar; Howard, David H; Schold, Jesse D

    2018-03-01

    This paper describes the background, rationale, and design of an NIH-funded, single-center study to test the impact of offering reimbursement for donor lost wages incurred during the post-nephrectomy recovery period on the live donor kidney transplant (LDKT) rate in newly evaluated kidney transplant candidates, to examine whether offering reimbursement for donor lost wages reduces racial disparity in LDKT rates, and to determine whether higher reimbursement amounts lead to higher LDKT rates. LDKT is the optimal treatment for renal failure. However, living kidney donation has declined in the past decade, particularly among men, younger adults, blacks, and low-income adults. There is evidence that donation-related costs may deter both transplant candidates and potential donors from considering LDKT. Lost wages is a major source of financial loss for some living donors and, unlike travel and lodging expenses, is not reimbursed by financial assistance programs. The study addresses the transplant community's call to reduce the financial burden of living donation and examine its impact on LDKT rates. Findings have the potential to influence policy, clinical practice, LDKT access, and income-related and racial disparities in LDKT and living donation.

  8. Inflammation is a Continuous Trait in Children regardless of Asthma Symptoms

    DEFF Research Database (Denmark)

    Schoos, Ann-Marie Malby; Chawes, Bo Lund Krogsgaard; Bønnelykke, Klaus

    2011-01-01

    asymptomatic children to children with intermittent asthmatic symptoms and children with persistent asthma. Methods: An unselected group of 196 six-year-old children were included from the Copenhagen Prospective Study on Asthma in Childhood (COPSAC) birth cohort born of mothers with asthma. Bronchial...... for a dichotomized approach to asthma diagnosis. Childhood asthma remains a clinical diagnosis and surrogate markers may only be used cautiously as supportive evidence.......Rationale: Elevated fractional exhaled nitric oxide (FeNO) and bronchial hyperresponsiveness are used as surrogate markers of asthma. Objective: To investigate the association between FeNO and bronchial responsiveness in a population of high risk children including the full spectrum from...

  9. Multiancestry association study identifies new asthma risk loci that colocalize with immune-cell enhancer marks

    DEFF Research Database (Denmark)

    Demenais, Florence; Margaritte-Jeannin, Patricia; Barnes, Kathleen C

    2018-01-01

    We examined common variation in asthma risk by conducting a meta-analysis of worldwide asthma genome-wide association studies (23,948 asthma cases, 118,538 controls) of individuals from ethnically diverse populations. We identified five new asthma loci, found two new associations at two known...

  10. Moisture damage and asthma: a birth cohort study.

    Science.gov (United States)

    Karvonen, Anne M; Hyvärinen, Anne; Korppi, Matti; Haverinen-Shaughnessy, Ulla; Renz, Harald; Pfefferle, Petra I; Remes, Sami; Genuneit, Jon; Pekkanen, Juha

    2015-03-01

    Excess moisture and visible mold are associated with increased risk of asthma. Only a few studies have performed detailed home visits to characterize the extent and location of moisture damage and mold growth. Structured home inspections were performed in a birth cohort study when the children were 5 months old (on average). Children (N = 398) were followed up to the age of 6 years. Specific immunoglobulin E concentrations were determined at 6 years. Moisture damage and mold at an early age in the child's main living areas (but not in bathrooms or other interior spaces) were associated with the risk of developing physician-diagnosed asthma ever, persistent asthma, and respiratory symptoms during the first 6 years. Associations with asthma ever were strongest for moisture damage with visible mold in the child's bedroom (adjusted odds ratio: 4.82 [95% confidence interval: 1.29-18.02]) and in the living room (adjusted odds ratio: 7.51 [95% confidence interval: 1.49-37.83]). Associations with asthma ever were stronger in the earlier part of the follow-up and among atopic children. No consistent associations were found between moisture damage with or without visible mold and atopic sensitization. Moisture damage and mold in early infancy in the child's main living areas were associated with asthma development. Atopic children may be more susceptible to the effects of moisture damage and mold. Copyright © 2015 by the American Academy of Pediatrics.

  11. Asthma Insights and Management in India: Lessons Learnt from the Asia Pacific - Asthma Insights and Management (AP-AIM) Study.

    Science.gov (United States)

    Salvi, Sundeep S; Apte, Komalkirti K; Dhar, Raja; Shetty, Pradeep; Faruqi, Rab A; Thompson, Philip J; Guleria, Randeep

    2015-09-01

    Despite a better understanding of the pathophysiology of asthma, presence of reliable diagnostic tools, availability of a wide array of effective and affordable inhaled drugs and simplified national and international asthma management guidelines, asthma remains poorly managed in India. The Asia-Pacific Asthma Insight and Management (AP-AIM) study was aimed at understanding the characteristics of asthma, current management, level of asthma control and its impact on quality of life across Australia, China, Hong Kong, India, Malaysia, Singapore, South Korea, Taiwan and Thailand. This paper describes the results of asthma management issues in India in detail and provides a unique insight into asthma in India. The AP-AIM India study was conducted in eight urban cities in India, viz: Ajmer, Delhi, Kolkata, Rourkela, Chennai, Mangalore, Mumbai and Rajkot from February to July 2011. Face-to-face interviews were conducted in adult asthmatics and parents of asthmatic children between the ages of 12 and 17 years with a confirmed diagnosis or a treatment history of 1 year for asthma. Four hundred asthmatics (M:F::1:1.273), with a mean age of 50 ± 17.8 years, from across India were studied. 91% of the asthmatics in India perceived their asthma to be under control, however, none of the asthmatics had controlled asthma by objective measures. Asthmatics in India believed that their asthma was under control if they have up to 2 emergency doctor visits a year. The quality of life of these patients was significantly affected with 93% school/work absenteeism and a loss of 50% productivity. Seventy-five percent of the asthmatics have never had a lung function test. The common triggers for asthmatics in India were dust (49%) and air pollution (49%), while only 5% reported of pollen as triggers. Eighty-nine percent of Indian asthmatics reported an average use of oral steroids 10.5 times a year. Only 36% and 50% of Indian asthmatics used controller and rescue inhalers with a majority

  12. Changes in asthma control, work productivity, and impairment with omalizumab: 5-year EXCELS study results.

    Science.gov (United States)

    Zazzali, James L; Raimundo, Karina P; Trzaskoma, Benjamin; Rosén, Karin E; Schatz, Michael

    2015-01-01

    Asthma poses a significant disease burden worldwide. Current guidelines emphasize achieving and maintaining asthma control. To describe longitudinal changes of asthma control and asthma-related work, school, and activity impairment for patients with moderate-to-severe asthma treated with omalizumab and those who did not receive omalizumab in a real-world setting. This study used 5 years of data from patients ages ≥12 years old with moderate-to-severe persistent allergic asthma who were enrolled in the Evaluating Clinical Effectiveness and Long-term Safety in Patients with Moderate-to-Severe Asthma observational study. Asthma control was assessed with the Asthma Control Test for 5 years, and asthma-related work, school, and activity impairment was measured with the Work Productivity/Activity Impairment-Asthma questionnaire for the first 2 years. The percentage of patients treated with omalizumab (n = 4930) and with well-controlled asthma (Asthma Control Test score, >20) increased from 45% at baseline to 61% at month 60, and it was 49% (baseline) and 67% (month 60) for the non-omalizumab-treated cohort (n = 2779). For new starters to omalizumab (n = 576), the percentage with well-controlled asthma increased from 25% at baseline to 51% at month 6, and to 60% at month 60. Patients in the omalizumab-treated cohort and those in the non-omalizumab-treated cohort experienced a reduction in asthma-related work, school, and activity impairment. The amount of improvement in asthma control achieved and the reduction in asthma-related work, school, and activity impairment were similar, regardless of asthma severity. On average, patients in the Evaluating Clinical Effectiveness and Long-term Safety in Patients with Moderate-to-Severe Asthma observational study who initiated omalizumab experienced clinically significant improvement in asthma control, which was observed within 6 months and persisted for 5 years.

  13. Outpatient management of childhood asthma by paediatrician or asthma nurse : randomised controlled study with one year follow up

    NARCIS (Netherlands)

    Kamps, Arvid W. A.; Brand, PLP; Kimpen, JLL; Maille, AR; Overgoor-van de Groes, AW; van Helsdingen-Peek, LCJAM

    2003-01-01

    Background: Until now, care provided by asthma nurses has been additional to care provided by paediatricians. A study was undertaken to compare nurse led outpatient management of childhood asthma with follow up by a paediatrician. Methods: Seventy four children referred because of insufficient

  14. A randomized, double-blind, placebo-controlled study of tumor necrosis factor-alpha blockade in severe persistent asthma

    NARCIS (Netherlands)

    Wenzel, Sally E.; Barnes, Peter J.; Bleecker, Eugene R.; Bousquet, Jean; Busse, William; Dahlén, Sven-Erik; Holgate, Stephen T.; Meyers, Deborah A.; Rabe, Klaus F.; Antczak, Adam; Baker, James; Horvath, Ildiko; Mark, Zsuzsanna; Bernstein, David; Kerwin, Edward; Schlenker-Herceg, Rozsa; Lo, Kim Hung; Watt, Rosemary; Barnathan, Elliot S.; Chanez, Pascal; Chanez, P.; Tunon-de-Lara, M.; Antczak, A.; Pierzchala, W.; Bukowczan, Z.; Trawinska, E.; Baker, J.; Wenzel, S. E.; Katial, R.; Bernstein, D.; Kerwin, E.; Bensch, G.; Castro, M.; Noonan, M.; Nayak, A.; Chupp, G.; Kline, J.; Busse, W.; Kavuru, M. S.; Lang, D.; Wolfe, R.; Baughman, R.; Korenblat, P.; Mansfield, L.; Bleecker, E.; Lisberg, E.; Liu, M.; Panettieri, R.; Spangenthal, S.; Bel, E. H.

    2009-01-01

    RATIONALE: The treatment effect of golimumab, a human monoclonal antibody against tumor necrosis factor (TNF)-alpha, in severe persistent asthma is unknown. OBJECTIVES: To assess the safety and efficacy of golimumab in a large population of patients with uncontrolled, severe persistent asthma.

  15. Fibromyalgia as a cause of uncontrolled asthma: a case-control multicenter study.

    Science.gov (United States)

    Martinez-Moragon, Eva; Plaza, Vicente; Torres, Isabel; Rosado, Ana; Urrutia, Isabel; Casas, Xavier; Hinojosa, Belen; Blanco-Aparicio, Marina; Delgado, Julio; Quirce, Santiago; Sabadell, Carles; Cebollero, Pilar; Muñoz-Fernández, Ana

    2017-12-01

    Fibromyalgia can affect the control of asthma when both diseases are present in a single patient. To characterize asthma in patients with concomitant fibromyalgia to assess whether fibromyalgia is an independent factor of asthma severity that influences poor asthma control. We also evaluated how dyspnea is perceived by patients in order to demonstrate that alterations in the perception of airway obstruction may be responsible for poor asthma control. This was a cross-sectional case-control multicenter study, in which 56 patients in the asthma and fibromyalgia group were matched to 36 asthmatics by sex, approximate age, and asthma severity level. All patients were women. Study variables included the Asthma Control Test (ACT), the Mini Asthma Quality of Life Questionnaire (MiniAQLQ), the Nijmegen hyperventilation syndrome questionnaire, the Hospital Anxiety and Depression Scale, and perception of dyspnea after acute bronchoconstriction. Although patients in both study groups showed similar asthma severity and use of anti-asthmatic drugs, patients in the asthma and fibromyalgia group showed lower scores on the ACT and MiniAQLQ questionnaires, and higher scores of anxiety and depression as well as hyperventilation compared to asthma patients without fibromyalgia. All these differences were statistically significant. Fibromyalgia in patients with asthma influences poor control of the respiratory disease and is associated with altered perception of dyspnea, hyperventilation syndrome, high prevalence of depression and anxiety, and impaired quality of life. Fibromyalgia may be considered a risk factor for uncontrolled asthma in patients suffering from asthma and fibromyalgia concomitantly.

  16. Impact of childhood asthma on growth trajectories in early adolescence: Findings from the Childhood Asthma Prevention Study (CAPS).

    Science.gov (United States)

    Movin, Maria; Garden, Frances L; Protudjer, Jennifer L P; Ullemar, Vilhelmina; Svensdotter, Frida; Andersson, David; Kruse, Andreas; Cowell, Chris T; Toelle, Brett G; Marks, Guy B; Almqvist, Catarina

    2017-04-01

    Understanding the associations between childhood asthma and growth in early adolescence by accounting for the heterogeneity of growth during puberty has been largely unexplored. The objective was to identify sex-specific classes of growth trajectories during early adolescence, using a method which takes the heterogeneity of growth into account and to evaluate the association between childhood asthma and different classes of growth trajectories in adolescence. Our longitudinal study included participants with a family history of asthma born during 1997-1999 in Sydney, Australia. Hence, all participants were at high risk for asthma. Asthma status was ascertained at 8 years of age using data from questionnaires and lung function tests. Growth trajectories between 11 and 14 years of age were classified using a latent basis growth mixture model. Multinomial regression analyses were used to evaluate the association between asthma and the categorized classes of growth trajectories. In total, 316 participants (51.6% boys), representing 51.3% of the entire cohort, were included. Sex-specific classes of growth trajectories were defined. Among boys, asthma was not associated with the classes of growth trajectories. Girls with asthma were more likely than girls without asthma to belong to a class with later growth (OR: 3.79, 95% CI: 1.33, 10.84). Excluding participants using inhaled corticosteroids or adjusting for confounders did not significantly change the results for either sex. We identified sex-specific heterogeneous classes of growth using growth mixture modelling. Associations between childhood asthma and different classes of growth trajectories were found for girls only. © 2016 Asian Pacific Society of Respirology.

  17. Prevalence of asthma symptoms in Latin America: the International Study of Asthma and Allergies in Childhood (ISAAC).

    Science.gov (United States)

    Mallol, J; Solé, D; Asher, I; Clayton, T; Stein, R; Soto-Quiroz, M

    2000-12-01

    The prevalence of respiratory symptoms indicative of asthma in children from Latin America has been largely ignored. As part of the International Study of Asthma and Allergies in Childhood (ISAAC), 17 centers in 9 different Latin American countries participated in the study, and data from 52,549 written questionnaires (WQ) in children aged 13-14 years and from 36,264 WQ in 6-7 year olds are described here. In children aged 13-14 years, the prevalence of asthma ever ranged from 5.5-28%, and the prevalence of wheezing in the last 12 months from 6.6-27%. In children aged 6-7 years, the prevalence of asthma ever ranged from 4.1-26.9%, and the prevalence of wheezing in the last 12 months ranged from 8.6-32.1%. The lower prevalence in centers with higher levels of atmospheric pollution suggests that chronic inhalation of polluted air in children does not contribute to asthma. Furthermore, the high figures for asthma in a region with a high level of gastrointestinal parasite infestation, and a high burden of acute respiratory infections occurring early in life, suggest that these factors, considered as protective in other regions, do not have the same effect in this region. The present study indicates that the prevalence of asthma and related symptoms in Latin America is as high and variable as described in industrialized or developed regions of the world. Copyright 2000 Wiley-Liss, Inc.

  18. Parental illness perceptions and medication perceptions in childhood asthma, a focus group study

    NARCIS (Netherlands)

    Klok, Ted; Brand, Paul L.; Bomhof-Roordink, Hanna; Duiverman, Eric J.; Kaptein, Adrian A.

    Aim: Asthma treatment according to guidelines fails frequently, through patients' nonadherence to doctors' advice. This study aimed to explore how differences in asthma care influence parents' perceptions to inhaled corticosteroids (ICS). Methods: We conducted six semistructured focus groups,

  19. Asthma characteristics and biomarkers from the Airways Disease Endotyping for Personalized Therapeutics (ADEPT) longitudinal profiling study

    DEFF Research Database (Denmark)

    Silkoff, P E; Strambu, I; Laviolette, M

    2015-01-01

    BACKGROUND: Asthma is a heterogeneous disease and development of novel therapeutics requires an understanding of pathophysiologic phenotypes. The purpose of the ADEPT study was to correlate clinical features and biomarkers with molecular characteristics, by profiling asthma (NCT01274507). This re...

  20. Exacerbations of asthma - A descriptive study of 425 severe exacerbations

    NARCIS (Netherlands)

    Tattersfield, AE; Postma, DS; Barnes, PJ; Svensson, K; Bauer, CA; O'Byrne, PM; Lofdahl, CG; Pauwels, RA; Ullman, A

    The identification, prevention, and prompt treatment of exacerbations are major objectives of asthma management. We looked at change in PEF, symptoms, and use of rescue p-agonists during the 425 severe exacerbations that occurred during a 12-mo parallel group study (FACET) in which low and high

  1. Limited agreement between current and long-term asthma control in children : the PACMAN cohort study

    NARCIS (Netherlands)

    Koster, Ellen S.; Raaijmakers, Jan A. M.; Vijverberg, Susanne J. H.; Koenderman, Leo; Postma, Dirkje S.; Koppelman, Gerard H.; van der Ent, Cornelis K.; Maitland-van der Zee, Anke-Hilse

    2011-01-01

    Background: Several studies have shown that predictors of asthma treatment outcomes differ depending on the definition of the outcome chosen. This provides evidence that different outcomes studied may reflect distinct aspects of asthma control. To assess predictors of asthma control, we need firm

  2. Secular trends of allergic asthma in Danish adults. The Copenhagen Allergy Study

    DEFF Research Database (Denmark)

    Linneberg, A; Nielsen, N H; Madsen, F

    2001-01-01

    Numerous studies have reported increases in asthma prevalence among children world-wide. Less is known about similar trends in adults. We aimed to investigate whether the prevalence of allergic asthma symptoms had increased in an adult general population. Two cross-sectional surveys using identical......, the prevalence of allergic asthma symptoms increased significantly in this adult general population over a 9-year period....

  3. Factors associated with overestimation of asthma control: A cross-sectional study in Australia.

    Science.gov (United States)

    Bereznicki, Bonnie J; Chapman, Millicent P; Bereznicki, Luke R E

    2017-05-01

    To investigate actual and perceived disease control in Australians with asthma, and identify factors associated with overestimation of asthma control. This was a cross-sectional study of Australian adults with asthma, who were recruited via Facebook to complete an online survey. The survey included basic demographic questions, and validated tools assessing asthma knowledge, medication adherence, medicine beliefs, illness perception and asthma control. Items that measured symptoms and frequency of reliever medication use were compared to respondents' self-rating of their own asthma control. Predictors of overestimation of asthma control were determined using multivariate logistic regression. Of 2971 survey responses, 1950 (65.6%) were complete and eligible for inclusion. Overestimation of control was apparent in 45.9% of respondents. Factors independently associated with overestimation of asthma control included education level (OR = 0.755, 95% CI: 0.612-0.931, P = 0.009), asthma knowledge (OR = 0.942, 95% CI: 0.892-0.994, P = 0.029), total asthma control, (OR = 0.842, 95% CI: 0.818-0.867, P addictive (OR = 1.144, 95% CI: 1.017-1.287, P = 0.025), and increased feelings of control over asthma (OR = 1.261, 95% CI: 1.191-1.335), P < 0.001). Overestimation of asthma control remains a significant issue in Australians with asthma. The study highlights the importance of encouraging patients to express their feelings about asthma control and beliefs about medicines, and to be more forthcoming with their asthma symptoms. This would help to reveal any discrepancies between perceived and actual asthma control.

  4. A twin study of early-childhood asthma in Puerto Ricans.

    Directory of Open Access Journals (Sweden)

    Supinda Bunyavanich

    Full Text Available The relative contributions of genetics and environment to asthma in Hispanics or to asthma in children younger than 3 years are not well understood.To examine the relative contributions of genetics and environment to early-childhood asthma by performing a longitudinal twin study of asthma in Puerto Rican children ≤ 3 years old.678 twin infants from the Puerto Rico Neo-Natal Twin Registry were assessed for asthma at age 1 year, with follow-up data obtained for 624 twins at age 3 years. Zygosity was determined by DNA microsatellite profiling. Structural equation modeling was performed for three phenotypes at ages 1 and 3 years: physician-diagnosed asthma, asthma medication use in the past year, and ≥ 1 hospitalization for asthma in the past year. Models were additionally adjusted for early-life environmental tobacco smoke exposure, sex, and age.The prevalences of physician-diagnosed asthma, asthma medication use, and hospitalization for asthma were 11.6%, 10.8%, 4.9% at age 1 year, and 34.1%, 40.1%, and 8.5% at 3 years, respectively. Shared environmental effects contributed to the majority of variance in susceptibility to physician-diagnosed asthma and asthma medication use in the first year of life (84%-86%, while genetic effects drove variance in all phenotypes (45%-65% at age 3 years. Early-life environmental tobacco smoke, sex, and age contributed to variance in susceptibility.Our longitudinal study in Puerto Rican twins demonstrates a changing contribution of shared environmental effects to liability for physician-diagnosed asthma and asthma medication use between ages 1 and 3 years. Early-life environmental tobacco smoke reduction could markedly reduce asthma morbidity in young Puerto Rican children.

  5. Influences on hospital admission for asthma in south Asian and white adults: qualitative interview study.

    Science.gov (United States)

    Griffiths, C; Kaur, G; Gantley, M; Feder, G; Hillier, S; Goddard, J; Packe, G

    2001-10-27

    To explore reasons for increased risk of hospital admission among south Asian patients with asthma. Qualitative interview study using modified critical incident technique and framework analysis. Newham, east London, a deprived area with a large mixed south Asian population. 58 south Asian and white adults with asthma (49 admitted to hospital with asthma, 9 not admitted); 17 general practitioners; 5 accident and emergency doctors; 2 out of hours general practitioners; 1 asthma specialist nurse. Patients' and health professionals' views on influences on admission, events leading to admission, general practices' organisation and asthma strategies, doctor-patient relationship, and cultural attitudes to asthma. South Asian and white patients admitted to hospital coped differently with asthma. South Asians described less confidence in controlling their asthma, were unfamiliar with the concept of preventive medication, and often expressed less confidence in their general practitioner. South Asians managed asthma exacerbations with family advocacy, without systematic changes in prophylaxis, and without systemic corticosteroids. Patients describing difficulty accessing primary care during asthma exacerbations were registered with practices with weak strategies for asthma care and were often south Asian. Patients with easy access described care suggesting partnerships with their general practitioner, had better confidence to control asthma, and were registered with practices with well developed asthma strategies that included policies for avoiding hospital admission. The different ways of coping with asthma exacerbations and accessing care may partly explain the increased risk of hospital admission in south Asian patients. Interventions that increase confidence to control asthma, confidence in the general practitioner, understanding of preventive treatment, and use of systemic corticosteroids in exacerbations may reduce hospital admissions. Development of more sophisticated

  6. Ambient particulate pollution and the world-wide prevalence of asthma, rhinoconjunctivitis and eczema in children: Phase One of the International Study of Asthma and Allergies in Childhood (ISAAC).

    NARCIS (Netherlands)

    Anderson, H.R.; Ruggles, R.; Pandey, K.D.; Kapetanakis, V.; Brunekreef, B.; Lai, C.K.; Strachan, D.P.; Weiland, S.K.

    2010-01-01

    OBJECTIVES: To investigate the effect of ambient particulate matter on variation in childhood prevalence of asthma, rhinoconjunctivitis and eczema. METHODS: Prevalences of asthma, rhinoconjunctivitis and eczema obtained in Phase One of the International Study of Asthma and Allergies in Childhood

  7. A population-based prescription study of asthma drugs during pregnancy

    DEFF Research Database (Denmark)

    Olesen, Charlotte; Thrane, Nana; Nielsen, G.L.

    2001-01-01

    Background: Among the goals of gestational asthma, therapy is optimisation of pulmonary function. According to the US Food and Drug Administration, no asthma drugs can be considered ‘safe’ during pregnancy. Fear of adverse fetal effects may thus lead to restrictive use of asthma drugs during...... pregnancy, and no population-based studies concerning gestational asthma therapy exist. Objectives: To examine whether asthma drugs or changing intensity of asthma therapy during pregnancy was associated with deviations from expected values of gestational age, birth weight, length at birth, or malformations....... Methods: The Birth Registry was used to identify all 15,756 primiparous women who gave birth in the County of North Jutland between 1991 and 1996. According to the North Jutland Prescription Database, 303 of these women received prescriptions for asthma drugs during pregnancy. Women who did not purchase...

  8. RhinAsthma patient perspective: A Rasch validation study.

    Science.gov (United States)

    Molinengo, Giorgia; Baiardini, Ilaria; Braido, Fulvio; Loera, Barbara

    2018-02-01

    In daily practice, Health-Related Quality of Life (HRQoL) tools are useful for supplementing clinical data with the patient's perspective. To encourage their use by clinicians, the availability of tools that can quickly provide valid results is crucial. A new HRQoL tool has been proposed for patients with asthma and rhinitis: the RhinAsthma Patient Perspective-RAPP. The aim of this study was to evaluate the psychometric robustness of the RAPP using the Item Response Theory (IRT) approach, to evaluate the scalability of items and test whether or not patients use the items response scale correctly. 155 patients (53.5% women, mean age 39.1, range 16-76) were recruited during a multicenter study. RAPP metric properties were investigated using IRT models. Differential item functioning (DIF) was used for gender, age, and asthma control test (ACT). The RAPP adequately fitted the Rating Scale model, demonstrating the equality of the rating scale structure for all items. All statistics on items were satisfactory. The RAPP had adequate internal reliability and showed good ability to discriminate among different groups of participants. DIF analysis indicated that there were no differential item functioning issues for gender. One item showed a DIF by age and four items by ACT. The psychometric evaluation performed using IRT models demonstrated that the RAPP met all the criteria to be considered a reliable and valid method of measurement. From a clinical perspective, this will allow physicians to confidently interpret scores as good indicators of Quality of Life of patients with asthma.

  9. Feasibility of exercising adults with asthma: a randomized pilot study

    Directory of Open Access Journals (Sweden)

    Boyd Amy

    2012-08-01

    Full Text Available Abstract Background Aerobic exercise appears to have clinical benefits for many asthmatics, yet a complete understanding of the mechanisms underlying these benefits has not been elucidated at this time. Purpose The objective of this study was to determine feasibility for a larger, future study that will define the effect of aerobic exercise on cellular, molecular, and functional measures in adults with mild-moderate asthma. Design Recruited subjects were randomized into usual care (sedentary or usual care with moderate intensity aerobic exercise treatment groups. Setting / Participants Nineteen adults with mild-moderate asthma but without a recent history of exercise were recruited at the UAB Lung Health Center, Birmingham, AL. Intervention The exercise group underwent a 12 week walking program exercising at 60 – 75% of maximum heart rate (HRmax. Subjects self-monitored HRmax levels using heart rate monitors; exercise diaries and recreation center sign-in logs were also used. Main outcome measures Functional measures, including lung function and asthma control scores, were evaluated for all subjects at pre- and post-study time-points; fitness measures were also assessed for subjects in the exercise group. Peripheral blood and nasal lavage fluid were collected from all subjects at pre- and post-study visits in order to evaluate cellular and molecular measures, including cell differentials and eosinophilic cationic protein (ECP. Results Sixteen subjects completed the prescribed protocol. Results show that subjects randomized to the exercise group adhered well (80% to the exercise prescription and exhibited a trend toward improved fitness levels upon study completion. Both groups exhibited improvements in ACQ scores. No changes were observed in lung function (FEV1, FEV1/FVC, cell differentials, or ECP between groups. Conclusions Results indicate that a moderate intensity aerobic exercise training program may improve asthma control and fitness

  10. Polygenic risk and the development and course of asthma: Evidence from a 4-decade longitudinal study

    Science.gov (United States)

    Belsky, DW; Sears, MR; Hancox, RJ; Harrington, HL; Houts, R; Moffitt, TE; Sugden, K; Williams, B; Poulton, R; Caspi, A

    2013-01-01

    BACKGROUND Genome-wide association studies (GWAS) have discovered loci that predispose to asthma. To integrate these new discoveries with emerging models of asthma pathobiology, research is needed to test how genetic discoveries relate to developmental and biological characteristics of asthma. METHODS We derived a multi-locus profile of genetic risk from published GWAS of asthma case status. We then tested associations between this “genetic risk score” and developmental and biological characteristics of asthma in a population-based long-running birth cohort, the Dunedin Longitudinal Study (n=1,037). We evaluated asthma onset, persistence, atopy, airway hyperresponsiveness, incompletely reversible airflow obstruction, and asthma-related school and work absenteeism and hospitalization during 9 prospective assessments spanning ages 9–38 years, when 95% of surviving cohort members were seen. INTERPRETATION Cohort members at higher genetic risk experienced asthma onset earlier in life (HR=1.12 [1.01–1.26]). Childhood-onset asthma cases at higher genetic risk were more likely to become life-course-persistent asthma cases (RR=1.36 [1.14–1.63]). Asthma cases at higher genetic risk more often manifested atopy (RR=1.07 [1.01–1.14]), airway hyperresponsiveness (RR=1.16 [1.03–1.32]), and incompletely reversible airflow obstruction (RR=1.28 [1.04–1.57]). They were also more likely to miss school or work due to asthma (IRR=1.38 [1.02–1.86]) and to be hospitalized with breathing problems (HR=1.38 [1.07–1.79]). Genotypic information about asthma risk was independent of and additive to information derived from cohort members’ family histories of asthma. CONCLUSIONS Findings from this population study confirm that GWAS-discoveries for asthma associate with a childhood-onset phenotype and advance asthma genetics beyond the original GWAS-discoveries in three ways: (1) We show that genetic risks predict which childhood-onset asthma cases remit and which become

  11. Developing pictorial asthma action plans to promote self-management and health in rural youth with asthma: A qualitative study.

    Science.gov (United States)

    Duncan, Christina L; Walker, Heather A; Brabson, Laurel; Williford, Desireé N; Hynes, Lisa; Hogan, Mary Beth

    2017-09-21

    Asthma action plans (AAPs) provide asthma management instructions to families; however, AAPs typically are written at a 7th-9th grade reading level, making them less useful in lower literacy families. There is a need to develop simpler AAP formats and content to optimize their utility across all families, including those who are rural and may be at a risk for literacy concerns. Because using pictures can simplify and enhance health education, our study's aim was to develop a pictorial AAP through a series of focus groups with key stakeholders - youth with asthma, caregivers, and physicians. Fourteen caregiver/youth dyads and four physicians participated in separate focus groups where their preferences for pictorial AAP structure and content were obtained. Focus groups were audio recorded, transcribed, coded with ATLAS.ti, and analyzed for themes. Youth and their caregivers prefer that the AAPs include simple, cartoon-like pictures customized to the patient. Physicians emphasized AAP's capability to display pictures of controller medication given its importance in preventing asthma exacerbations. A stoplight format, currently used in most written AAPs, received positive reviews. Specific suggestions for pictures showing symptoms, medications, and how to take medication were suggested. Words and short phrases accompanying the pictures were thought to add clarity. Key stakeholders viewed pictorial AAPs as positive and potentially effective alternatives to standard written AAPs. It is expected that low literacy youth and caregivers would more easily understand a pictorial AAP presentation, which should facilitate better medication adherence and asthma outcomes in these children.

  12. Rationales Shaping International Linkages in Higher Education: A Qualitative Case Study of the ASU-ITESM Strategic Alliance

    Science.gov (United States)

    Camacho Lizarraga, Monica Irene

    2011-01-01

    This qualitative case study examines the rationales of the relationship between Arizona State University (ASU)--an American public research university--and Tecnologico de Monterrey (ITESM), a Mexican private not for profit research university. The focus of the study is to document the different meanings participants attached to the rationales of…

  13. A Patient Advocate to facilitate access and improve communication, care, and outcomes in adults with moderate or severe asthma: Rationale, design, and methods of a randomized controlled trial

    Science.gov (United States)

    Apter, Andrea J.; Morales, Knashawn H.; Han, Xiaoyan; Perez, Luzmercy; Huang, Jingru; Ndicu, Grace; Localio, Anna; Nardi, Alyssa; Klusaritz, Heather; Rogers, Marisa; Phillips, Alexis; Cidav, Zuleyha; Schwartz, J. Sanford

    2017-01-01

    Few interventions to improve asthma outcomes have targeted low-income minority adults. Even fewer have focused on the real-world practice where care is delivered. We adapted a patient navigator, here called a Patient Advocate (PA), a term preferred by patients, to facilitate and maintain access to chronic care for adults with moderate or severe asthma and prevalent co-morbidities recruited from clinics serving low-income urban neighborhoods. We describe the planning, design, methodology (informed by patient and provider focus groups), baseline results, and challenges of an ongoing randomized controlled trial of 312 adults of a PA intervention implemented in a variety of practices. The PA coaches, models, and assists participants with preparations for a visit with the asthma clinician; attends the visit with permission of participant and provider; and confirms participants’ understanding of what transpired at the visit. The PA facilitates scheduling, obtaining insurance coverage, overcoming patients’ unique social and administrative barriers to carrying out medical advice and transfer of information between providers and patients. PA activities are individualized, take account of comorbidities, and are generalizable to other chronic diseases. PAs are recent college graduates interested in health-related careers, research experience, working with patients, and generally have the same race/ethnicity distribution as potential participants. We test whether the PA intervention, compared to usual care, is associated with improved and sustained asthma control and other asthma outcomes (prednisone bursts, ED visits, hospitalizations, quality of life, FEV1) relative to baseline. Mediators and moderators of the PA-asthma outcome relationship are examined along with the intervention’s cost-effectiveness. PMID:28315481

  14. Ecological study of socio-economic indicators and prevalence of asthma in schoolchildren in urban Brazil

    Directory of Open Access Journals (Sweden)

    Genser Bernd

    2007-08-01

    Full Text Available Abstract Background There is evidence of higher prevalence of asthma in populations of lower socio-economic status in affluent societies, and the prevalence of asthma is also very high in some Latin American countries, where societies are characterized by a marked inequality in wealth. This study aimed to examine the relationship between estimates of asthma prevalence based on surveys conducted in children in Brazilian cities and health and socioeconomic indicators measured at the population level in the same cities. Methods We searched the literature in the medical databases and in the annals of scientific meeting, retrieving population-based surveys of asthma that were conducted in Brazil using the methodology defined by the International Study of Asthma and Allergies in Childhood. We performed separate analyses for the age groups 6–7 years and 13–14 years. We examined the association between asthma prevalence rates and eleven health and socio-economic indicators by visual inspection and using linear regression models weighed by the inverse of the variance of each survey. Results Six health and socioeconomic variables showed a clear pattern of association with asthma. The prevalence of asthma increased with poorer sanitation and with higher infant mortality at birth and at survey year, GINI index and external mortality. In contrast, asthma prevalence decreased with higher illiteracy rates. Conclusion The prevalence of asthma in urban areas of Brazil, a middle income country, appears to be higher in cities with more marked poverty or inequality.

  15. Environmental and Personal Factors Related to Asthma Severity among Children: Hospital Based Study, Egypt

    Directory of Open Access Journals (Sweden)

    Omaima Ibrahim AboElkheir

    2016-09-01

    Full Text Available Background: Childhood asthma is a complex disorder in which many environmental and personal factors play a role. However, the contribution of these factors to asthma severity is poorly understood. This study aims to determine the relationship between environmental exposures, personal factors and asthma severity among asthmatic children. Methods: This cross-sectional hospital based study was conducted on 180 asthmatic children; they were divided into mild, moderate and severe asthma according to forced expiratory volume in first second. Environmental factors (indoor and outdoor, food allergy, history of other allergic diseases, family history of allergic disorders, time trend of attacks as well as asthma outcome were reported. Results: Children with severe asthma were younger than those with mild or moderate asthma. Severe asthma was significantly linked to family history of allergy, presence of co-morbid allergic diseases, fish, egg and milk allergy, as well as exposure to passive smoking (73.7% and poor housing conditions. Also, it was significantly linked to presence of unauthorized factories in residential area (31.6 %, p=0.001. As well as, contact with pets (42.1%. Children with severe asthma had more limitations of physical activities (73.7%, missed school days (81.5%, with poor school performance (p=0.04 than those with mild moderate or asthma. Conclusion: Severe asthma was linked to female gender and younger age, co-morbid allergic diseases, family history of atopy and food allergy. It was higher among children residing in places with unauthorized factories and living in substandard housing condition. Children with severe asthma had poor asthma outcome.

  16. Low-dose budesonide treatment improves lung function in patients with infrequent asthma symptoms at baseline

    DEFF Research Database (Denmark)

    Reddel, H. K.; Busse, W. W.; Pedersen, Søren

    2015-01-01

    symptom frequency groups (Figure). CONCLUSIONS: Long-term, once-daily, low-dose budesonide treatment plus usual asthma medication improves lung function in patients with mild, recent-onset asthma. These beneficial effects were seen even in patients with the lowest baseline asthma symptom frequency (0......RATIONALE: Inhaled corticosteroids (ICS) are highly effective in low doses for improving asthma outcomes, including lung function. In the past, ICS treatment was recommended for patients with 'persistent' asthma, defined by symptoms >2 days/week.1 However, evidence is lacking for the benefit of ICS...... in patients with less frequent symptoms at presentation. This was investigated in a post-hoc analysis of the multinational inhaled Steroid Treatment As Regular Therapy in early asthma (START) study.2 METHODS: Patients aged 4-66 years (median 21 years) with a history of recent-onset mild asthma (11 years...

  17. Risk factors for near-fatal asthma. A case-control study in hospitalized patients with asthma.

    Science.gov (United States)

    Turner, M O; Noertjojo, K; Vedal, S; Bai, T; Crump, S; Fitzgerald, J M

    1998-06-01

    We prospectively recruited patients admitted to the hospital with severe asthma to comprehensively evaluate the association of historical and physiologic features with the risk of near-fatal asthma (NFA). A case-control study design was used. All patients admitted with NFA (cases) were identified prospectively and compared with asthma patients admitted during the same period without respiratory failure (controls). Nineteen cases (age: 40.2 +/- 12.0 yr) (mean +/- SD) and 80 controls (age: 36 +/- 13.5 yr) were enrolled. Duration of asthma, gender, smoking status, ethnicity, and prevalence of atopy were similar in the case and control groups. More than 80% of patients in both groups reported worsening symptoms for more than 48 h before admission, and more than 50% were worse for longer than 7 d. There was no difference in degree of airways obstruction or bronchial hyperresponsiveness (PC20). Perception of dyspnea was similar in the cases and controls, but among cases the males had greater impairment than the females (Borg score: 1.9 +/- 1. 4 versus 3.9 +/- 1.2: p = 0.05). Univariate analysis identified a history of previous mechanical ventilation (OR: 27.5; 95% CI: 6.60 to 113.7), admission to the intensive care unit (ICU) (OR: 9.9; 95% CI: 3.0 to 32.9), history of worse asthma during January and February (OR: 3.5; 95% CI: 1.0 to 11.8), and use of air-conditioning (OR: 15.0; 95% CI: 1.3 to 166) as risk factors for NFA. Of concern was the dependence of most patients (59.8%) on the emergency department (ED) for initial care, and the small number of cases (16%) in which patients visited a physician before admission to the hospital. We have confirmed risk factors identified previously in retrospective studies of fatal and NFA, and have also shown that hospitalized patients with asthma, irrespective of severity of their asthma, share several characteristics, especially in terms of their failure to respond to worsening asthma.

  18. Long-term prognosis of asthma, chronic obstructive pulmonary disease, and asthma-chronic obstructive pulmonary disease overlap in the Copenhagen City Heart study

    DEFF Research Database (Denmark)

    Lange, Peter; Çolak, Yunus; Ingebrigtsen, Truls Sylvan

    2016-01-01

    BACKGROUND: Long-term prognosis of patients with characteristics of both chronic obstructive pulmonary disease (COPD) and asthma, named asthma-COPD overlap, is poorly described. We investigated the long-term prognosis of individuals with different types of chronic airway disease, with a special...... were 39·48 (95% CI 25·93-60·11) in asthma-COPD overlap with early-onset asthma, 83·47 (61·67-112·98) in asthma-COPD overlap with late-onset asthma, 23·80 (17·43-33·50) in COPD, and 14·74 (10·06-21·59) in asthma compared with never-smokers without lung disease (all p... focus on individuals with asthma-COPD overlap. METHODS: We assigned participants from the Copenhagen City Heart Study into six subgroups: healthy never-smokers, ever-smokers without asthma and COPD, those with asthma with low cumulated smoking exposure and no airflow limitation, those with COPD, those...

  19. Asthma Control and Sputum Eosinophils: A Longitudinal Study in Daily Practice.

    Science.gov (United States)

    Demarche, Sophie F; Schleich, Florence N; Paulus, Virginie A; Henket, Monique A; Van Hees, Thierry J; Louis, Renaud E

    Longitudinal trials have suggested that asthma control may be influenced by fluctuations in eosinophilic inflammation. This association has however never been confirmed in daily practice. To investigate the relationship between asthma control and sputum eosinophils in clinical practice. A retrospective longitudinal study was conducted on 187 patients with asthma with at least 2 successful sputum inductions at our Asthma Clinic. Linear mixed models were used to assess the relationship between asthma control and individual changes in sputum eosinophils. Receiver-operating characteristic curves were constructed to define minimal important differences (MIDs) of sputum eosinophils associated with a change of at least 0.5 in Asthma Control Questionnaire (ACQ) score. Then, a validation cohort of 79 patients with asthma was recruited to reassess this relationship and the accuracy of the MID values. A multivariate analysis showed that asthma control was independently associated with individual fluctuations in sputum eosinophil count (P eosinophilic asthma, we calculated a minimal important decrease of 4.3% in the percentage of sputum eosinophils (area under the curve [AUC], 0.69; P eosinophils and the accuracy of the MIDs of sputum eosinophils were confirmed in the validation cohort. At the individual level, asthma control was associated with fluctuations in sputum eosinophil count over time. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  20. A community study of factors related to poorly controlled asthma among Brazilian urban children.

    Directory of Open Access Journals (Sweden)

    Silvia de Magalhães Simões

    Full Text Available Asthma constitutes a serious public health problem in many regions of the world, including the city of Salvador, State of Bahia-Brazil. The purpose of this study was to analyse the factors associated with poor asthma control.Two definitions were used for asthma: 1 wheezing in the last 12 months; 2 wheezing in the last 12 months plus other asthma symptoms or asthma diagnosis ever. The definition of poorly controlled asthma was: at least one reported hospitalisation due to asthma and/or high frequency of symptoms, in the last year. Children with poorly controlled asthma (N = 187/374 were compared with wheezing children with controlled asthma regarding age, gender, atopy, parental asthma, rhinitis, eczema, exposure to second hand tobacco smoke, presence of moulds, pets and pests in the house, helminth infections and body mass index. Crude and logistic regression adjusted odds ratios were used as measures of association. There was a higher proportion of poorly controlled asthma among children with eczema (OR = 1.55; 95% CI 1.02; 2.37. The strength of the association was greater among children with eczema and rhinitis (42.6%, 53.4% and 57.7%, respectively, in children who had no rhinitis nor eczema, had only one of those, and had both (p = 0.02 for trend test. The presence of mould in the houses was inversely associated with poorly controlled asthma (OR = 0.54; 95% CI 0.34; 0.87.Our results indicate an association between eczema and poor asthma control in this environment, but emphasize the role of various other individual and environmental factors as determinants of poor control.

  1. Rationales, design and recruitment for the Elfe longitudinal study

    Directory of Open Access Journals (Sweden)

    Salines Georges

    2009-09-01

    Full Text Available Abstract Background Many factors act simultaneously in childhood to influence health status, life chances and well being, including pre-birth influences, the environmental pollutants of early life, health status but also the social influences of family and school. A cohort study is needed to disentangle these influences and explore attribution. Methods Elfe will be a nationally representative cohort of 20 000 children followed from birth to adulthood using a multidisciplinary approach. The cohort will be based on the INSEE Permanent Demographic Panel (EDP established using census data and civil records. The sample size has been defined in order to match the representativeness criteria and to obtain some prevalence estimation, but also to address the research area of low exposure/rare effects. The cohort will be based on repeated surveys by face to face or phone interview (at birth and each year as well as medical interview (at 2 years and examination (at 6 years. Furthermore, biological samples will be taken at birth to evaluate the foetal exposition to toxic substances, environmental sensors will be placed in the child's homes. Pilot studies have been initiated in 2007 (500 children with an overall acceptance rate of 55% and are currently under progress, the 2-year survey being carried out in October this year. Discussion The longitudinal study will provide a unique source of data to analyse the development of children in their environment, to study the various factors interacting throughout the life course up to adulthood and to determine the impact of childhood experience on the individual's physical, psychological, social and professional development.

  2. Smoking patterns among adolescents with asthma attending upper secondary schools: a community-based study

    DEFF Research Database (Denmark)

    Precht, Dorthe Hansen; Keiding, Lis; Madsen, Mette

    2003-01-01

    adjusted for age, gender, parents' job and smoking, family type, body mass index, and exercise habits. RESULTS: In total, 37.7% smoked currently and 16.5% smoked daily; more girls than boys smoked. More pupils with asthma than without smoked daily (adjusted odds ratio [OR]: 1.15; 95% confidence interval......OBJECTIVE: Smoking among people who have asthma may be a serious health problem. We studied the prevalence of smoking and the relations between smoking and asthma, symptoms, medicine, and gender differences among adolescents with asthma. METHODS: A national cross-sectional study on health...... and lifestyles was performed in 1996-1997 using a computerized questionnaire in upper secondary schools in Denmark. We included 1887 pupils with asthma (defined as self-reported asthma diagnosed by a physician) and 20 688 controls. Smoking was categorized as daily, occasional, ex-smokers, and never smoked. We...

  3. Sudden death in young persons with uncontrolled asthma--a nationwide cohort study in Denmark

    DEFF Research Database (Denmark)

    Gullach, Anders Juul; Risgaard, Bjarke; Lynge, Thomas Hadberg

    2015-01-01

    BACKGROUND: Asthma is a common chronic disease among young adults, and several studies have reported increased mortality rates in patients with asthma. However, no study has described sudden unexpected death in a nationwide setting in patients with uncontrolled asthma. We defined uncontrolled...... in preventing sudden unexpected deaths. We therefore aimed to describe clinical characteristics, symptoms, causes of death, and contact with the healthcare system prior to sudden unexpected death in young persons with uncontrolled asthma. METHODS: Through the review of death certificates, we found 625 sudden...... individuals who suffered from uncontrolled asthma. This corresponds to an incidence rate of 0.32 per 100,000 person-years. The cause of death in 31 cases (63%) was sudden cardiac death, and in 13 cases (27%), it was a fatal asthma attack. Symptoms (chest pain, dyspnea, seizures, general malaise, syncope...

  4. Studying the Effects of Fasting during Ramadan on Pulmonary Functioning Test and Asthma Severity

    Directory of Open Access Journals (Sweden)

    Seyyed Hassan Adeli

    2015-03-01

    Full Text Available Background and Objectives: Studies have shown that fasting can have an impact on the course and severity of chronic diseases. There are a few studies on the association of fasting and asthma. Therefore, this study has been conducted with the purpose of examining the effects of fasting on asthma severity and pulmonary functioning tests. Methods: 30 patients with asthma who attended a pulmonology clinic in Qom were enrolled in this study. The severity of patients’ asthma has been studied by questionnaire and spirometry of pulmonary functioning in the month of Shaban, Ramadan and Shawwal. The results of Asthma Control Questionnaire and the pulmonary functioning tests in three months have been compared. Results: The average age of patients was 43.42 years and 43.3% of patients were males. The Average score for asthma severity questionnaire in three months were 20.4, 21 and 20.17 respectively. Statistically, there haven’t been any significant differences between the results of pulmonary functioning test and asthma severity before Ramadan (Shaban, during Ramadan and after that (Shawwal. Conclusion: The findings of this study showed that fasting in patients with asthma has no effect on pulmonary function and asthma severity.

  5. The Inhaled Steroid Treatment As Regular Therapy in Early Asthma (START) study 5-year follow-up: effectiveness of early intervention with budesonide in mild persistent asthma

    DEFF Research Database (Denmark)

    Busse, William W; Pedersen, Søren; Pauwels, Romain A

    2008-01-01

    BACKGROUND: The Inhaled Steroid Treatment as Regular Therapy in Early Asthma (START) study enrolled 7241 patients aged 5 to 66 years with recent-onset, mild persistent asthma to assess early intervention with the inhaled corticosteroid budesonide on long-term asthma control. OBJECTIVE: The open......-label phase of the START study was included to determine the effect on lung function and asthma control of adding budesonide to the reference group patients who had not initially received inhaled corticosteroids. METHODS: Patients were randomized to double-blind treatment with budesonide, 200 mug (those aged...

  6. Vitamin D as an adjunctive therapy in asthma. Part 2: A review of human studies.

    Science.gov (United States)

    Kerley, Conor P; Elnazir, Basil; Faul, John; Cormican, Liam

    2015-06-01

    Vitamin D deficiency (VDD) is highly prevalent worldwide, with adverse effects on bone health but also potentially other unfavorable consequences. VDD and asthma-incidence/severity share many common risk factors, including winter season, industrialization, poor diet, obesity, dark skin pigmentation, and high latitude. Multiple anatomical areas relevant to asthma contain both the enzyme responsible for producing activated vitamin D and the vitamin D receptor suggesting that activated vitamin D (1,25-dihydroxyvitamin D) may have important local effects at these sites. Emerging evidence suggests that VDD is associated with increased airway hyperresponsiveness, decreased pulmonary function, worse asthma control, and possibly decreased response to standard anti-asthma therapy. However the effect is inconsistent with preliminary evidence from different studies suggesting vitamin D is both beneficial and detrimental to asthma genesis and severity. Current evidence suggests that supplementation with moderate doses of vitamin D may be appropriate for maintenance of bone health in asthmatics, particularly steroid users. However emerging data from an increasing number of randomized, controlled, intervention studies of vitamin D supplementation in pediatric and adult asthma are becoming available and should help determine the importance, if any of vitamin D for asthma pathogenesis. The purpose of this second of a two-part review is to review the current human literature on vitamin D and asthma, discussing the possible consequences of VDD for asthma and the potential for vitamin D repletion as adjunct therapy. Copyright © 2015 Elsevier Ltd. All rights reserved.

  7. The Urban Environment and Childhood Asthma (URECA birth cohort study: design, methods, and study population

    Directory of Open Access Journals (Sweden)

    Sandel Megan T

    2009-05-01

    Full Text Available Abstract Background The incidence and morbidity of wheezing illnesses and childhood asthma is especially high in poor urban areas. This paper describes the study design, methods, and population of the Urban Environment and Childhood Asthma (URECA study, which was established to investigate the immunologic causes of asthma among inner-city children. Methods and Results URECA is an observational prospective study that enrolled pregnant women in central urban areas of Baltimore, Boston, New York City, and St. Louis and is following their offspring from birth through age 7 years. The birth cohort consists of 560 inner-city children who have at least one parent with an allergic disease or asthma, and all families live in areas in which at least 20% of the population has incomes below the poverty line. In addition, 49 inner-city children with no parental history of allergies or asthma were enrolled. The primary hypothesis is that specific urban exposures in early life promote a unique pattern of immune development (impaired antiviral and increased Th2 responses that increases the risk of recurrent wheezing and allergic sensitization in early childhood, and of asthma by age 7 years. To track immune development, cytokine responses of blood mononuclear cells stimulated ex vivo are measured at birth and then annually. Environmental assessments include allergen and endotoxin levels in house dust, pre- and postnatal maternal stress, and indoor air nicotine and nitrogen dioxide. Nasal mucous samples are collected from the children during respiratory illnesses and analyzed for respiratory viruses. The complex interactions between environmental exposures and immune development will be assessed with respect to recurrent wheeze at age 3 years and asthma at age 7 years. Conclusion The overall goal of the URECA study is to develop a better understanding of how specific urban exposures affect immune development to promote wheezing illnesses and asthma.

  8. Bidirectionality in the relationship between asthma and smoking in adolescents : A population-based cohort study

    NARCIS (Netherlands)

    De Ven, Monique O. M. Van; Engels, Rutger C. M. E.; Kerstjens, Huib A. M.; Van Den Eijnden, Regina J. J. M.

    Purpose: Several cross-sectional studies have showed higher smoking rates among adolescents with asthma, but hardly any study has investigated this relation longitudinally. This study examines whether these cross-sectional results are caused by higher smoking onset among adolescents with asthma, or

  9. Associations between asthma, overweight and physical activity in children: a cross-sectional study.

    Science.gov (United States)

    Willeboordse, Maartje; van de Kant, Kim D G; van der Velden, Charlotte A; van Schayck, Constant P; Dompeling, Edward

    2016-09-01

    Asthma and obesity are highly prevalent in children, and are interrelated resulting in a difficult-to-treat asthma-obesity phenotype. The exact underlying mechanisms of this phenotype remain unclear, but decreased physical activity (PA) could be an important lifestyle factor. We hypothesize that both asthma and overweight/obesity decrease PA levels and interact on PA levels in asthmatic children with overweight/obesity. School-aged children (n = 122) were divided in 4 groups (healthy control, asthma, overweight/obesity and asthma, and overweight/obesity). Children were asked to perform lung function tests and wear an activity monitor for 7 days. PA was determined by: step count, active time, screen time, time spent in organized sports and active transport forms. We used multiple linear regression techniques to investigate whether asthma, body mass index-standard deviation score (BMI-SDS), or the interaction term asthma x BMI-SDS were associated with PA. Additionally, we tested if asthma features (including lung function and medication) were related to PA levels in asthmatic children. Asthma, BMI-SDS and the interaction between asthma x BMI-SDS were not related to any of the PA variables (p ≥ 0.05). None of the asthma features could predict PA levels (p ≥ 0.05). Less than 1 in 5 children reached the recommended daily step count guidelines of 12,000 steps/day. We found no significant associations between asthma, overweight and PA levels in school-aged children in this study. However, as PA levels were worryingly low, effective PA promotion in school-aged children is necessary.

  10. The contribution of an asthma diagnostic consultation service in obtaining an accurate asthma diagnosis for primary care patients: results of a real-life study.

    Science.gov (United States)

    Gillis, R M E; van Litsenburg, W; van Balkom, R H; Muris, J W; Smeenk, F W

    2017-05-19

    Previous studies showed that general practitioners have problems in diagnosing asthma accurately, resulting in both under and overdiagnosis. To support general practitioners in their diagnostic process, an asthma diagnostic consultation service was set up. We evaluated the performance of this asthma diagnostic consultation service by analysing the (dis)concordance between the general practitioners working hypotheses and the asthma diagnostic consultation service diagnoses and possible consequences this had on the patients' pharmacotherapy. In total 659 patients were included in this study. At this service the patients' medical history was taken and a physical examination and a histamine challenge test were carried out. We compared the general practitioners working hypotheses with the asthma diagnostic consultation service diagnoses and the change in medication that was incurred. In 52% (n = 340) an asthma diagnosis was excluded. The diagnosis was confirmed in 42% (n = 275). Furthermore, chronic rhinitis was diagnosed in 40% (n = 261) of the patients whereas this was noted in 25% (n = 163) by their general practitioner. The adjusted diagnosis resulted in a change of medication for more than half of all patients. In 10% (n = 63) medication was started because of a new asthma diagnosis. The 'one-stop-shop' principle was met with 53% of patients and 91% (n = 599) were referred back to their general practitioner, mostly within 6 months. Only 6% (n = 41) remained under control of the asthma diagnostic consultation service because of severe unstable asthma. In conclusion, the asthma diagnostic consultation service helped general practitioners significantly in setting accurate diagnoses for their patients with an asthma hypothesis. This may contribute to diminish the problem of over and underdiagnosis and may result in more appropriate treatment regimens. SERVICE HELPS GENERAL PRACTITIONERS MAKE ACCURATE DIAGNOSES: A consultation service can

  11. Asthma and Attention-Deficit/Hyperactivity Disorder: A Nationwide Population-Based Prospective Cohort Study

    Science.gov (United States)

    Chen, Mu-Hong; Su, Tung-Ping; Chen, Ying-Sheue; Hsu, Ju-Wei; Huang, Kai-Lin; Chang, Wen-Han; Chen, Tzeng-Ji; Bai, Ya-Mei

    2013-01-01

    Background: Previous cross-sectional studies have suggested an association between asthma and attention-deficit/hyperactivity disorder (ADHD), but the temporal relationship was not determined. Using a nationwide population-based prospective case-control cohort study (1:4, age-/gender-matched), we hypothesized that asthma in infanthood or early…

  12. Prenatal and infant paracetamol exposure and development of asthma: the Norwegian Mother and Child Cohort Study.

    Science.gov (United States)

    Magnus, Maria C; Karlstad, Øystein; Håberg, Siri E; Nafstad, Per; Davey Smith, George; Nystad, Wenche

    2016-04-01

    Paracetamol exposure has been positively associated with asthma development. The relative importance of prenatal vs infant exposure and confounding by indication remains elusive. We examined the association of prenatal and infant (first 6 months) paracetamol exposure with asthma development while addressing confounding by indication. We used information from the Norwegian Mother and Child Cohort Study, including 53169 children for evaluation of current asthma at 3 years, 25394 for current asthma at 7 years and 45607 for dispensed asthma medications at 7 years in the Norwegian Prescription Database. We calculated adjusted relative risks (adj. RR) and 95% confidence intervals (CI) using log-binomial regression. There were independent modest associations between asthma at 3 years with prenatal paracetamol exposure (adj. RR 1.13; 95% CI: 1.02-1.25) and use of paracetamol during infancy (adj. RR 1.29; 95% CI: 1.16-1.45). The results were consistent for asthma at 7 years. The associations with prenatal paracetamol exposure were seen for different indications (pain, respiratory tract infections/influenza and fever). Maternal pain during pregnancy was the only indication that showed an association both with and without paracetamol use. Maternal paracetamol use outside pregnancy and paternal paracetamol use were not associated with asthma development. In a secondary analysis, prenatal ibuprofen exposure was positively associated with asthma at 3 years but not asthma at 7 years. This study provides evidence that prenatal and infant paracetamol exposure have independent associations with asthma development. Our findings suggest that the associations could not be fully explained by confounding by indication. © The Author 2016; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.

  13. Mother's education and offspring asthma risk in 10 European cohort studies

    NARCIS (Netherlands)

    Lewis, Kate Marie; Ruiz, Milagros; Goldblatt, Peter; Morrison, Joana; Porta, Daniela; Forastiere, Francesco; Hryhorczuk, Daniel; Zvinchuk, Oleksandr; Saurel-Cubizolles, Marie-Josephe; Lioret, Sandrine; Annesi-Maesano, Isabella; Vrijheid, Martine; Torrent, Maties; Iniguez, Carmen; Larranaga, Isabel; Harskamp-van Ginkel, Margreet W.; Vrijkotte, Tanja G. M.; Klanova, Jana; Svancara, Jan; Barross, Henrique; Correia, Sofia; Jarvelin, Marjo-Riitta; Taanila, Anja; Ludvigsson, Johnny; Faresjo, Tomas; Marmot, Michael; Pikhart, Hynek

    2017-01-01

    Highly prevalent and typically beginning in childhood, asthma is a burdensome disease, yet the risk factors for this condition are not clarified. To enhance understanding, this study assessed the cohort-specific and pooled risk of maternal education on asthma in children aged 3-8 across 10 European

  14. Antibiotic sales and the prevalence of symptoms of asthma, rhinitis, and eczema: The International Study of Asthma and Allergies in Childhood (ISAAC).

    Science.gov (United States)

    Foliaki, Sunia; Nielsen, Sandy Kildegaard; Björkstén, Bengt; Von Mutius, Erika; Cheng, Soo; Pearce, Neil

    2004-06-01

    It has been hypothesized that antibiotic use early in life may increase the subsequent risk of asthma. We have conducted an ecologic analysis of the relationship between antibiotics sales and the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema in 99 centres from 28 countries. Data for antibiotics sales for 28 countries were obtained from the Institute for Medical Statistics (IMS), Health Global Services, UK and converted to defined daily doses (DDD). Data on the prevalence of symptoms of asthma, rhinitis, and eczema in 13-14 year olds were based on the responses to the written and video questionnaires from the International Study of Asthma and Allergies in Childhood (ISAAC). The analysis was adjusted for gross national product (GNP) as an estimate of the level of affluence. In general, there was a positive association between per capita antibiotics sales and the prevalence of symptoms for asthma, rhinitis, and eczema, but the associations generally became negative once the analyses had been adjusted for GNP. In particular, there were non-significant negative associations between total antibiotics sales and the prevalence of wheeze ever, wheeze in the last 12 months, nose problems with itchy-watery eyes, itchy rash in the last 12 months, and eczema ever. On the other hand there were weak non-significant positive associations for asthma ever, nose problems ever, nose problems in the last 12 months, and itchy rash ever. There was a statistically significant positive association with wheeze at rest as measured by the asthma video questionnaire; however, even this association was weak and would not account for more than a 1% difference in asthma prevalence between countries. These findings are generally not consistent with the hypothesis that antibiotic use increases the risk of asthma, rhinitis, or eczema. If there is a causal association of antibiotic use with asthma risk, it does not appear to explain the international differences in

  15. Childhood Asthma: A Clinical Study in Southern Nigeria | Okoh ...

    African Journals Online (AJOL)

    The most common recognized trigger factor for exacerbation of asthmatic symptoms was extreme cold seen in 29 (72.5%) patients, while the most common identified early childhood risk factor for development of asthma was a positive family history of asthma in 21 (52.5%) patients. Thirty five of the subjects (87.5%) had mild ...

  16. Comorbidities of asthma during childhood : possibly important, yet poorly studied

    NARCIS (Netherlands)

    de Groot, E. P.; Duiverman, E. J.; Brand, P. L. P.

    Asthma in adults is associated with comorbidities such as obesity, gastro-oesophageal reflux, dysfunctional breathing and mental disorders. Herein, we provide an overview of the current state of evidence on these comorbidities in childhood asthma. The prevalence, known mechanisms and possible

  17. Accuracy of spirometry for detection of asthma: a cross-sectional study.

    Science.gov (United States)

    Meneghini, Andréa Cristina; Paulino, Ana Carolina Botto; Pereira, Luciano Penha; Vianna, Elcio Oliveira

    2017-01-01

    Asthma is a chronic inflammatory disease with airway hyperresponsiveness. Spirometry is the most commonly used test among asthmatic patients. Another functional test used for diagnosing asthma is the bronchial challenge test. The aim of this study was to analyze the accuracy of spirometry for detecting asthma in the general population. Cross-sectional study with data analysis to evaluate the accuracy of spirometry through calculating sensitivity, specificity and predictive values and through the kappa agreement test. Subjects who constituted a birth cohort were enrolled at the age of 23 to 25 years. Spirometric abnormality was defined as reduced forced expiratory volume in one second, i.e. lower than 80% of the predicted value. Measurement of bronchial responsiveness was performed by means of the bronchial challenge test with methacholine. The gold-standard diagnosis of asthma was defined as the presence of bronchial hyperresponsiveness in association with respiratory symptoms. Asthma was detected in 200 subjects (10.4%) out of the sample of 1922 individuals. Spirometric abnormality was detected in 208 subjects (10.9%) of the sample. The specificity of spirometric abnormality for detecting asthma was 90%, sensitivity was 23%, positive predictive value was 22%, and negative predictive value was 91%. The kappa test revealed weak agreement of 0.13 (95% confidence interval, CI: 0.07-0.19) between spirometry and the diagnosis of asthma. Spirometry, as a single test, has limitations for detecting asthma in the general population.

  18. Omalizumab treats chronic rhinosinusitis with nasal polyps and asthma together-a real life study.

    Science.gov (United States)

    Bidder, T; Sahota, J; Rennie, C; Lund, V J; Robinson, D S; Kariyawasam, H H

    2018-03-01

    Chronic rhinosinusitis with nasal polyps (CRSwNP) and asthma often coexist and thus treating both with one intervention is an attractive strategy. To prospectively evaluate whether treatment with the monoclonal antibody against IgE Omalizumab for severe allergic asthma also effectively treats co-existent CRSwNP. SNOT-22 and the ACQ-7 scores were recorded at 4 and 16 weeks of treatment in a cohort of patients with both CRSwNP and severe refractory allergic asthma treated with Omalizumab (n=13) according to UK guidelines for their severe asthma. SNOT-22 in a surgery only treated CRSwNP with asthma group (n=24) was compared. Rapid improvement was seen at 4 weeks and 16 weeks of treatment in both CRSwNP and asthma control. The improvement in CRSwNP with Omalizumab was similar to that seen in a group of patients who received upper airway surgery. Omalizumab treatment for severe allergic asthma also improves co-existent CRSwNP. Further clinical studies of current and emerging biological agents for severe asthma should include upper airway outcomes. These agents may be effective for severe CRSwNP and comparative studies with surgery are warranted.

  19. Risk factors for asthma in young adults: a co-twin control study

    DEFF Research Database (Denmark)

    Thomsen, S F; Ulrik, C S; Kyvik, K O

    2006-01-01

    and females = 0.54, 95% CI: 0.36-0.80, P = 0.002), and increasing levels of body mass index (BMI; OR per unit = 1.11, 95% CI: 1.02-1.20, P = 0.009) were significant predictors of asthma. CONCLUSIONS: Hay fever, eczema, female sex, exercise and increasing levels of BMI were risk factors for asthma in young...... who were initially unaffected with respect to asthma at a nationwide questionnaire-based study in 1994 participated in a similar follow-up study in 2002. Subjects were regarded incident asthma cases when responding affirmatively to the question 'Do you have, or have you ever had asthma'? in 2002...

  20. Attitudes and actions of asthma patients on regular maintenance therapy: the INSPIRE study

    Directory of Open Access Journals (Sweden)

    Myrseth Sven-Erik

    2006-06-01

    Full Text Available Abstract Background This study examined the attitudes and actions of 3415 physician-recruited adults aged ≥ 16 years with asthma in eleven countries who were prescribed regular maintenance therapy with inhaled corticosteroids or inhaled corticosteroids plus long-acting β2-agonists. Methods Structured interviews were conducted to assess medication use, asthma control, and patients' ability to recognise and self-manage worsening asthma. Results Despite being prescribed regular maintenance therapy, 74% of patients used short-acting β2-agonists daily and 51% were classified by the Asthma Control Questionnaire as having uncontrolled asthma. Even patients with well-controlled asthma reported an average of 6 worsenings/year. The mean period from the onset to the peak symptoms of a worsening was 5.1 days. Although most patients recognised the early signs of worsenings, the most common response was to increase short-acting β2-agonist use; inhaled corticosteroids were increased to a lesser extent at the peak of a worsening. Conclusion Previous studies of this nature have also reported considerable patient morbidity, but in those studies approximately three-quarters of patients were not receiving regular maintenance therapy and not all had a physician-confirmed diagnosis of asthma. This study shows that patients with asthma receiving regular maintenance therapy still have high levels of inadequately controlled asthma. The study also shows that patients recognise deteriorating asthma control and adjust their medication during episodes of worsening. However, they often adjust treatment in an inappropriate manner, which represents a window of missed opportunity.

  1. Sunny hours and variations in the prevalence of asthma in schoolchildren according to the International Study of Asthma and Allergies (ISAAC) Phase III in Spain

    Science.gov (United States)

    Arnedo-Pena, Alberto; García-Marcos, Luis; Fernández-Espinar, Jorge Fuertes; Bercedo-Sanz, Alberto; Aguinaga-Ontoso, Ines; González-Díaz, Carlos; Carvajal-Urueña, Ignacio; Busquet-Monge, Rosa; Suárez-Varela, Maria Morales; de Andoin, Nagore García; Batlles-Garrido, Juan; Blanco-Quirós, Alfredo; Varela, Angel López-Silvarrey; García-Hernández, Gloria

    2011-05-01

    The objective of this study was to estimate the relationship between the prevalence of asthma in schoolchildren aged 6-7 years and 13-14 years and the mean annual sunny hours (MASH) in Spain, and to explore predictive models for asthma prevalence. The prevalence of asthma was obtained from the International Study of Asthma and Allergies (ISAAC) Phase III 2002-2003, and climate and socio-economic variables from official sources. Nine centres were studied and a further four centres, two of which are in ISAAC, to test the predictive models. Logistic regression was used to estimate adjusted prevalence rates of asthma for each centre, and multiple regression models to study the effects of MASH and other meteorological and socio-economic variables. The adjusted prevalence rate of asthma decreased 0.6% [95% confidence interval (CI) 0.4-0.8%] for the 6-7 years group and 1.1% (95% CI 0.8-1.3%) for the 13-14 years group with an increase in the MASH of 100 h. Relative humidity was negatively associated with asthma in the older age group, and gross province product per capita (GPP) was positively associated with asthma in the younger age group. The predictive models, which included MASH, gender, relative humidity, and GPP, anticipated prevalence rates of asthma without significant differences between the levels observed and those expected in 9 of the11 measurements carried out. The results indicate that sunny hours have a protective effect on the prevalence of asthma in schoolchildren.

  2. The Mediterranean healthy eating, ageing, and lifestyle (MEAL) study: rationale and study design.

    Science.gov (United States)

    Grosso, Giuseppe; Marventano, Stefano; D'Urso, Maurizio; Mistretta, Antonio; Galvano, Fabio

    2017-08-01

    There is accumulating evidence suggesting that Mediterranean lifestyles, including nutrition and sleeping patterns as well as social integration, may play a role in reducing age-related diseases. However, the literature is mostly deficient of evidence provided by Italian Mediterranean islands that more closely adhered to the originally described lifestyles. In this paper, we described the rationale and the study design of the Mediterranean healthy Eating, Ageing, and Lifestyle (MEAL) study, a prospective population-based cohort established in Sicily, southern Italy. The main exposures investigated are classical determinants of health, including demographic, nutritional habits, smoking and physical activity status, as well as eating-related behaviors, sleeping habits, sun exposure, social resources, and perceived stress. Anthropometric measurements will be collected. The main outcomes included depression, quality of life, and, after the follow-up period, also cardiovascular disease and cancer. The MEAL study may provide important data to increase our knowledge regarding the prevalence, incidence, and risk factors of age-related disorders in the Mediterranean region.

  3. Longitudinal Andhra Pradesh Eye Disease Study: rationale, study design and research methodology.

    Science.gov (United States)

    Khanna, Rohit C; Murthy, Gudlavalleti Vs; Marmamula, Srinivas; Mettla, Asha Latha; Giridhar, Pyda; Banerjee, Seema; Shekhar, Konegari; Chakrabarti, Subhabrata; Gilbert, Clare; Rao, Gullapalli N

    2016-03-01

    The rationale, objectives, study design and procedures for the longitudinal Andhra Pradesh Eye Disease Study are described. A longitudinal cohort study was carried out. Participants include surviving cohort from the rural component of Andhra Pradesh Eye Disease Study. During 1996-2000, Andhra Pradesh Eye Disease Survey was conducted in three rural (n = 7771) and one urban (n = 2522) areas (now called Andhra Pradesh Eye Disease Study 1). In 2009-2010, a feasibility exercise (Andhra Pradesh Eye Disease Study 2) for a longitudinal study (Andhra Pradesh Eye Disease Study 3) was undertaken in the rural clusters only, as urban clusters no longer existed. In Andhra Pradesh Eye Disease Study 3, a detailed interview will be carried out to collect data on sociodemographic factors, ocular and systemic history, risk factors, visual function, knowledge of eye diseases and barriers to accessing services. All participants will also undergo a comprehensive eye examination including photography of lens, optic disc and retina, Optic Coherence Tomography of the posterior segment, anthropometry, blood pressure and frailty measures. Measures include estimates of the incidence of visual impairment and age-related eye disease (lens opacities, glaucoma and age-related macular degeneration) and the progression of eye disease (lens opacities and myopia) and associated risk factors. Of the 7771 respondents examined in rural areas in Andhra Pradesh Eye Disease Study 1, 5447 (70.1%) participants were traced in Andhra Pradesh Eye Disease Study 2. These participants will be re-examined. Andhra Pradesh Eye Disease Study 3 will provide data on the incidence and progression of visual impairment and major eye diseases and their associated risk factors in India. The study will provide further evidence to aid planning eye care services. © 2015 Royal Australian and New Zealand College of Ophthalmologists.

  4. PET/CT-guided interventional procedures: rationale, justification, initial study, and research plan

    Energy Technology Data Exchange (ETDEWEB)

    Wong, K.; Rahill, J.; Cleary, K. [Computer Aided Interventions and Medical Robotics (CAIMR), Imaging Science and Information Systems (ISIS) Center, Georgetown Univ. Medical Center, Washington, DC (United States); Petrillo, S.; Earl-Graef, D. [Dept. of Radiology, Georgetown Univ. Hospital, MedStar Health, Washington, DC (United States); Banovac, F.; Levy, E. [Computer Aided Interventions and Medical Robotics (CAIMR), Imaging Science and Information Systems (ISIS) Center, Georgetown Univ. Medical Center, Washington, DC (United States); Dept. of Radiology, Georgetown Univ. Hospital, MedStar Health, Washington, DC (United States); Shekhar, R. [Dept. of Radiology, Univ. of Maryland Medical Center, Baltimore, MD (United States)

    2007-06-15

    Positron-emission tomography (PET) and PET/CT (computed tomography) are becoming increasingly important for diagnosis and treatment of cancer. Clinically relevant changes can sometimes be seen on PET that are not seen on other imaging modalities. However, PET is not suitable for guiding biopsy as the images are not obtained in real-time. Therefore, our research group has begun developing a concept for PET/CT-guided interventional procedures. This paper presents the rationale for this concept, outlines our research plan, and includes an initial study to evaluate the relative sensitivity of CT and PET/CT in detecting suspicious lesions. (orig.)

  5. Evaluating web-based cognitive-affective remediation in recent trauma survivors: study rationale and protocol.

    Science.gov (United States)

    Fine, Naomi B; Achituv, Michal; Etkin, Amit; Merin, Ofer; Shalev, Arieh Y

    2018-01-01

    Background : The immediate aftermath of traumatic events is a period of enhanced neural plasticity, following which some survivors remain with post-traumatic stress disorder (PTSD) whereas others recover. Evidence points to impairments in emotional reactivity, emotion regulation, and broader executive functions as critically contributing to PTSD. Emerging evidence further suggests that the neural mechanisms underlying these functions remain plastic in adulthood and that targeted retraining of these systems may enhance their efficiency and could reduce the likelihood of developing PTSD. Administering targeted neurocognitive training shortly after trauma exposure is a daunting challenge. This work describes a study design addressing that challenge. The study evaluated the direct effects of cognitive remediation training on neurocognitive mechanisms that hypothetically underlay PTSD, and the indirect effect of this intervention on emerging PTSD symptoms. Method : We describe a study rationale, design, and methodological choices involving: (a) participants' enrolment; (b) implementation and management of a daily self-administered, web-based intervention; (c) reliable, timely screening and assessment of treatment of eligible survivors; and (d) defining control conditions and outcome measures. We outline the rationale of choices made regarding study sample, timing of intervention, measurements, monitoring participants' adherence, and ways to harmonize and retain interviewers' fidelity and mitigate eventual burnout by repeated contacts with recently traumatized survivors. Conclusion : Early web-based interventions targeting causative mechanisms of PTSD can be informed by the model presented in this paper.

  6. Effect of Education on Asthma Control in Children: A Quasi- Experimental Study

    Directory of Open Access Journals (Sweden)

    Arash Kalantari

    2017-12-01

    Full Text Available Introduction: The prevalence of asthma has increased significantly in recent decades1 especially in lower socioeconomic groups and in minority populations. Because of the increasing prevalence of asthma among children in worldwide and Iran, the importance of timely control of the disease after its diagnosis and few studies on the effect of education on asthma control in Iran, the aim of this study was to investigate the effect of education on asthma control in children. Methods: In this quasi-experimental study, 104 Iranian children (6-14 years old with asthma referred to asthma and allergy clinic of Children's Medical Center in Tehran were studied via convenience sampling method. Recruitment was occurred between 2011 to 2014. Subjects randomly were divided into two equal groups of intervention and control. For intervention group, common education as well as special education in format of booklet, pamphlets, CD and group training sessions were applied every two weeks within the first two months of follow up and every two months then after. While, the control group received usual careResults: The means of FEV1/ FVC change, frequency of admission to the ED, hospitalization and absence from school and use of steroids were significantly different before and after education in the intervention group. While changes among measured parameters in the control group were not significantly different.Conclusion: The results of this study showed that specific education has significant helpful effect on asthma attack control in children.

  7. Relationship between obesity and asthma symptoms among children in Ahvaz, Iran: a cross sectional study

    Directory of Open Access Journals (Sweden)

    Alipoor Mohammad

    2011-01-01

    Full Text Available Abstract Background Obesity has been identified as a risk factor for higher prevalence of asthma and asthma-related symptoms in children. The objective of this study was to evaluate the relationship between the prevalence of asthma symptoms and obesity among school-age children in the city of Ahvaz, Iran. Methods A total of 903 children, 7 to 11 years of age, were enrolled in this study through cluster sampling. The International Study of Asthma and Allergies in Childhood (ISAAC questionnaire was used to identify the children who were currently suffering from asthma. Height and weight were measured and body mass index (BMI was calculated in kg/m2. Overweight was defined as BMI greater than the age- and sex-specific 85th percentile, and obesity as BMI greater than the 95th percentile. We determined the relationship between obesity and asthma symptoms by chi-square tests. Results The prevalence of wheeze ever, current wheezing, obesity, and overweight was 21.56%, 8.7%, 6.87%, and 9.5%, respectively. The current prevalence of wheezing among obese and overweight children was 68.75% and 37%, respectively, and there was a statistical association between obesity and the prevalence of current wheezing (p Conclusion There is a strong association between asthma symptoms and both overweight and obesity in both sexes among school-age children.

  8. mHealth intervention to support asthma self-management in adolescents: the ADAPT study.

    Science.gov (United States)

    Kosse, Richelle C; Bouvy, Marcel L; de Vries, Tjalling W; Kaptein, Ad A; Geers, Harm Cj; van Dijk, Liset; Koster, Ellen S

    2017-01-01

    Poor medication adherence in adolescents with asthma results in poorly controlled disease and increased morbidity. The aim of the ADolescent Adherence Patient Tool (ADAPT) study is to develop an mHealth intervention to support self-management and to evaluate the effectiveness in improving medication adherence and asthma control. The ADAPT intervention consists of an interactive smartphone application (app) connected to a desktop application for health care providers, in this study, the community pharmacist. The app contains several functions to improve adherence as follows: 1) a questionnaire function to rate asthma symptoms and monitor these over time; 2) short movie clips with medication and disease information; 3) a medication reminder; 4) a chat function with peers; and 5) a chat function with the pharmacist. The pharmacist receives data from the patient's app through the desktop application, which enables the pharmacist to send information and feedback to the patient. The ADAPT intervention is tested in a community pharmacy-based cluster randomized controlled trial in the Netherlands, aiming to include 352 adolescents with asthma. The main outcome is adherence, measured by patient's self-report and refill adherence calculated from pharmacy dispensing records. In addition, asthma control, illness perceptions, medication beliefs, and asthma-related quality of life are measured. This study will provide in-depth knowledge on the effectiveness of an mHealth intervention to support asthma self-management in adolescents. These insights will also be useful for adolescents with other chronic diseases.

  9. Determinants of the incidence of childhood asthma: a two-stage case-control study.

    Science.gov (United States)

    Martel, Marie-Josée; Rey, Evelyne; Malo, Jean-Luc; Perreault, Sylvie; Beauchesne, Marie-France; Forget, Amélie; Blais, Lucie

    2009-01-15

    Extensive literature exists on potential risk factors for childhood asthma. To the authors' knowledge, no investigators have yet attempted to disentangle the effects of those determinants within a single study setting. The authors aimed to evaluate the independent effects of 47 potential determinants (from the prenatal, perinatal, and childhood periods) of asthma development in children within the first 10 years of life. From a Canadian birth cohort of 26,265 children (1990-2002), a 2-stage case-control study was conducted. In the first stage, 20 controls per case were selected from 3 administrative databases. In the second stage, selected mothers were mailed questionnaires for assessment of additional determinants. Increased risks of childhood asthma were found for > or =1 previous diagnosis of bronchopulmonary disease and atopic dermatitis in the child, oxygen administration after birth, prescription of antibiotics within the first 6 months of life, male gender, asthma during pregnancy, use of antibiotics during pregnancy, maternal receipt of social aid, paternal asthma, and asthma in siblings. Protective effects included use of intranasal corticosteroids during pregnancy, having a wood-burning fireplace, having pets in the home prior to the index date, breastfeeding, and day-care attendance. This study allowed the authors to identify, within a single setting, the most influential determinants of childhood asthma among 47 predictors assessed for the prenatal, perinatal, and childhood periods.

  10. Pediatric Asthma Care Coordination in Underserved Communities: A Quasiexperimental Study.

    Science.gov (United States)

    Janevic, Mary R; Stoll, Shelley; Wilkin, Margaret; Song, Peter X K; Baptist, Alan; Lara, Marielena; Ramos-Valencia, Gilberto; Bryant-Stephens, Tyra; Persky, Victoria; Uyeda, Kimberly; Lesch, Julie Kennedy; Wang, Wen; Malveaux, Floyd J

    2016-11-01

    To assess the effect of care coordination on asthma outcomes among children in underserved urban communities. We enrolled children, most of whom had very poorly or not well-controlled asthma, in medical-social care coordination programs in Los Angeles, California; Chicago, Illinois; Philadelphia, Pennsylvania; and San Juan, Puerto Rico in 2011 to 2014. Participants (n = 805; mean age = 7 years) were 60% male, 50% African American, and 42% Latino. We assessed asthma symptoms and health care utilization via parent interview at baseline and 12 months. To prevent overestimation of intervention effects, we constructed a comparison group using bootstrap resampling of matched control cases from previous pediatric asthma trials. At follow-up, intervention participants had 2.2 fewer symptom days per month (SD = 0.3; P < .01) and 1.9 fewer symptom nights per month (SD = 0.35; P < .01) than did the comparison group. The relative risk in the past year associated with the intervention was 0.63 (95% confidence interval [CI] = 0.45, 0.89) for an emergency department visit and 0.69 (95% CI = 0.47, 1.01) for hospitalization. Care coordination may improve pediatric asthma symptom control and reduce emergency department visits. Expanding third-party reimbursement for care coordination services may help reduce pediatric asthma disparities.

  11. Heritability and confirmation of genetic association studies for childhood asthma in twins.

    Science.gov (United States)

    Ullemar, V; Magnusson, P K E; Lundholm, C; Zettergren, A; Melén, E; Lichtenstein, P; Almqvist, C

    2016-02-01

    Although the genetics of asthma has been extensively studied using both quantitative and molecular genetic analysis methods, both approaches lack studies specific to the childhood phenotype and including other allergic diseases. This study aimed to give specific estimates for the heritability of childhood asthma and other allergic diseases, to attempt to replicate findings from genomewide association studies (GWAS) for childhood asthma and to test the same variants against other allergic diseases. In a cohort of 25 306 Swedish twins aged 9 or 12 years, data on asthma were available from parental interviews and population-based registers. The interviews also inquired about wheeze, hay fever, eczema, and food allergy. Through structural equation modeling, the heritability of all phenotypes was calculated. A subset of 10 075 twins was genotyped for 16 single nucleotide polymorphisms (SNPs) selected from previous GWAS; these were first tested for association with asthma and significant findings also against the other allergic diseases. The heritability of any childhood asthma was 0.82 (95% CI 0.79-0.85). For the other allergic diseases, the range was approximately 0.60-0.80. Associations for six SNPs with asthma were replicated, including rs2305480 in the GSDMB gene (OR 0.80, 95% CI 0.74-0.86, P = 1.5*10(-8) ; other significant associations all below P = 3.5*10(-4) ). Of these, only rs3771180 in IL1RL1 was associated with any other allergic disease (for hay fever, OR 0.64, 95% CI 0.53-0.77, P = 2.5*10(-6) ). Asthma and allergic diseases of childhood are highly heritable, and these high-risk genetic variants associated specifically with childhood asthma, except for one SNP shared with hay fever. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  12. Children's, parents' and health professionals' views on the management of childhood asthma: a qualitative study.

    Science.gov (United States)

    Searle, Aidan; Jago, Russell; Henderson, John; Turner, Katrina M

    2017-09-11

    The management of childhood asthma is often sub-optimal. Parents and other caregivers are primarily responsible for disease management and this responsibility includes communication with health professionals. The aim of this multi-perspective qualitative study was to explore the views of children, parents and health professionals to gain insight into the approach to clinical care in the management of childhood asthma. Interviews were held with nine parent-child (6-8 years) dyads, and 13 health professionals working in primary and secondary care. Interviews were transcribed verbatim and analysed thematically. Three key themes emerged that were common to all data sets; (1) Child and parent awareness of symptoms; (2) Management and child wellbeing; and (3) Professional communication education and consultation with families. Although some children demonstrate good awareness of symptoms and appropriate use of medication, some parents expressed difficulty in identifying triggers and symptoms of asthma. Furthermore, parents lacked awareness regarding appropriate use of medication for preventing and managing symptoms of asthma. Health professionals believed that communication and education was lacking. Data from all participants suggested that consultations could be enhanced with greater emphasis on children's and parents' perceptions of asthma in the development of asthma management plans. GUIDING FAMILIES THROUGH DISEASE MANAGEMENT: Both parents' and children's perceptions and understanding of childhood asthma should be considered when developing asthma management plans. The management of asthma is challenging and can result in poor disease outcomes if care is not taken. An individual's perception of their (or their child's) asthma can also affect the efficacy of treatment. Aidan Searle at the Bristol Biomedical Research Centre, UK, and co-workers, interviewed nine parent-child groups and thirteen health professionals to determine their perceptions of childhood asthma

  13. Risk of psoriasis in patients with childhood asthma: a Danish nationwide cohort study.

    Science.gov (United States)

    Egeberg, A; Khalid, U; Gislason, G H; Mallbris, L; Skov, L; Hansen, P R

    2015-07-01

    Psoriasis and asthma are disorders driven by inflammation. Psoriasis may carry an increased risk of asthma, but the reverse relationship has not been investigated. To investigate the risk of psoriasis in subjects with childhood asthma in a nationwide Danish cohort. Data on all Danish individuals aged 6-14 years at study entry between 1 January 1997 and 31 December 2011 (n = 1,478,110) were linked at an individual level in nationwide registers. Incidence rates per 10,000 person-years were calculated, and incidence rate ratios (IRRs) adjusted for age, sex, concomitant medication and comorbidity were estimated by Poisson regression models. There were 21,725 cases of childhood asthma and 6586 incident cases of psoriasis. There were 5697 and 889 incident cases of mild and severe psoriasis, respectively. The incidence rates of overall, mild and severe psoriasis were 4.49, 3.88 and 0.61 for the reference population, and 5.95, 5.18 and 0.83 for subjects with childhood asthma, respectively. The IRRs for overall, mild and severe psoriasis were 3.94 [95% confidence interval (CI) 2.16-7.17], 5.03 (95% CI 2.48-10.21) and 2.27 (95% CI 0.61-8.42) for patients with childhood asthma. Childhood asthma was associated with a significantly increased risk of psoriasis. Further studies are warranted to determine the clinical significance and effects of therapeutic interventions on this association. © 2015 British Association of Dermatologists.

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

    Directory of Open Access Journals (Sweden)

    Lin Jiang

    2015-10-01

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

  15. The Urban-Rural Gradient In Asthma: A Population-Based Study in Northern Europe

    Directory of Open Access Journals (Sweden)

    Signe Timm

    2015-12-01

    Full Text Available The early life environment appears to have a persistent impact on asthma risk. We hypothesize that environmental factors related to rural life mediate lower asthma prevalence in rural populations, and aimed to investigate an urban-rural gradient, assessed by place of upbringing, for asthma. The population-based Respiratory Health In Northern Europe (RHINE study includes subjects from Denmark, Norway, Sweden, Iceland and Estonia born 1945–1973. The present analysis encompasses questionnaire data on 11,123 RHINE subjects. Six categories of place of upbringing were defined: farm with livestock, farm without livestock, village in rural area, small town, city suburb and inner city. The association of place of upbringing with asthma onset was analysed with Cox regression adjusted for relevant confounders. Subjects growing up on livestock farms had less asthma (8% than subjects growing up in inner cities (11% (hazard ratio 0.72 95% CI 0.57–0.91, and a significant urban-rural gradient was observed across six urbanisation levels (p = 0.02. An urban-rural gradient was only evident among women, smokers and for late-onset asthma. Analyses on wheeze and place of upbringing revealed similar results. In conclusion, this study suggests a protective effect of livestock farm upbringing on asthma development and an urban-rural gradient in a Northern European population.

  16. Risks of pneumonia in patients with asthma taking inhaled corticosteroids

    DEFF Research Database (Denmark)

    O'Byrne, Paul M; Pedersen, Soren; Carlsson, Lars-Göran

    2011-01-01

    Rationale: Inhaled corticosteroids (ICS) are the mainstay of asthma treatment. Studies in chronic obstructive pulmonary disease reported increased rates of pneumonia with ICS. Concerns exist about an increased pneumonia risk in patients with asthma taking ICS. Objectives: To evaluate the risks...... of pneumonia in patients with asthma taking ICS. Methods: A retrospective analysis evaluated studies of the ICS budesonide in asthma. The primary data set were all double-blind, placebo-controlled trials lasting at least 3 months, involving budesonide (26 trials, n = 9,067 for budesonide; n = 5...... effect of ICS on pneumonia adverse events (AEs) or serious adverse events (SAEs). Measurements and Main Results: In the primary data set, the occurrence of pneumonia AEs was 0.5% (rate 10.0 events/1,000 patient-years [TPY]) for budesonide and 1.2% (19.3 per TPY) for placebo (hazard ratio, 0.52; 95...

  17. Obesity and Asthma

    DEFF Research Database (Denmark)

    Juel, Caroline Trunk-Black; Ulrik, Charlotte Suppli

    2013-01-01

    Asthma is more prevalent in obese compared with normal weight subjects. Our aim has been to review current knowledge of the impact of obesity on asthma severity, asthma control, and response to therapy.Several studies have shown that overweight and obesity is associated with more severe asthma...... and impaired quality of life compared with normal weight individuals. Furthermore, obesity is associated with poorer asthma control, as assessed by asthma control questionnaires, limitations in daily activities, breathlessness and wheezing, use of rescue medication, unscheduled doctor visits, emergency...... department visits, and hospitalizations for acute asthma. Studies of the impact of a high body mass index (BMI) on response to asthma therapy have, however, revealed conflicting results. Most studies show that overweight and obesity is associated with less favorable response to asthma therapy with regard...

  18. Risk factors for onset of asthma: a 12-year prospective follow-up study

    DEFF Research Database (Denmark)

    Porsbjerg, C; von Linstow, Marie-Louise; Ulrik, Charlotte Suppli

    2006-01-01

    BACKGROUND: Studies of the clinical outcome in adulthood of asymptomatic airway hyperresponsiveness (AHR) to histamine or exercise-induced bronchospasm (EIB) detected in childhood in general population samples are sparse and have produced conflicting results. OBJECTIVE: To describe the outcome of...... disposition to asthma, furred pets ownership, and concomitant rhinitis or dermatitis increase the risk of asthma development in individuals with AHR to histamine....... asthma, compared with only 5% of individuals in whom these test results were negative. In patients with AHR to histamine, parental asthma (odds ratio [OR], 12.6; 95% confidence interval [CI], 1.5-108.5), furred pets ownership (OR, 6.0; 95% CI, 1.2-19.6), and dermatitis and/or rhinitis in childhood (OR, 2.......2; 95% CI, 1.1-5.1) predicted the subsequent development of asthma, whereas no risk factors for the development of asthma could be identified in individuals with EIB CONCLUSION: Asymptomatic AHR to histamine and EIB in childhood predict the subsequent development of asthma in adulthood. A genetic...

  19. Phenotypic and genetic heterogeneity in a genome-wide linkage study of asthma families

    Directory of Open Access Journals (Sweden)

    Schuster Antje

    2005-01-01

    Full Text Available Abstract Background Asthma is a complex genetic disease with more than 20 genome-wide scans conducted so far. Regions on almost every chromosome have been linked to asthma and several genes have been associated. However, most of these associations are weak and are still awaiting replication. Methods In this study, we conducted a second-stage genome-wide scan with 408 microsatellite markers on 201 asthma-affected sib pair families and defined clinical subgroups to identify phenotype-genotype relations. Results The lowest P value for asthma in the total sample was 0.003 on chromosome 11, while several of the clinical subsets reached lower significance levels than in the overall sample. Suggestive evidence for linkage (p = 0.0007 was found for total IgE on chromosomes 1, 7 and again on chromosome 11, as well as for HDM asthma on chromosome 12. Weaker linkage signals could be found on chromosomes 4 and 5 for early onset and HDM, and, newly described, on chromosome 2 for severe asthma and on chromosome 9 for hay fever. Conclusions This phenotypic dissection underlines the importance of detailed clinical characterisations and the extreme genetic heterogeneity of asthma.

  20. Physical activity and asthma: A longitudinal and multi-country study.

    Science.gov (United States)

    Russell, Melissa A; Janson, Christer; Real, Francisco Gómez; Johannessen, Ane; Waatevik, Marie; Benediktsdóttir, Bryndis; Holm, Mathias; Lindberg, Eva; Schlünssen, Vivi; Raza, Wasif; Dharmage, Shyamali C; Svanes, Cecilie

    2017-11-01

    To investigate the impact of physical activity on asthma in middle-aged adults, in one longitudinal analysis, and one multi-centre cross-sectional analysis. The Respiratory Health in Northern Europe (RHINE) is a population-based postal questionnaire cohort study. Physical activity, height and weight were self-reported in Bergen, Norway, at RHINE II (1999-2001) and all centres at RHINE III (2010-2012). A longitudinal analysis of Bergen data investigated the association of baseline physical activity with follow-up asthma, incident asthma and symptoms, using logistic and zero-inflated Poisson regression (n = 1782). A cross-sectional analysis of all RHINE III centres investigated the association of physical activity with concurrent asthma and symptoms (n = 13,542) using mixed-effects models. Body mass index (BMI) was categorised (asthma (odds ratio [OR] 0.44, 95% confidence interval [CI] 0.22, 0.89), whilst an effect from undertaking vigorous activity 3+ times/week was not detected (OR 1.22, 95% CI 0.44, 2.76). The associations were attenuated with BMI adjustment. In the all-centre cross-sectional analysis an interaction was found, with the association between physical activity and asthma varying across BMI categories. These findings suggest potential longer-term benefit from lighter physical activity, whilst improvement in asthma outcomes from increasing activity intensity was not evident. Additionally, it appears the benefit from physical activity may differ according to BMI.

  1. Asthma, corticosteroid use and schizophrenia: A nationwide population-based study in Taiwan.

    Directory of Open Access Journals (Sweden)

    Wei-Chen Wang

    Full Text Available Asthma and corticosteroid use have been implicated as possible risk factors for schizophrenia. The retrospective cohort study herein aimed to investigate the association between asthma, corticosteroid use, and schizophrenia.Longitudinal data (2000 to 2007 from adults with asthma (n = 50,046 and without asthma (n = 50,046 were compared on measures of schizophrenia incidence using Taiwan's National Health Insurance Research Database (NHIRD. Incidence of schizophrenia diagnosis (ICD-9 codes 295.XX between 2000 and 2007 were compared between groups. Competing risk-adjusted Cox regression analyses were conducted, adjusting for sex, age, residence, socioeconomic status, corticosteroid use, outpatient and emergency room visit frequency, Charlson comorbidity index, and total length of hospital stays days for any disorder.Of the 75,069 subjects, 238 received a diagnosis of schizophrenia. The mean (SD follow-up interval for all subjects was 5.8 (2.3 years. After adjusting for potential confounding factors, asthma was associated with significantly greater hazard ratio for incident schizophrenia 1.40 (95% CI = 1.05, 1.87. Additional factors associated with greater incidence of schizophrenia were rural residence, lower economic status, and poor general health. Older age (i.e. ≥65 years was negatively associated with schizophrenia incidence. Corticosteroid use was not associated with increased risk for schizophrenia.Asthma was associated with increased risk for schizophrenia. The results herein suggest that a convergent disturbance in the immune-inflammatory system may contribute to the pathoetiology of asthma and schizophrenia.

  2. Longitudinal study of diet quality and change in asthma symptoms in adults, according to smoking status.

    Science.gov (United States)

    Li, Zhen; Kesse-Guyot, Emmanuelle; Dumas, Orianne; Garcia-Aymerich, Judith; Leynaert, Bénédicte; Pison, Christophe; Le Moual, Nicole; Romieu, Isabelle; Siroux, Valérie; Camargo, Carlos A; Nadif, Rachel; Varraso, Raphaëlle

    2017-02-01

    It has been hypothesised that increased asthma prevalence in westernised countries is associated with changes in lifestyle factors, including a poorer diet. However, little is known regarding the association between diet quality and asthma. In the diet-asthma association, the role of BMI as a potential mediator needs clarification; moreover, potential effect modification by non-diet sources of oxidants, such as smoking, merits investigation. We investigated the association between diet quality and change in asthma symptoms, as well as assessed effect modification by smoking, while accounting for BMI as a potential mediator. Using data from the French prospective Epidemiological study on the Genetics and Environment of Asthma study, we assessed diet quality using the Alternate Healthy Eating Index 2010 (AHEI-2010) at baseline and change in asthma symptoms (stable (reference), worsening, improved; mean follow-up time: 7 years). Mediation analysis was used to disentangle total and direct effects and the indirect effect mediated by BMI. The analyses included 969 adults (mean age 43 years; 49 % men; 42 % ever asthma). We observed a significant interaction between smoking and AHEI-2010 on change in asthma symptoms (P for interaction=0·04). Among never smokers (n 499), we observed a positive total effect (multivariable OR 1·39; 95 % CI 1·07, 1·80) and a positive direct effect (OR 1·41; 95 % CI 1·09, 1·80) of the AHEI-2010 (per ten-point increment) on improved symptoms. No indirect effect mediated through BMI was observed (OR 0·99; 95 % CI 0·91, 1·07). Among former and current smokers, all effects were statistically non-significant. Better diet quality was associated with improved asthma symptoms over time in never smokers, independently of BMI.

  3. Ethnobotanical study of plants used to treat asthma in the maritime ...

    African Journals Online (AJOL)

    Ethnobotanical study of plants used to treat asthma in the maritime region in Togo. Holaly E. Gbekley, Gnatoulma Katawa, Simplice D. Karou, Kokou Anani, Tchacondo Tchadjobo, Yaovi Ameyapoh, Komlan Batawila, Jacques Simpore ...

  4. Prevalence of asthma-triggering drug use in adults and its impact on asthma control: A cross-sectional study – Saudi (Jeddah

    Directory of Open Access Journals (Sweden)

    Moufag Mohammed Saeed Tayeb

    2017-12-01

    Full Text Available ABSTRACT Background The use of asthma-triggering drugs (ATDs is a major factor in poor asthma control (PAC, which can be either uncontrolled or partially controlled. ATDs include angiotensin-converting enzyme (ACE inhibitors, β-blockers, aspirin, and nonsteroidal anti-inflammatory drugs (NSAIDs. Aims To measure the prevalence of ATD use in adult asthmatics and their control levels. Methods This is a one-year cross-sectional study (starting March 2016. A sample of 173 adult asthmatics (mean age: 44±16 years was enrolled from five primary care centres in Jeddah city (Saudi Arabia. Asthmatics were clinically diagnosed according to the British Thoracic Society’s asthma guidelines. Chronic obstructive pulmonary disease was excluded by reversibility (i.e., symptom improvement after using asthma drugs. The four questions about asthma control from the Global Initiative for Asthma’s 2016 guidelines were translated to Arabic, photos and names of ATDs available in local pharmacies were collected, and a questionnaire was drafted. The questionnaire was presented to adult asthmatics by medical students during a personal interview. Data were statistically analysed using SPSS. Results Fifty percent of the adult asthmatics who used ATDs had badly controlled asthma: 31 per cent uncontrolled and 19 per cent partially controlled. Of the patients who took ATDs, 97 per cent had used several ATDs for extended periods of time without any warnings from health professionals. In order of prevalence, aspirin, ACE inhibitors, other NSAIDs, and β-blockers were the most common ATDs used. Conclusion ATDs are a major cause of PAC. ATD use is extensive and often goes unnoticed. The present findings highlight the low awareness of health professionals about the undesirable effects of ATDs on asthma control. This problem needs to be resolved by regular and continuous asthma health educational courses. During clinic visits, health professionals should inquire about ATD use

  5. Association of Blood Eosinophil and Blood Neutrophil Counts with Asthma Exacerbations in the Copenhagen General Population Study

    DEFF Research Database (Denmark)

    Vedel-Krogh, Signe; Nielsen, Sune Fallgaard; Lange, Peter

    2017-01-01

    BACKGROUND: Blood eosinophil count is a marker of eosinophilic airway inflammation and disease severity in asthma. However, blood neutrophil count might also be associated with disease severity. We tested the hypothesis that high blood eosinophil and neutrophil counts are both associated...... with the risk of asthma exacerbations among individuals with asthma from the general population. METHODS: From the Copenhagen General Population Study with 81351 participants, we included 4838 with self-reported asthma. We recorded baseline blood eosinophil and neutrophil counts, and asthma exacerbations during...... with blood eosinophil counts >0.29 × 10(9)/L (highest tertile) vs individuals with blood eosinophil counts

  6. Impact of Asthma on the Sexual Functioning of Patients. A Case-Control Study.

    Science.gov (United States)

    Soto Campos, José Gregorio; Rojas Villegas, Josefa; Padilla Galo, Alicia; Marina Malanda, Nuria; Garcia Rivero, Juan Luis; Pinedo Sierra, Celia; Garcia Salmones, Mercedes; Cabrera Galán, Carmen; Segura Molina, Esperanza; Plaza, Vicente; Pascual Erquicia, Silvia

    2017-12-01

    Sexual limitations play an important role in the quality of life of patients with chronic diseases. Very limited information is available on the impact of asthma on the sexual functioning of these individuals. Cross-sectional, observational, multicenter study. Asthma patients and healthy individuals were recruited. All subjects participated in an interview in which demographic and clinical data were recorded, and completed the Goldberg Anxiety-Depression Scale (GADS) to evaluate the presence of concomitant psychiatric disease. Men also completed the International Index of Erectile Function (IIEF), and women, the Female Sexual Function Index (FSFI). A total of 276cases were included, comprising 172asthma patients (63 men and 109 women) with a mean age of 42 (±14) years, and 104 controls (52men and 51women) with a mean age of 39 (±12) years. Time since onset of asthma was 15 years and severity distribution was: 6.4% intermittent, 17.9% mild persistent, 47.4% moderate, and 28.2% severe. Disease was considered controlled in 57.7%, partially controlled in 28.2%, and uncontrolled in 14.1%. Women with asthma had greater sexual limitations than women in the control group, with a total FSFI score of 22.1 (±9) compared to 26.5 (±6.8), respectively (P<.005). Men with asthma had significantly more severe erectile dysfunction with a total IIEF score of 59.5 (±12.5) compared to 64.3 (±8.2) in male controls (P<.05). An association was also observed between sexual problems and poorer asthma control. Asthma is associated with a poorer sexual quality of life among patients. These results should arouse the interest of healthcare professionals in detecting and alleviating possible sexual limitations among their asthma patients in routine clinical practice. Copyright © 2017 SEPAR. Publicado por Elsevier España, S.L.U. All rights reserved.

  7. Impact of patients' judgment skills on asthma self-management: a pilot study.

    Science.gov (United States)

    Londoño, Ana Maria Moreno; Schulz, Peter J

    2014-12-02

    The majority of current health literacy tools assess functional skills including reading, writing, and numeracy. Although these tools have been able to underline the impact of such skills on individuals' health behaviour, there is a need for comprehensive measures to examine more advanced skills. The individual's ability to use health-related information considering his/her own health context, and judging positive and negative consequences of their decisions has been conceptualized as judgment skills. The present study used a newly developed judgment skills tool to explore asthma self-management practices. Eighty asthma patients were recruited from medical offices during the year 2013. The questionnaire was self-administered and contained health literacy questions, the judgment skill tool, the Asthma Control Test, and several self-management questions. Sixty-nine percent of participants had adequate health literacy, while 24% and 5% had marginal and inadequate levels, respectively. The high-judgment group referred more to their doctor when experiencing asthma problems t(76)=-2.18, Pskills tool can help identify asthma patients' health information use and reveal how this use may affect some self-management practices. Significance for public healthPatients' health literacy has a great impact on their health behaviours and their health outcomes. Therefore, it has become more and more common to measure health literacy within the healthcare setting to determine the most effective approach to target patients. The measurement of asthma judgment skills contribute to a deeper understanding of patients' asthma self-management in crucial topics for asthma control, and have the advantage of assessing the specific abilities needed for this particular condition, which in turn benefits the translation of the findings from the use of this tool into strategies that directly tackle the needs of asthma patients.

  8. The contribution of twin studies to the understanding of the aetiology of asthma and atopic diseases

    DEFF Research Database (Denmark)

    Thomsen, Simon F

    2015-01-01

    The prevalence of asthma and other atopic diseases has increased markedly during the past decades and the reasons for this are not fully understood. Asthma is still increasing in many parts of the world, notably in developing countries, and this emphasizes the importance of continuing research...... aimed at studying the aetiological factors of the disease and the causes of its increase in prevalence. Twin studies enable investigations into the genetic and environmental causes of individual variation in multifactorial diseases such as asthma. Thorough insight into these causes is important...... as this will ultimately guide the development of preventive strategies and targeted therapies. This review explores the contribution of twin studies to the understanding of the aetiology of asthma and atopic diseases....

  9. Does migration affect asthma, rhinoconjunctivitis and eczema prevalence? Global findings from the international study of asthma and allergies in childhood.

    Science.gov (United States)

    Garcia-Marcos, Luis; Robertson, Colin F; Ross Anderson, H; Ellwood, Philippa; Williams, Hywel C; Wong, Gary Wk

    2014-12-01

    Immigrants to Westernized countries adopt the prevalence of allergic diseases of native populations, yet no data are available on immigrants to low-income or low-disease prevalence countries. We investigated these questions using data from the International Study of Asthma and Allergies in Childhood. Standardized questionnaires were completed by 13-14-year-old adolescents and by the parent/guardians of 6-7-year-old children. Questions on the symptom prevalence of asthma, rhinoconjunctivitis and eczema, and a wide range of factors postulated to be associated with these conditions, including birth in or not in the country and age at immigration, were asked. Odds ratios for risk of the three diseases according to immigration status were calculated using generalized linear mixed models. These were adjusted for: world region; language and gross national income; and individual risk factors including gender, maternal education, antibiotic and paracetamol use, maternal smoking, and diet. Effect modification by gross national income and by prevalence was examined. There were 326 691 adolescents from 48 countries and 208 523 children from 31 countries. Immigration was associated with a lower prevalence of asthma, rhinoconjunctivitis and eczema in both age groups than among those born in the country studied, and this association was mainly confined to high-prevalence/affluent countries. This reduced risk was greater in those who had lived fewer years in the host country. Recent migration to high prevalence/affluent countries is associated with a lower prevalence of allergic diseases. The protective pre-migration environment quickly decreases with increasing time in the host country. © The Author 2014; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.

  10. A longitudinal study of adult-onset asthma incidence among HMO members

    Directory of Open Access Journals (Sweden)

    Rosiello Richard A

    2003-08-01

    Full Text Available Abstract Background HMO databases offer an opportunity for community based epidemiologic studies of asthma incidence, etiology and treatment. The incidence of asthma in HMO populations and the utility of HMO data, including use of computerized algorithms and manual review of medical charts for determining etiologic factors has not been fully explored. Methods We identified adult-onset asthma, using computerized record searches in a New England HMO. Monthly, our software applied exclusion and inclusion criteria to identify an "at-risk" population and "potential cases". Electronic and paper medical records from the past year were then reviewed for each potential case. Persons with other respiratory diseases or insignificant treatment for asthma were excluded. Confirmed adult-onset asthma (AOA cases were defined as those potential cases with either new-onset asthma or reactivated mild intermittent asthma that had been quiescent for at least one year. We validated the methods by reviewing charts of selected subjects rejected by the algorithm. Results The algorithm was 93 to 99.3% sensitive and 99.6% specific. Sixty-three percent (n = 469 of potential cases were confirmed as AOA. Two thirds of confirmed cases were women with an average age of 34.8 (SD 11.8, and 45% had no evidence of previous asthma diagnosis. The annualized monthly rate of AOA ranged from 4.1 to 11.4 per 1000 at-risk members. Physicians most commonly attribute asthma to infection (59% and allergy (14%. New-onset cases were more likely attributed to infection, while reactivated cases were more associated with allergies. Medical charts included a discussion of work exposures in relation to asthma in only 32 (7% cases. Twenty-three of these (72% indicated there was an association between asthma and workplace exposures for an overall rate of work-related asthma of 4.9%. Conclusion Computerized HMO records can be successfully used to identify AOA. Manual review of these records is

  11. A longitudinal study of adult-onset asthma incidence among HMO members.

    Science.gov (United States)

    Sama, Susan R; Hunt, Phillip R; Cirillo, C I H Priscilla; Marx, Arminda; Rosiello, Richard A; Henneberger, Paul K; Milton, Donald K

    2003-08-07

    HMO databases offer an opportunity for community based epidemiologic studies of asthma incidence, etiology and treatment. The incidence of asthma in HMO populations and the utility of HMO data, including use of computerized algorithms and manual review of medical charts for determining etiologic factors has not been fully explored. We identified adult-onset asthma, using computerized record searches in a New England HMO. Monthly, our software applied exclusion and inclusion criteria to identify an "at-risk" population and "potential cases". Electronic and paper medical records from the past year were then reviewed for each potential case. Persons with other respiratory diseases or insignificant treatment for asthma were excluded. Confirmed adult-onset asthma (AOA) cases were defined as those potential cases with either new-onset asthma or reactivated mild intermittent asthma that had been quiescent for at least one year. We validated the methods by reviewing charts of selected subjects rejected by the algorithm. The algorithm was 93 to 99.3% sensitive and 99.6% specific. Sixty-three percent (n = 469) of potential cases were confirmed as AOA. Two thirds of confirmed cases were women with an average age of 34.8 (SD 11.8), and 45% had no evidence of previous asthma diagnosis. The annualized monthly rate of AOA ranged from 4.1 to 11.4 per 1000 at-risk members. Physicians most commonly attribute asthma to infection (59%) and allergy (14%). New-onset cases were more likely attributed to infection, while reactivated cases were more associated with allergies. Medical charts included a discussion of work exposures in relation to asthma in only 32 (7%) cases. Twenty-three of these (72%) indicated there was an association between asthma and workplace exposures for an overall rate of work-related asthma of 4.9%. Computerized HMO records can be successfully used to identify AOA. Manual review of these records is important to confirm case status and is useful in evaluation of

  12. Evaluation of CHESS: Utah asthma study, 1971-1972. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Olsen, A.R.; Tolley, H.D.; Simpson, J.C.; Namekata, T.; Woods, J.S.

    1983-02-01

    This report is divided into five main sections. The first reviews the use of asthma as a health indicator in environmental epidemiology, including a review of selected asthma panel studies. The next two sections consider the impact of the data quality: the limitations and characteristics of the aerometric data and of the panelists' data, respectively. The last two sections contain statistical analyses: analyses correcting for variation among panelists and analyses based on person-days.

  13. Prevalence of asthma symptoms in schoolchildren, and climate in west European countries: an ecologic study.

    Science.gov (United States)

    Arnedo-Pena, Alberto; García-Marcos, Luis; Bercedo-Sanz, Alberto; Aguinaga-Ontoso, Inés; González-Díaz, Carlos; García-Merino, Agueda; Busquets-Monge, Rosa; Suárez-Varela, Maria Morales; Batlles-Garrido, Juan; Blanco-Quirós, Alfredo A; López-Silvarrey, Angel; García-Hernández, Gloria; Fuertes, Jorge

    2013-09-01

    The aim of the present study was to estimate the associations between the prevalence of asthma symptoms in schoolchildren and meteorological variables in west European countries that participated in the International Study of Asthma and Allergies in Children (ISAAC), Phase III 1997-2003. An ecologic study was carried out. The prevalence of asthma was obtained from this study from 48 centers in 14 countries, and meteorological variables from those stations closest to ISAAC centers, together with other socioeconomic and health care variables. Multilevel mixed-effects linear regression models were used. For schoolchildren aged 6-7 years, the prevalence rate of asthma decreased with an increase in mean annual sunshine hours, showed a positive association with rainy weather, and warm temperature, and a negative one with relative humidity and physician density (PD). Current wheeze prevalence was stronger in autumn/winter seasons and decreased with increasing PD. Severe current wheeze decreased with PD. For schoolchildren aged 13-14 years, the prevalence rates of asthma and current wheeze increased with rainy weather, and these rates decreased with increased PD. Current wheeze, as measured by a video questionnaire, was inversely associated with sunny weather, and nurse density. Severe current wheeze prevalence was stronger during autumn/winter seasons, decreased with PD, and indoor chlorinated public swimming pool density, and increased with rainy weather. Meteorological factors, including sunny and rainy weather, and PD may have some effect on the prevalence rates of asthma symptoms in children from west European countries.

  14. Decline in admissions for childhood asthma, a 26-year period population-based study.

    Science.gov (United States)

    Mikalsen, Ingvild Bruun; Skeiseid, Liliane; Tveit, Line Merete; Engelsvold, David Hugo; Øymar, Knut

    2015-12-01

    The prevalence of childhood asthma has increased, although the rate of hospitalization for asthma seems to decrease. In Norway, the rate of hospital admission for childhood asthma from 1984 to 2000 increased. The aim of this study was to assess further trends in hospital admissions for childhood asthma up to 2010. A population-based study including children 1-13 yrs of age hospitalized for asthma during six periods from 1984/1985 to 2009/2010 in Rogaland, Norway, was performed. Medical records from 1536 admissions (1050 children) were studied; and gender, age, number of admissions, length of hospital stay, medications and symptoms were recorded. For all age groups, the rate of admissions per 10.000 increased from 20.1 in 1984/85 to 33.7 in 1989/90, but declined to 14.4 in 2009/2010. Rates were highest in boys (OR 1.87; 95% CI: 1.69, 2.09), younger age groups (OR 2.51; 2.38, 2.64) and decreased from 1984 to 2010 (OR 0.92; 0.88, 0.94). The rates of readmissions were higher than for primary admissions (OR 1.33; 1.19, 1.47). From 1984 to 2010, there was an increased use of inhaled corticosteroids prior to admission (6 to 51%) and started at discharge (7 to 37%), and systemic steroids given during admission (19 to 83%). There has been a substantial decline in the rate of hospital admissions for childhood asthma after 1989/1990, with major differences between age groups and genders. The decline could be due to improved care of children with asthma or a real reduction in asthma exacerbations. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  15. Maternal and paternal beliefs, support and parenting as determinants of sport participation of adolescents with asthma

    NARCIS (Netherlands)

    Tiggelman, D.; Ven, M.O.M. van de; Schayck, C.P. van; Engels, R.C.M.E.; Sluijs, E.M.F. van

    2015-01-01

    RATIONALE: Few studies have examined determinants of physical activity in patients with chronic illnesses, like asthma. The aim of this study was to examine whether baseline maternal and paternal beliefs, support and parenting were associated with changes in sport participation of adolescents with

  16. Maternal smoking in pregnancy and asthma in preschool children: a pooled analysis of eight birth cohorts

    NARCIS (Netherlands)

    Neuman, A.; Hohmann, C.; Pershagen, G.; Eller, E.; Kjaer, H.F.; Gehring, U.; Granell, R.; Henderson, J.; Lau, S.; Nieuwenhuijsen, M.; Sunyer, J.; Tischer, C.; Torrent, M.; Wahn, U.; Wijga, A.H.; Wickman, M.; Keil, T.; Bergström, A.

    2012-01-01

    Rationale: Although epidemiological studies suggest that exposure to maternal smoking during fetal and early life increases the risk of childhood wheezing and asthma, previous studies were not able to differentiate the effects of prenatal from postnatal exposure. Objectives: To assess the effect of

  17. Collaborative Behavioral Management for Drug-Involved Parolees: Rationale and Design of the Step'n Out Study

    Science.gov (United States)

    Friedmann, Peter D.; Katz, Elizabeth C.; Rhodes, Anne G.; Taxman, Faye S.; O'Connell, Daniel J.; Frisman, Linda K.; Burdon, William M.; Fletcher, Bennett W.; Litt, Mark D.; Clarke, Jennifer; Martin, Steven S.

    2008-01-01

    This article describes the rationale, study design, and implementation for the Step'n Out study of the Criminal Justice Drug Abuse Treatment Studies. Step'n Out tests the relative effectiveness of collaborative behavioral management of drug-involved parolees. Collaborative behavioral management integrates the roles of parole officers and treatment…

  18. Fragrance materials in asthma: a pilot study using a surrogate aerosol product.

    Science.gov (United States)

    Vethanayagam, Dilini; Vliagoftis, Harissios; Mah, Dennell; Beach, Jeremy; Smith, Ladd; Moqbel, Redwan

    2013-11-01

    Many household products contain fragrances. Little is known about exposure to fragrances on human health, particularly within the airways. This study aimed to evaluate how common household fragrance products (i.e. air fresheners, cleaning products) affect people with asthma, who frequently report sensitivity to these products. Many of these products have volatile organic compounds or semi-volatile organic compounds. This study evaluated nine fragrance materials in an aerosol formulation to assess effects on airway physiology, airway inflammation and symptom perception in normal controls and those with asthma. The effects of fragrances were evaluated in people without asthma, people with mild asthma and people with moderate asthma in a four-way crossover placebo-controlled study. Subjects were exposed twice to a fragranced aerosol and twice to a placebo aerosol (15 and 30 min each). Subjects completed a questionnaire for 29 symptoms during and up to 3 h after each exposure scenario. Spirometry was performed prior to and 3 h post-exposure; sputum induction was conducted 3 h post-exposure. Nasal symptoms showed the greatest frequency of response in all three subject groups, and moderate asthmatics reported the greatest symptom severity and symptom types. No significant differences were noted in physiology or cellular inflammation. A trend for increased symptoms was noted in moderate asthmatics, suggesting that asthma severity may play a factor in fragrance sensitivity.

  19. Caesarean section and asthma in Malaysian children: a case-control study.

    Science.gov (United States)

    Nathan, Anna Marie; de Bruyne, Jessie; Khalid, Farah; Arumugam, Kulantheran

    2012-09-01

    Birth cohort studies in some countries have shown a link between caesarean section and asthma. To determine if there is an association between asthma and delivery via caesarean section in Malaysian children. This is a case-control study involving 156 children aged 3-15 years old, in a tertiary hospital in Kuala Lumpur, Malaysia. Seventy-eight children with a confirmed diagnosis of asthma and seventy-eight age-matched controls (no history of asthma or wheezing) were enrolled. Demographic data including mode of delivery and family history of allergic disorders was obtained. Total serum immunoglobulin E (IgE) was measured and skin prick tests (SPT) to 6 common aeroallergens were performed. The median age of the patients was 8 years old. One hundred and three (66%) children were delivered via normal vaginal delivery, 8 (5.1%) via assisted vaginal delivery and 45 children (28.9%) via caesarean section. Delivery via caesarean section was not significantly associated with asthma (OR = 1.21 [95% CI 0.60-2.41], p = 0.596). Children delivered via caesarean section did not have higher IgE levels nor were they more sensitized to aeroallergens. Multiple logistic regression showed that asthma was significantly associated with a positive family history of atopy (OR = 13.8 [95% CI 5.96, 32.1], p food after 6 months old had a protective effect against asthma (OR = 0.97 [95% CI 0.94, 0.99], p = 0.034). Childhood asthma in Malaysian children was not associated with delivery by caesarean section.

  20. Risks of exposure to occupational asthmogens in atopic and nonatopic asthma: a case-control study in Taiwan.

    Science.gov (United States)

    Wang, Tsu-Nai; Lin, Meng-Chih; Wu, Chao-Chien; Leung, Sum-Yee; Huang, Ming-Shyan; Chuang, Hung-Yi; Lee, Chien-Hung; Wu, Deng-Chyang; Ho, Pei-Shan; Ko, Albert Min-Shan; Chang, Po-Ya; Ko, Ying-Chin

    2010-12-01

    Asthma is often work-related and can be classified as atopic or nonatopic on the basis of its pathogenesis. Few studies have reported an association between exposure to occupational asthmogens and asthma with and without atopy. We investigated, in adults with asthma, whether occupational exposure to asthmogens influenced the risk of having atopic or nonatopic asthma, and their level of lung function. We recruited 504 hospital-based adults with current asthma, 504 community-based control subjects, and 504 hospital-based control subjects in southern Taiwan. Asthma with atopy was defined as having asthma in combination with an increase in total IgE (≥100 U/ml) or a positive Phadiatop test (≥0.35 Pharmacia arbitrary unit/L) (Pharmacia ImmunoCAP; Pharmacia, Uppsala, Sweden). Occupational exposure to asthmogens was assessed with an asthma-specific job exposure matrix. We found a significant association between atopic asthma and exposure to high molecular weight asthmogens (adjusted odds ratio [AOR], 4.0; 95% confidence interval [CI], 1.8-8.9). Nonatopic asthma was significantly associated with exposure to low molecular weight asthmogens (AOR, 2.6; 95% CI, 1.6-4.3), including industrial cleaning agents and metal sensitizers. Agriculture was associated with both atopic and nonatopic asthma (AOR, 7.8; 95% CI, 2.8-21.8; and AOR, 4.1; 95% CI, 1.3-13.0, respectively). The ratio of FEV₁ to FVC in the high-risk group was significantly lower than in the no-risk group (P = 0.026) in currently employed patients with asthma. In adults with asthma, occupational exposure to high and low molecular weight asthmogens appears to produce differential risks for atopic and nonatopic asthma.

  1. [Deliberate interruptions and changes of dose of inhaled corticosteroids by asthma patients: "a community pharmacy study"].

    Science.gov (United States)

    Laforest, L; Van Ganse, É; Devouassoux, G; Chatté, G; Tamberou, C; Belhassen, M; Chamba, G

    2015-01-01

    Adherence to inhaled corticosteroids (ICS) remains a major issue for asthma management, even among patients receiving a regular prescription from their doctor. The frequency of deliberate interruption of ICS, and of spontaneous changes of dose, were studied in a population of asthma patients recruited in community pharmacies. Asthma patients (aged 18-50) recruited in community pharmacies reported in self-administered questionnaires their spontaneous interruptions and changes of doses of ICS during the past 3 months. The characteristics of patients who interrupted their therapy or who modified the dose were compared with other patients. The studied population included 252 patients (mean age 35 year-old, females: 59%), of whom 62% had inadequately controlled asthma. Among these patients, 25% had interrupted ICS therapy during the past 3 months, while 21% spontaneously changed the dose. The most reported reason for interrupting ICS was the cessation of symptoms (50%). In multivariate analysis, interrupting ICS was mainly associated with inadequate asthma control (OR=3.1, 95% CI 1.5-6.4), while the strongest association with changing ICS doses was the patients' perception of asthma as a concern in their lives (OR=3.2, 95% CI 1.2-8.4). These results underline a poor understanding of the purpose of ICS therapy by patients. They also highlight the need of therapeutic education to improve the management of the disease. Copyright © 2014 SPLF. Published by Elsevier Masson SAS. All rights reserved.

  2. Meteorological factors, aeroallergens and asthma-related visits inKuwait: a 12-month retrospective study

    International Nuclear Information System (INIS)

    Qasem, Jafar A.; Al-Sherfyee, A.; Al-Mathkouri, Samirah A.; Nasrallah, H.; Al-Khalaf, Bader N.; Al-Sharifi, F.; Al-Saraf, H.

    2008-01-01

    The increasing prevalence of asthma in many countries has been related toweather factors and aerllergen concentrations, but this has not been studiedin Kuwait. We evaluated the effect of meteorological factors and theoccurrence of aerobiologicals on the number of asthma cases in Kuwait. Thenumber of daily asthma visits to the allergy center and emergency departmentat Al-Sabha Hospital for 1 year were examined on a monthly basis forcorrelation with major meteorological factors (temperature, relativehumidity, rain, wind speed and direction). Spore and pollen counts werecollected hourly. A total of 4353 patients received asthma treatment duringthe year. The highest pollen count was in the month of September with amaximum relative humidity of 47% and no precipitation, but with a high meantemperature of 39.7C. Pollen counts were higher in the late summer(September) and occurred with a high patient visit to the allergy center.Fungal spore counts were significantly higher in early winter (December). Thehigh fungal spore count seemed related to with high relative humidity andhigh precipitation with a low mean average temperature of 19.7C. The increasenumber of patients with bronchial asthma visiting an emergency clinic duringDecember was significantly associated with high aerial counts for fungalspores (P<0.3) and the months of September and October were more significantfor pollen. This study indicates that meteorological factors, aeroallergenconcentrations and asthma-related visits were interrelated. The results mayprove useful in the generation of hypotheses and development of designs formore comprehensive, individual-based epidemiological studies. (author)

  3. Pediatric Asthma

    Science.gov (United States)

    ... Science Education & Training Home Conditions Asthma (Pediatric) Asthma (Pediatric) Make an Appointment Refer a Patient Ask a ... meet the rising demand for asthma care. Our pediatric asthma team brings together physicians, nurses, dietitians, physical ...

  4. Exercise-induced bronchoconstriction : clinical studies in childhood asthma

    NARCIS (Netherlands)

    W.B. Hofstra (Winfried)

    1997-01-01

    textabstractAt present, astluna is regarded as a chronic inflammatory disorder of the airways, In susceptible individuals, asthma causes symptoms, that are usually associated with variable, but often reversible airflow obstmction. Astlulla is the most conunon lung disease in childhood, with

  5. Exposure to Mobile Source Air Pollution in Early-life and Childhood Asthma Incidence: The Kaiser Air Pollution and Pediatric Asthma Study.

    Science.gov (United States)

    Pennington, Audrey Flak; Strickland, Matthew J; Klein, Mitchel; Zhai, Xinxin; Bates, Josephine T; Drews-Botsch, Carolyn; Hansen, Craig; Russell, Armistead G; Tolbert, Paige E; Darrow, Lyndsey A

    2018-01-01

    Early-life exposure to traffic-related air pollution exacerbates childhood asthma, but it is unclear what role it plays in asthma development. The association between exposure to primary mobile source pollutants during pregnancy and during infancy and asthma incidence by ages 2 through 6 was examined in the Kaiser Air Pollution and Pediatric Asthma Study, a racially diverse birth cohort of 24,608 children born between 2000 and 2010 and insured by Kaiser Permanente Georgia. We estimated concentrations of mobile source fine particulate matter (PM2.5, µg/m), nitrogen oxides (NOX, ppb), and carbon monoxide (CO, ppm) at the maternal and child residence using a Research LINE source dispersion model for near-surface releases. Asthma was defined using diagnoses and medication dispensings from medical records. We used binomial generalized linear regression to model the impact of exposure continuously and by quintiles on asthma risk. Controlling for covariates and modeling log-transformed exposure, a 2.7-fold increase in first year of life PM2.5 was associated with an absolute 4.1% (95% confidence interval, 1.6%, 6.6%) increase in risk of asthma by age 5. Quintile analysis showed an increase in risk from the first to second quintile, but similar risk across quintiles 2-5. Risk differences increased with follow-up age. Results were similar for NOX and CO and for exposure during pregnancy and the first year of life owing to high correlation. Results provide limited evidence for an association of early-life mobile source air pollution with childhood asthma incidence with a steeper concentration-response relationship observed at lower levels of exposure.

  6. Estimated cost of asthma in outpatient treatment: a real-world study

    Science.gov (United States)

    Costa, Eduardo; Caetano, Rosangela; Werneck, Guilherme Loureiro; Bregman, Maurício; Araújo, Denizar Vianna; Rufino, Rogério

    2018-01-01

    ABSTRACT OBJECTIVE To estimate the cost of diagnosis and treatment of asthma. METHODS We used the perspective of society. We sequentially included for 12 months, in 2011-2012, 117 individuals over five years of age who were treated for asthma in the Pneumology and Allergy-Immunology Services of the Piquet Carneiro Polyclinic, Universidade do Estado do Rio de Janeiro. All of them were interviewed twice with a six-month interval for data collection, covering 12 months. The cost units were identified and valued according to defined methods. We carried out a sensitivity analysis and applied statistical methods with a significance level of 5% for cost comparisons between subgroups. RESULTS The study consisted of 108 patients, and 73.8% of them were women. Median age was 49.5 years. Rhinitis was present in 83.3% of the individuals, and more than half were overweight or obese. Mean family income was U$915.90/month (SD = 879.12). Most workers and students had absenteeism related to asthma. Total annual mean cost was U$1,291.20/patient (SD = 1,298.57). The cost related to isolated asthma was U$1,155.43/patient-year (SD = 1,305.58). Obese, severe, and uncontrolled asthmatic patients had higher costs than non-obese, non-severe, and controlled asthmatics, respectively. Severity and control level were independently associated with higher cost (p = 0.001 and 0.000, respectively). The direct cost accounted for 82.3% of the estimated total cost. The cost of medications for asthma accounted for 62.2% of the direct costs of asthma. CONCLUSIONS Asthma medications, environmental control measures, and long-term health leaves had the greatest potential impact on total cost variation. The results are an estimate of the cost of treating asthma at a secondary level in the Brazilian Unified Health System, assuming that the treatment used represents the ideal approach to the disease. PMID:29641652

  7. History of Asthma From Childhood and Arterial Stiffness in Asymptomatic Young Adults: The Bogalusa Heart Study.

    Science.gov (United States)

    Sun, Dianjianyi; Li, Xiang; Heianza, Yoriko; Nisa, Hoirun; Shang, Xiaoyun; Rabito, Felicia; Kelly, Tanika; Harville, Emily; Li, Shengxu; He, Jiang; Bazzano, Lydia; Chen, Wei; Qi, Lu

    2018-05-01

    Asthma is related to various cardiovascular risk. Whether a history of asthma from childhood contributes to arterial stiffness in adulthood, a noninvasive surrogate for cardiovascular events, is unknown. Prospective analyses were performed among 1746 Bogalusa Heart Study participants aged 20 to 51 years with data on self-report asthma collected since childhood. Aorta-femoral pulse wave velocity (af-PWV, m/s) was repeatedly assessed among adults ≥aged 18 years. Generalized linear mixed models and generalized linear models were fitted for the repeated measurements of af-PWV and its changes between the last and the first measurements, respectively. After a median follow-up of 11.1 years, participants with a history of asthma from childhood had a higher af-PWV (6.78 versus 6.13; P =0.048) and a greater increase in af-PWV (8.99 versus 2.95; P =0.043) than those without asthma, adjusted for age, sex, race, smoking status, heart rate, body mass index, systolic blood pressure, lipids, and glycemia. In addition, we found significant interactions of asthma with body mass index and systolic blood pressure on af-PWV and its changes ( P for interaction The associations of asthma with af-PWV and its changes appeared to be stronger among participants who were overweight and obese (body mass index ≥25 kg/m 2 ) or with prehypertension and hypertension (systolic blood pressure ≥120 mm Hg) compared with those with a normal body mass index or systolic blood pressure. Our findings indicate that a history of asthma from childhood is associated with higher af-PWV and greater increases in af-PWV, and such associations are stronger among young adults who are overweight or with elevated blood pressure. © 2018 American Heart Association, Inc.

  8. Longitudinal study of parental smoking habits and development of asthma in early childhood.

    Science.gov (United States)

    Kanoh, Miki; Kaneita, Yoshitaka; Hara, Megumi; Harada, Shohei; Gon, Yasuhiro; Kanamaru, Hiroshi; Ohida, Takashi

    2012-01-01

    This study examined the association between parental smoking habits and the development of asthma in early childhood by using representative samples. The survey subjects included all of the 53,575 babies born in Japan during the periods January 10-17 and July 10-17, 2001. The families of the subjects were asked to complete questionnaires that were delivered by post at 6 months, 1 year 6 months, 2 years 6 months, 3 years 6 months, and 4 years 6 months postpartum. The first survey contained questions regarding the smoking habits of the parents. The second to fifth surveys asked if the child had needed medical attention for the treatment of asthma. Data from 36,888 subjects (collection rate: 68.9%) were analyzed. The 4-year cumulative incidence of asthma was 12.0%. Maternal indoor smoking significantly increased the risk of asthma development in children, 4-year risk 14.4% vs. 11.7%, risk ratio=1.24, 95% CI: 1.11 to 1.38. No statistically significant association was found between paternal smoking and asthma development in children. In order to prevent the development of asthma in early childhood, it is necessary to formulate measures to stop or discourage maternal smoking. Copyright © 2011. Published by Elsevier Inc.

  9. Outstanding animal studies in allergy I. From asthma to food allergy and anaphylaxis.

    Science.gov (United States)

    Jensen-Jarolim, Erika; Pali-Schöll, Isabella; Roth-Walter, Franziska

    2017-06-01

    Animal models published within the past 18 months on asthma, food allergy and anaphylaxis, all conditions of rising public health concern, were reviewed. While domestic animals spontaneously develop asthma, food allergy and anaphylaxis, in animal models, divergent sensitization and challenge routes, dosages, intervals and antigens are used to induce asthmatic, food allergic or anaphylactic phenotypes. This must be considered in the interpretation of results. Instead of model antigens, gradually relevant allergens such as house dust mite in asthma, and food allergens like peanut, apple and peach in food allergy research were used. Novel engineered mouse models such as a mouse with a T-cell receptor for house dust mite allergen Der p 1, or with transgenic human hFcγR genes, facilitated the investigation of single molecules of interest. Whole-body plethysmography has become a state-of-the-art in-vivo readout in asthma research. In food allergy and anaphylaxis research, novel techniques were developed allowing real-time monitoring of in-vivo effects following allergen challenge. Networks to share tissues were established as an effort to reduce animal experiments in allergy which cannot be replaced by in-vitro measures. Natural and artificial animal models were used to explore the pathophysiology of asthma, food allergy and anaphylaxis and to improve prophylactic and therapeutic measures. Especially the novel mouse models mimicking molecular aspects of the complex immune network in asthma, food allergy and anaphylaxis will facilitate proof-of-concept studies under controlled conditions.

  10. Social determinants of childhood asthma symptoms: an ecological study in urban Latin America.

    Science.gov (United States)

    Fattore, Gisel L; Santos, Carlos A T; Barreto, Mauricio L

    2014-04-01

    Asthma is an important public health problem in urban Latin America. This study aimed to analyze the role of socioeconomic and environmental factors as potential determinants of asthma symptoms prevalence in children from Latin American (LA) urban centers. We selected 31 LA urban centers with complete data, and an ecological analysis was performed. According to our theoretical framework, the explanatory variables were classified in three levels: distal, intermediate, and proximate. The association between variables in the three levels and prevalence of asthma symptoms was examined by bivariate and multivariate linear regression analysis weighed by sample size. In a second stage, we fitted several linear regression models introducing sequentially the variables according to the predefined hierarchy. In the final hierarchical model Gini Index, crowding, sanitation, variation in infant mortality rates and homicide rates, explained great part of the variance in asthma prevalence between centers (R(2) = 75.0 %). We found a strong association between socioeconomic and environmental variables and prevalence of asthma symptoms in LA urban children, and according to our hierarchical framework and the results found we suggest that social inequalities (measured by the Gini Index) is a central determinant to explain high prevalence of asthma in LA.

  11. A case-control study of the relation between plasma selenium and asthma in European populations

    DEFF Research Database (Denmark)

    Burney, P; Potts, J; Makowska, J

    2008-01-01

    BACKGROUND: There is evidence that selenium levels are relatively low in Europe and may be falling. Low levels of selenium or low activity of some of the enzymes dependent on selenium have been associated with asthma. METHODS: The GA(2)LEN network has organized a multicentre case-control study...... in Europe to assess the relation of plasma selenium to asthma. The network compared 569 cases in 14 European centres with a diagnosis of asthma and reporting asthma symptoms in the last 12 months with 576 controls from the same centres with no diagnosis of asthma and no asthmatic symptoms in the last 12......-analysis of the results from the centres showed no overall association between asthma and plasma selenium [odds ratio (OR)/10 microg/l increase in plasma selenium: 1.04; 95% confidence interval (CI): 0.89-1.21] though there was a significantly protective effect in Lodz (OR: 0.48; 95% CI: 0.29-0.78) and a marginally...

  12. Tiotropium Bromide in Chronic Obstructive Pulmonary Disease and Bronchial Asthma.

    Science.gov (United States)

    Alvarado-Gonzalez, Alcibey; Arce, Isabel

    2015-11-01

    Inhaled bronchodilators are the mainstay of pharmacological treatment for stable chronic obstructive pulmonary disease (COPD), including β2-agonists and muscarinic antagonists. Tiotropium bromide, a long-acting antimuscarinic bronchodilator (LAMA), is a treatment choice for moderate-to-severe COPD; its efficacy and safety have been demonstrated in recent trials. Studies also point to a beneficial role of tiotropium in the treatment of difficult-to-control asthma and a potential function in the asthma-COPD overlap syndrome (ACOS). Combination of different bronchodilator molecules and addition of inhaled corticosteroids are viable therapeutic alternatives. A condensation of the latest trials and the rationale behind these therapies will be presented in this article.

  13. Allergy in severe asthma.

    Science.gov (United States)

    Del Giacco, S R; Bakirtas, A; Bel, E; Custovic, A; Diamant, Z; Hamelmann, E; Heffler, E; Kalayci, Ö; Saglani, S; Sergejeva, S; Seys, S; Simpson, A; Bjermer, L

    2017-02-01

    It is well recognized that atopic sensitization is an important risk factor for asthma, both in adults and in children. However, the role of allergy in severe asthma is still under debate. The term 'Severe Asthma' encompasses a highly heterogeneous group of patients who require treatment on steps 4-5 of GINA guidelines to prevent their asthma from becoming 'uncontrolled', or whose disease remains 'uncontrolled' despite this therapy. Epidemiological studies on emergency room visits and hospital admissions for asthma suggest the important role of allergy in asthma exacerbations. In addition, allergic asthma in childhood is often associated with severe asthma in adulthood. A strong association exists between asthma exacerbations and respiratory viral infections, and interaction between viruses and allergy further increases the risk of asthma exacerbations. Furthermore, fungal allergy has been shown to play an important role in severe asthma. Other contributing factors include smoking, pollution and work-related exposures. The 'Allergy and Asthma Severity' EAACI Task Force examined the current evidence and produced this position document on the role of allergy in severe asthma. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  14. Adult asthma disease management: an analysis of studies, approaches, outcomes, and methods.

    Science.gov (United States)

    Maciejewski, Matthew L; Chen, Shih-Yin; Au, David H

    2009-07-01

    Disease management has been implemented for patients with asthma in various ways. We describe the approaches to and components of adult asthma disease-management interventions, examine the outcomes evaluated, and assess the quality of published studies. We searched the MEDLINE, EMBASE, CINAHL, PsychInfo, and Cochrane databases for studies published in 1986 through 2008, on adult asthma management. With the studies that met our inclusion criteria, we examined the clinical, process, medication, economic, and patient-reported outcomes reported, and the study designs, provider collaboration during the studies, and statistical methods. Twenty-nine articles describing 27 studies satisfied our inclusion criteria. There was great variation in the content, extent of collaboration between physician and non-physician providers responsible for intervention delivery, and outcomes examined across the 27 studies. Because of limitations in the design of 22 of the 27 studies, the differences in outcomes assessed, and the lack of rigorous statistical adjustment, we could not draw definitive conclusions about the effectiveness or cost-effectiveness of the asthma disease-management programs or which approach was most effective. Few well-designed studies with rigorous evaluations have been conducted to evaluate disease-management interventions for adults with asthma. Current evidence is insufficient to recommend any particular intervention.

  15. The PROgnostic Value of unrequested Information in Diagnostic Imaging (PROVIDI) Study: rationale and design

    International Nuclear Information System (INIS)

    Gondrie, M. J. A.; Mali, W. P. Th. M.; Buckens, C. F. M.; Jacobs, P. C. A.; Grobbee, D. E.; Graaf, Y van der

    2010-01-01

    We describe the rationale for a new study examining the prognostic value of unrequested findings in diagnostic imaging. The deployment of more advanced imaging modalities in routine care means that such findings are being detected with increasing frequency. However, as the prognostic significance of many types of unrequested findings is unknown, the optimal response to such findings remains uncertain and in many cases an overly defensive approach is adopted, to the detriment of patient-care. Additionally, novel and promising image findings that are newly available on many routine scans cannot be used to improve patient care until their prognostic value is properly determined. The PROVIDI study seeks to address these issues using an innovative multi-center case-cohort study design. PROVIDI is to consist of a series of studies investigating specific, selected disease entities and clusters. Computed Tomography images from the participating hospitals are reviewed for unrequested findings. Subsequently, this data is pooled with outcome data from a central population registry. Study populations consist of patients with endpoints relevant to the (group of) disease(s) under study along with a random control sample from the cohort. This innovative design allows PROVIDI to evaluate selected unrequested image findings for their true prognostic value in a series of manageable studies. By incorporating unrequested image findings and outcomes data relevant to patients, truly meaningful conclusions about the prognostic value of unrequested and emerging image findings can be reached and used to improve patient-care.

  16. Details of development of the resource for adults with asthma in the RAISIN (randomized trial of an asthma internet self-management intervention) study.

    Science.gov (United States)

    Morrison, Deborah; Mair, Frances S; Chaudhuri, Rekha; McGee-Lennon, Marilyn; Thomas, Mike; Thomson, Neil C; Yardley, Lucy; Wyke, Sally

    2015-07-28

    Around 300 million people worldwide have asthma and prevalence is increasing. Self-management can be effective in improving a range of outcomes and is cost effective, but is underutilised as a treatment strategy. Supporting optimum self-management using digital technology shows promise, but how best to do this is not clear. We aimed to develop an evidence based, theory informed, online resource to support self-management in adults with asthma, called 'Living well with Asthma', as part of the RAISIN (Randomized Trial of an Asthma Internet Self-Management Intervention) study. We developed Living well with Asthma in two phases. Phase 1: A low fidelity prototype (paper-based) version of the website was developed iteratively through input from a multidisciplinary expert panel, empirical evidence from the literature, and potential end users via focus groups (adults with asthma and practice nurses). Implementation and behaviour change theories informed this process. Phase 2: The paper-based designs were converted to a website through an iterative user centred process. Adults with asthma (n = 10) took part in think aloud studies, discussing the paper based version, then the web-based version. Participants considered contents, layout, and navigation. Development was agile using feedback from the think aloud sessions immediately to inform design and subsequent think aloud sessions. Think aloud transcripts were also thematically analysed, further informing resource development. The website asked users to aim to be symptom free. Key behaviours targeted to achieve this include: optimising medication use (including inhaler technique); attending primary care asthma reviews; using asthma action plans; increasing physical activity levels; and stopping smoking. The website had 11 sections, plus email reminders, which promoted these behaviours. Feedback on the contents of the resource was mainly positive with most changes focussing on clarification of language, order of pages and

  17. Remote monitoring of inhaled bronchodilator use and weekly feedback about asthma management: an open-group, short-term pilot study of the impact on asthma control.

    Directory of Open Access Journals (Sweden)

    David Van Sickle

    Full Text Available OBJECTIVE: Adequate symptom control is a problem for many people with asthma. We asked whether weekly email reports on monitored use of inhaled, short-acting bronchodilators might improve scores on composite asthma-control measures. METHODS: Through an investigational electronic medication sensor attached to each participant's inhaler, we monitored 4 months' use of inhaled, short-acting bronchodilators. Participants completed surveys, including the Asthma Control Test(TM (ACT, to assess asthma control at entry and monthly thereafter. After the first month, participants received weekly email reports for 3 months. The reports summarized inhaled bronchodilator use during the preceding week and provided suggestions derived from National Asthma Education and Prevention Program (NAEPP guidelines. Paired t-tests and random-effects mixed models were implemented to assess changes in primary asthma endpoints. RESULTS: Thirty individuals participated in the 4-month study; 29 provided complete asthma control information. Mean age was 36.8 years (range: 19-74 years; 52% of respondents were female. Mean ACT scores were 17.6 (Standard Deviation [SD]  = 3.35 at entry and 18.4 (SD = 3.60 at completion of the first month. No significant difference appeared between ACT values at entry and completion of the first month (p = 0.66; however, after participants began receiving email reports and online information about their inhaler use, mean ACT scores increased 1.40 points (95% CI: 0.61, 2.18 for each subsequent study month. Significant decreases occurred in 2-week histories of daytime symptoms (β = -1.35, 95% CI: -2.65, -0.04 and nighttime symptoms (β = -0.84, 95% CI: -1.25, -0.44; no significant change in activity limitation (β = -0.21, 95% CI: -0.69, 0.26 was observed. Participants reported increased awareness and understanding of asthma patterns, level of control, bronchodilator use (timing, location and triggers, and improved

  18. Rationale and Design of the Echocardiographic Study of Hispanics/Latinos (ECHO-SOL).

    Science.gov (United States)

    Rodriguez, Carlos J; Dharod, Ajay; Allison, Matthew A; Shah, Sanjiv J; Hurwitz, Barry; Bangdiwala, Shrikant I; Gonzalez, Franklyn; Kitzman, Dalane; Gillam, Linda; Spevack, Daniel; Dadhania, Rupal; Langdon, Sarah; Kaplan, Robert

    2015-01-01

    Information regarding the prevalence and determinants of cardiac structure and function (systolic and diastolic) among the various Hispanic background groups in the United States is limited. The Echocardiographic Study of Latinos (ECHO-SOL) ancillary study recruited 1,824 participants through a stratified-sampling process representative of the population-based Hispanic Communities Health Study - Study of Latinos (HCHS-SOL) across four sites (Bronx, NY; Chicago, Ill; San Diego, Calif; Miami, Fla). The HCHS-SOL baseline cohort did not include an echo exam. ECHO-SOL added the echocardiographic assessment of cardiac structure and function to an array of existing HCHS-SOL baseline clinical, psychosocial, and socioeconomic data and provides sufficient statistical power for comparisons among the Hispanic subgroups. Standard two-dimensional (2D) echocardiography protocol, including M-mode, spectral, color and tissue Doppler study was performed. The main objectives were to: 1) characterize cardiac structure and function and its determinants among Hispanics and Hispanic subgroups; and 2) determine the contributions of specific psychosocial factors (acculturation and familismo) to cardiac structure and function among Hispanics. We describe the design, methods and rationale of currently the largest and most comprehensive study of cardiac structure and function exclusively among US Hispanics. ECHO-SOL aims to enhance our understanding of Hispanic cardiovascular health as well as help untangle the relative importance of Hispanic subgroup heterogeneity and sociocultural factors on cardiac structure and function.

  19. Pet ownership and risk of asthma: a case-controlled study

    Directory of Open Access Journals (Sweden)

    Sharifi

    2008-08-01

    Full Text Available Background: In the treatment of bronchial asthma, the identification, isolation, and elimination of causative allergens is the most effective part of treatment. With the recent diversification within the pet industry, pet owner exposure to many unknown antigens is on the rise. The results of population studies have been contradictory and some epidemiological studies have failed to confirm this, some indicating that keeping pets might actually reduce the risk of sensitization and asthma. The purpose of this study was to determine the association between pet ownership and asthma. Methods: This case-control study included 300 asthmatic participants referred to the Children's Medical Center over a two-year period. Participants were asked to fill out a questionnaire regarding pet ownership, pet gender and puberty, the place it was kept, how long the pet was kept and the reason for keeping the pet. The same questions were asked from 300 age- and gender-matched nonasthmatic individuals as the control group. Statistical analysis was performed to calculate odds ratios (OR of asthma morbidity in individuals who kept pets. Results: The OR for asthma morbidity in patients who kept pets was 2.59 (CI=1.60-4.21 and p>0.001. Financial aim was the most common reason for keeping a pet and most pets were mature and kept outdoors. No significant correlations for pet genders were observed. Conclusion: This survey provides evidence that pet ownership is an important risk factor for asthma, therefore we suggest that individuals at risk for asthma (atopic individuals must avoid contact with pets. However, more research in this field in Iran is necessary.

  20. A pilot feeding study for adults with asthma: The healthy eating better breathing trial.

    Directory of Open Access Journals (Sweden)

    Emily P Brigham

    Full Text Available Evidence from observational studies and to a lesser extent clinical trials suggest that a healthy diet may improve symptoms and lung function in patients with asthma. We conducted a pilot study to determine the feasibility of conducting a larger scale dietary trial and to provide preliminary evidence on the impact of a healthy diet on asthma outcomes.In a randomized, two period cross-over trial, participants with asthma received a 4-week dietary intervention followed by a usual diet (or vice versa, separated by a 4-week washout. The dietary intervention was a healthy diet rich in unsaturated fat. During the dietary intervention, participants ate three meals per week on site at the Johns Hopkins ProHealth Research Center. All remaining meals and snacks were provided for participants to consume off-site. During the control diet, participants were instructed to continue their usual dietary intake. Relevant biomarkers and asthma clinical outcomes were assessed at 0, 2, and 4 weeks after starting each arm of the study.Eleven participants were randomized, and seven completed the full study protocol. Among these seven participants, average age was 42 years, six were female, and six were African American. Participant self-report of dietary intake revealed significant increases in fruit, vegetable, and omega-3 fatty acid intake with the dietary intervention compared to usual diet. Serum carotenoids (eg. lutein and beta-cryptoxanthin increased in the intervention versus control. Total cholesterol decreased in the intervention versus control diet. There was no consistent effect on asthma outcomes.The findings suggest that a feeding trial in participants with asthma is feasible. Larger trials are needed to definitively assess the potential benefits of dietary interventions on pulmonary symptoms and function in patients with asthma.

  1. Effects of BMI, Fat Mass, and Lean Mass on Asthma in Childhood: A Mendelian Randomization Study

    Science.gov (United States)

    Granell, Raquel; Henderson, A. John; Evans, David M.; Smith, George Davey; Ness, Andrew R.; Lewis, Sarah; Palmer, Tom M.; Sterne, Jonathan A. C.

    2014-01-01

    Background Observational studies have reported associations between body mass index (BMI) and asthma, but confounding and reverse causality remain plausible explanations. We aim to investigate evidence for a causal effect of BMI on asthma using a Mendelian randomization approach. Methods and Findings We used Mendelian randomization to investigate causal effects of BMI, fat mass, and lean mass on current asthma at age 7½ y in the Avon Longitudinal Study of Parents and Children (ALSPAC). A weighted allele score based on 32 independent BMI-related single nucleotide polymorphisms (SNPs) was derived from external data, and associations with BMI, fat mass, lean mass, and asthma were estimated. We derived instrumental variable (IV) estimates of causal risk ratios (RRs). 4,835 children had available data on BMI-associated SNPs, asthma, and BMI. The weighted allele score was strongly associated with BMI, fat mass, and lean mass (all p-valuesBMI on asthma was 1.55 (95% CI 1.16–2.07) per kg/m2, p = 0.003. This effect appeared stronger for non-atopic (1.90, 95% CI 1.19–3.03) than for atopic asthma (1.37, 95% CI 0.89–2.11) though there was little evidence of heterogeneity (p = 0.31). The estimated causal RRs for the effects of fat mass and lean mass on asthma were 1.41 (95% CI 1.11–1.79) per 0.5 kg and 2.25 (95% CI 1.23–4.11) per kg, respectively. The possibility of genetic pleiotropy could not be discounted completely; however, additional IV analyses using FTO variant rs1558902 and the other BMI-related SNPs separately provided similar causal effects with wider confidence intervals. Loss of follow-up was unlikely to bias the estimated effects. Conclusions Higher BMI increases the risk of asthma in mid-childhood. Higher BMI may have contributed to the increase in asthma risk toward the end of the 20th century. Please see later in the article for the Editors' Summary PMID:24983943

  2. An ADAM33 polymorphism associates with progression of preschool wheeze into childhood asthma: a prospective case-control study with replication in a birth cohort study.

    Science.gov (United States)

    Klaassen, Ester M M; Penders, John; Jöbsis, Quirijn; van de Kant, Kim D G; Thijs, Carel; Mommers, Monique; van Schayck, Constant P; van Eys, Guillaume; Koppelman, Gerard H; Dompeling, Edward

    2015-01-01

    The influence of asthma candidate genes on the development from wheeze to asthma in young children still needs to be defined. To link genetic variants in asthma candidate genes to progression of wheeze to persistent wheeze into childhood asthma. In a prospective study, children with recurrent wheeze from the ADEM (Asthma DEtection and Monitoring) study were followed until the age of six. At that age a classification (transient wheeze or asthma) was based on symptoms, lung function and medication use. In 198 children the relationship between this classification and 30 polymorphisms in 16 asthma candidate genes was assessed by logistic regression. In case of an association based on a pchildhood asthma. When replicated in the KOALA study, ADAM33 rs528557 showed a negative association of the CG/GG-genotype with progression of recurrent wheeze into childhood asthma (0.50 (0.26-0.97) p = 0.04) and no association with preschool wheeze. Polymorphisms in ADAM33, ORMDL3/GSDMB and IL4 were associated with childhood asthma in a group of children with recurrent wheeze. The replication of the negative association of the CG/GG-genotype of rs528557 ADAM33 with childhood asthma in an independent birth cohort study confirms that a compromised ADAM33 gene may be implicated in the progression of wheeze into childhood asthma.

  3. Caffeine for asthma

    OpenAIRE

    Welsh, EJ; Bara, A; Barley, E; Cates, CJ

    2010-01-01

    Background\\ud \\ud Caffeine has a variety of pharmacological effects; it is a weak bronchodilator and it also reduces respiratory muscle fatigue. It is chemically related to the drug theophylline which is used to treat asthma. It has been suggested that caffeine may reduce asthma symptoms and interest has been expressed in its potential role as an asthma treatment. A number of studies have explored the effects of caffeine in asthma, this is the first review to systematically examine and summar...

  4. Dietary patterns and adult asthma: population-based case-control study.

    Science.gov (United States)

    Bakolis, I; Hooper, R; Thompson, R L; Shaheen, S O

    2010-05-01

    Epidemiological studies of diet and asthma have focused on relations with intakes of individual nutrients and foods and evidence has been conflicting. Few studies have examined associations with dietary patterns. We carried out a population-based case-control study of asthma in adults aged between 16 and 50 in South London, UK. Information about usual diet was obtained by food frequency questionnaire and we used principal components analysis to define five dietary patterns in controls. We used logistic and linear regression, controlling for confounders, to relate these patterns to asthma, asthma severity, rhinitis and chronic bronchitis in 599 cases and 854 controls. Overall, there was weak evidence that a 'vegetarian' dietary pattern was positively associated with asthma [adjusted odds ratio comparing top vs bottom quintile of pattern score 1.43 (95% CI: 0.93-2.20), P trend 0.075], and a 'traditional' pattern (meat and vegetables) was negatively associated [OR 0.68 (0.45-1.03), P trend 0.071]. These associations were stronger amongst nonsupplement users (P trend 0.030 and 0.001, respectively), and the association with the 'vegetarian' pattern was stronger amongst whites (P trend 0.008). No associations were observed with asthma severity. A 'prudent' dietary pattern (wholemeal bread, fish and vegetables) was positively associated with chronic bronchitis [OR 2.61 (1.13-6.05), P trend 0.025], especially amongst nonsupplement users (P trend 0.002). Overall there were no clear relations between dietary patterns and adult asthma; associations in nonsupplement users and whites require confirmation. The finding for chronic bronchitis was unexpected and also requires replication.

  5. The economic burden of adult asthma in Cyprus; a prevalence-based cost of illness study

    Directory of Open Access Journals (Sweden)

    Savvas Zannetos

    2017-03-01

    Full Text Available Abstract Background Asthma is one of the main non-infectious diseases of the respiratory system with substantial economic burden worldwide. The objective of this study was to estimate the economic burden of adult asthma in Cyprus during 2015. Methods A retrospective probabilistic prevalence-based cost of illness model was developed to calculate the economic burden of asthma including direct and indirect costs. The bottom-up approach (person-based data was used for the calculation of direct costs while for the calculation of indirect costs the approach of human capital was employed. In addition, bootstrapped sensitivity analysis with 1000 bootstrap simulations was performed in order to calculate a 95% Confidence Interval (CI. Results Mean patient cost of asthma in Cyprus in 2015 was estimated at €579.64 (95% CI: €376.90–€813.68. Direct costs accounted for 82.08% of the overall expenses, €475.75 per patient (95% CI: €296.94–€697.69. Indirect costs of €103.89 (95% CI: €49.59–€181.46 accounted for 17.92% of the overall expenses. Conclusion This was the first study in Cyprus, which used bootstrapped prevalence-based cost of illness model to estimate the cost of asthma. This study confirms that asthma is an expensive disease for the society. In addition, it provides important information and analysis of the economic consequences of asthma to policy makers in order to strengthen surveillance of the disease as well as draft the national health policy accordingly.

  6. Association between protozoa in sputum and asthma: a case-control study.

    Science.gov (United States)

    van Woerden, Hugo C; Ratier-Cruz, Adriana; Aleshinloye, Olabode B; Martinez-Giron, Rafael; Gregory, Clive; Matthews, Ian P

    2011-06-01

    Atypical infectious agents have been proposed as potential contributors to asthma. A novel set of morphological and staining criteria permit the identification of flagellated protozoa in sputum. This case-control study was designed to use this novel method and to assess: (1) are protozoa more common in asthmatics than in non-asthmatics; (2) is the presence of protozoa associated with the use of steroid inhalers; and (3) is the presence of protozoa associated with living in damp housing? Induced sputum samples were collected from asthma patients and local non-atopic, non-smoking controls. Questionnaires assessed asthma severity and housing conditions. Sputum was examined for flagellated protozoa using a previously described staining technique. 96 participants were recruited for this study; 54 asthma patients and 42 controls, age range 21-62 years, 70% female participants. Limiting results to those who were clearly positive or negative for flagellated protozoa, 66.7% (20/30) of asthmatics and 30.8% (4/13) of controls had protozoa (p = 0.046). Among the asthma patients, prevalence of protozoa was not significantly different between those who had (10/18), and those who had not (10/12), used steroid inhaler in the preceding two weeks (p = 0.11). Similarly, the prevalence of protozoa was not significantly different between those who did (6/11) and those who did not (18/32), live in damp homes (p = 0.92). This case-control study demonstrates an association between flagellated protozoa in sputum and asthma. It is now necessary to confirm and characterise the protozoa using genetic techniques based on 18S ribosomal RNA. Once tis is established it would be worthwhile to determine if asthma symptoms improve when treated by anti-protozoal agents. Copyright © 2010 Elsevier Ltd. All rights reserved.

  7. Asthma in goldminers

    African Journals Online (AJOL)

    Objectives. To detennine whether asthma in goldminers is caused by or contributed to by their working environment. Design. A case-control stUdy in which men with asthma working underground in goldmines were compared with underground goldminers without asthma in relation to their age, duration of exposure to the ...

  8. Childhood asthma and smoking exposures before conception-A three-generational cohort study.

    Science.gov (United States)

    Bråbäck, Lennart; Lodge, Caroline J; Lowe, Adrian J; Dharmage, Shyamali C; Olsson, David; Forsberg, Bertil

    2018-06-01

    Some human and animal studies have recently shown that maternal grandmother's smoking during pregnancy increases the risk of asthma in the grandchildren. We have investigated whether sex of the exposed parent and/or grandchild modifies the association between grandmaternal smoking and grandchild asthma. We formed a cohort study based on linkage of national registries with prospectively collected data over three generations. Smoking habits in early pregnancy were registered since 1982 and purchases of prescribed medication since 2005. In all, 10 329 children born since 2005 had information on maternal and grandmaternal smoking on both sides and were followed from birth up to 6 years of age. Ages when medication was purchased were used to classify the cohort into never, early transient (0-3 years), early persistent (0-3 and 4-6 years), and late-onset (4-6 years) phenotypes of childhood asthma. Maternal grandmother's smoking was associated with an increased odds of early persistent asthma after adjustment for maternal smoking and other confounders (odds ratio 1.29, 95% confidence interval 1.10-1.51). Grandchild sex did not modify the association. Paternal grandmother's smoking was not associated with any of the asthma phenotypes. Maternal but not paternal exposure to nicotine before conception was related to an increased risk of early persistent childhood asthma, but not other asthma phenotypes. Our findings are possibly consistent with a sex-specific mode of epigenetic transfer. © 2018 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.

  9. Mother's education and offspring asthma risk in 10 European cohort studies.

    Science.gov (United States)

    Lewis, Kate Marie; Ruiz, Milagros; Goldblatt, Peter; Morrison, Joana; Porta, Daniela; Forastiere, Francesco; Hryhorczuk, Daniel; Zvinchuk, Oleksandr; Saurel-Cubizolles, Marie-Josephe; Lioret, Sandrine; Annesi-Maesano, Isabella; Vrijheid, Martine; Torrent, Maties; Iniguez, Carmen; Larranaga, Isabel; Harskamp-van Ginkel, Margreet W; Vrijkotte, Tanja G M; Klanova, Jana; Svancara, Jan; Barross, Henrique; Correia, Sofia; Jarvelin, Marjo-Riitta; Taanila, Anja; Ludvigsson, Johnny; Faresjo, Tomas; Marmot, Michael; Pikhart, Hynek

    2017-09-01

    Highly prevalent and typically beginning in childhood, asthma is a burdensome disease, yet the risk factors for this condition are not clarified. To enhance understanding, this study assessed the cohort-specific and pooled risk of maternal education on asthma in children aged 3-8 across 10 European countries. Data on 47,099 children were obtained from prospective birth cohort studies across 10 European countries. We calculated cohort-specific prevalence difference in asthma outcomes using the relative index of inequality (RII) and slope index of inequality (SII). Results from all countries were pooled using random-effects meta-analysis procedures to obtain mean RII and SII scores at the European level. Final models were adjusted for child sex, smoking during pregnancy, parity, mother's age and ethnicity. The higher the score the greater the magnitude of relative (RII, reference 1) and absolute (SII, reference 0) inequity. The pooled RII estimate for asthma risk across all cohorts was 1.46 (95% CI 1.26, 1.71) and the pooled SII estimate was 1.90 (95% CI 0.26, 3.54). Of the countries examined, France, the United Kingdom and the Netherlands had the highest prevalence's of childhood asthma and the largest inequity in asthma risk. Smaller inverse associations were noted for all other countries except Italy, which presented contradictory scores, but with small effect sizes. Tests for heterogeneity yielded significant results for SII scores. Overall, offspring of mothers with a low level of education had an increased relative and absolute risk of asthma compared to offspring of high-educated mothers.

  10. Rationale and Design of the Women and Inclusion in Academic Medicine Study.

    Science.gov (United States)

    Hill, Emorcia V; Wake, Michael; Carapinha, René; Normand, Sharon-Lise; Wolf, Robert E; Norris, Keith; Reede, Joan Y

    2016-04-21

    Women of color (WOC) (African American, Hispanic, Native American/Alaskan Native, and Asian American) faculty remain disproportionately underrepresented among medical school faculty and especially at senior ranks compared with White female faculty. The barriers or facilitators to the career advancement of WOC are poorly understood. The Women and Inclusion in Academic Medicine (WIAM) study was developed to characterize individual, institutional and sociocultural factors that influence the entry, progression and persistence, and advancement of women faculty in academic medical careers with a focus on WOC. Using a purposive sample of 13 academic medical institutions, we collected qualitative interview data from 21 WOC junior faculty and quantitative data from 3,127 (38.9% of 8,053 eligible women) respondents via an online survey. To gather institutional data, we used an online survey and conducted 23 key administrative informant interviews from the 13 institutions. Grounded theory methodology will be used to analyze qualitative data. Multivariable analysis including hierarchical linear modeling will be used to investigate outcomes, such as the inclusiveness of organizational gender climate and women faculty's intent to stay. We describe the design, methods, rationale and limitations of one of the largest and most comprehensive studies of women faculty in academic medicine with a focus on WOC. This study will enhance our understanding of challenges that face women, and, especially WOC, faculty in academic medicine and will provide solutions at both the individual and institutional levels.

  11. JAK2 inhibitor therapy in myeloproliferative disorders: rationale, preclinical studies and ongoing clinical trials.

    Science.gov (United States)

    Pardanani, A

    2008-01-01

    The recent identification of somatic mutations such as JAK2V617F that deregulate Janus kinase (JAK)-signal transducer and activator of transcription signaling has spurred development of orally bioavailable small-molecule inhibitors that selectively target JAK2 kinase as an approach to pathogenesis-directed therapy of myeloproliferative disorders (MPD). In pre-clinical studies, these compounds inhibit JAK2V617F-mediated cell growth at nanomolar concentrations, and in vivo therapeutic efficacy has been demonstrated in mouse models of JAK2V617F-induced disease. In addition, ex vivo growth of progenitor cells from MPD patients harboring JAK2V617F or MPLW515L/K mutations is also potently inhibited. JAK2 inhibitors currently in clinical trials can be grouped into those designed to primarily target JAK2 kinase (JAK2-selective) and those originally developed for non-MPD indications, but that nevertheless have significant JAK2-inhibitory activity (non-JAK2 selective). This article discusses the rationale for using JAK2 inhibitors for the treatment of MPD, as well as relevant aspects of clinical trial development for these patients. For instance, which group of MPD patients is appropriate for initial Phase I studies? Should JAK2V617F-negative MPD patients be included in the initial studies? What are the likely consequences of 'off-target' JAK3 and wild-type JAK2 inhibition? How should treatment responses be monitored?

  12. Bisphenol A exposure and asthma development in school-age children: a longitudinal study.

    Directory of Open Access Journals (Sweden)

    Kyoung-Nam Kim

    Full Text Available Although the effect of bisphenol A on various health outcomes has been extensively examined, few studies have investigated its effect on asthma.We hypothesized that exposure to bisphenol A in school-age children was associated with wheezing and asthma.Participants included 127 children aged 7-8 years without a previous asthma diagnosis in an elementary school in Seoul, Korea. Three surveys were conducted, each 2 years apart. Bisphenol A concentration was measured at the baseline survey, and PC20, which is defined as the methacholine concentration that induces a decrease in FEV1 of 20% from baseline, was measured at every survey. Associations between bisphenol A concentration at 7-8 years of age and wheezing, asthma, and PC20 at ages up to 11-12 years were examined using generalized estimating equations, a marginal Cox regression model, and a linear mixed model.The log-transformed creatinine-adjusted urinary bisphenol A concentration at 7-8 years was positively associated with wheezing (odds ratio, 2.48; 95% confidence interval, 1.15-5.31; P = .02 and asthma (hazard ratio, 2.13; 95% confidence interval, 1.51-3.00; P<.001 at ages up to 11-12 years. Bisphenol A was also negatively associated with PC20 (ß = -2.33; P = .02. When stratified by sex, the association between bisphenol A and asthma remained significant only in girls (hazard ratio, 2.45; 95% confidence interval, 2.18-2.76; P<.001.Increased urinary bisphenol A concentrations at 7-8 years old were positively associated with wheezing and asthma and negatively associated with PC20 at ages up to 11-12 years.

  13. Higher body mass index may induce asthma among adolescents with pre-asthmatic symptoms: a prospective cohort study

    Directory of Open Access Journals (Sweden)

    Myers Leann

    2011-07-01

    Full Text Available Abstract Background Limited studies have prospectively examined the role of body mass index (BMI as a major risk factor for asthma during adolescence. This study investigates whether BMI is associated with increased risk of developing physician-diagnosed asthma during 12-month follow-up among adolescents with undiagnosed asthma-like symptoms at baseline. Methods A total of 4,052 adolescents with undiagnosed asthma-like symptoms at baseline were re-examined after a 12-month follow-up. Asthma cases were considered confirmed only after diagnosis by a physician based on the New England core and International Study of Asthma and Allergies in Childhood (ISAAC criteria video questionnaires, and accompanying pulmonary function tests. Logistic regression analyses were used to evaluate the relationship of BMI and the risk of acquiring asthma. Results The results indicated that girls with higher BMI were at an increased risk of developing asthma during the 12-month follow-up. The odds ratios for girls developing physician-diagnosed asthma were 1.75 (95% CI = 1.18-2.61 and 1.12 (95% CI = 0.76-1.67, respectively, for overweight and obesity as compared to the normal weight reference group after adjustment for other covariates. A similar relationship was not observed for overweight and obese boys who were also significantly more active than their female counterparts. Conclusions Increased BMI exaggerates the risk of acquiring asthma in symptomatic adolescent females but not in adolescent males. Thus, gender is an important modifier of BMI-related asthma risk. Additional research will be required to determine whether the increased asthma risk results from genetic, physiological or behavioural differences.

  14. Design and rationale for examining neuroimaging genetics in ischemic stroke: The MRI-GENIE study.

    Science.gov (United States)

    Giese, Anne-Katrin; Schirmer, Markus D; Donahue, Kathleen L; Cloonan, Lisa; Irie, Robert; Winzeck, Stefan; Bouts, Mark J R J; McIntosh, Elissa C; Mocking, Steven J; Dalca, Adrian V; Sridharan, Ramesh; Xu, Huichun; Frid, Petrea; Giralt-Steinhauer, Eva; Holmegaard, Lukas; Roquer, Jaume; Wasselius, Johan; Cole, John W; McArdle, Patrick F; Broderick, Joseph P; Jimenez-Conde, Jordi; Jern, Christina; Kissela, Brett M; Kleindorfer, Dawn O; Lemmens, Robin; Lindgren, Arne; Meschia, James F; Rundek, Tatjana; Sacco, Ralph L; Schmidt, Reinhold; Sharma, Pankaj; Slowik, Agnieszka; Thijs, Vincent; Woo, Daniel; Worrall, Bradford B; Kittner, Steven J; Mitchell, Braxton D; Rosand, Jonathan; Golland, Polina; Wu, Ona; Rost, Natalia S

    2017-10-01

    To describe the design and rationale for the genetic analysis of acute and chronic cerebrovascular neuroimaging phenotypes detected on clinical MRI in patients with acute ischemic stroke (AIS) within the scope of the MRI-GENetics Interface Exploration (MRI-GENIE) study. MRI-GENIE capitalizes on the existing infrastructure of the Stroke Genetics Network (SiGN). In total, 12 international SiGN sites contributed MRIs of 3,301 patients with AIS. Detailed clinical phenotyping with the web-based Causative Classification of Stroke (CCS) system and genome-wide genotyping data were available for all participants. Neuroimaging analyses include the manual and automated assessments of established MRI markers. A high-throughput MRI analysis pipeline for the automated assessment of cerebrovascular lesions on clinical scans will be developed in a subset of scans for both acute and chronic lesions, validated against gold standard, and applied to all available scans. The extracted neuroimaging phenotypes will improve characterization of acute and chronic cerebrovascular lesions in ischemic stroke, including CCS subtypes, and their effect on functional outcomes after stroke. Moreover, genetic testing will uncover variants associated with acute and chronic MRI manifestations of cerebrovascular disease. The MRI-GENIE study aims to develop, validate, and distribute the MRI analysis platform for scans acquired as part of clinical care for patients with AIS, which will lead to (1) novel genetic discoveries in ischemic stroke, (2) strategies for personalized stroke risk assessment, and (3) personalized stroke outcome assessment.

  15. Outdoor air pollution, exhaled 8-isoprostane and current asthma in adults: the EGEA study.

    Science.gov (United States)

    Havet, Anaïs; Zerimech, Farid; Sanchez, Margaux; Siroux, Valérie; Le Moual, Nicole; Brunekreef, Bert; Stempfelet, Morgane; Künzli, Nino; Jacquemin, Bénédicte; Matran, Régis; Nadif, Rachel

    2018-04-01

    Associations between outdoor air pollution and asthma in adults are still scarce, and the underlying biological mechanisms are poorly understood. Our aim was to study the associations between 1) long-term exposure to outdoor air pollution and current asthma, 2) exhaled 8-isoprostane (8-iso; a biomarker related to oxidative stress) and current asthma, and 3) outdoor air pollution and exhaled 8-iso.Cross-sectional analyses were conducted in 608 adults (39% with current asthma) from the first follow-up of the French case-control and family study on asthma (EGEA; the Epidemiological study of the Genetic and Environmental factors of Asthma). Data on nitrogen dioxide, nitrogen oxides, particulate matter with a diameter ≤10 and ≤2.5 µm (PM 10 and PM 2.5 ), road traffic, and ozone (O 3 ) were from ESCAPE (European Study of Cohorts for Air Pollution Effects) and IFEN (French Institute for the Environment) assessments. Models took account of city and familial dependence.The risk of current asthma increased with traffic intensity (adjusted (a)OR 1.09 (95% CI 1.00-1.18) per 5000 vehicles per day), with O 3 exposure (aOR 2.04 (95% CI 1.27-3.29) per 10 µg·m -3 ) and with exhaled 8-iso concentration (aOR 1.50 (95% CI 1.06-2.12) per 1 pg·mL -1 ). Among participants without asthma, exhaled 8-iso concentration increased with PM 2.5 exposure (adjusted (a)β 0.23 (95% CI 0.005-0.46) per 5 µg·m -3 ), and decreased with O 3 and O 3-summer exposures (aβ -0.20 (95% CI -0.39- -0.01) and aβ -0.52 (95% CI -0.77- -0.26) per 10 µg·m -3 , respectively).Our results add new insights into a potential role of oxidative stress in the associations between outdoor air pollution and asthma in adults. Copyright ©ERS 2018.

  16. Electronic Adherence Monitoring in a High-Utilizing Pediatric Asthma Cohort: A Feasibility Study.

    Science.gov (United States)

    Kenyon, Chén Collin; Chang, Joyce; Wynter, Sheri-Ann; Fowler, Jessica C; Long, Jin; Bryant-Stephens, Tyra C

    2016-06-22

    Inner-city, minority children with asthma have the highest rates of morbidity and death from asthma and the lowest rates of asthma controller medication adherence. Some recent electronic medication monitoring interventions demonstrated dramatic improvements in adherence in lower-risk populations. The feasibility and acceptability of such an intervention in the highest-risk children with asthma has not been studied. Our objective was to assess the feasibility and acceptability of a community health worker-delivered electronic adherence monitoring intervention among the highest utilizers of acute asthma care in an inner-city practice. This was a prospective cohort pilot study targeting children with the highest frequency of asthma-related emergency department and hospital care within a local managed care Medicaid plan. The 3-month intervention included motivational interviewing, electronic monitoring of controller and rescue inhaler use, and outreach by a community health worker for predefined medication alerts. We measured acceptability by using a modified technology acceptability model and changes in asthma control using the Asthma Control Test (ACT). Given prominent feasibility issues, we describe qualitative patterns of medication use at baseline only. We enrolled 14 non-Hispanic black children with a median age of 3.5 years. Participants averaged 7.8 emergency or hospital visits in the year preceding enrollment. We observed three distinct patterns of baseline controller use: 4 patients demonstrated sustained use, 5 patients had periodic use, and 5 patients lapsed within 2 weeks. All participants initiated use of the electronic devices; however, no modem signal was transmitted for 5 or the 14 participants after a mean of 45 days. Of the 9 (64% of total) caregivers who completed the final study visit, all viewed the electronic monitoring device favorably and would recommend it to friends, and 5 (56%) believed that the device helped to improve asthma control. ACT

  17. Prevalence of asthma in Latin America. Critical look at ISAAC and other studies

    Directory of Open Access Journals (Sweden)

    Jaime Ocampo

    2017-06-01

    Full Text Available Currently, the ISAAC (International Study of Asthma and Allergies in Childhood project is a global approach to assess the prevalence of asthma and other allergies in different latitudes. One of the great advantages of this project is that it compares using the same methodology, the prevalence of asthma in more than 50 cities during the same period of time, nevertheless the reproducibility of these results when compared with other studies of prevalence in each region has not been evaluated. In this review we aim to compare the epidemiological data provided by the ISAAC against the data identified in some regional cohort studies and by means of a critical evaluation to highlight the main similarities and to analyze the differences between these epidemiological data.

  18. Vitamin D as an adjunctive therapy in asthma. Part 2: A review of human studies.

    LENUS (Irish Health Repository)

    Kerley, Conor P

    2015-03-05

    Vitamin D deficiency (VDD) is highly prevalent worldwide, with adverse effects on bone health but also potentially other unfavorable consequences. VDD and asthma-incidence\\/severity share many common risk factors, including winter season, industrialization, poor diet, obesity, dark skin pigmentation, and high latitude. Multiple anatomical areas relevant to asthma contain both the enzyme responsible for producing activated vitamin D and the vitamin D receptor suggesting that activated vitamin D (1,25-dihydroxyvitamin D) may have important local effects at these sites. Emerging evidence suggests that VDD is associated with increased airway hyperresponsiveness, decreased pulmonary function, worse asthma control, and possibly decreased response to standard anti-asthma therapy. However the effect is inconsistent with preliminary evidence from different studies suggesting vitamin D is both beneficial and detrimental to asthma genesis and severity. Current evidence suggests that supplementation with moderate doses of vitamin D may be appropriate for maintenance of bone health in asthmatics, particularly steroid users. However emerging data from an increasing number of randomized, controlled, intervention studies of vitamin D supplementation in pediatric and adult asthma are becoming available and should help determine the importance, if any of vitamin D for asthma pathogenesis. The purpose of this second of a two-part review is to review the current human literature on vitamin D and asthma, discussing the possible consequences of VDD for asthma and the potential for vitamin D repletion as adjunct therapy.

  19. Risk factors for asthma in young adults: a co-twin control study

    DEFF Research Database (Denmark)

    Thomsen, SF; Ulrik, Charlotte Suppli; Kyvik, KO

    2006-01-01

    BACKGROUND: The liability to asthma is influenced both by genetic and environmental factors. The objective of this study was to identify risk factors for asthma in young adult twin pairs during an 8-year period. METHODS: From the birth cohorts 1953-1982 of the Danish Twin Registry, 6,090 twin pairs....... Pairs in which only one twin developed asthma -- discordant pairs -- were identified and conditional logistic regression was applied to detect effects of risk factors. RESULTS: A total of 126 monozygotic (MZ) and 273 dizygotic (DZ) discordant twin pairs were identified. In MZ twins hay fever (OR = 3...... and females = 0.54, 95% CI: 0.36-0.80, P = 0.002), and increasing levels of body mass index (BMI; OR per unit = 1.11, 95% CI: 1.02-1.20, P = 0.009) were significant predictors of asthma. CONCLUSIONS: Hay fever, eczema, female sex, exercise and increasing levels of BMI were risk factors for asthma in young...

  20. Linking clinical quality indicators to research evidence - a case study in asthma management for children.

    Science.gov (United States)

    Choong, Miew Keen; Tsafnat, Guy; Hibbert, Peter; Runciman, William B; Coiera, Enrico

    2017-07-21

    Clinical quality indicators are used to monitor the performance of healthcare services and should wherever possible be based on research evidence. Little is known however about the extent to which indicators in common use are based on research. The objective of this study is to measure the extent to which clinical quality indicators used in asthma management in children with outcome measurements can be linked to results in randomised controlled clinical trial (RCT) reports. This work is part of a broader research program to trial methods that improve the efficiency and accuracy of indicator development. National-level indicators for asthma management in children were extracted from the National Quality Measures Clearinghouse database and the National Institute for Health and Care Excellence quality standards by two independent appraisers. Outcome measures were extracted from all published English language RCT reports for asthma management in children below the age of 12 published between 2005 and 2014. The two sets were then linked by manually mapping both to a common set of Unified Medical Language System (UMLS) concepts. The analysis identified 39 indicators and 562 full text RCTs dealing with asthma management in children. About 95% (37/39) of the indicators could be linked to RCT outcome measures. It is possible to identify relevant RCT reports for the majority of indicators used to assess the quality of asthma management in childhood. The methods reported here could be automated to more generally support assessment of candidate indicators against the research evidence.

  1. Consequences of occupational asthma on employment and financial status: a follow-up study.

    Science.gov (United States)

    Ameille, J; Pairon, J C; Bayeux, M C; Brochard, P; Choudat, D; Conso, F; Devienne, A; Garnier, R; Iwatsubo, Y

    1997-01-01

    The aim of this study was to describe changes in employment and income following a diagnosis of occupational asthma, and to determine what factors might affect these changes. Two hundred and nine patients with occupational asthma were reviewed on average 3.1 yrs after the diagnosis had been made. They were contacted by telephone or were sent a self-administered questionnaire by post. Multiple logistic regression models were constructed to determine which variables were associated with loss of employment after the diagnosis. At the time of review, 44% of patients had left their previous job and 25% were currently unemployed. Remarkably, 32% remained exposed to the offending agents in the same job. Forty six percent of the patients had suffered a reduction of income (84% of those who had left their employer versus 19% of those still employed in the same company (p company, level of education, and age at the time of diagnosis were significantly associated with a risk for becoming unemployed or having a new employer after the diagnosis of occupational asthma. Occupational asthma results in severe socioeconomic consequences. The French compensation system for occupational asthma should be revised, as the criteria currently used to determine compensation for this disease largely underestimate the social and occupational damages.

  2. Evaluation of selected immunological parameters and the concentration of vitamin D in children with asthma. Case-control study

    Science.gov (United States)

    Wawrzyniak, Agata; Lipińska-Opałka, Agnieszka; Zdanowski, Robert; Murawski, Piotr; Kalicki, Bolesław

    2017-01-01

    Due to the increased incidence of allergic diseases and emerging effects of unsatisfactory control of asthma, new mechanisms for supervising the immune system should be searched. The aim of the study was to analyze the percentage of CD3, CD4, CD8, CD19, CD16/56, NKT, CD3 anti-HLADR3 and Foxp3 regulatory lymphocytes in patients with asthma. Additionally the correlation between immune parameters, severity of asthma and serum concentration of vitamin D was performed. 25 children diagnosed with asthma were enrolled. Disease severity was assessed with the Asthma Control Test (ACT) and spirometry. The control group consisted of 15 healthy children. Venous blood from each patient was collected on EDTA or on “clott”. Phenotypes of lymphocytes were evaluated by flow cytometry. Vitamin D concentration was assessed by chemiluminescent immunoassay (CLIA) technology. There was a significant decrease in the percentage of T regulatory cells (p asthma compared to the control group. There were no significant differences in the other investigated immunological parameters. In addition, in asthma group statistically significant decreased of vitamin D concentration (p asthma or percentage of regulatory cells. The results confirmed the role of regulatory T cells in the pathogenesis of asthma. Effects of vitamin D on the severity of the disease has not been proven. PMID:28680338

  3. Evaluation of selected immunological parameters and the concentration of vitamin D in children with asthma. Case-control study

    Directory of Open Access Journals (Sweden)

    Agata Wawrzyniak

    2017-05-01

    Full Text Available Due to the increased incidence of allergic diseases and emerging effects of unsatisfactory control of asthma, new mechanisms for supervising the immune system should be searched. The aim of the study was to analyze the percentage of CD3, CD4, CD8, CD19, CD16/56, NKT, CD3 anti-HLADR3 and Foxp3 regulatory lymphocytes in patients with asthma. Additionally the correlation between immune parameters, severity of asthma and serum concentration of vitamin D was performed. 25 children diagnosed with asthma were enrolled. Disease severity was assessed with the Asthma Control Test (ACT and spirometry. The control group consisted of 15 healthy children. Venous blood from each patient was collected on EDTA or on “clott”. Phenotypes of lymphocytes were evaluated by flow cytometry. Vitamin D concentration was assessed by chemiluminescent immunoassay (CLIA technology. There was a significant decrease in the percentage of T regulatory cells (p < 0.006 in children with asthma compared to the control group. There were no significant differences in the other investigated immunological parameters. In addition, in asthma group statistically significant decreased of vitamin D concentration (p < 0.04 was observed. There were also no significant correlations between vitamin D3 concentration and the course of asthma or percentage of regulatory cells. The results confirmed the role of regulatory T cells in the pathogenesis of asthma. Effects of vitamin D on the severity of the disease has not been proven.

  4. The Pediatric Obsessive-Compulsive Disorder Treatment Study II: rationale, design and methods

    Directory of Open Access Journals (Sweden)

    March John S

    2009-01-01

    Full Text Available Abstract This paper presents the rationale, design, and methods of the Pediatric Obsessive-Compulsive Disorder Treatment Study II (POTS II, which investigates two different cognitive-behavior therapy (CBT augmentation approaches in children and adolescents who have experienced a partial response to pharmacotherapy with a serotonin reuptake inhibitor for OCD. The two CBT approaches test a "single doctor" versus "dual doctor" model of service delivery. A specific goal was to develop and test an easily disseminated protocol whereby child psychiatrists would provide instructions in core CBT procedures recommended for pediatric OCD (e.g., hierarchy development, in vivo exposure homework during routine medical management of OCD (I-CBT. The conventional "dual doctor" CBT protocol consists of 14 visits over 12 weeks involving: (1 psychoeducation, (2, cognitive training, (3 mapping OCD, and (4 exposure with response prevention (EX/RP. I-CBT is a 7-session version of CBT that does not include imaginal exposure or therapist-assisted EX/RP. In this study, we compared 12 weeks of medication management (MM provided by a study psychiatrist (MM only with two types of CBT augmentation: (1 the dual doctor model (MM+CBT; and (2 the single doctor model (MM+I-CBT. The design balanced elements of an efficacy study (e.g., random assignment, independent ratings with effectiveness research aims (e.g., differences in specific SRI medications, dosages, treatment providers. The study is wrapping up recruitment of 140 youth ages 7–17 with a primary diagnosis of OCD. Independent evaluators (IEs rated participants at weeks 0,4,8, and 12 during acute treatment and at 3,6, and 12 month follow-up visits. Trial registration NCT00074815

  5. Environment and Health in Children Day Care Centres (ENVIRH) - Study rationale and protocol.

    Science.gov (United States)

    Araújo-Martins, J; Carreiro Martins, P; Viegas, J; Aelenei, D; Cano, M M; Teixeira, J P; Paixão, P; Papoila, A L; Leiria-Pinto, P; Pedro, C; Rosado-Pinto, J; Annesi-Maesano, I; Neuparth, N

    2014-01-01

    Indoor air quality (IAQ) is considered an important determinant of human health. The association between exposure to volatile organic compounds, particulate matter, house dust mite, molds and bacteria in day care centers (DCC) is not completely clear. The aim of this project was to study these effects. This study comprised two phases. Phase I included an evaluation of 45 DCCs (25 from Lisbon and 20 from Oporto, targeting 5161 children). In this phase, building characteristics, indoor CO2 and air temperature/relative humidity, were assessed. A children's respiratory health questionnaire derived from the ISAAC (International Study on Asthma and Allergies in Children) was also distributed. Phase II encompassed two evaluations and included 20 DCCs selected from phase I after a cluster analysis (11 from Lisbon and 9 from Oporto, targeting 2287 children). In this phase, data on ventilation, IAQ, thermal comfort parameters, respiratory and allergic health, airway inflammation biomarkers, respiratory virus infection patterns and parental and child stress were collected. In Phase I, building characteristics, occupant behavior and ventilation surrogates were collected from all DCCs. The response rate of the questionnaire was 61.7% (3186 children). Phase II included 1221 children. Association results between DCC characteristics, IAQ and health outcomes will be provided in order to support recommendations on IAQ and children's health. A building ventilation model will also be developed. This paper outlines methods that might be implemented by other investigators conducting studies on the association between respiratory health and indoor air quality at DCC. Copyright © 2013 Sociedade Portuguesa de Pneumologia. Published by Elsevier España. All rights reserved.

  6. A methodology to establish a database to study gene environment interactions for childhood asthma

    Directory of Open Access Journals (Sweden)

    McCormick Jonathan

    2010-12-01

    Full Text Available Abstract Background Gene-environment interactions are likely to explain some of the heterogeneity in childhood asthma. Here, we describe the methodology and experiences in establishing a database for childhood asthma designed to study gene-environment interactions (PAGES - Paediatric Asthma Gene Environment Study. Methods Children with asthma and under the care of a respiratory paediatrician are being recruited from 15 hospitals between 2008 and 2011. An asthma questionnaire is completed and returned by post. At a routine clinic visit saliva is collected for DNA extraction. Detailed phenotyping in a proportion of children includes spirometry, bronchodilator response (BDR, skin prick reactivity, exhaled nitric oxide and salivary cotinine. Dietary and quality of life questionnaires are completed. Data are entered onto a purpose-built database. Results To date 1045 children have been invited to participate and data collected in 501 (48%. The mean age (SD of participants is 8.6 (3.9 years, 57% male. DNA has been collected in 436 children. Spirometry has been obtained in 172 children, mean % predicted (SD FEV1 97% (15 and median (IQR BDR is 5% (2, 9. There were differences in age, socioeconomic status, severity and %FEV1 between the different centres (p≤0.024. Reasons for non-participation included parents not having time to take part, children not attending clinics and, in a small proportion, refusal to take part. Conclusions It is feasible to establish a national database to study gene-environment interactions within an asthmatic paediatric population; there are barriers to participation and some different characteristics in individuals recruited from different centres. Recruitment to our study continues and is anticipated to extend current understanding of asthma heterogeneity.

  7. Long-term clinical effects of aspirin-desensitization therapy among patients with poorly controlled asthma and non-steroidal anti-inflammatory drug hypersensitivity: An exploratory study

    Directory of Open Access Journals (Sweden)

    U. Förster-Ruhrmann

    2015-11-01

    Full Text Available Background: According to the Global Initiative for Asthma (GINA, the levels of asthma symptom control can be divided into controlled, partially controlled and uncontrolled asthma. Optional therapy for non-steroidal anti-inflammatory drugs (NSAIDs-hypersensitive asthmatics uses aspirin desensitization, but until now, this therapy is not established in difficult to treat cases. The aim of this study was to evaluate the efficacy of aspirin desensitization in patients with poorly controlled asthma. Methods: Patients with poorly controlled asthma, NDAIDs hypersensitivity and aspirin desensitization were included in the retrospective study. The data were compared to those obtained from patients with controlled asthma and aspirin therapy. Lung function, levels of asthma symptom control, asthma medication, the size of nasal polyps (NP and smell function were evaluated over 18 months. Results: Thirty-two patients were included in the study (uncontrolled/partially controlled asthma n = 12; controlled asthma n = 20. After 18 months of follow-up, the patients with poorly controlled asthma had significantly increased forced expiratory volume in 1 s (FEV1 values, as compared to the baseline (66–82%; p = 0.02, the levels of asthma control improved significantly (p  0.05 and the asthma medication was constant. In relation to nasal parameters the sense of smell improved significantly in both groups, NP-scores did not differ significantly. Conclusions: Patients with a poorly controlled asthma and NSAIDs hypersensitivity profit from an add-on aspirin therapy. Keywords: Asthma, Levels of asthma symptom control, GINA, Uncontrolled asthma, Aspirin-exacerbated respiratory disease (AERD, NSAIDs hypersensitivity, NSAIDs sensitive asthma, Nasal polyps

  8. The Reversal Intervention for Metabolic Syndrome (TRIMS study: rationale, design, and baseline data

    Directory of Open Access Journals (Sweden)

    Troughton Jacqui

    2011-05-01

    Full Text Available Abstract Background Recent attention has focused on strategies to combat the forecast epidemic of type-2 diabetes (T2DM and its major vascular sequelae. Metabolic syndrome (MetS comprises a constellation of factors that increase the risk of cardiovascular disease (CVD and T2DM. Our study aims to develop a structured self-management education programme for people with MetS, which includes management of cardiovascular and diabetes risk factors, and to determine its impact. This paper describes the rationale and design of the TRIMS study, including intervention development, and presents baseline data. Methods Subjects recruited from a mixed-ethnic population with MetS were randomised to intervention or control arms. The intervention arm received structured group education based on robust psychological theories and current evidence. The control group received routine care. Follow-up data will be collected at 6 and 12 months. The primary outcome measure will be reversal of metabolic syndrome in the intervention group subjects compared to controls at 12 months follow-up. Results 82 participants (44% male, 22% South Asian were recruited between November 2009 and July 2010. Baseline characteristics were similar for both the intervention (n = 42 and control groups (n = 40. Median age was 63 years (IQR 57 - 67, mean waist size 106 cm (SD ± 11, and prescribing of statins and anti-hypertensives was 51% in each case. Conclusion Results will provide information on changes in diabetes and CVD risk factors and help to inform primary prevention strategies in people with MetS from varied ethnic backgrounds who are at high risk of developing T2DM and CVD. Information gathered in relation to the programme's acceptability and effectiveness in a multi-ethnic population would ensure that our results are widely applicable. Trial registration The study is registered at ClinicalTrials.gov, study identifier: NCT01043770.

  9. Work stress, family stress and asthma: a cross-sectional study among women in China.

    Science.gov (United States)

    Loerbroks, Adrian; Ding, Hui; Han, Wei; Wang, Hong; Wu, Jiang-Ping; Yang, Liu; Angerer, Peter; Li, Jian

    2017-05-01

    Research addressing links of work stress or family stress with asthma is constrained by (1) inconsistent evidence, (2) failure to consider the combined exposure to work stress and family stress, and (3) its primary focus on Western study populations. We aimed to address these knowledge gaps. We used cross-sectional data collected in 2015 among 7816 women from five professional groups in five Chinese cities. Work stress was measured by the 10-item effort-reward imbalance (ERI) questionnaire. Family stress was assessed by a psychometrically evaluated instrument comprising five items on, e.g., familial conflicts or domestic workload. Asthma was operationalized by self-reports of a physician diagnosis. Associations were examined by multivariable logistic regression estimating odds ratios (ORs) and 95% confidence intervals (CIs). Both high work stress (i.e., ERI score >1) and high family stress (i.e., score above the median) were associated with asthma (OR 1.66, 95% CI 1.22-2.27 and OR 1.48, 95% CI 1.10-1.99, respectively). Women with combined exposure (versus none) had somewhat higher odds of asthma (OR 2.13, 95% CI 1.42-3.19) than those with sole exposure to either work stress (OR 1.89, 95% CI 1.20-2.96) or family stress (OR 1.71, 95% CI 1.03-2.84). Interaction terms were significant for continuous variables (p = 0.046), but not for dichotomized variables (p = 0.199). The present study suggests that both work stress and family stress are positively associated with asthma in women in China. Further, the combined exposure may be associated with a further excess of asthma occurrence. Longitudinal studies are needed to confirm our findings and to explore potential temporal relationships.

  10. Meteorological factors, aeroallergens and asthma-related visits in Kuwait : A 12-month retrospective study

    International Nuclear Information System (INIS)

    Jafar A Qasem

    2010-01-01

    The increasing prevalence of asthma in many countries has been related to weather factors and aeroallergen concentrations , but this has not been studied in Kuwait. We evaluated the effect of meteorological factors and the occurrence of aerobiologicals on the number of asthma cases in Kuwait.The number of daily asthma visits to the allergy center and emergency department at Al-Sabha Hospital for 1 year were examined on a monthly basis for correlation with major metereological factors (temperature , relative humidity , rain , wind speed and direction). Spore and pollen counts were collected hourly. Results: A total of 4353 patients received asthma treatment during the year. The highest pollen count was in the month of September with a maximum relative humidity of 47% and no precipitation , but with a high mean temperature of 39.7 0 C. . Pollen counts were higher in the late summer (September) and occurred with a high patient visit to the allergy center. Fungal spore counts were significantly higher in early winter (December). The high fungal spore count seemed related to with high relative humidity and high precipitation with a low mean average temperature of 19.7 0 C. The increase number of patients with bronchial asthma visiting an emergency clinic during December was significantly associated with high aerial counts for fungal spores (P<.03) , and the months of September and October were more significant for pollen.This study indicates that meteorological factors , aeroallergen concentrations and asthma related visits are interrelated. The results may prove useful in the generation of hypotheses and development of designs for more comprehensive , individual-based epidemiological studies (Author).

  11. Long-term studies of the natural history of asthma in childhood

    DEFF Research Database (Denmark)

    Bisgaard, Hans; Bønnelykke, Klaus

    2010-01-01

    Segmentation of children with asthma and other wheezy disorders remains the main research challenge today, as it was when described 2 centuries ago. Early childhood wheezy disorders follow different temporal trajectories, probably representing different underlying mechanisms (endophenotypes...... secondary prevention through the use of inhaled corticosteroids can effectively halt the long-term disease progression in childhood. In conclusion, the natural history of asthma and the associated airway changes is still poorly understood, and we have not managed to translate findings from long-term studies......). Prospective identification of endophenotypes allowing accurate prediction of the clinical course is currently not possible. The variability of the clinical course remains an enigma and difficult to predict. Three of 4 school-aged children with asthma have outgrown disease by midadulthood. The risk...

  12. Obesity and asthma

    DEFF Research Database (Denmark)

    Sivapalan, Pradeesh; Diamant, Zuzana; Ulrik, Charlotte Suppli

    2015-01-01

    PURPOSE OF REVIEW: Obesity has significant impact on asthma incidence and manifestations. The purpose of the review is to discuss recent observations regarding the association between obesity and asthma focusing on underlying mechanisms, clinical presentation, response to therapy and effect...... of weight reduction. RECENT FINDINGS: Clinical and epidemiological studies indicate that obese patients with asthma may represent a unique phenotype, which is more difficult to control, less responsive to asthma medications and by that may have higher healthcare utilization. A number of common comorbidities...... have been linked to both obesity and asthma, and may, therefore, contribute to the obese-asthma phenotype. Furthermore, recently published studies indicate that even a modest weight reduction can improve clinical manifestations and outcome of asthma. SUMMARY: Compared with normal-weight patients, obese...

  13. mHealth intervention to support asthma self-management in adolescents: the ADAPT study

    Directory of Open Access Journals (Sweden)

    Kosse RC

    2017-03-01

    Full Text Available Richelle C Kosse,1 Marcel L Bouvy,1 Tjalling W de Vries,2 Ad A Kaptein,3 Harm CJ Geers,1 Liset van Dijk,4 Ellen S Koster1 1Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, 2Department of Paediatrics, Medical Center Leeuwarden, Leeuwarden, 3Medical Psychology, Leiden University Medical Center, Leiden, 4NIVEL, the Netherlands Institute for Health Services Research, Utrecht, the Netherlands Purpose: Poor medication adherence in adolescents with asthma results in poorly controlled disease and increased morbidity. The aim of the ADolescent Adherence Patient Tool (ADAPT study is to develop an mHealth intervention to support self-management and to evaluate the effectiveness in improving medication adherence and asthma control. Intervention: The ADAPT intervention consists of an interactive smartphone application (app connected to a desktop application for health care providers, in this study, the community pharmacist. The app contains several functions to improve adherence as follows: 1 a questionnaire function to rate asthma symptoms and monitor these over time; 2 short movie clips with medication and disease information; 3 a medication reminder; 4 a chat function with peers; and 5 a chat function with the pharmacist. The pharmacist receives data from the patient’s app through the desktop application, which enables the pharmacist to send information and feedback to the patient. Study design: The ADAPT intervention is tested in a community pharmacy-based cluster randomized controlled trial in the Netherlands, aiming to include 352 adolescents with asthma. The main outcome is adherence, measured by patient’s self-report and refill adherence calculated from pharmacy dispensing records. In addition, asthma control, illness perceptions, medication beliefs, and asthma-related quality of life are measured. Conclusion: This study will provide in

  14. A Population-based Clinical Study of Allergic and Non-allergic Asthma

    DEFF Research Database (Denmark)

    Knudsen, T.B.; Thomsen, S.F.; Nolte, H.

    2009-01-01

    Background. The aim of this study was to describe differences between allergic and non-allergic asthma in a large community-based sample of Danish adolescents and adults. Methods. A total of 1,186 subjects, 14 to 44 years of age, who in a screening questionnaire had reported a history of airway...... symptoms suggestive of asthma and/or allergy, or who were taking any medication for these conditions were clinically examined. All participants were interviewed about respiratory symptoms, and furthermore skin test reactivity, lung function, and airway responsiveness were measured. Results. A total of 489...

  15. SDS-Polyacrylamide Electrophoresis and Western Blotting Applied to the Study of Asthma.

    Science.gov (United States)

    García-Solaesa, Virginia; Abad, Sara Ciria

    2016-01-01

    Western blotting is used to analyze proteins after being separated by electrophoresis and subsequently electro-transferred to a membrane. Once immobilized, a specific protein can be identified through its reaction with a labeled antibody or antigen. It is a methodology commonly used in biomedical research such as asthma studies, to assess the pathways of inflammatory mediators involved in the disease.Here, we describe an example of western blotting to determine the factors involved in asthma. In this chapter, the methodology of western blotting is reviewed, paying attention on potential problems and giving interesting recommendations.

  16. Narrative reconstruction therapy for prolonged grief disorder—rationale and case study

    Directory of Open Access Journals (Sweden)

    Tuvia Peri

    2016-05-01

    Full Text Available Background: Prolonged grief disorder (PGD is a potentially disabling condition affecting approximately 10% of bereaved people. It has been suggested that the impaired integration of the loss memory, as expressed in recurrent memories of the loss and disorganization of memory, is involved in the development of PGD. Narrative reconstruction (NR, originally designed for the treatment of posttraumatic stress disorder (PTSD in an integrative therapy module, and consisting of exposure to the loss memory, detailed written reconstruction of the loss memory narrative and an elaboration of the personal significance of that memory for the bereaved, has been shown to be effective in the treatment of intrusion symptoms. Objective: In light of findings that cognitive behavior therapy (CBT, including cognitive restructuring and exposure, is effective in the treatment of PGD, we suggest the implementation of a somewhat novel therapy module, NR, for the treatment of intrusive phenomena in bereaved patients. Method: The rationale for the implementation of NR for PGD and a case study of the treatment of a woman suffering from PGD after the death of her father are presented. Therapy took place in a university outpatient training clinic. Results: Evaluations conducted before and after treatment and at a 3-month follow-up demonstrated the effectiveness of NR in reducing symptoms of PGD and depression. The analysis of spontaneous narratives recorded before and after treatment showed an increased organization of the narratives. Conclusions: This case report demonstrates an adaptation of NR for the treatment of PGD. The results provide preliminary support for the effectiveness of NR for PGD. The significance of the study and its limitations are discussed.

  17. Basal or stress-induced cortisol and asthma development : the TRAILS study

    NARCIS (Netherlands)

    Vink, Nienke M; Boezen, Hendrika; Postma, Dirkje S; Rosmalen, Judith G M

    We examined the association between: 1) cortisol levels and asthma or asthma development; 2) cortisol levels upon stress and asthma. In addition, we performed a post hoc meta-analysis on results from the literature. Cortisol, cortisol upon stress, asthma (doctor diagnosis of asthma and/or symptoms

  18. Preeclampsia Associates with Asthma, Allergy, and Eczema in Childhood

    DEFF Research Database (Denmark)

    Stokholm, Jakob; Sevelsted, Astrid; Anderson, Ulrik D

    2017-01-01

    RATIONALE: Preeclampsia reflects an unusual increase in systemic inflammation during pregnancy. OBJECTIVES: We studied associations between preeclampsia and asthma, allergy, and eczema in Copenhagen Prospective Studies on Asthma in Childhood2000 (COPSAC2000) and in national registries. METHODS....... The register-based cohort included 1.7 million children from Danish national registries in the 35-year period 1977-2012. Children born to mothers with preeclampsia were analyzed regarding risk of asthma, allergy, and eczema. MEASUREMENTS AND MAIN RESULTS: In the COPSAC2000 cohort, 5.6% (n = 23) were diagnosed...... with preeclampsia. Preeclampsia was associated with increased risk of treatment with inhaled corticosteroids at age 7 years (adjusted odds ratio, 4.01 [95% confidence interval (CI), 1.11-14.43]; P = 0.0337), increased bronchial responsiveness to methacholine (adjusted β-coefficient log-μmol, -0.80 [95% CI, -1...

  19. Auranofin in the treatment of steroid dependent asthma: a double blind study.

    Science.gov (United States)

    Nierop, G; Gijzel, W P; Bel, E H; Zwinderman, A H; Dijkman, J H

    1992-01-01

    BACKGROUND: Long term administration of oral corticosteroids in patients with asthma may be associated with serious side effects. Non-steroidal anti-inflammatory drugs, including gold salts, have been shown to reduce the need for systemic corticosteroid treatment in uncontrolled studies. The effect of oral gold (auranofin) on asthma symptoms, lung function, and the need for oral prednisone treatment was investigated. METHODS: A 26 week randomised, double blind, placebo controlled, parallel group trial of auranofin was performed in 32 patients with moderately severe chronic asthma who required an oral corticosteroid dose of at least 5 mg prednisone a day (or equivalent) or 2.5 mg/day prednisone plus more than 800 micrograms/day inhaled corticosteroids. Auranofin was given orally in a dose of 3 mg twice daily. Asthma symptoms, lung function, and adverse effects were assessed at regular intervals. After 12 weeks of treatment prednisone dosage was tapered down by 2.5 mg every two weeks if the patient was clinically stable. Asthma exacerbations were treated with short courses of high doses of oral steroids. RESULTS: Twenty eight of the 32 patients, 13 in the placebo group and 15 in the auranofin group, completed the study. The total corticosteroid reduction achieved after 26 weeks of treatment was significantly greater (4 mg) in the auranofin group than in the placebo group (0.3 mg). The number of exacerbations requiring an increase of steroids was greater in the placebo group (2.1) than in the active group (0.9). A significant increase in FEV1 of 6.4% predicted occurred in the auranofin group during the study and there was a reduction of asthma symptoms such as wheezing and cough. There was no difference between the groups in peak flow measurements or in the number of asthma attacks. The incidence of side effects of auranofin was low, but exacerbations of constitutional eczema were noticeable. CONCLUSION: Auranofin provides an effective adjunct to treatment for steroid

  20. Homeopathy for Perennial Asthma in Adolescents: Pilot Feasibility Study Testing a Randomised Withdrawal Design.

    Science.gov (United States)

    Mitchiguian Hotta, Livia; Cardinalli Adler, Ubiratan; de Toledo Cesar, Amarilys; Martinez, Edson Zangiacomi; Demarzo, Marcelo Marcos Piva

    2018-05-01

     Previous findings from a pragmatic trial suggest that usual care compared with usual care plus individualised homeopathy is not a feasible design to address homeopathic interventions for asthma.  The main purpose of this article was to investigate the feasibility of the randomised withdrawal design as a strategy to assess the effectiveness of a standardised clinical-pharmaceutical homeopathic protocol ( Organon.modus ) on perennial asthma in adolescents.  Randomised withdrawal, double-blind, parallel, placebo-controlled, 12-week study. 12 to 17 years old adolescents, with the diagnosis of perennial asthma, using inhalatory beclomethasone (plus fenoterol for wheezing episodes), who achieved 3 months of well-controlled asthma, after a variable period of individualised homeopathic treatment according to Organon.modus protocol. a secondary care medical specialist centre. continuation with the individualised homeopathic medicine or with indistinguishable placebo during 12 weeks of beclomethasone step-down. number of days of well-controlled asthma. Secondary measures: number of days of fenoterol use, number of visits to an emergency service (without hospitalisation) and percentage of patients excluded due to an exacerbation characterising a partly controlled asthma. Tolerability was assessed by Adverse Events, registered at every visit.  Nineteen patients were randomised to continue treatment with homeopathy and 21 with placebo. Effectiveness measures for the homeopathy and placebo groups respectively were median number of days of good clinical control: 84 versus 30 ( p  = 0.18); median number of days of fenoterol use per patient: 3 versus 5 ( p  = 0.41); visits to an emergency room: 1 versus 6 ( p  = 0.35); percentage of exclusion due to partly controlled asthma: 36.8% versus 71.4% ( p  = 0.05). Few Adverse Events were reported.  This pilot study supports the feasibility of the double-blind randomised withdrawal design in studies investigating

  1. Hair cortisol as a hypothalamic-pituitary-adrenal axis biomarker in pregnant women with asthma: a retrospective observational study.

    Science.gov (United States)

    Smy, Laura; Shaw, Kaitlyn; Amstutz, Ursula; Smith, Anne; Berger, Howard; Carleton, Bruce; Koren, Gideon

    2016-07-20

    Cortisol is a hormone involved in many physiological functions including fetal maturation and epigenetic programming during pregnancy. This study aimed to use hair cortisol as a biomarker of chronic inhaled corticosteroid (ICS) exposure and assess the potential effects of asthma on the hypothalamic-pituitary-adrenal (HPA) axis in pregnant women. We hypothesized that pregnant women with asthma treated with ICS would exhibit lower hair cortisol concentrations, indicative of adrenal suppression, compared to women with asthma not using ICS and women who do not have asthma. We performed an observational retrospective cohort study. Hair samples were analyzed from pregnant women with asthma, with (n = 56) and without (n = 31) ICS treatment, and pregnant women without asthma (n = 31). Hair samples were segmented based on the growth rate of 1 cm/month and analyzed by enzyme immunoassay to provide cortisol concentrations corresponding to preconception, trimesters 1-3, and postpartum. Hair cortisol concentrations were compared within and among the groups using non-parametric statistical tests. Hair cortisol concentrations increased across trimesters for all three groups, but this increase was dampened in women with asthma (P = 0.03 for Controls vs. ICS Treated and Controls vs. No ICS). ICS Treated women taking more than five doses per week had hair cortisol concentrations 47 % lower in third trimester than Controls. Linear regression of the third trimester hair cortisol results identified asthma as a significant factor when comparing consistent ICS use or asthma as the predictor (F(1, 25) = 9.7, P = 0.005, R(2) adj = 0.257). Hair cortisol successfully showed the expected change in cortisol over the course of pregnancy and may be a useful biomarker of HPA axis function in pregnant women with asthma. The potential impact of decreased maternal cortisol in women with asthma on perinatal outcomes remains to be determined.

  2. Gender differences in effects of obesity and asthma on adolescent lung function: Results from a population-based study.

    Science.gov (United States)

    Chen, Yi-Chun; Huang, Yu-Li; Ho, Wen-Chao; Wang, Yu-Chun; Yu, Yang-Hao

    2017-04-01

    To investigate lung function associated with asthma and body mass index (BMI) among adolescents at 96 northern Taiwan junior high schools participating in an asthma screening program. The questionnaires and lung function test results measured for 3669 boys and 3523 girls were included in this study for data analysis. Measures of forced vital capacity (FVC), forced expiratory volume in 1 second (FEV 1 ) and FEV 1 /FVC ratio were compared by sex, asthma status and BMI. Overall mean FVC levels were similar between students with and without asthma, 3.71 L vs. 3.71 L for boys (p = 0.991) and 2.79 vs. 2.78 for girls (p = 0.517). The overall mean FEV 1 levels were also similar between girls with and without asthma. Asthmatic boys had lower FEV 1 than non-asthmatic boys. Mean FEV 1 /FVC was significantly lower in students with asthma than those without asthma. Mean FVC and FEV 1 increased with BMI in both sexes. A lower mean FEV 1 /FVC was observed among students with asthma and high BMI, and was more pronounced in boys than in girls. Multivariable regression analysis also showed that FEV 1 /FVC ratios were negatively associated with asthma and high BMI, stronger in boys than in girls for asthma (β = -2.176 (standard errors (SE) = 0.268) vs. -1.085 (SE = 0.258) and for BMI (β = -0.309 (SE = 0.025) vs. -0.218 (SE = 0.029)). This northern Taiwan study suggests that FEV 1 /FVC is negatively associated with asthma and high BMI in adolescents, stronger for boys than for girls.

  3. Worldwide trends in the prevalence of asthma symptoms: phase III of the International Study of Asthma and Allergies in Childhood (ISAAC).

    Science.gov (United States)

    Pearce, Neil; Aït-Khaled, Nadia; Beasley, Richard; Mallol, Javier; Keil, Ulrich; Mitchell, Ed; Robertson, Colin

    2007-09-01

    Phase I of the International Study of Asthma and Allergies in Childhood (ISAAC) was designed to allow worldwide comparisons of the prevalence of asthma symptoms. In phase III the phase I survey was repeated in order to assess changes over time. The phase I survey was repeated after an interval of 5-10 years in 106 centres in 56 countries in children aged 13-14 years (n = 304,679) and in 66 centres in 37 countries in children aged 6-7 years (n = 193,404). The mean symptom prevalence of current wheeze in the last 12 months changed slightly from 13.2% to 13.7% in the 13-14 year age group (mean increase of 0.06% per year) and from 11.1% to 11.6% in the 6-7 year age group (mean increase of 0.13% per year). There was also little change in the mean symptom prevalence of severe asthma or the symptom prevalence measured with the asthma video questionnaire. However, the time trends in asthma symptom prevalence showed different regional patterns. In Western Europe, current wheeze decreased by 0.07% per year in children aged 13-14 years but increased by 0.20% per year in children aged 6-7 years. The corresponding findings per year for the other regions in children aged 13-14 years and 6-7 years, respectively, were: Oceania (-0.39% and -0.21%); Latin America (+0.32% and +0.07%); Northern and Eastern Europe (+0.26% and +0.05%); Africa (+0.16% and +0.10%); North America (+0.12% and +0.32%); Eastern Mediterranean (-0.10% and +0.79%); Asia-Pacific (+0.07% and -0.06%); and the Indian subcontinent (+0.02% and +0.06%). There was a particularly marked reduction in current asthma symptom prevalence in English language countries (-0.51% and -0.09%). Similar patterns were observed for symptoms of severe asthma. However, the percentage of children reported to have had asthma at some time in their lives increased by 0.28% per year in the 13-14 year age group and by 0.18% per year in the 6-7 year age group. These findings indicate that international differences in asthma symptom prevalence

  4. Asthma education

    African Journals Online (AJOL)

    2011-01-01

    ). Allergy and Asthma Clinic, Red Cross War Memorial Hospital. Mike Levin runs a secondary level asthma/ allergy clinic and does a tertiary allergy session once a week, focusing on difficult asthma and food allergies. He has ...

  5. Outcomes of Childhood Asthma and Wheezy Bronchitis. A 50-Year Cohort Study.

    Science.gov (United States)

    Tagiyeva, Nara; Devereux, Graham; Fielding, Shona; Turner, Stephen; Douglas, Graham

    2016-01-01

    Cohort studies suggest that airflow obstruction is established early in life, manifests as childhood asthma and wheezy bronchitis, and continues into early adulthood. Although an association between childhood asthma and chronic obstructive pulmonary disease (COPD) in later life has been demonstrated, it is unclear if childhood wheezy bronchitis is associated with COPD. To investigate whether childhood wheezy bronchitis increases the risk of COPD in the seventh decade. A cohort of children recruited in 1964 at age 10 to 15 years, which was followed up in 1989, 1995, and 2001, was followed up again in 2014 when at age 60 to 65 years. Discrete time-to-event and linear mixed effects models were used. FEV1 and FVC were measured. COPD was defined as post-bronchodilator FEV1/FVC Childhood wheezing phenotype was related to 1989, 1995, 2001, and 2014 spirometry data. Three hundred thirty subjects, mean age 61 years, were followed up: 38 with childhood asthma; 53 with childhood wheezy bronchitis; and 239 control subjects (of whom 57 developed adulthood-onset wheeze between ages 16 and 46 yr). In adjusted multivariate analyses, childhood asthma was associated with an increased risk of COPD (odds ratio, 6.37; 95% confidence interval, 3.73-10.94), as was childhood wheezy bronchitis (odd ratio 1.81; 95% confidence interval, 1.12-2.91). The COPD risk increased with childhood asthma, and wheezy bronchitis was associated with reduced FEV1 that was evident by the fifth decade and not an accelerated rate of FEV1 decline. In contrast, adulthood-onset wheeze was associated with accelerated FEV1 decline. Childhood wheezy bronchitis and asthma are associated with an increased risk of COPD and reduced ventilatory function.

  6. Prevalence of asthma by industry in the US population: a study of 2001 NHIS data.

    Science.gov (United States)

    Bang, Ki Moon; Hnizdo, Eva; Doney, Brent

    2005-06-01

    The estimated number of US workers potentially exposed to asthmagens ranges from 8 to 20 million. This study was undertaken to estimate the US prevalence of asthma in adults by industry of employment and to identify industries with elevated risk of asthma. Prevalence analysis was performed on 20,991 adults, 18 years of age and older who participated in the 2001 National Health Interview survey. We used SUDAAN software to estimate the prevalence of self-reported physician diagnosed asthma by industry, and odds ratios (ORs) for asthma and industry adjusted for age, sex, race, and smoking status. The overall prevalence of physician diagnosed asthma was 6.5% (95% CI 6.1-6.9); 4.7% (95% CI 4.1-5.3) for males and 8.5% (95% CI 7.9-9.1) for females. In whites, the prevalence and ORs were significantly elevated for printing, publishing, and allied industries (OR = 2.4, 95% CI 1.2-5.0) and health care (OR = 1.3, 95% CI 1.0-1.7). In blacks, ORs were elevated for furniture, lumber, and wood (OR = 5.9, 95% CI 1.4-25.4) and entertainment and recreation industries (OR = 4.1, 95% CI 1.1-15.9). Other industries with elevated ORs included automobile dealers and gasoline station; durable goods; elementary, secondary schools, and colleges; other personal services; eating and drinking places; entertainment and recreation services; and utility and sanitary. Industries with elevated prevalence of asthma are identified. This information helps to target workplaces where detailed investigations for prevention and control may be appropriate.

  7. A daily SMS reminder increases adherence to asthma treatment: a three-month follow-up study

    DEFF Research Database (Denmark)

    Strandbygaard, Ulla; Thomsen, Simon Francis; Backer, Vibeke

    2010-01-01

    Poor adherence to asthma treatment is a well-recognised challenge and is associated with increased morbidity, mortality and consumption of health care resources. This study examined the impact of receiving a daily text message reminder on one's cell phone on adherence to asthma treatment....

  8. Characteristics and severity of asthma in children with and without atopic conditions : a cross-sectional study

    NARCIS (Netherlands)

    Arabkhazaeli, Ali; Vijverberg, Susanne J H; van Erp, Francine C; Raaijmakers, Jan A M; van der Ent, Cornelis K.; Maitland van der Zee, Anke H

    2015-01-01

    BACKGROUND: Childhood allergic diseases have a major impact on a child's quality of life, as well as that of their parents. We studied the coexistence of reported allergies in children who use asthma medication. Additionally, we tested the hypothesis that asthma severity is greater among children

  9. Characteristics and severity of asthma in children with and without atopic conditions: A cross-sectional study

    NARCIS (Netherlands)

    Arabkhazaeli, Ali; Vijverberg, Susanne J. H.; van Erp, Francine C.; Raaijmakers, Jan A. M.; van der Ent, Cornelis K.; Maitland van der Zee, Anke H.

    2015-01-01

    Background: Childhood allergic diseases have a major impact on a child's quality of life, as well as that of their parents. We studied the coexistence of reported allergies in children who use asthma medication. Additionally, we tested the hypothesis that asthma severity is greater among children

  10. Apixaban for treatment of embolic stroke of undetermined source (ATTICUS randomized trial): Rationale and study design.

    Science.gov (United States)

    Geisler, Tobias; Poli, Sven; Meisner, Christoph; Schreieck, Juergen; Zuern, Christine S; Nägele, Thomas; Brachmann, Johannes; Jung, Werner; Gahn, Georg; Schmid, Elisabeth; Bäezner, Hansjörg; Keller, Timea; Petzold, Gabor C; Schrickel, Jan-Wilko; Liman, Jan; Wachter, Rolf; Schön, Frauke; Schabet, Martin; Lindner, Alfred; Ludolph, Albert C; Kimmig, Hubert; Jander, Sebastian; Schlegel, Uwe; Gawaz, Meinrad; Ziemann, Ulf

    2017-12-01

    Rationale Optimal secondary prevention of embolic stroke of undetermined source is not established. The current standard in these patients is acetylsalicylic acid, despite high prevalence of yet undetected paroxysmal atrial fibrillation. Aim The ATTICUS randomized trial is designed to determine whether the factor Xa inhibitor apixaban administered within 7 days after embolic stroke of undetermined source, is superior to acetylsalicylic acid for prevention of new ischemic lesions documented by brain magnetic resonance imaging within 12 months after index stroke. Design Prospective, randomized, blinded, parallel-group, open-label, German multicenter phase III trial in approximately 500 patients with embolic stroke of undetermined source. A key inclusion criterion is the presence or the planned implantation of an insertable cardiac monitor. Patients are 1:1 randomized to apixaban or acetylsalicylic acid and treated for a 12-month period. It is an event-driven trial aiming for core-lab adjudicated primary outcome events. Study outcomes The primary outcome is the occurrence of at least one new ischemic lesion identified by axial T2-weighted FLAIR magnetic resonance imaging and/or axial DWI magnetic resonance imaging at 12 months when compared with the baseline magnetic resonance imaging. Key secondary outcomes are the combination of recurrent ischemic strokes, hemorrhagic strokes, systemic embolism; combination of MACE including recurrent stroke, myocardial infarction, and cardiovascular death and combination of major and clinically relevant non-major bleeding defined according to ISTH, and change of cognitive function and quality of life (EQ-5D, Stroke Impact Scale). Discussion Embolic stroke of undetermined source is caused by embolic disease and associated with a high risk of recurrent ischemic strokes and clinically silent cerebral ischemic lesions. ATTICUS will investigate the impact of atrial fibrillation detected by insertable cardiac monitor and the effects of

  11. Design, rationale and feasibility of a multidimensional experimental protocol to study early life stress

    Directory of Open Access Journals (Sweden)

    M. Dillwyn Bartholomeusz

    2017-09-01

    Full Text Available There is a rapidly accumulating body of evidence regarding the influential role of early life stress (ELS upon medical and psychiatric conditions. While self-report instruments, with their intrinsic limitations of recall, remain the primary means of detecting ELS in humans, biological measures are generally limited to a single biological system. This paper describes the design, rationale and feasibility of a study to simultaneously measure neuroendocrine, immune and autonomic nervous system (ANS responses to psychological and physiological stressors in relation to ELS. Five healthy university students were recruited by advertisement. Exclusion criteria included chronic medical conditions, psychotic disorders, needle phobia, inability to tolerate pain, and those using anti-inflammatory medications. They were clinically interviewed and physiological recordings made over a two-hour period pre, during and post two acute stressors: the cold pressor test and recalling a distressing memory. The Childhood Trauma Questionnaire and the Parental Bonding Index were utilised to measure ELS. Other psychological measures of mood and personality were also administered. Measurements of heart rate, blood pressure, respiratory rate, skin conductance, skin blood flow and temporal plasma samples were successfully obtained before, during and after acute stress. Participants reported the extensive psychological and multisystem physiological data collection and stress provocations were tolerable. Most (4/5 participants indicated a willingness to return to repeat the protocol, indicating acceptability. Our protocol is viable and safe in young physically healthy adults and allows us to assess simultaneously neuroendocrine, immune and autonomic nervous system responses to stressors in persons assessed for ELS. Keywords: Childhood-stress, Adverse-childhood-events, Childhood-trauma questionnaire, Parental-bonding-instrument, Type D scale (DS14

  12. Understanding reasons for asthma outpatient (non)-attendance and exploring the role of telephone and e-consulting in facilitating access to care: exploratory qualitative study.

    NARCIS (Netherlands)

    Baar, J.D. van; Joosten, H.; Car, J.; Freeman, G.; Partridge, M.R.; Weel, C. van; Sheikh, A.

    2006-01-01

    OBJECTIVE: To understand factors influencing patients' decisions to attend for outpatient follow up consultations for asthma and to explore patients' attitudes to telephone and email consultations in facilitating access to asthma care. DESIGN: Exploratory qualitative study using in depth interviews.

  13. Occupational Asthma

    Science.gov (United States)

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

  14. Childhood Asthma

    Science.gov (United States)

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

  15. Ethnic variations in incidence of asthma episodes in England & Wales: national study of 502,482 patients in primary care.

    Science.gov (United States)

    Netuveli, Gopalakrishnan; Hurwitz, Brian; Sheikh, Aziz

    2005-10-21

    Recent studies have demonstrated marked international variations in the prevalence of asthma, but less is known about ethnic variations in asthma epidemiology within individual countries and in particular the impact of migration on risk of developing asthma. Recent within country comparisons have however revealed that despite originating from areas of the world with a low risk for developing asthma, South Asian and Afro-Caribbean people in the UK are significantly (3x and 2x respectively) more likely to be admitted to hospital for asthma related problems than Whites. Using data from the Fourth National Study of Morbidity Statistics in General Practice, a one-percent broadly representative prospective cohort study of consultations in general practice, we investigated ethnic variations in incident asthma consultations (defined as new or first consultations), and compared consultation rates between those born inside and outside the UK (migrant status). Logistic regression models were used to examine the combined effects of ethnicity and migration on asthma incident consultations. Results showed significantly lower new/first asthma consultation rates for Whites than for each of the ethnic minority groups studied (mean age-adjusted consultation rates per 1000 patient-years: Whites 26.4 (95%CI 26.4, 26.4); South Asians 30.4 (95%CI 30.3, 30.5); Afro-Caribbeans 35.1 (95%CI 34.9, 35.3); and Others 27.8 (27.7, 28.0). Within each of these ethnic groups, those born outside of the UK showed consistently lower rates of incident asthma consultations. Modelling the combined effects of ethnic and migrant status revealed that UK-born South Asians and Afro-Caribbeans experienced comparable risks for incident GP consultations for asthma to UK-born Whites. Non-UK born Whites however experienced reduced risks (adjusted OR 0.82, 95%CI 0.69, 0.97) whilst non-UK born South Asians experienced increased risks (adjusted OR 1.33, 95%CI 1.04, 1.70) compared to UK-born Whites. These findings

  16. Adding formoterol to budesonide in moderate asthma - health economic results from the FACET study

    NARCIS (Netherlands)

    Andersson, F; Stahl, E; Barnes, PJ; Lofdahl, CG; O'Byrne, PM; Pauwels, RA; Postma, DS; Tattersfield, AE; Ullman, A

    The FACET (Formoterol and Corticosteroid Establishing Therapy) study established that there is a clear clinical benefit in adding formoterol to budesonide therapy in patients who have persistent symptoms of asthma despite treatment with low to moderate doses of an inhaled corticosteroid. We combined

  17. Study of the level of stem cell factor in patients with bronchial asthma

    Directory of Open Access Journals (Sweden)

    Ahmad Gouda El-Gazzar

    2016-01-01

    Conclusion: This study demonstrated that the serum level of SCF was higher in asthmatic patients especially among eosinophilic phenotype than among healthy control subjects. Also there was a significant association between higher SCF and higher levels of asthma severity, sputum and blood eosinophil%.

  18. Fall episodes in elderly patients with asthma and COPD - a pilot study.

    Science.gov (United States)

    Bozek, Andrzej; Jarzab, Jerzy; Hadas, Ewa; Jakalski, Marek; Canonica, Giorgio Walter

    2018-05-08

    Evidence of an increased risk of falls in patients with chronic obstructive pulmonary disease (COPD) exists; however, this has not been studied in elderly asthmatic patients. The aim of the study was to determine the incidence of falls in elderly patients who were diagnosed with bronchial asthma compared to subjects with COPD. A 12 - month prospective observational study in elderly outpatients with diagnosis of either asthma or COPD was conducted. All of the participants were monitored on the following parameters: falls, comorbidities, drug therapy and The Berg Balance Scale. The rate of falls was shown as an incidence ratio. Cluster analysis for subgroups with similar features was performed on all patients included in the study. Two clusters of frequent fallers were determined. The fall incidence rate in falls per person per year was 1.41 (95% CI: 0.86-1.96) in asthmatic patients and 1.49 (95% CI: 1.05-2.11) in the COPD group. Frequent fallers were more prevalent in the COPD group, with 32% in this group compared to 28% in the groups of patients with asthma. In cluster analysis, frequent fallers were grouped into two models characterized by polytherapy, depression symptoms, hospitalizations, coronary disease, dementia and diagnosis of COPD or asthma. Elderly asthmatic patients presented a high rate of falls, which is comparable to that of patients with COPD.

  19. Evidence for an asthma risk locus on chromosome Xp: a replication linkage study

    DEFF Research Database (Denmark)

    Brasch-Andersen, C; Møller, M U; Haagerup, A

    2008-01-01

    replication sample as used in the present study. The aim of the study was to replicate linkage to candidate regions for asthma in an independent Danish sample. METHODS: We performed a replication study investigating linkage to candidate regions for asthma on chromosomes 1p36.31-p36.21, 5q15-q23.2, 6p24.3-p22...... studies have been carried out the results are still conflicting and call for replication experiments. A Danish genome-wide scan has prior reported evidence for candidate regions for asthma susceptibility genes on chromosomes 1p, 5q, 6p, 12q and Xp. Linkage to chromosome 12q was later confirmed in the same.......3, and Xp22.31-p11.4 using additional markers in an independent set of 136 Danish asthmatic sib pair families. RESULTS: Nonparametric multipoint linkage analyses yielded suggestive evidence for linkage to asthma to chromosome Xp21.2 (MLS 2.92) but failed to replicate linkage to chromosomes 1p36.31-p36.21, 5...

  20. mHealth intervention to support asthma self-management in adolescents : The ADAPT study

    NARCIS (Netherlands)

    Kosse, R.C.; Bouvy, M.L.; de Vries, T.W.; Kaptein, A.A.; Geers, H.C.J.; van Dijk, Liset; Koster, E.S.

    2017-01-01

    Purpose: Poor medication adherence in adolescents with asthma results in poorly controlled disease and increased morbidity. The aim of the ADolescent Adherence Patient Tool (ADAPT) study is to develop an mHealth intervention to support self-management and to evaluate the effectiveness in improving

  1. mHealth intervention to support asthma self-management in adolescents: the ADAPT study.

    NARCIS (Netherlands)

    Kosse, R.C.; Bouvy, M.L.; Vries, T.W. de; Kaptein, A.A.; Geers, H.C.J.; Dijk, L. van; Koster, E.S.

    2017-01-01

    Purpose: Poor medication adherence in adolescents with asthma results in poorly controlled disease and increased morbidity. The aim of the ADolescent Adherence Patient Tool (ADAPT) study is to develop an mHealth intervention to support self-management and to evaluate the effectiveness in improving

  2. Long-term studies of the natural history of asthma in childhood

    DEFF Research Database (Denmark)

    Bisgaard, Hans; Bønnelykke, Klaus

    2010-01-01

    secondary prevention through the use of inhaled corticosteroids can effectively halt the long-term disease progression in childhood. In conclusion, the natural history of asthma and the associated airway changes is still poorly understood, and we have not managed to translate findings from long-term studies...

  3. A genome-wide association study identifies CDHR3 as a susceptibility locus for early childhood asthma with severe exacerbations

    DEFF Research Database (Denmark)

    Bønnelykke, Klaus; Sleiman, Patrick; Nielsen, Kasper

    2014-01-01

    Asthma exacerbations are among the most frequent causes of hospitalization during childhood, but the underlying mechanisms are poorly understood. We performed a genome-wide association study of a specific asthma phenotype characterized by recurrent, severe exacerbations occurring between 2 and 6......1RL1, were previously reported as asthma susceptibility loci, but the effect sizes for these loci in our cohort were considerably larger than in the previous genome-wide association studies of asthma. We also obtained strong evidence for a new susceptibility gene, CDHR3 (encoding cadherin......-related family member 3), which is highly expressed in airway epithelium. These results demonstrate the strength of applying specific phenotyping in the search for asthma susceptibility genes....

  4. Interleukin-4 (IL4 and Interleukin-4 receptor (IL4RA polymorphisms in asthma: a case control study

    Directory of Open Access Journals (Sweden)

    Lorente Félix

    2005-11-01

    Full Text Available Abstract Background IL4/IL4RA pathway plays an important role in atopy and asthma. Different polymorphisms in IL4 and IL4RA genes have been described. Particularly, -33C>TIL4 and 576Q>RIL4RA SNPs have been independently associated to atopy and asthma. The purpose of this study was to analyse these polymorphisms in a population of patients with a well-characterized asthma phenotype. Methods A total of 212 unrelated Caucasian individuals, 133 patients with asthma and 79 healthy subjects without symptoms or history of asthma or atopy and with negative skin prick tests were recruited. Lung function was measured by spirometry and asthma was specialist physician-diagnosed according to the ATS (American Thoracic Society criteria and classified following the GINA (Global Initiative for Asthma guidelines. Skin prick tests were performed according to EAACI recommendations. -33C>TIL4 was studied with TaqMan assay and 576Q>RIL4RA by PCR-RFLP technique. Hardy-Weinberg equilibrium was analysed in all groups. Dichotomous variables were analysed using χ2, Fisher exact test, Monte Carlo simulation test and odds ratio test. To model the effects of multiple covariates logistic regression was used. Results No statistically significant differences between the group of patients with asthma and the controls were found when the allele and genotype distribution of -33C>TIL4 and 576Q>RIL4RA polymorphisms were compared. However, the T allele of the -33C>TIL4 SNP was more frequent in patients with persistent asthma. Multivariate analysis adjusted for age and sex confirmed that carriers of allele T had an increased risk of persistent asthma (OR:2.77, 95%CI:1.18–6.49; p = 0.019. Analysis of combination of polymorphisms showed that patients carrying both the T allele of -33C>TIL4 and the A allele of 576Q>RIL4RA had an increased risk of asthma. This association was particularly observed in persistent asthma [Fisher's p value = 0.0021, Monte Carlo p value (after 104

  5. Cooking fuels and prevalence of asthma: a global analysis of phase three of the International Study of Asthma and Allergies in Childhood (ISAAC).

    Science.gov (United States)

    Wong, Gary W K; Brunekreef, Bert; Ellwood, Philippa; Anderson, H Ross; Asher, M Innes; Crane, Julian; Lai, Christopher K W

    2013-07-01

    Indoor air pollution from a range of household cooking fuels has been implicated in the development and exacerbation of respiratory diseases. In both rich and poor countries, the effects of cooking fuels on asthma and allergies in childhood are unclear. We investigated the association between asthma and the use of a range of cooking fuels around the world. For phase three of the International Study of Asthma and Allergies in Childhood (ISAAC), written questionnaires were self-completed at school by secondary school students aged 13-14 years, 244,734 (78%) of whom were then shown a video questionnaire on wheezing symptoms. Parents of children aged 6-7 years completed the written questionnaire at home. We investigated the association between types of cooking fuels and symptoms of asthma using logistic regression. Adjustments were made for sex, region of the world, language, gross national income, maternal education, parental smoking, and six other subject-specific covariates. The ISAAC study is now closed, but researchers can continue to use the instruments for further research. Data were collected between 1999 and 2004. 512,707 primary and secondary school children from 108 centres in 47 countries were included in the analysis. The use of an open fire for cooking was associated with an increased risk of symptoms of asthma and reported asthma in both children aged 6-7 years (odds ratio [OR] for wheeze in the past year, 1·78, 95% CI 1·51-2·10) and those aged 13-14 years (OR 1·20, 95% CI 1·06-1·37). In the final multivariate analyses, ORs for wheeze in the past year and the use of solely an open fire for cooking were 2·17 (95% CI 1·64-2·87) for children aged 6-7 years and 1·35 (1·11-1·64) for children aged 13-14 years. Odds ratios for wheeze in the past year and the use of open fire in combination with other fuels for cooking were 1·51 (1·25-1·81 for children aged 6-7 years and 1·35 (1·15-1·58) for those aged 13-14 years. In both age groups, we

  6. Risk of Periodontal Disease in Patients With Asthma: A Nationwide Population-Based Retrospective Cohort Study.

    Science.gov (United States)

    Shen, Te-Chun; Chang, Pei-Ying; Lin, Cheng-Li; Wei, Chang-Ching; Tu, Chih-Yen; Hsia, Te-Chun; Shih, Chuen-Ming; Hsu, Wu-Huei; Sung, Fung-Chang; Kao, Chia-Hung

    2017-08-01

    Studies have reported an association between asthma and oral diseases, including periodontal diseases. The aim of this retrospective study is to investigate risk of periodontal diseases for patients with asthma. Using the claims data of National Health Insurance of Taiwan and patients without a history of periodontal diseases, 19,206 asthmatic patients, who were newly diagnosed from 2000 through 2010, were identified. For each case, four comparison individuals without history of asthma and periodontal disease were randomly selected from the general population and frequency matched (categorical matched) by sex, age, and year of diagnosis (n = 76,824). Both cohorts were followed to the end of 2011 to monitor occurrence of periodontal diseases. Adjusted hazard ratios (aHRs) of periodontal disease were estimated using Cox proportional hazards regression analysis. Overall incidence of periodontal diseases was 1.18-fold greater in the asthma cohort than in the comparison cohort (P periodontal diseases compared with those with a mean of less than one visit. Patients with at least three admissions annually also had a similar aHR (51.8) for periodontal disease. In addition, asthmatic patients on inhaled corticosteroid (ICS) therapy had greater aHRs than non-users (aHR = 1.12; 95% CI = 1.03 to 1.23). In the studied population, asthmatic patients are at an elevated risk of developing periodontal diseases. The risk is much greater for those with emergency medical demands or hospital admissions and those on ICS treatment.

  7. Improving metabolic parameters of antipsychotic child treatment (IMPACT) study: rationale, design, and methods

    OpenAIRE

    Reeves, Gloria M; Keeton, Courtney; Correll, Christoph U; Johnson, Jacqueline L; Hamer, Robert M; Sikich, Linmarie; Hazzard, Lindsey; Alderman, Cheryl; Scheer, Abigail; Mabe, Micah; Kapoor, Sandeep; Sheridan, Eva; Borner, Irmgard; Bussell, Kristin; Pirmohamed, Sara

    2013-01-01

    Background Youth with serious mental illness may experience improved psychiatric stability with second generation antipsychotic (SGA) medication treatment, but unfortunately may also experience unhealthy weight gain adverse events. Research on weight loss strategies for youth who require ongoing antipsychotic treatment is quite limited. The purpose of this paper is to present the design, methods, and rationale of the Improving Metabolic Parameters in Antipsychotic Child Treatment (IMPACT) stu...

  8. Pre-natal exposure to paracetamol and risk of wheezing and asthma in children: A birth cohort study

    DEFF Research Database (Denmark)

    Rebordosa, Cristina; Kogevinas, Manolis; Sørensen, Henrik T

    2008-01-01

    BACKGROUND: Paracetamol use has been associated with increased prevalence of asthma in children and adults, and one study reported an association between pre-natal exposure to paracetamol and asthma in early childhood. METHODS: To examine if pre-natal exposure to paracetamol is associated...... with the risk of asthma or wheezing in early childhood, we selected 66 445 women from the Danish National Birth Cohort for whom we had information on paracetamol use during pregnancy and who participated in an interview when their children were 18-months-old and 12 733 women whose children had reached the age...... of 7 and estimated the prevalence of physician-diagnosed asthma and wheezing at the ages of 18 months and 7 years. We also linked our population to the Danish National Hospital Registry to record all hospitalizations due to asthma up to age of 18 months. RESULTS: Paracetamol use during any time...

  9. The Strathclyde Evaluation of Children's Active Travel (SE-CAT: study rationale and methods

    Directory of Open Access Journals (Sweden)

    McMinn David

    2011-12-01

    Full Text Available Abstract Background The school commute is a prime opportunity to increase children's physical activity levels. However, active commuting has decreased over the past 40 years. Strategies that increase walking to school are therefore needed. Travelling Green (TG is a school-based active travel resource aimed at increasing children's walking to school. The resource consists of a curriculum-based program of lessons and goal setting activities. A previous study found that children who received the TG intervention increased self-reported distance travelled to school by active modes and reduced the distance travelled by inactive modes. This study was limited by self-reported outcome measures, a small sample, and no follow-up measures. A more robust evaluation of TG is required to address these limitations. This paper describes the rationale and methods for such an evaluation of Travelling Green, and describes the piloting of various active commuting measures in primary school children. Methods/Design Measures of active commuting were piloted in a sample of 26 children (aged 8-9 years over one school week. These measures were subsequently used in an 18-month quasi-experimental design to evaluate the effect of TG on commuting behaviour. Participants were 166 children (60% male aged 8-9 years from 5 primary schools. Two schools (n = 79 children received TG in September/October 2009. Three schools (n = 87 children acted as a comparison group, and subsequently received TG at a later date. Physical activity was measured using Actigraph GT1M accelerometers. Personal and environmental determinants of active commuting were measured via parent and child questionnaires, as were factors related to the Theory of Planned Behaviour and the construct of habit. Measures were taken pre- and post-intervention and at 5 and 12 months follow-up. Discussion The piloted protocol was practical and feasible and piloted measures were reliable and valid. All study data, including

  10. Asthma and Allergies in Children With Autism Spectrum Disorders: Results From the CHARGE Study.

    Science.gov (United States)

    Lyall, Kristen; Van de Water, Judy; Ashwood, Paul; Hertz-Picciotto, Irva

    2015-10-01

    Immune aberrations are often noted in children with autism spectrum disorder (ASD), but whether asthma and allergy are related to ASD is not well defined. This study examined asthma and allergies in association with ASD and phenotypic subsets. Participants were 560 children with confirmed ASD and 391 typically developing children from the CHildhood Autism Risks from Genetics and the Environment study. Maternally reported child asthma and allergy was compared between cases and controls, and in association with cognitive and behavioral test scores. Prevalence of asthma and overall allergies did not differ between cases and controls, but overall allergy in children with ASD was associated with higher stereotypy scores as measured by the Aberrant Behavior Checklist. In addition, reported food allergies were significantly associated with ASD (adjusted odds ratio = 2.23, 95% confidence interval 1.28, 3.89). Our results suggest food allergies and sensitivities may be more common in children with ASD, and that these issues may correlate with other behaviors. © 2015 International Society for Autism Research, Wiley Periodicals, Inc.

  11. Burden of Respiratory Disease in Korea: An Observational Study on Allergic Rhinitis, Asthma, COPD, and Rhinosinusitis.

    Science.gov (United States)

    Yoo, Kwang Ha; Ahn, Hae Ryun; Park, Jae Kyoung; Kim, Jong Woong; Nam, Gui Hyun; Hong, Soon Kwan; Kim, Mee Ja; Ghoshal, Aloke Gopal; Muttalif, Abdul Razak Bin Abdul; Lin, Horng Chyuan; Thanaviratananich, Sanguansak; Bagga, Shalini; Faruqi, Rab; Sajjan, Shiva; Baidya, Santwona; Wang, De Yun; Cho, Sang Heon

    2016-11-01

    The Asia-Pacific Burden of Respiratory Diseases (APBORD) study is a cross-sectional, observational one which has used a standard protocol to examine the disease and economic burden of allergic rhinitis (AR), asthma, chronic obstructive pulmonary disorder (COPD), and rhinosinusitis across the Asia-Pacific region. Here, we report on symptoms, healthcare resource use, work impairment, and associated costs in Korea. Consecutive participants aged ≥18 years with a primary diagnosis of asthma, AR, COPD, or rhinosinusitis were enrolled. Participants and their treating physician completed a survey detailing respiratory symptoms, healthcare resource use, and work productivity and activity impairment. Costs included direct medical cost and indirect cost associated with lost work productivity. The study enrolled 999 patients. Patients were often diagnosed with multiple respiratory disorders (42.8%), with asthma/AR and AR/rhinosinusitis the most frequently diagnosed combinations. Cough or coughing up phlegm was the primary reason for the medical visit in patients with a primary diagnosis of asthma and COPD, whereas nasal symptoms (watery runny nose, blocked nose, and congestion) were the main reasons in those with AR and rhinosinusitis. The mean annual cost for patients with a respiratory disease was US$8,853 (SD 11,245) per patient. Lost productivity due to presenteeism was the biggest contributor to costs. Respiratory disease has a significant impact on disease burden in Korea. Treatment strategies for preventing lost work productivity could greatly reduce the economic burden of respiratory disease.

  12. A Citizen-Science Study Documents Environmental Exposures and Asthma Prevalence in Two Communities

    Directory of Open Access Journals (Sweden)

    Samantha Eiffert

    2016-01-01

    Full Text Available A citizen-science study was conducted in two low-income, flood-prone communities in Atlanta, Georgia, in order to document environmental exposures and the prevalence of occupant asthma. Teams consisting of a public-health graduate student and a resident from one of the two communities administered a questionnaire, inspected residences for mold growth, and collected a dust sample for quantifying mold contamination. The dust samples were analyzed for the 36 molds that make up the Environmental Relative Moldiness Index (ERMI. Most residents (76% were renters. The median duration of residence was 2.5 years. Although only 12% of occupants reported a history of flooding, 46% reported at least one water leak. Homes with visible mold (35% had significantly (P<0.05 higher mean ERMI values compared to homes without (14.0 versus 9.6. The prevalence of self-reported, current asthma among participants was 14%. In logistic regression models controlling for indoor smoking, among participants residing at their current residence for two years or less, a positive association was observed between asthma and the homes’ ERMI values (adjusted odds ratio per unit increase in ERMI = 1.12, 95% confidence intervals (CI: 1.01–1.25; two-tailed P=0.04. Documentation of the exposures and asthma prevalence has been presented to the communities and public officials. Community-based organizations have taken responsibility for planning and implementing activities in response to the study findings.

  13. Genome Wide Association Study to predict severe asthma exacerbations in children using random forests classifiers

    Directory of Open Access Journals (Sweden)

    Litonjua Augusto A

    2011-06-01

    Full Text Available Abstract Background Personalized health-care promises tailored health-care solutions to individual patients based on their genetic background and/or environmental exposure history. To date, disease prediction has been based on a few environmental factors and/or single nucleotide polymorphisms (SNPs, while complex diseases are usually affected by many genetic and environmental factors with each factor contributing a small portion to the outcome. We hypothesized that the use of random forests classifiers to select SNPs would result in an improved predictive model of asthma exacerbations. We tested this hypothesis in a population of childhood asthmatics. Methods In this study, using emergency room visits or hospitalizations as the definition of a severe asthma exacerbation, we first identified a list of top Genome Wide Association Study (GWAS SNPs ranked by Random Forests (RF importance score for the CAMP (Childhood Asthma Management Program population of 127 exacerbation cases and 290 non-exacerbation controls. We predict severe asthma exacerbations using the top 10 to 320 SNPs together with age, sex, pre-bronchodilator FEV1 percentage predicted, and treatment group. Results Testing in an independent set of the CAMP population shows that severe asthma exacerbations can be predicted with an Area Under the Curve (AUC = 0.66 with 160-320 SNPs in comparison to an AUC score of 0.57 with 10 SNPs. Using the clinical traits alone yielded AUC score of 0.54, suggesting the phenotype is affected by genetic as well as environmental factors. Conclusions Our study shows that a random forests algorithm can effectively extract and use the information contained in a small number of samples. Random forests, and other machine learning tools, can be used with GWAS studies to integrate large numbers of predictors simultaneously.

  14. Child/Adolescent Anxiety Multimodal Study (CAMS: rationale, design, and methods

    Directory of Open Access Journals (Sweden)

    Waslick Bruce D

    2010-01-01

    Full Text Available Abstract Objective To present the design, methods, and rationale of the Child/Adolescent Anxiety Multimodal Study (CAMS, a recently completed federally-funded, multi-site, randomized placebo-controlled trial that examined the relative efficacy of cognitive-behavior therapy (CBT, sertraline (SRT, and their combination (COMB against pill placebo (PBO for the treatment of separation anxiety disorder (SAD, generalized anxiety disorder (GAD and social phobia (SoP in children and adolescents. Methods Following a brief review of the acute outcomes of the CAMS trial, as well as the psychosocial and pharmacologic treatment literature for pediatric anxiety disorders, the design and methods of the CAMS trial are described. Results CAMS was a six-year, six-site, randomized controlled trial. Four hundred eighty-eight (N = 488 children and adolescents (ages 7-17 years with DSM-IV-TR diagnoses of SAD, GAD, or SoP were randomly assigned to one of four treatment conditions: CBT, SRT, COMB, or PBO. Assessments of anxiety symptoms, safety, and functional outcomes, as well as putative mediators and moderators of treatment response were completed in a multi-measure, multi-informant fashion. Manual-based therapies, trained clinicians and independent evaluators were used to ensure treatment and assessment fidelity. A multi-layered administrative structure with representation from all sites facilitated cross-site coordination of the entire trial, study protocols and quality assurance. Conclusions CAMS offers a model for clinical trials methods applicable to psychosocial and psychopharmacological comparative treatment trials by using state-of-the-art methods and rigorous cross-site quality controls. CAMS also provided a large-scale examination of the relative and combined efficacy and safety of the best evidenced-based psychosocial (CBT and pharmacologic (SSRI treatments to date for the most commonly occurring pediatric anxiety disorders. Primary and secondary results

  15. Asthma medication prescribing before, during and after pregnancy: a study in seven European regions.

    Science.gov (United States)

    Charlton, Rachel A; Pierini, Anna; Klungsøyr, Kari; Neville, Amanda J; Jordan, Susan; de Jong-van den Berg, Lolkje T W; Thayer, Daniel; Bos, H Jens; Puccini, Aurora; Hansen, Anne V; Gini, Rosa; Engeland, Anders; Nybo Andersen, Anne-Marie; Dolk, Helen; Garne, Ester

    2016-01-19

    To explore utilisation patterns of asthma medication before, during and after pregnancy as recorded in seven European population-based databases. A descriptive drug utilisation study. 7 electronic healthcare databases in Denmark, Norway, the Netherlands, Italy (Emilia Romagna and Tuscany), Wales, and the Clinical Practice Research Datalink representing the rest of the UK. All women with a pregnancy ending in a delivery that started and ended between 2004 and 2010, who had been present in the database for the year before, throughout and the year following pregnancy. The percentage of deliveries where the woman received an asthma medicine prescription, based on prescriptions issued (UK) or dispensed (non-UK), during the year before, throughout or during the year following pregnancy. Asthma medicine prescribing patterns were described for 3-month time periods and the choice of asthma medicine and changes in prescribing over the study period were evaluated in each database. In total, 1,165,435 deliveries were identified. The prevalence of asthma medication prescribing during pregnancy was highest in the UK and Wales databases (9.4% (CI95 9.3% to 9.6%) and 9.4% (CI95 9.1% to 9.6%), respectively) and lowest in the Norwegian database (3.7% (CI95 3.7% to 3.8%)). In the year before pregnancy, the prevalence of asthma medication prescribing remained constant in all regions. Prescribing levels peaked during the second trimester of pregnancy and were at their lowest during the 3-month period following delivery. A decline was observed, in all regions except the UK, in the prescribing of long-acting β-2-agonists during pregnancy. During the 7-year study period, there were only small changes in prescribing patterns. Differences were found in the prevalence of prescribing of asthma medications during and surrounding pregnancy in Europe. Inhaled β-2 agonists and inhaled corticosteroids were, however, the most popular therapeutic regimens in all databases. Published by the BMJ

  16. Ethnic variations in incidence of asthma episodes in England & Wales:national study of 502,482 patients in primary care

    OpenAIRE

    Netuveli, Gopalakrishnan; Hurwitz, Brian; Sheikh, Aziz

    2005-01-01

    Summary Background Recent studies have demonstrated marked international variations in the prevalence of asthma, but less is known about ethnic variations in asthma epidemiology within individual countries and in particular the impact of migration on risk of developing asthma. Recent within country comparisons have however revealed that despite originating from areas of the world with a low risk for developing asthma, South Asian and Afro-Caribbean people in the UK are significantly (3× and 2...

  17. Nocturnal gastro-oesophageal reflux, asthma and symptoms of OSA: a longitudinal, general population study.

    Science.gov (United States)

    Emilsson, Össur I; Bengtsson, Anna; Franklin, Karl A; Torén, Kjell; Benediktsdóttir, Bryndís; Farkhooy, Amir; Weyler, Joost; Dom, Sandra; De Backer, Wilfried; Gislason, Thorarinn; Janson, Christer

    2013-06-01

    Nocturnal gastro-oesophageal reflux (nGOR) is associated with asthma and obstructive sleep apnoea (OSA). Our aim was to investigate whether nGOR is a risk factor for onset of asthma and onset of respiratory and OSA symptoms in a prospective population-based study. We invited 2640 subjects from Iceland, Sweden and Belgium for two evaluations over a 9-year interval. They participated in structured interviews, answered questionnaires, and underwent spirometries and methacholine challenge testing. nGOR was defined by reported symptoms. Subjects with persistent nGOR (n=123) had an independent increased risk of new asthma at follow-up (OR 2.3, 95% CI 1.1-4.9). Persistent nGOR was independently related to onset of respiratory symptoms (OR 3.0, 95% CI 1.6-5.6). The risk of developing symptoms of OSA was increased in subjects with new and persistent nGOR (OR 2.2, 95% CI 1.3-1.6, and OR 2.0, 95% CI 1.0-3.7, respectively). No significant association was found between nGOR and lung function or bronchial responsiveness. Persistent symptoms of nGOR contribute to the development of asthma and respiratory symptoms. New onset of OSA symptoms is higher among subjects with symptoms of nGOR. These findings provide evidence that nGOR may play a role in the genesis of respiratory symptoms and diseases.

  18. 'Real-life' effectiveness studies of omalizumab in adult patients with severe allergic asthma: systematic review.

    Science.gov (United States)

    Abraham, I; Alhossan, A; Lee, C S; Kutbi, H; MacDonald, K

    2016-05-01

    We reviewed 24 'real-life' effectiveness studies of omalizumab in the treatment of severe allergic asthma that included 4117 unique patients from 32 countries with significant heterogeneity in patients, clinicians and settings. The evidence underscores the short- and long-term benefit of anti-IgE therapy in terms of the following: improving lung function; achieving asthma control and reducing symptomatology, severe exacerbations and associated work/school days lost; reducing healthcare resource utilizations, in particular hospitalizations, hospital lengths of stay and accident specialist or emergency department visits; reducing or discontinuing other asthma medications; and improving quality of life - thus confirming, complementing and extending evidence from randomized trials. Thus, omalizumab therapy is associated with signal improvements across the full objective and subjective burden of illness chain of severe allergic asthma. Benefits of omalizumab may extend up to 2-4 years, and the majority of omalizumab-treated patients may benefit for many years. Omalizumab has positive short- and long-term safety profiles similar to what is known from randomized clinical trials. Initiated patients should be monitored for treatment response at 16 weeks. Those showing positive response at that time are highly likely to show sustained treatment response and benefit in terms of clinical, quality of life and health resource utilization outcomes. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  19. Longterm clinical outcomes of omalizumab therapy in severe allergic asthma: Study of efficacy and safety.

    Science.gov (United States)

    Mansur, Adel H; Srivastava, Sapna; Mitchell, Verity; Sullivan, Julie; Kasujee, Ismail

    2017-03-01

    Omalizumab has been shown to be an effective add-on therapy for patients with uncontrolled severe persistent allergic asthma. There has been a steady accumulation of evidence on the long-term effectiveness of omalizumab; however, data on real-life outcomes beyond one year of treatment is limited. In this study, we report on long-term outcomes of omalizumab treatment. We collected data from our severe asthma registry on hospitalisations, exacerbations, corticosteroid sparing, asthma control, lung function, biomarkers and side effects, to determine if the benefit was sustained and treatment was safe on the long term. Forty-five patients [mean age 44.9 years (range 19-69), females 37/45 (82%), mean duration of omalizumab treatment = 60.7 ± 30.9 months (range 23-121) were included in the analysis. We observed a reduction in the annual acute asthma related hospital admissions for the total population from 207 at baseline to 40 on treatment (80.7% reduction), whilst the per patient annual hospitalisations were reduced from a mean of 4.8 to 0.89 post-omalizumab treatment (p omalizumab therapy. Copyright © 2017 Elsevier Ltd. All rights reserved.

  20. Efficacy and tolerability of salmeterol/fluticasone propionate versus montelukast in childhood asthma: A prospective, randomized, double-blind, double-dummy, parallel-group study

    DEFF Research Database (Denmark)

    Maspero, Jorge; Guerra, Frances; Cuevas, Francisco

    2008-01-01

    BACKGROUND: Asthma control remains suboptimal in adults and children worldwide. Inhaled salmeterol/fluticasone propionate combination (SFC) and oral montelukast (MON) are 2 treatments available for childhood asthma. OBJECTIVE: This study, the PEdiatric Asthma Control Evaluation (PEACE......), investigated the efficacy and tolerability of SFC compared with MON for the control of persistent asthma in children. METHODS: Children with asthma (forced expiratory volume in 1 second [FEV(1)] 55%-80% predicted; reversibility >or=12%) aged 6 to 14 years who were receiving only short-acting beta(2)-agonists...... in morning peak expiratory flow (PEF). Efficacy assessments included lung function, asthma symptoms, rescue medication use, and asthma control. Tolerability was assessed by recording the number and type of adverse events (AEs) and the number of asthma exacerbations. RESULTS: Of 607 patients screened, 548...

  1. Does Ecuadorians with asthma has preferences in the use of information and communication technologies? Pilot study

    Directory of Open Access Journals (Sweden)

    Iván Chérrez-Ojeda

    2017-12-01

    Full Text Available Background: Inadequate communication between asthmatic patients and their physicians may interfere directly with asthma control. In the last years, the use of information and communication technologies (ICTs it has increased in Latin-America. This technology seems to be a good tool to improve communication and management of the asthmatic patient. Objective: We evaluated the frequency and preference patterns of communication and information technologies in Ecuadorian patients with bronchial asthma. Methods: We conducted a pilot cross-sectional study to identify the frequency and preferences of ICT in patients with asthma. The Spanish version of the Michigan questionnaire was used. Age and educational level were categorized into 3 groups. We used logistic regression between these groups regarding the frequency of use, interest in seeking and receiving information related to their asthma for the age and educational level of the patients. Results: A total of 222 patients participated in our study. The mean age was 45.6 years (SD 17.4, the most common sex was female with 89.25 %. Almost all patients had a cell phone (87.5 % and internet access (62.7 %. The three ICTs most likely to be used to search for or receive information about their illness were WhatsApp, Facebook and Email (p <0.05. Conclusion: Information and communication technologies improve the care of asthmatic patients. In our pilot study email and text messages are the most preferred ICT among patients however WhatsApp and Facebook may be appropriate for certain ages especially young asthmatic. Knowledge of preferences can help the development of ICT in a personalized way and improve the outcomes in patients with asthma.

  2. Know How to Use Your Asthma Inhaler

    Medline Plus

    Full Text Available ... Profile Tables and Graphs Asthma Call-back Survey Technical Information Prevalence Tables BRFSS Prevalence Data NHIS Prevalence ... Case Studies Open Airways for Schools Asthma Care Training Wee Wheezers Adventures of Puff Inner City Asthma ...

  3. Know How to Use Your Asthma Inhaler

    Medline Plus

    Full Text Available ... Controlling Tools for Control Triggers Indoors In the Workplace Outdoors Management Asthma Action Plan Flu Shots Inhalers ... Case Studies Open Airways for Schools Asthma Care Training Wee Wheezers Adventures of Puff Inner City Asthma ...

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

    Science.gov (United States)

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

    2016-01-01

    Purpose Omalizumab is the preferred add-on therapy for patients with moderate-to-severe persistent allergic asthma and has demonstrated efficacy and safety in various ethnicities. This study evaluated the efficacy and safety of omalizumab in Chinese patients with moderate-to-severe allergic asthma. Methods This randomized, double-blind, parallel-group, placebo-controlled, phase III study assessed lung function, quality of life, asthma control, and safety of omalizumab after 24-week therapy in Chinese patients (18-75 years of age). Results A total of 616 patients were randomized (1:1) to omalizumab or placebo. The primary endpoint, least squares mean treatment difference (LSM-TD) in morning peak expiratory flow (PEF) (omalizumab vs placebo), at Weeks >20-24 was 8.85 L/min (Full analysis set; P=0.062). Per-protocol analysis set showed significant improvements with LSM-TD of 11.53 L/min in mean mPEF at Weeks >20-24 (P=0.022). The FEV1 % predicted was significantly improved with omalizumab vs placebo from 8 to 24 weeks (after 24-week treatment: LSM-TD=4.12%; P=0.001). At Week 24, a higher proportion of omalizumab-treated patients achieved clinically relevant improvements in standardized AQLQ (58.2% vs 39.3%; LSM=0.51 vs 0.10; Pquality of life, and asthma control in Chinese patients with moderate-to-severe persistent allergic asthma and has a good safety profile. PMID:27126725

  5. Changing adherence-related beliefs about ICS maintenance treatment for asthma: feasibility study of an intervention delivered by asthma nurse specialists.

    Science.gov (United States)

    Chapman, Sarah C E; Barnes, Neil; Barnes, Mari; Wilkinson, Andrea; Hartley, John; Piddock, Cher; Weinman, John; Horne, Rob

    2015-06-05

    The Necessity-Concerns Framework (NCF) posits that non-adherence to inhaled corticosteroids (ICS) in asthma is influenced by doubts about the necessity for ICS and concerns about their potential adverse effects. This feasibility study examined whether these beliefs could be changed by briefing asthma nurse specialists on ways of addressing necessity beliefs and concerns within consultations. Pre-post intervention study. Secondary care. Patients with a diagnosis of moderate to severe asthma who were prescribed daily ICS were recruited to either a hospital care group (n=79; 71.0% female) or intervention group (n=57; 66.7% female). Asthma nurse specialists attended a 1.5-day NCF briefing. Beliefs about ICS (primary outcome) and self-reported adherence were measured preconsultation and 1 month postconsultation. Participants also rated their satisfaction with their consultations immediately after the consultation. Consultation recordings were coded to assess intervention delivery. After the NCF briefing, nurse specialists elicited and addressed beliefs about medicine more frequently. The frequency of using the NCF remained low, for example, open questions eliciting adherence were used in 0/59 hospital care versus 14/49 (28.6%) intervention consultations. Doubts about personal necessity for, and concerns about, ICS were reduced at 1 month postbriefing (pchanged nurse consultations, but not sufficiently enough to fully address non-adherence or adherence-related ICS beliefs (necessity and concerns). More effective techniques are needed to support nurse specialists and other practitioners to apply the intervention in hospital asthma review consultations. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  6. Genetic Ancestry and Asthma and Rhinitis Occurrence in Hispanic Children: Findings from the Southern California Children's Health Study.

    Directory of Open Access Journals (Sweden)

    Muhammad T Salam

    Full Text Available Asthma and rhinitis are common childhood health conditions. Being an understudied and rapidly growing population in the US, Hispanic children have a varying risk for these conditions that may result from sociocultural (including acculturative factors, exposure and genetic diversities. Hispanic populations have varying contributions from European, Amerindian and African ancestries. While previous literature separately reported associations between genetic ancestry and acculturation factors with asthma, whether Amerindian ancestry and acculturative factors have independent associations with development of early-life asthma and rhinitis in Hispanic children remains unknown. We hypothesized that genetic ancestry is an important determinant of early-life asthma and rhinitis occurrence in Hispanic children independent of sociodemographic, acculturation and environmental factors.Subjects were Hispanic children (5-7 years who participated in the southern California Children's Health Study. Data from birth certificates and questionnaire provided information on acculturation, sociodemographic and environmental factors. Genetic ancestries (Amerindian, European, African and Asian were estimated based on 233 ancestry informative markers. Asthma was defined by parental report of doctor-diagnosed asthma. Rhinitis was defined by parental report of a history of chronic sneezing or runny or blocked nose without a cold or flu. Sample sizes were 1,719 and 1,788 for investigating the role of genetic ancestry on asthma and rhinitis, respectively.Children had major contributions from Amerindian and European ancestries. After accounting for potential confounders, per 25% increase in Amerindian ancestry was associated with 17.6% (95% confidence interval [CI]: 0.74-0.99 and 13.6% (95% CI: 0.79-0.98 lower odds of asthma and rhinitis, respectively. Acculturation was not associated with either outcome.Earlier work documented that Hispanic children with significant

  7. Grandmother's smoking when pregnant with the mother and asthma in the grandchild: the Norwegian Mother and Child Cohort Study.

    Science.gov (United States)

    Magnus, Maria C; Håberg, Siri E; Karlstad, Øystein; Nafstad, Per; London, Stephanie J; Nystad, Wenche

    2015-03-01

    A trans-generational influence of prenatal tobacco smoke exposure on asthma development has been proposed but the evidence remains sparse. We examined the grandmother's smoking when pregnant with the mother in relation to asthma outcomes in the grandchild (current asthma at 36 months (N=53 169, cases=3013), current asthma at 7 years (N=25 394, cases=1265) and dispensed asthma medications at 7 years in the Norwegian Prescription Database (N=45 607, cases=1787)) within the Norwegian Mother and Child Cohort Study (MoBa). We calculated adjusted RR (adj. RR) and 95% CIs using log binomial regression. A total of 23.5% of mothers reported that their mother smoked when pregnant with them. The grandmother's smoking when pregnant with the mother was positively associated with asthma at 36 months (adj. RR 1.15 (95% CI 1.06 to 1.24)), asthma at 7 years (adj. RR 1.21 (95% CI 1.07 to 1.37)) and dispensed asthma medications at 7 years (adj. RR 1.15 (95% CI 1.04 to 1.26)). This positive association did not differ significantly by the mother's smoking status when pregnant with the child (p values for multiplicative interaction >0.1). The grandmother's smoking when pregnant with the mother increased the risk of asthma in the grandchild independent of the mother's smoking status. However, given limited information on the grandmother's socioeconomic status, asthma status and other factors, unmeasured confounding may be present. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  8. Exposure to toxics during pregnancy and childhood and asthma in children: A pilot study

    Directory of Open Access Journals (Sweden)

    Souheil Hallit

    2017-09-01

    Full Text Available Environmental factors, pesticides, alcohol and smoking are linked to asthma in children. The association of toxic substances exposure with asthma has not been evaluated. Our objective is to assess such associations among children aged less than 16 years old. This is a cross-sectional study, conducted between January and May 2015, using a sample of Lebanese students from private schools in Beirut and Mount Lebanon. Out of 700 distributed questionnaires, 527 (75.2% were returned to us. Verbal informed consent was also obtained from all parents prior to participating in the study. A significant association was found between waterpipe smoking and diagnosed asthma (p = 0.003; ORa = 13.25; 95% CI 2.472–71.026. Alcohol during pregnancy, waterpipe smoking during pregnancy and parents respiratory problems significantly increased the risk of respiratory problems by approximately 5 times, 6 times and 2 times respectively (p = 0.016; ORa = 4.889; 95% CI 1.339–17.844, p = 0.021; ORa = 6.083; 95% CI 1.314–28.172, p = 0.004; ORa = 1.748; 95% CI 1.197–2.554 respectively. Waterpipe smoking, alcohol during pregnancy, recurrent otitis and humidity at home seem to be significantly correlated with asthma in children. Spreading awareness by health care professionals is needed to permit a reduction of the prevalence of these allergic diseases, especially asthma, in children.

  9. Using information technology to reduce asthma disparities in underserved populations: a pilot study.

    Science.gov (United States)

    Vargas, Perla A; Robles, Elias; Harris, Judith; Radford, Peggy

    2010-10-01

    Low health literacy has been identified as an independent predictor of poor asthma control. The Institute of Medicine considers the role of information technology (IT) as critical in providing "safe, effective, patient centered, timely, efficient, and equitable" care with the potential to reduce health disparities in underserved populations. The aim of this study was to design and evaluate an interactive computer-based questionnaire to assess asthma symptoms in children of parents with limited health literacy and/or limited English proficiency. Volunteer caregivers attending a mobile asthma clinic were randomly assigned to complete the electronic or the paper-and-pencil version of an asthma screening questionnaire (ASQ) in their language of choice (English or Spanish). In the electronic version, a tablet computer was used to present the ASQ questions as video clips and to collect information through the touchscreen. Participants also completed a demographic questionnaire, a brief health literacy questionnaire, and a system usability and satisfaction questionnaire. Reliability of the paper and electronic self-assessments was evaluated by comparing each participant's answers to information they provided during a nurse-guided structured interview (gold standard). A total of 48 parents participated in the study, 26 completed the electronic ASQ and 21 the paper-and-pencil form. Thirty-five percent of the children had well-controlled asthma (n = 17). Most participants were Spanish speaking (67%) Hispanic (n = 44) mothers (n = 43) with a median age of 32 years. More than half had ≤8 years of education (n = 25) and earned education was significant (ρ = .47, p higher than concordance between the paper ASQ and the nurse interview (68% versus 54%; p technology tools may help reduce barriers to access due to inadequate levels of English proficiency and health literacy.

  10. Asthma Basics

    Science.gov (United States)

    ... Staying Safe Videos for Educators Search English Español Asthma KidsHealth / For Parents / Asthma What's in this article? ... I Know? Print en español Asma What Is Asthma? Asthma is a condition that causes breathing problems. ...

  11. Factor analysis in the Genetics of Asthma International Network family study identifies five major quantitative asthma phenotypes

    NARCIS (Netherlands)

    Pillai, S. G.; Tang, Y.; van den Oord, E.; Klotsman, M.; Barnes, K.; Carlsen, K.; Gerritsen, J.; Lenney, W.; Silverman, M.; Sly, P.; Sundy, J.; Tsanakas, J.; von Berg, A.; Whyte, M.; Ortega, H. G.; Anderson, W. H.; Helms, P. J.

    Background Asthma is a clinically heterogeneous disease caused by a complex interaction between genetic susceptibility and diverse environmental factors. In common with other complex diseases the lack of a standardized scheme to evaluate the phenotypic variability poses challenges in identifying the

  12. Asthma phenotypes in childhood.

    Science.gov (United States)

    Reddy, Monica B; Covar, Ronina A

    2016-04-01

    This review describes the literature over the past 18 months that evaluated childhood asthma phenotypes, highlighting the key aspects of these studies, and comparing these studies to previous ones in this area. Recent studies on asthma phenotypes have identified new phenotypes on the basis of statistical analyses (using cluster analysis and latent class analysis methodology) and have evaluated the outcomes and associated risk factors of previously established early childhood asthma phenotypes that are based on asthma onset and patterns of wheezing illness. There have also been investigations focusing on immunologic, physiologic, and genetic correlates of various phenotypes, as well as identification of subphenotypes of severe childhood asthma. Childhood asthma remains a heterogeneous condition, and investigations into these various presentations, risk factors, and outcomes are important since they can offer therapeutic and prognostic relevance. Further investigation into the immunopathology and genetic basis underlying childhood phenotypes is important so therapy can be tailored accordingly.

  13. Asthma and obesity

    DEFF Research Database (Denmark)

    Ulrik, Charlotte S

    2016-01-01

    PURPOSE OF REVIEW: Obesity has significant negative impact on asthma control and risk of exacerbations. The purpose of this review is to discuss recent studies evaluating the effects of weight reduction on asthma control in obese adults. RECENT FINDINGS: Clinical studies have shown that weight...... reduction in obese patients is associated with improvements in symptoms, use of controller medication, and asthma-related quality of life together with a reduction in the risk for severe exacerbations. Furthermore, several studies have also revealed improvements in lung function and airway responsiveness...... reduction in obese adults with asthma leads to an overall improvement in asthma control, including airway hyperresponsiveness and inflammation. Weight reduction should be a cornerstone in the management of obese patients with asthma....

  14. An ADAM33 polymorphism associates with progression of preschool wheeze into childhood asthma: a prospective case-control study with replication in a birth cohort study.

    Directory of Open Access Journals (Sweden)

    Ester M M Klaassen

    Full Text Available The influence of asthma candidate genes on the development from wheeze to asthma in young children still needs to be defined.To link genetic variants in asthma candidate genes to progression of wheeze to persistent wheeze into childhood asthma.In a prospective study, children with recurrent wheeze from the ADEM (Asthma DEtection and Monitoring study were followed until the age of six. At that age a classification (transient wheeze or asthma was based on symptoms, lung function and medication use. In 198 children the relationship between this classification and 30 polymorphisms in 16 asthma candidate genes was assessed by logistic regression. In case of an association based on a p<0.10, replication analysis was performed in an independent birth cohort study (KOALA study, n = 248 included for the present analysis.In the ADEM study, the minor alleles of ADAM33 rs511898 and rs528557 and the ORMDL3/GSDMB rs7216389 polymorphisms were negatively associated, whereas the minor alleles of IL4 rs2243250 and rs2070874 polymorphisms were positively associated with childhood asthma. When replicated in the KOALA study, ADAM33 rs528557 showed a negative association of the CG/GG-genotype with progression of recurrent wheeze into childhood asthma (0.50 (0.26-0.97 p = 0.04 and no association with preschool wheeze.Polymorphisms in ADAM33, ORMDL3/GSDMB and IL4 were associated with childhood asthma in a group of children with recurrent wheeze. The replication of the negative association of the CG/GG-genotype of rs528557 ADAM33 with childhood asthma in an independent birth cohort study confirms that a compromised ADAM33 gene may be implicated in the progression of wheeze into childhood asthma.

  15. Correlation between Bronchovascular and Cardiovascular Disorders in Children with Bronchial Asthma: Multifacetedness and Inexhaustibility of Problem Study

    Directory of Open Access Journals (Sweden)

    T.Ye. Shumna

    2014-11-01

    Full Text Available Due to tight functional interrelation between respiratory apparatus and blood circulation, exacerbation of bronchial asthma in children is associated with changes of cardiovascular system. Multifacetedness of this problem determines comprehensive approach to examination of children with bronchial asthma, involving most available methods of heart function evaluation: echocardiographic heart study with Doppler sonography and electrocardiography. Of great importance is investigation of systemic and pulmonary hemodynamics and microcirculation in bronchial asthma depending on its clinical course. It was found that children with exacerbation of bronchial asthma were detected with pulmonary hypertension, which had gradual regression after attack alleviation. During the remission stage, hemodynamics disturbances in lesser circulation were present in long-lasting and severe course of disease. However, the increase in the pulmonary blood flow parameters in patients only in the early period after attack can be regarded as a compensatory response from the lesser circulation to the decline in respiratory function indices. Therefore, despite the great achievements of science in the study of pathophysiological mechanisms and clinical features of bronchial asthma at different ages, it is necessary to continue further study of all aspects of bronchial asthma in children, because it is not as well studied as asthma in adults.

  16. Association between high school students’ cigarette smoking, asthma and related beliefs: a population-based study

    Directory of Open Access Journals (Sweden)

    Resa M. Jones

    2016-09-01

    Full Text Available Abstract Background Smoking has a detrimental effect on the symptoms and severity of asthma, a common chronic disease among adolescents. The purpose of this study was to examine the association between asthma and smoking among high school students and assess provider-patient communication with asthmatic adolescents regarding smoking and adolescents’ beliefs about the harms of smoking. Methods In fall 2014, data from high school students, ages 14–18 years, completing the 2009-2010 Virginia Youth Tobacco Survey (N = 1796 were used in descriptive analyses and multivariable logistic regression models adjusting for model-specific confounders as appropriate. Results Overall, an estimated 19 % of high school students in Virginia smoked and 16 % had asthma. Odds of smoking did not differ by asthma status; however, asthmatics had 1.5 times higher odds of being asked if they smoke (95 % CI 1.06–2.13 and being advised not to smoke by a health professional (95 % CI 1.10–2.14 compared to non-asthmatics. Asthmatics who believed second-hand smoke or smoking 1–5 cigarettes/day was not harmful had respectively 4.2 and 2.8 times higher odds of smoking than those who thought each was harmful. Further, asthmatics who thought smoking 1−2 years is safe had 3.4 times higher odds of smoking than those who did not (95 % CI 1.57–10.1. Conclusions While asthmatic adolescents are just as likely to smoke as non-asthmatics, less healthy beliefs about the risks of smoking increase the odds of smoking among asthmatics. Thus, targeted asthma-specific smoking prevention and education to change attitudes and beliefs could be an effective tool for adolescents.

  17. Prescription of respiratory medication without an asthma diagnosis in children: a population based study.

    NARCIS (Netherlands)

    Zuidgeest, M.G.P.; Dijk, L. van; Smit, H.A.; Wouden, J.C. van der; Brunekreef, B.; Leufkens, H.G.M.; Bracke, M.

    2008-01-01

    BACKGROUND: In pre-school children a diagnosis of asthma is not easily made and only a minority of wheezing children will develop persistent atopic asthma. According to the general consensus a diagnosis of asthma becomes more certain with increasing age. Therefore the congruence between asthma

  18. The Principal and Nurse Perspective on Gaps in Asthma Care and Barriers to Physical Activity in New York City Schools: A Qualitative Study.

    Science.gov (United States)

    Cain, Agnieszka; Reznik, Marina

    2017-10-01

    School officials and nurses play an important role in facilitating asthma management in schools. Little is known about their perspectives on in-school asthma management and barriers to physical activity (PA) at school. The goal of this study is to explore school officials' and nurses' perspectives on asthma care and barriers to PA in children with asthma attending New York City schools. We conducted qualitative, semistructured interviews with 10 principals, 3 assistant principals, and 9 nurses in 10 Bronx, New York elementary schools. Sampling continued until thematic saturation was reached. Interviews were recorded, transcribed, and coded for common themes. The thematic and content review was subsequently used to analyze interview data. Emerging themes were discussed and agreed on by both investigators. Three main categories arose from the analysis: (1) procedures and policies around asthma management in school, (2) barriers to effective medication administration in school, and (3) barriers to PA in children with asthma. Participants identified gaps to in-school asthma management and barriers to PA participation: ineffective ways of identifying students with asthma; lack of written procedures for asthma management; difficulty in meeting the administrative requirements to administer asthma medication; lack of knowledge and training on asthma management for the parents, students, and school staff; parental limitation of children's PA; and schools not meeting the state physical education requirement. Our findings suggest the need for policy reform on asthma management and PA in urban schools and should be considered in the design of future interventions.

  19. Gun Violence, African Ancestry, and Asthma: A Case-Control Study in Puerto Rican Children.

    Science.gov (United States)

    Rosas-Salazar, Christian; Han, Yueh-Ying; Brehm, John M; Forno, Erick; Acosta-Pérez, Edna; Cloutier, Michelle M; Alvarez, María; Colón-Semidey, Angel; Canino, Glorisa; Celedón, Juan C

    2016-06-01

    Exposure to gun violence and African ancestry have been separately associated with increased risk of asthma in Puerto Rican children. The objective of this study was to examine whether African ancestry and gun violence interact on asthma and total IgE in school-aged Puerto Rican children. This is a case-control study of 747 Puerto Rican children aged 9 to 14 years living in San Juan, Puerto Rico (n = 472), and Hartford, Connecticut (n = 275). Exposure to gun violence was defined as the child's report of hearing gunshots more than once, and the percentage of African ancestry was estimated using genome-wide genotypic data. Asthma was defined as parental report of physician-diagnosed asthma and wheeze in the previous year. Serum total IgE (IU/mL) was measured in study participants. Multivariate logistic and linear regressions were used for the analysis of asthma and total IgE, respectively. In multivariate analyses, there was a significant interaction between exposure to gun violence and African ancestry on asthma (P = .001) and serum total IgE (P = .04). Among children exposed to gun violence, each quartile increase in the percentage of African ancestry was associated with approximately 45% higher odds of asthma (95% CI, 1.15-1.84; P = .002) and an approximately 19% increment in total IgE (95% , 0.60-40.65, P = .04). In contrast, there was no significant association between African ancestry and asthma or total IgE in children not exposed to gun violence. Our results suggest that exposure to gun violence modifies the estimated effect of African ancestry on asthma and atopy in Puerto Rican children. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  20. Asthma and asthma related symptoms in 23,326 Chinese children in relation to indoor and outdoor environmental factors: The Seven Northeastern Cities (SNEC) Study

    Energy Technology Data Exchange (ETDEWEB)

    Liu, Fan, E-mail: liufan-sky@163.com [Department of Orthodontics, School of Stomatology, China Medical University, Shenyang, Liaoning Province 110001 (China); Zhao, Yang, E-mail: zhaoyang_cmu@126.com [Department of Biostatistics and Epidemiology, School of Public Health, China Medical University, Shenyang, Liaoning Province 110001 (China); Liu, Yu-Qin, E-mail: xinxin_lyq@163.com [Department of Biostatistics and Epidemiology, School of Public Health, China Medical University, Shenyang, Liaoning Province 110001 (China); Liu, Yang, E-mail: liuyang071506@126.com [Department of Biostatistics and Epidemiology, School of Public Health, China Medical University, Shenyang, Liaoning Province 110001 (China); Sun, Jing, E-mail: sunjingjl_2007@126.com [Department of Biostatistics and Epidemiology, School of Public Health, China Medical University, Shenyang, Liaoning Province 110001 (China); Huang, Mei-Meng, E-mail: gghuangmeimeng@163.com [Department of Biostatistics and Epidemiology, School of Public Health, China Medical University, Shenyang, Liaoning Province 110001 (China); Liu, Yi, E-mail: liuyi256@126.com [Department of Orthodontics, School of Stomatology, China Medical University, Shenyang, Liaoning Province 110001 (China); Dong, Guang-Hui, E-mail: donggh5@mail.sysu.edu.cn [Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong Province 510080 (China)

    2014-11-01

    Background: Both the levels and patterns of outdoor and indoor air pollutants have changed dramatically during the last decade in China. However, few studies have evaluated the effects of the present air pollution on the health of Chinese children. This study examines the association between outdoor and indoor air pollution and respiratory diseases among children living in Liaoning, a heavy industrial province of China. Methods: A cross-sectional study of 23,326 Chinese children aged 6 to 13 years was conducted in 25 districts of 7 cities in Northeast China during 2009. Three-year (2006–2008) average concentrations of particles with an aerodynamic diameter of ≤ 10 μm (PM{sub 10}), sulfur dioxide (SO{sub 2}), nitrogen dioxides (NO{sub 2}), and ozone (O{sub 3}) were calculated from monitoring stations in each of the 25 districts. We used two-level logistic regression models to examine the effects of yearly variations in exposure to each pollutant, controlling for important covariates. Results: The prevalence of respiratory symptoms was higher for those dwelling close to a busy road, those living near smokestacks or factories, those living with smokers, those living in one-story houses typically with small yards, and those with home renovation, bedroom carpet or pets. Ventilation device use was associated with decreased odds of asthma in children. The adjusted odds ratio for diagnosed-asthma was 1.34 (95% confidence interval [CI], 1.24–1.45) per 31 μg/m{sup 3} increase in PM{sub 10}, 1.23 (95%CI, 1.14–1.32) per 21 μg/m{sup 3} increase in SO{sub 2}, 1.25 (95%CI, 1.16–1.36) per 10 μg/m{sup 3} increase in NO{sub 2}, and 1.31 (95%CI, 1.21–1.41) per 23 μg/m{sup 3} increase in O{sub 3}, respectively. Conclusion: Outdoor and indoor air pollution was associated with an increased likelihood of respiratory morbidity among Chinese children. - Highlights: • We studied air pollution and respiratory health in 23,326 Chinese children. • Home renovation, carpet

  1. Asthma and asthma related symptoms in 23,326 Chinese children in relation to indoor and outdoor environmental factors: The Seven Northeastern Cities (SNEC) Study

    International Nuclear Information System (INIS)

    Liu, Fan; Zhao, Yang; Liu, Yu-Qin; Liu, Yang; Sun, Jing; Huang, Mei-Meng; Liu, Yi; Dong, Guang-Hui

    2014-01-01

    Background: Both the levels and patterns of outdoor and indoor air pollutants have changed dramatically during the last decade in China. However, few studies have evaluated the effects of the present air pollution on the health of Chinese children. This study examines the association between outdoor and indoor air pollution and respiratory diseases among children living in Liaoning, a heavy industrial province of China. Methods: A cross-sectional study of 23,326 Chinese children aged 6 to 13 years was conducted in 25 districts of 7 cities in Northeast China during 2009. Three-year (2006–2008) average concentrations of particles with an aerodynamic diameter of ≤ 10 μm (PM 10 ), sulfur dioxide (SO 2 ), nitrogen dioxides (NO 2 ), and ozone (O 3 ) were calculated from monitoring stations in each of the 25 districts. We used two-level logistic regression models to examine the effects of yearly variations in exposure to each pollutant, controlling for important covariates. Results: The prevalence of respiratory symptoms was higher for those dwelling close to a busy road, those living near smokestacks or factories, those living with smokers, those living in one-story houses typically with small yards, and those with home renovation, bedroom carpet or pets. Ventilation device use was associated with decreased odds of asthma in children. The adjusted odds ratio for diagnosed-asthma was 1.34 (95% confidence interval [CI], 1.24–1.45) per 31 μg/m 3 increase in PM 10 , 1.23 (95%CI, 1.14–1.32) per 21 μg/m 3 increase in SO 2 , 1.25 (95%CI, 1.16–1.36) per 10 μg/m 3 increase in NO 2 , and 1.31 (95%CI, 1.21–1.41) per 23 μg/m 3 increase in O 3 , respectively. Conclusion: Outdoor and indoor air pollution was associated with an increased likelihood of respiratory morbidity among Chinese children. - Highlights: • We studied air pollution and respiratory health in 23,326 Chinese children. • Home renovation, carpet, and pet were associated with increased ORs of asthma

  2. A cross-sectional study on prevalence of chronic obstructive pulmonary disease (COPD) in India: rationale and methods.

    Science.gov (United States)

    Rajkumar, Prabu; Pattabi, Kamaraj; Vadivoo, Selvaraj; Bhome, Arvind; Brashier, Bill; Bhattacharya, Prashanta; Mehendale, Sanjay M

    2017-05-29

    Chronic obstructive pulmonary disease (COPD) is a common preventable and treatable chronic respiratory disease, which affects 210 million people globally. Global and national guidelines exist for the management of COPD. Although evidence-based, they are inadequate to address the phenotypic and genotypic heterogeneity in India. Co-existence of other chronic respiratory diseases can adversely influence the prognosis of COPD.India has a huge burden of COPD with various risk factors and comorbid conditions. However, valid prevalence estimates employing spirometry as the diagnostic tool and data on important comorbid conditions are not available. This study protocol is designed to address this knowledge gap and eventually to build a database to undertake long-term cohort studies to describe the phenotypic and genotypic heterogeneity among COPD patients in India. The primary objective is to estimate the prevalence of COPD among adults aged ≥25 years for each gender in India. The secondary objective is to identify the risk factors for COPD and important comorbid conditions such as asthma and post-tuberculosis sequelae. It is also proposed to validate the currently available definitions for COPD diagnosis in India. A cross-sectional study will be undertaken among the populations of sub-urban areas of Chennai and Shillong cities, which represent the Southern and Northeastern regions of India. We will collect data on sociodemographic variables, economic characteristics, risk factors of COPD and comorbidities. The Global Initiative for Obstructive Lung Disease (GOLD) and Global Initiative for Asthma (GINA) definitions will be used for the diagnosis of COPD and asthma. Data will be analysed for estimation of the prevalence of COPD, asthma and associated factors. This study proposal was approved by the respective institutional ethics committees of participating institutions. The results will be disseminated through publications in the peer-reviewed journals and a report

  3. Prevalence of asthma and allergic diseases in adolescents: nine-year follow-up study (2003-2012

    Directory of Open Access Journals (Sweden)

    Dirceu Solé

    2015-02-01

    Full Text Available OBJECTIVE: To determine the prevalence of symptoms of asthma, rhinitis, and atopic eczema in adolescents (AD; 13-14 years living in seven Brazilian cities, by applying the standardized written questionnaire (WQ of the International Study of Asthma and Allergies in Childhood (ISAAC, and to evaluate the time trend nine years after the last assessment of ISAAC phase 3 (ISP3. METHODS: The ISAAC-WQ was answered by 20,099 AD from the Northern, Northeastern, Southeastern, and Southern Brazilian regions. Values obtained were compared to those observed in ISP3 using nonparametric (chi-squared or Fisher tests, and the ratio of annual increment/decrement was established for each of the centers, according to the symptom assessed. RESULTS: Considering the national data and comparing to values of ISP3, there was a decrease in the mean prevalence of active asthma (18.5% vs. 17.5% and an increase in the frequency of severe asthma (4.5% vs. 4.7% and physician-diagnosed asthma (14.3% vs. 17.6%. An increase in prevalence of rhinitis, rhinoconjunctivitis, and atopic eczema was also observed. CONCLUSIONS: The prevalence of asthma, rhinitis, and atopic eczema in Brazil was variable; higher prevalence values, especially of asthma and eczema, were observed in regions located closer to the Equator.

  4. Serum carotenoid and tocopherol concentrations and risk of asthma in childhood: a nested case-control study.

    Science.gov (United States)

    Hämäläinen, N; Nwaru, B I; Erlund, I; Takkinen, H-M; Ahonen, S; Toppari, J; Ilonen, J; Veijola, R; Knip, M; Kaila, M; Virtanen, S M

    2017-03-01

    The antioxidant hypothesis regarding the risk of asthma in childhood has resulted in inconsistent findings. Some data indicate that the role of antioxidants in childhood asthma risk may have a critical time window of effect, but only a well-designed longitudinal cohort study can clarify this hypothesis. To study the longitudinal associations between serum carotenoid and tocopherol concentrations during the first 4 years of life and asthma risk by the age of 5 years. Based on a case-control design nested within a Finnish birth cohort, 146 asthma cases were matched to 270 controls on birth time, sex, genetic risk, and birth place. Non-fasting blood samples were collected at the ages of 1, 1.5, 2, 3, and 4 years and serum carotenoids and tocopherols were analysed. Parents reported the presence and age at start of persistent doctor-diagnosed asthma in the child at the age of 5 years. Data analyses were conducted using generalized estimating equations. We did not find strong associations between serum carotenoids and tocopherols and the risk of asthma based on age-specific and longitudinal analyses. Both lower and higher quarters of α-carotene and γ-tocopherol increased the risk of asthma. The current findings do not support the suggestion that the increased prevalence of asthma may be a consequence of decreased intake of antioxidant nutrients. Moreover, we did not confirm any critical time window of impact of antioxidants on asthma risk. Replication of these findings in similar longitudinal settings will strengthen this evidence base. © 2017 John Wiley & Sons Ltd.

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

    Science.gov (United States)

    Loerbroks, A; Gadinger, M C; Bosch, J A; Stürmer, T; Amelang, M

    2010-10-01

    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. 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). 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. This is the first study to show a cross-sectional and longitudinal association of work stress with asthma.

  6. Individual traffic-related air pollution and new onset adult asthma:A GIS-based pilot study

    DEFF Research Database (Denmark)

    Lysbeck Hansen, Carl; Jensen, Steen Solvang; Baelum, Jesper

    The background for the project is that traffic-related air pollution may provoke the onset of asthma. The objective of this pilot study is to investigate the relation between asthma and wheeze debut and individually estimated exposure to traffic-related air pollutants with a validated exposure...... system (AirGIS). The project applied the following methodology. A non-smoking cohort with recently acquired asthma or wheeze as well as matched controls were identified from a large cross-sectional study. All residential and working addresses with corresponding time periods for a 10 year period were...... successfully identified for all study participants (N=33). Using AirGIS traffic-related air pollutant levels from both urban background and street level were estimated for the 10 year study period on an hourly basis. Individual levels of air pollutants in the years preceding debut of asthma or wheeze were...

  7. Pharmacists' views on the development of asthma pharmaceutical care model in Indonesia: A needs analysis study.

    Science.gov (United States)

    Widayati, Aris; Virginia, Dita Maria; Setiawan, Christianus Heru; Fenty, Fenty; Donowati, Maria Wisnu; Christasani, Putu Dyana; Hartayu, Titien Siwi; Suhadi, Rita; Saini, Bandana; Armour, Carol

    2018-01-30

    Over recent years the pharmacy profession in Indonesia has adopted a stance of pharmaceutical care to expand their scope of practice. Asthma management presents a key opportunity for pharmacists to test expanded roles in health service provision. There is however no exploratory work on the willingness, experience or future practice needs of Indonesian pharmacists in the realm of specialised asthma service provision. The objectives of this study were to explore Indonesian pharmacists' experiences, perspectives, and needs regarding the provision of pharmaceutical care for asthma patients in Indonesia. The study utilised conventional qualitative content analyses with two stages, i.e.: deductive analyses and inductive concept development. Data were collected using Focus Group Discussion (FGD) Method. FGDs were conducted using a topic guide and by facilitators trained in FGD conduct. FGDs were audio-recorded and transcribed verbatim prior to analysis. A maximum variation sampling methods targeted pharmacist across various settings of practice within Yogyakarta Indonesia. Nine focus groups with 103 pharmacist participants were conducted, with an average of 11 participants in each group. Inductively derived concepts that emerged included: willingness to adopt asthma service provision roles, pragmatism in recognising essential barriers/facilitators in adopting such roles, reflections regarding practice gaps and barriers to interprofessional collaboration mainly in relation to doctors. Inductive data analysis indicated clear differences in responses between hospital and non-hospital pharmacists. Key barriers to service provision included lack of training, lack of supportive professional frameworks, time and lack of reimbursement channels for services. Participants urged for a visionary leadership to facilitate pharmacists' role expansion into health services provision in Indonesia. Indonesian pharmacists were willing to adopt change and reported universally recognised

  8. The Canadian Healthy Infant Longitudinal Development (CHILD) Study: examining developmental origins of allergy and asthma.

    Science.gov (United States)

    Subbarao, Padmaja; Anand, Sonia S; Becker, Allan B; Befus, A Dean; Brauer, Michael; Brook, Jeffrey R; Denburg, Judah A; HayGlass, Kent T; Kobor, Michael S; Kollmann, Tobias R; Kozyrskyj, Anita L; Lou, W Y Wendy; Mandhane, Piushkumar J; Miller, Gregory E; Moraes, Theo J; Pare, Peter D; Scott, James A; Takaro, Tim K; Turvey, Stuart E; Duncan, Joanne M; Lefebvre, Diana L; Sears, Malcolm R

    2015-10-01

    The Canadian Healthy Infant Longitudinal Development (CHILD) birth cohort study recruited 3624 pregnant women, most partners and 3542 eligible offspring. We hypothesise that early life physical and psychosocial environments, immunological, physiological, nutritional, hormonal and metabolic influences interact with genetics influencing allergic diseases, including asthma. Environmental and biological sampling, innate and adaptive immune responses, gene expression, DNA methylation, gut microbiome and nutrition studies complement repeated environmental and clinical assessments to age 5. This rich data set, linking prenatal and postnatal environments, diverse biological samples and rigorous phenotyping, will inform early developmental pathways to allergy, asthma and other chronic inflammatory diseases. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  9. The Salford Lung Study protocol: a pragmatic, randomised phase III real-world effectiveness trial in asthma

    OpenAIRE

    Woodcock, Ashley; Bakerly, Nawar Diar; New, John P.; Gibson, J. Martin; Wu, Wei; Vestbo, J?rgen; Leather, David

    2015-01-01

    Background Novel therapies need to be evaluated in normal clinical practice to allow a true representation of the treatment effectiveness in real-world settings. Methods/design The Salford Lung Study is a pragmatic randomised controlled trial in adult asthma, evaluating the clinical effectiveness and safety of once-daily fluticasone furoate (100??g or 200??g)/vilanterol 25??g in a novel dry-powder inhaler, versus existing asthma maintenance therapy. The study was initiated before this investi...

  10. The Shozu Herpes Zoster (SHEZ) Study: Rationale, Design, and Description of a Prospective Cohort Study

    Science.gov (United States)

    Takao, Yukiko; Miyazaki, Yoshiyuki; Onishi, Fumitake; Kumihashi, Hideaki; Gomi, Yasuyuki; Ishikawa, Toyokazu; Okuno, Yoshinobu; Mori, Yasuko; Asada, Hideo; Yamanishi, Koichi; Iso, Hiroyasu

    2012-01-01

    Background The incidence and risk factors for herpes zoster have been studied in cross-sectional and cohort studies, although most such studies have been conducted in Western countries. Evidence from Asian populations is limited, and no cohort study has been conducted in Asia. We are conducting a 3-year prospective cohort study in Shozu County in Kagawa Prefecture, Japan to determine the incidence and predictive and immunologic factors for herpes zoster among Japanese. Methods The participants are followed for 3 years, and a telephone survey is conducted every 4 weeks. The participants were assigned to 1 of 3 studies. Participants in study A gave information on past history of herpes zoster and completed health questionnaires. Study B participants additionally underwent varicella-zoster virus (VZV) skin testing, and study C participants additionally underwent blood testing. If the participants develop herpes zoster, we evaluate clinical symptoms, measure cell-mediated immunity and humoral immunity using venous blood sampling, photograph skin areas with rash, conduct virus identification testing by polymerase chain reaction (PCR) and virus isolation from crust sampling, and evaluate postherpetic pain. Results We recruited 12 522 participants aged 50 years or older in Shozu County from December 2009 through November 2010. The participation rate was 65.7% of the target population. Conclusions The present study is likely to provide valuable data on the incidence and predictive and immunologic factors for herpes zoster in a defined community-based population of Japanese. PMID:22343323

  11. [Guideline implementation study on asthma: Results of a pragmatic implementation approach].

    Science.gov (United States)

    Redaèlli, Marcus; Vollmar, Horst Christian; Simic, Dusan; Maly-Schürer, Cornelia; Löscher, Susanne; Koneczny, Nikolaus

    2015-01-01

    Knowledge transfer from theory to practice in healthcare systems poses a challenge worldwide. Typical examples include national disease management guidelines. The present study contributes towards improving implementation strategies for an asthma guideline. A guideline implementation strategy was examined in a four-armed, non-randomised, controlled intervention study with an additional control group. The study participants were general practitioners and paediatricians recruited from primary care quality circles. All study participants attended an interactive seminar on the evidence-based recommendations for patients with asthma. In addition, the participants were asked to choose among the following options: no further intervention, additional e-learning, training of their practice nurses, or e-learning and training of their practice nurses. The success of the intervention was measured by questionnaire (and the success rate expressed as a percentage). About one third of all participants (n=313) opted for the combination of an interactive seminar and a training of practice nurses; two third preferred the classic way of continuing medical education with an interactive seminar without a further intervention. Just 10 % of the physicians participated in e-learning. Independently of their choice for continuing medical education, all participants demonstrated an increase in knowledge about asthma and an improvement in the management of asthma. The physicians exhibited an average increase in both categories of about 10 % of the percentage values, compared to an increase of about 28 % among the practice nurses without continuing medical education. The physicians' free choice of the educative modules might be an integral part of successful implementation strategies. However, this will require a change of focus from general continuing medical education packages to a more individualised culture of continuing professional development in Germany. Copyright © 2015. Published by

  12. Integrating Smart Health in the US Health Care System: Infodemiology Study of Asthma Monitoring in the Google Era.

    Science.gov (United States)

    Mavragani, Amaryllis; Sampri, Alexia; Sypsa, Karla; Tsagarakis, Konstantinos P

    2018-03-12

    With the internet's penetration and use constantly expanding, this vast amount of information can be employed in order to better assess issues in the US health care system. Google Trends, a popular tool in big data analytics, has been widely used in the past to examine interest in various medical and health-related topics and has shown great potential in forecastings, predictions, and nowcastings. As empirical relationships between online queries and human behavior have been shown to exist, a new opportunity to explore the behavior toward asthma-a common respiratory disease-is present. This study aimed at forecasting the online behavior toward asthma and examined the correlations between queries and reported cases in order to explore the possibility of nowcasting asthma prevalence in the United States using online search traffic data. Applying Holt-Winters exponential smoothing to Google Trends time series from 2004 to 2015 for the term "asthma," forecasts for online queries at state and national levels are estimated from 2016 to 2020 and validated against available Google query data from January 2016 to June 2017. Correlations among yearly Google queries and between Google queries and reported asthma cases are examined. Our analysis shows that search queries exhibit seasonality within each year and the relationships between each 2 years' queries are statistically significant (PGoogle queries are robust and validated against available data from January 2016 to June 2017. Significant correlations were found between (1) online queries and National Health Interview Survey lifetime asthma (r=-.82, P=.001) and current asthma (r=-.77, P=.004) rates from 2004 to 2015 and (2) between online queries and Behavioral Risk Factor Surveillance System lifetime (r=-.78, P=.003) and current asthma (r=-.79, P=.002) rates from 2004 to 2014. The correlations are negative, but lag analysis to identify the period of response cannot be employed until short-interval data on asthma

  13. The New Zealand Asthma and Allergy Cohort Study (NZA2CS: Assembly, Demographics and Investigations

    Directory of Open Access Journals (Sweden)

    Epton Michael J

    2007-02-01

    Full Text Available Abstract Background Asthma and allergy are highly prevalent in industrialised countries. Longitudinal and cross-sectional studies have identified a number of potential risk factors for these conditions, including genetic and environmental factors, with significant gene-environment relationships. Birth cohort studies have been proposed as an important tool to explore these risk factors, particularly exposures in early life that are associated with later disease or protection from disease. This paper describes the establishment of a birth cohort in New Zealand. Methods A birth cohort was established in 1996 in Christchurch and Wellington and infants recruited between 1997–2001. Expectant mothers were recruited by midwives. Children and mothers have undergone assessment by serial questionnaires, environmental assessment including mould and allergen exposure, skin-prick testing, and at age six years are undergoing full assessment for the presence of asthma, atopy and allergic disease, including genetic assessment. Results A total of 1105 children have been recruited, and the retention rate at fifteen months was 91.4%. 15.2% of the children at recruitment have been identified as Maori. A positive family history of asthma, eczema or hay fever has been reported in 84% of children. All children have now been assessed at fifteen months and 685 children from the cohort have reached age six years and have completed the six year assessment. Conclusion The cohort is fully assembled, and assessment of children is well advanced, with good retention rates. The study is well placed to address many current hypotheses about the risk factors for allergic disease and asthma.

  14. Residential traffic exposure and children's emergency department presentation for asthma: a spatial study

    Directory of Open Access Journals (Sweden)

    Pereira Gavin

    2009-11-01

    Full Text Available Abstract Background There is increasing evidence that residential proximity to roadways is associated with an elevated risk of asthma exacerbation. However, there is no consensus on the distance at which these health effects diminishes to background levels. Therefore the optimal, clinically relevant measure of exposure remains uncertain. Using four spatially defined exposure metrics, we evaluated the association between residential proximity to roadways and emergency department (ED presentation for asthma in Perth, Western Australia. Method The study population consisted of 1809 children aged between 0 and 19 years who had presented at an ED between 2002 and 2006 and were resident in a south-west metropolitan area of Perth traversed by major motorways. We used a 1:2 matched case-control study with gastroenteritis and upper limb injury as the control conditions. To estimate exposure to traffic emissions, we used 4 contrasting methods and 2 independently derived sources of traffic data (video-monitored traffic counts and those obtained from the state government road authority. The following estimates of traffic exposure were compared: (1 a point pattern method, (2 a distance-weighted traffic exposure method, (3 a simple distance method and (4 a road length method. Results Risk estimates were sensitive to socio-economic gradients and the type of exposure method that was applied. Unexpectedly, a range of apparent protective effects were observed for some exposure metrics. The kernel density measure demonstrated more than a 2-fold (OR 2.51, 95% CI 2.00 - 3.15 increased risk of asthma ED presentation for the high exposure group compared to the low exposure group. Conclusion We assessed exposure using traffic data from 2 independent sources and compared the results of 4 different exposure metric types. The results indicate that traffic congestion may be one of the most important aspects of traffic-related exposures, despite being overlooked in many

  15. Snow crab allergy and asthma among Greenlandic workers – a pilot study

    Directory of Open Access Journals (Sweden)

    Jakob Hjort Bønløkke

    2012-08-01

    Full Text Available Objectives. To study snow crab sensitization, occupational allergy and asthma in the snow crab industry in Greenland, as high rates have been found in Canada, but no reports have emerged from the same industry in Greenland. Study design. Pilot survey. Methods. Twenty workers (19 of Inuit and 1 of other origin in a snow crab (Chionoecetes opilio and Atlantic shrimp (Pandalus borealis processing plant in Greenland were assessed with skin prick tests (SPTs with common aeroallergens and specific allergens from snow crab and shrimp extracts, spirometry, blood sampling for total IgE and specific IgE determination. Eighteen workers contributed a questionnaire-based medical interview. Results. Positive skin prick test reactions were common to snow crab (40% and shrimp (20%. Specific IgE to snow crab were positive in 4 workers (21%. Two workers had elevated total IgE levels. Symptoms suggestive of asthma were common (45%. Work-related symptoms of skin rash, rhinitis, and/or conjunctivitis were reported by 50%, and symptoms from the lower airways by 39%. Combining history of work-related symptoms with results from specific SPTs and/or specific IgE determination suggested that 11 and 22% of workers suffered from probable and possible occupational asthma, respectively, whereas 22% had possible occupational dermatitis or rhinitis. Conclusions. Greenlander Inuit do not appear to be protected against sensitization to snow crab or shrimp when occupationally exposed to these. This pilot study suggests that occupational allergy and asthma may be as common a problem in Greenlandic workers as in Canadian.

  16. Association between asthma and chronic periodontitis -A Case–Control Study in Shimla-Himachal Pradesh

    Directory of Open Access Journals (Sweden)

    Vinay Kumar Bhardwaj

    2017-01-01

    Full Text Available Introduction: The colonization of respiratory pathogens appears to be a risk factor for lung infection in high-risk individuals. Evidences dictate a bidirectional relationship between periodontitis and asthma. Aim: The aim of this study is to explore this potential association between asthma and periodontal disease. Materials and Methods: In a case–control study the individuals were selected from patients attending asthma clinic in a hospital. Individuals consist of fifty asthmatics and fifty nonasthmatic healthy controls evaluated for plaque index (PI, gingival index (GI, papillary bleeding index (PBI, calculus index (CI, and clinical attachment level (CAL. The data were analyzed by SPSS version 16. Results: Mean PI scores was 0.649 ± 0.316 for control group in comparison to 1.168 ± 0.46 for asthmatic group. Statistically significant difference among two groups was obtained on a comparison of GI score (P = 0.0231 CI scores (0.0461 for control group. CAL was 3.817 ± 0.722 mm and 4.964 ± 0.871 mm in control group and case group, respectively. The difference of CAL for two groups was statistically highly significant (P = 0.004. Comparison of PBI of test group and control group showed significant difference Comparison of all the parameters for two subgroups (mild asthmatics and moderate-to-severe asthmatics, i.e. PI, CI, GI, and PBI was statistically significant with P value for respective scores as 0.0281, 0.04, 0.027, and 0.0162. CAL measurement for both groups was highly significant (P = 0.001. Conclusion: The present study reveals an association between the occurrence of chronic periodontitis and asthma. Both periodontal and respiratory diseases have an inflammatory nature. Parameters measured using different indices have revealed higher scores for the asthmatics than nonasthmatics.

  17. A telehealth integrated asthma-COPD service for primary care: a proposal for a pilot feasibility study in Crete, Greece

    Directory of Open Access Journals (Sweden)

    Tzanakis Nikolaos E

    2010-07-01

    Full Text Available Abstract Background Chronic obstructive pulmonary disease (COPD and asthma are considered underdiagnosed and misdiagnosed chronic diseases. In The Netherlands, a COPD-asthma telemedicine service has been developed to increase GPs' ability to diagnose and manage COPD and asthma. A telemedicine COPD-asthma service may benefit Greece as it is a country, partly due to its geography, that does not have easy access to pulmonologists. Findings Therefore, a pilot feasibility study has been designed in Greece in order to establish this telemedicine service. Ten rural practices, in the island of Crete, with an average population of 2000 patients per practice will pilot the project supported by three pulmonologists. This paper presents the translated interfaces, the flowcharts and the steps that are considered as necessary for this feasibility study in Crete, Greece.

  18. Living with diabetes: rationale, study design and baseline characteristics for an Australian prospective cohort study

    Directory of Open Access Journals (Sweden)

    Donald Maria

    2012-01-01

    Full Text Available Abstract Background Diabetes mellitus is a major global public health threat. In Australia, as elsewhere, it is responsible for a sizeable portion of the overall burden of disease, and significant costs. The psychological and social impact of diabetes on individuals with the disease can be severe, and if not adequately addressed, can lead to the worsening of the overall disease picture. The Living With Diabetes Study aims to contribute to a holistic understanding of the psychological and social aspects of diabetes mellitus. Methods/Design The Living With Diabetes Study is a 5-year prospective cohort study, based in Queensland, Australia. The first wave of data, which was collected via a mailed self-report survey, was gathered in 2008, with annual collections thereafter. Measurements include: demographic, lifestyle, health and disease characteristics; quality of life (EQ-5D, ADDQoL; emotional well-being (CES-D, LOT-R, ESSI; disease self-management (PAM; and health-care utilisation and patient-assessed quality of care (PACIC. 29% of the 14,439 adults who were invited to participate in the study agreed to do so, yielding a sample size of 3,951 people. Discussion The data collected by the Living With Diabetes Study provides a good representation of Australians with diabetes to follow over time in order to better understand the natural course of the illness. The study has potential to further illuminate, and give a comprehensive picture of the psychosocial implications of living with diabetes. Data collection is ongoing.

  19. Early eczema and the risk of childhood asthma: a prospective, population-based study

    Directory of Open Access Journals (Sweden)

    Saunes Marit

    2012-10-01

    Full Text Available Abstract Background Severe eczema in young children is associated with an increased risk of developing asthma and rhino-conjunctivitis. In the general population, however, most cases of eczema are mild to moderate. In an unselected cohort, we studied the risk of current asthma and the co-existence of allergy-related diseases at 6 years of age among children with and without eczema at 2 years of age. Methods Questionnaires assessing various environmental exposures and health variables were administered at 2 years of age. An identical health questionnaire was completed at 6 years of age. The clinical investigation of a random subsample ascertained eczema diagnoses, and missing data were handled by multiple imputation analyses. Results The estimate for the association between eczema at 2 years and current asthma at 6 years was OR=1.80 (95% CI 1.10-2.96. Four of ten children with eczema at 6 years had the onset of eczema after the age of 2 years, but the co-existence of different allergy-related diseases at 6 years was higher among those with the onset of eczema before 2 years of age. Conclusions Although most cases of eczema in the general population were mild to moderate, early eczema was associated with an increased risk of developing childhood asthma. These findings support the hypothesis of an atopic march in the general population. Trial registration The Prevention of Allergy among Children in Trondheim study has been identified as ISRCTN28090297 in the international Current Controlled Trials database

  20. Rationale and study design of the Japan environment and children's study (JECS).

    Science.gov (United States)

    Kawamoto, Toshihiro; Nitta, Hiroshi; Murata, Katsuyuki; Toda, Eisaku; Tsukamoto, Naoya; Hasegawa, Manabu; Yamagata, Zentaro; Kayama, Fujio; Kishi, Reiko; Ohya, Yukihiro; Saito, Hirohisa; Sago, Haruhiko; Okuyama, Makiko; Ogata, Tsutomu; Yokoya, Susumu; Koresawa, Yuji; Shibata, Yasuyuki; Nakayama, Shoji; Michikawa, Takehiro; Takeuchi, Ayano; Satoh, Hiroshi

    2014-01-10

    There is global concern over significant threats from a wide variety of environmental hazards to which children face. Large-scale and long-term birth cohort studies are needed for better environmental management based on sound science. The primary objective of the Japan Environment and Children's Study (JECS), a nation-wide birth cohort study that started its recruitment in January 2011, is to elucidate environmental factors that affect children's health and development. Approximately 100,000 expecting mothers who live in designated study areas will be recruited over a 3-year period from January 2011. Participating children will be followed until they reach 13 years of age. Exposure to environmental factors will be assessed by chemical analyses of bio-specimens (blood, cord blood, urine, breast milk, and hair), household environment measurements, and computational simulations using monitoring data (e.g. ambient air quality monitoring) as well as questionnaires. JECS' priority outcomes include reproduction/pregnancy complications, congenital anomalies, neuropsychiatric disorders, immune system disorders, and metabolic/endocrine system disorders. Genetic factors, socioeconomic status, and lifestyle factors will also be examined as covariates and potential confounders. To maximize representativeness, we adopted provider-mediated community-based recruitment. Through JECS, chemical substances to which children are exposed during the fetal stage or early childhood will be identified. The JECS results will be translated to better risk assessment and management to provide healthy environment for next generations.

  1. Rationale and study design of the Japan environment and children’s study (JECS)

    Science.gov (United States)

    2014-01-01

    Background There is global concern over significant threats from a wide variety of environmental hazards to which children face. Large-scale and long-term birth cohort studies are needed for better environmental management based on sound science. The primary objective of the Japan Environment and Children’s Study (JECS), a nation-wide birth cohort study that started its recruitment in January 2011, is to elucidate environmental factors that affect children’s health and development. Methods/Design Approximately 100,000 expecting mothers who live in designated study areas will be recruited over a 3-year period from January 2011. Participating children will be followed until they reach 13 years of age. Exposure to environmental factors will be assessed by chemical analyses of bio-specimens (blood, cord blood, urine, breast milk, and hair), household environment measurements, and computational simulations using monitoring data (e.g. ambient air quality monitoring) as well as questionnaires. JECS’ priority outcomes include reproduction/pregnancy complications, congenital anomalies, neuropsychiatric disorders, immune system disorders, and metabolic/endocrine system disorders. Genetic factors, socioeconomic status, and lifestyle factors will also be examined as covariates and potential confounders. To maximize representativeness, we adopted provider-mediated community-based recruitment. Discussion Through JECS, chemical substances to which children are exposed during the fetal stage or early childhood will be identified. The JECS results will be translated to better risk assessment and management to provide healthy environment for next generations. PMID:24410977

  2. Maternal vitamin D status during pregnancy and risk of childhood asthma: A meta-analysis of prospective studies.

    Science.gov (United States)

    Song, Huihui; Yang, Lei; Jia, Chongqi

    2017-05-01

    Mounting evidence suggests that maternal vitamin D status during pregnancy may be associated with development of childhood asthma, but the results are still inconsistent. A dose-response meta-analysis was performed to quantitatively summarize evidence on the association of maternal vitamin D status during pregnancy with the risk of childhood asthma. A systematic search was conducted to identify all studies assessing the association of maternal 25-hydroxyvitamin D (25(OH)D) during pregnancy with risk of childhood asthma. The fixed or random-effect model was selected based on the heterogeneity test among studies. Nonlinear dose-response relationship was assessed by restricted cubic spline model. Fifteen prospective studies with 12 758 participants and 1795 cases were included in the meta-analysis. The pooled relative risk of childhood asthma comparing the highest versus lowest category of maternal 25(OH)D levels was 0.87 (95% confidence interval, CI, 0.75-1.02). For dose-response analysis, evidence of a U-shaped relationship was found between maternal 25(OH)D levels and risk of childhood asthma (P nonlinearity = 0.02), with the lowest risk at approximately 70 nmol/L of 25(OH)D. This dose-response meta-analysis suggested a U-shaped relationship between maternal blood 25(OH)D levels and risk of childhood asthma. Further studies are needed to confirm the association. © 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  3. Occupational asthma

    Science.gov (United States)

    ... in the airways of the lungs. When an asthma attack occurs, the lining of the air passages swells ... small amount of the substance can trigger an asthma attack. Using a respiratory device to protect or reduce ...

  4. Asthma Research

    Science.gov (United States)

    EPA is working to explore the role of common air pollutants in the development and exacerbation of asthma at different life stages as well as other environmental and genetic factors that might make a person more sensitive to developing asthma.

  5. Exploration of asthma risk by occupation--extended analysis of an incidence study of the Finnish population.

    Science.gov (United States)

    Karjalainen, Antti; Kurppa, Kari; Martikainen, Rami; Karjalainen, Jussi; Klaukka, Timo

    2002-02-01

    The objective of the study was to determine asthma risks at the most-detailed level of occupational classification in a previously described nationwide follow-up study that included the entire employed workforce of Finland. In Finland, persons with clinically verified persistent asthma are registered for medication reimbursement within the national health insurance scheme. Data were combined from three national registers, and all 25- to 59-year-old employed Finns were followed for asthma incidence in 1986-1998. Altogether 49,575 cases were detected. A log-linear model was used to estimate the relative risks of asthma for 275 nonadministrative occupations in comparison with administrative work (33 occupations). A significantly increased risk was found for either men or women in 125 occupations. For the men, the risk was highest among bakers, laundry workers, shoemakers and repairers, tanners, fell mongers and pelt dressers, and metal plating and coating workers. For the women, the risk was highest among shoemakers and repairers, railway and station personnel, jewelry engravers, engineroom crew, molders, round-timber workers. and bakers. The results suggest that the work-related excess of asthma incidence is much more widely spread across the labor force than has been previously thought. A great number of occupations deserves to be targeted for in-depth studies focusing on the determinants of asthma excess and on possibilities for better asthma control among asthmatics working in these occupations. The large work-relatedness of asthma incidence should also raise public health interest because of the economic losses incurred and the potential for prevention.

  6. Campath, calcineurin inhibitor reduction and chronic allograft nephropathy (3C) study: background, rationale, and study protocol

    Science.gov (United States)

    2013-01-01

    Background Kidney transplantation is the best treatment for patients with end-stage renal failure, but uncertainty remains about the best immunosuppression strategy. Long-term graft survival has not improved substantially, and one possible explanation is calcineurin inhibitor (CNI) nephrotoxicity. CNI exposure could be minimized by using more potent induction therapy or alternative maintenance therapy to remove CNIs completely. However, the safety and efficacy of such strategies are unknown. Methods/Design The Campath, Calcineurin inhibitor reduction and Chronic allograft nephropathy (3C) Study is a multicentre, open-label, randomized controlled trial with 852 participants which is addressing two important questions in kidney transplantation. The first question is whether a Campath (alemtuzumab)-based induction therapy strategy is superior to basiliximab-based therapy, and the second is whether, from 6 months after transplantation, a sirolimus-based maintenance therapy strategy is superior to tacrolimus-based therapy. Recruitment is complete, and follow-up will continue for around 5 years post-transplant. The primary endpoint for the induction therapy comparison is biopsy-proven acute rejection by 6 months, and the primary endpoint for the maintenance therapy comparison is change in estimated glomerular filtration rate from baseline to 2 years after transplantation. The study is sponsored by the University of Oxford and endorsed by the British Transplantation Society, and 18 centers for adult kidney transplant are participating. Discussion Late graft failure is a major issue for kidney-transplant recipients. If our hypothesis that minimizing CNI exposure with Campath-based induction therapy and/or an elective conversion to sirolimus-based maintenance therapy can improve long-term graft function and survival is correct, then patients should experience better graft function for longer. A positive outcome could change clinical practice in kidney transplantation. Trial

  7. Disease management programs for patients with asthma in Germany: a longitudinal population-based study.

    Science.gov (United States)

    Mehring, Michael; Donnachie, Ewan; Mutschler, Robert; Hofmann, Frank; Keller, Manfred; Schneider, Antonius

    2013-07-01

    The primary aim of the disease management program (DMP) for patients with asthma is to improve health outcomes and to reduce costs. Five years after its introduction in Germany, no consensus has yet been reached as to whether DMP has been effective in reaching these goals. To evaluate the DMP for asthma in Bavaria using routinely collected subject medical records. A longitudinal population-based study encompassing over 100,000 DMP participants between 2006 (when the program began) and 2010. The prescription rate of oral corticosteroids dropped from 15.7% in 2006 to 13.6% in 2007, and again from 7.5% in 2008 to 5.9% in 2010 (P management education increased from 4.4% to 23.4% (P management. The proportion of subjects requiring hospitalization decreased. Our results suggest that the German DMP for asthma has been effective in enhancing the quality of care in regard to an improved symptom frequency, adherence to guidelines, pharmacotherapy, and hospitalization.

  8. Maternal depressive symptoms across early childhood and asthma in school children: findings from a Longitudinal Australian Population Based Study.

    Directory of Open Access Journals (Sweden)

    Rebecca Giallo

    Full Text Available There is a growing body of evidence attesting to links between early life exposure to stress and childhood asthma. However, available evidence is largely based on small, genetically high risk samples. The aim of this study was to explore the associations between the course of maternal depressive symptoms across early childhood and childhood asthma in a nationally representative longitudinal cohort study of Australian children. Participants were 4164 children and their biological mothers from the Longitudinal Study of Australian Children. Latent class analysis identified three trajectories of maternal depressive symptoms across four biennial waves from the first postnatal year to when children were 6-7 years: minimal symptoms (74.6%, sub-clinical symptoms (20.8%, and persistent and increasing high symptoms (4.6%. Logistic regression analyses revealed that childhood asthma at age 6-7 years was associated with persistent and increasing high depressive symptoms after accounting for known risk factors including smoking during pregnancy and maternal history of asthma (adjusted OR 2.36, 95% CI 1.61-3.45, p.001. Our findings from a nationally representative sample of Australian children provide empirical support for a relationship between maternal depressive symptoms across the early childhood period and childhood asthma. The burden of disease from childhood asthma may be reduced by strengthening efforts to promote maternal mental health in the early years of parenting.

  9. Maternal depressive symptoms across early childhood and asthma in school children: findings from a Longitudinal Australian Population Based Study.

    Science.gov (United States)

    Giallo, Rebecca; Bahreinian, Salma; Brown, Stephanie; Cooklin, Amanda; Kingston, Dawn; Kozyrskyj, Anita

    2015-01-01

    There is a growing body of evidence attesting to links between early life exposure to stress and childhood asthma. However, available evidence is largely based on small, genetically high risk samples. The aim of this study was to explore the associations between the course of maternal depressive symptoms across early childhood and childhood asthma in a nationally representative longitudinal cohort study of Australian children. Participants were 4164 children and their biological mothers from the Longitudinal Study of Australian Children. Latent class analysis identified three trajectories of maternal depressive symptoms across four biennial waves from the first postnatal year to when children were 6-7 years: minimal symptoms (74.6%), sub-clinical symptoms (20.8%), and persistent and increasing high symptoms (4.6%). Logistic regression analyses revealed that childhood asthma at age 6-7 years was associated with persistent and increasing high depressive symptoms after accounting for known risk factors including smoking during pregnancy and maternal history of asthma (adjusted OR 2.36, 95% CI 1.61-3.45), p.001). Our findings from a nationally representative sample of Australian children provide empirical support for a relationship between maternal depressive symptoms across the early childhood period and childhood asthma. The burden of disease from childhood asthma may be reduced by strengthening efforts to promote maternal mental health in the early years of parenting.

  10. Rhinitis: a complication to asthma

    DEFF Research Database (Denmark)

    Hansen, J W; Thomsen, S F; Nolte, H

    2010-01-01

    Asthma and rhinitis often co-occur, and this potentially increases the disease severity and impacts negatively on the quality of life. We studied disease severity, airway responsiveness, atopy, quality of life and treatment in subjects with both asthma and rhinitis compared to patients with asthma...

  11. ATTITUDES OF PATIENTS WITH ASTHMA ON INHALER USE- A CROSS-SECTIONAL STUDY FROM SOUTH KERALA

    Directory of Open Access Journals (Sweden)

    Shajahan Purathel Sulaiman

    2017-03-01

    Full Text Available BACKGROUND Asthma is an important health problem worldwide. High prevalence and poor control of asthma make its management a major public health problem with more than 5,00,000 hospital admissions and 2,50,000 deaths annually all over the world. India contribute maximum to the death toll accounting for 22.3% of all global asthma deaths. Medications in the inhaled forms are the best therapeutic options currently available for asthma. Despite this, the percentage of patients opting inhalers as the preferred modality of treatment seems to be low. The patient’s ability to use the device correctly and the adherence to the treatment regimen are likely to be influenced by their beliefs, attitudes and concerns about the use of inhalers as the preferred mode of treatment. The aim of the study is to- 1. To find out the proportion of asthmatics using inhalers as the preferred modality of treatment. 2. To bring out the various beliefs and misconceptions on inhalers among the above study group. MATERIALS AND METHODS Study subjects were asthmatics in the age group of 15 to 45 years who attended the medical camps conducted in Alappuzha and Kottayam districts of Kerala during the period 2006-2009 (n=912. A semi-structured interview schedule regarding the use of inhalers were administered to collect the data. RESULTS 52% of the study subjects accept inhaled preparations as the preferred modality of treatment (male-68%, female-35%. 48% are reluctant to take inhalers in the first step (male- 32%, female- 65%. 47% believe the term inhaler is the name of a particular drug rather than a device (male- 45%, female- 48%. 76% of inhaler users do not know how to use it properly. 7% think the powder in the dry powder inhalers can block the airways. CONCLUSION Knowledge about asthma and the importance of its proper management are poor in our population. A joint effort in the form of health awareness programmes are needed to alleviate fears and misconceptions of patients

  12. CORONARY DIET INTERVENTION WITH OLIVE OIL AND CARDIOVASCULAR PREVENTION STUDY (THE CORDIOPREV STUDY): RATIONALE, METHODS, AND BASELINE CHARACTERISTICS

    Science.gov (United States)

    Delgado-Lista, Javier; Perez-Martinez, Pablo; Garcia-Rios, Antonio; Alcala-Diaz, Juan F; Perez-Caballero, Ana I.; Gomez-Delgado, Francisco; Fuentes, Francisco; Quintana-Navarro, Gracia; Lopez-Segura, Fernando; Ortiz-Morales, Ana M; Delgado-Casado, Nieves; Yubero-Serrano, Elena; Camargo, Antonio; Marin, Carmen; Rodriguez-Cantalejo, Fernando; Gomez-Luna, Purificacion; Ordovas, Jose M; Lopez-Miranda, Jose; Perez-Jimenez, Francisco

    2016-01-01

    Coronary heart disease (CHD) represents a major global health burden. However, despite the well-known influence that dietary habits exert over the progression of this disease, there are no well-established and scientifically sound dietary approaches to prevent the onset of clinical outcomes in secondary prevention. The objective of the CORonary Diet Intervention with Olive oil and cardiovascular PREVention study (CORDIOPREV study, clinical trials number NCT00924937) is to compare the ability of a Mediterranean diet rich in virgin olive oil versus a low-fat diet to influence the composite incidence of cardiovascular events after 7 years, in subjects with documented CHD at baseline. For this purpose, we enrolled 1002 coronary patients from Spain. Baseline assessment (2009–12) included detailed interviews and measurements to assess dietary, social and biological variables. Results of baseline characteristics: The CORDIOPREV study in Spain describes a population with a high BMI (37.2% overweight and 56.3% obesity), with a median of LDL-cholesterol of 88.5 mg/dL (70.6% of the patients having <100 mg/dL, and 20.3% patients < 70 mg/dL). 9.6% of the participants were active smokers, and 64.4% were former smokers. Metabolic Syndrome was present in 58% of this population. To sum up, we describe here the rationale, methods and baseline characteristics of the CORDIOPREV study, which will test for the first time the efficacy of a Mediterranean Diet rich in extra virgin olive oil as compared with a low-fat diet on the incidence of CHD recurrence in a long term follow-up study. PMID:27297848

  13. Exhaled nitric oxide in a population-based study of asthma and allergy in schoolchildren.

    Science.gov (United States)

    Nordvall, S L; Janson, C; Kalm-Stephens, P; Foucard, T; Torén, K; Alving, K

    2005-04-01

    Exhaled nitric oxide (NO) reflects inflammation in the lower airways and is well adapted for use in children. The aims of this study were to investigate the distribution of the fraction of expired NO (FENO) in school children and to compare FENO and spirometry in relation to the International Study of Asthma and Allergies in Childhood questionnaire. The study was performed in 959 randomly selected 13-14-year-old school children in Uppsala, Sweden. Exhaled NO was measured at an inhalation rate of 0.1 l/s (FENO0.1) and a spirometric test was performed and data from these measurements were related to questionnaire data. Exhaled NO was measured according to American Thoracic Society recommendations, except the use of a mouth wash and an exhalation flow rate of 0.1 l/s. The distribution of the mean FENO0.1 values was skewed, with a preponderance of very low levels and a widespread tail of values ranging up to 102 parts per billion (ppb). Boys exhibited significantly higher mean FENO0.1 values than girls, 5.2 (4.7-5.7) vs 4.4 (4.0-4.8) ppb (geometric mean and 95% CI), P <0.01). Children who reported wheezing in the last year had higher FENO0.1 values than children that had not, 8.5 (7.1-10.2) vs 4.3 (4.0-4.6) ppb, P <0.001). The same association was found to most symptoms indicating hay fever and eczema. In contrast to this, only weak or inconsistent associations were found between asthma and spirometric indices. Exhaled NO levels were found to be independently related to male gender, wheeze and rhinoconjuctivitis but not to current eczema. In conclusion, exhaled NO was closely associated with reported asthma and allergy symptoms whereas spirometric indices such as percent predicted forced expiratory volume in 1 s were not. As most asthma cases in a population are mild, the findings suggest that exhaled NO is a sensitive marker of asthma and allergy.

  14. Asthma control in children

    DEFF Research Database (Denmark)

    Pedersen, Søren

    2016-01-01

    The goal of asthma management is to achieve disease control. Poorly controlled asthma is associated with an increased number of days lost from school, exacerbations and days in hospital. Furthermore, children with uncontrolled asthma have more frequent contacts with the health-care system. Recent...... studies have added new information about the effects of poorly controlled asthma on a range of important, but less studied outcomes, including risk of obesity, daily physical activity, cardiovascular fitness, stress, concentration and focused attention, learning disabilities and risk of depression. From...... these studies it seems that poor asthma control may have a greater impact on the child than previously thought. This may have important long-term consequences for the child such as an increased risk of life-style associated diseases and poorer school performance. The level of control seems to be the most...

  15. Fertility outcomes in asthma

    DEFF Research Database (Denmark)

    Gade, Elisabeth Juul; Thomsen, Simon Francis; Lindenberg, Svend

    2016-01-01

    Evidence is increasing of an association between asthma and aspects of female reproduction. However, current knowledge is limited and furthermore relies on questionnaire studies or small populations. In a prospective observational cohort study to investigate whether time to pregnancy, the number...... of fertility treatments, and the number of successful pregnancies differ significantly between women with unexplained infertility with and without asthma.245 women with unexplained infertility (aged 23-45 years) underwent questionnaires and asthma and allergy testing while undergoing fertility treatment. 96...... women entering the study had either a former doctor's diagnosis of asthma or were diagnosed with asthma when included. After inclusion they were followed for a minimum of 12 months in fertility treatment, until they had a successful pregnancy, stopped treatment, or the observation ended.The likelihood...

  16. An integrated model of environmental factors in adult asthma lung function and disease severity: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Katz Patricia P

    2010-05-01

    Full Text Available Abstract Background Diverse environmental exposures, studied separately, have been linked to health outcomes in adult asthma, but integrated multi-factorial effects have not been modeled. We sought to evaluate the contribution of combined social and physical environmental exposures to adult asthma lung function and disease severity. Methods Data on 176 subjects with asthma and/or rhinitis were collected via telephone interviews for sociodemographic factors and asthma severity (scored on a 0-28 point range. Dust, indoor air quality, antigen-specific IgE antibodies, and lung function (percent predicted FEV1 were assessed through home visits. Neighborhood socioeconomic status, proximity to traffic, land use, and ambient air quality data were linked to the individual-level data via residential geocoding. Multiple linear regression separately tested the explanatory power of five groups of environmental factors for the outcomes, percent predicted FEV1 and asthma severity. Final models retained all variables statistically associated (p Results Mean FEV1 was 85.0 ± 18.6%; mean asthma severity score was 6.9 ± 5.6. Of 29 variables screened, 13 were retained in the final model of FEV1 (R2 = 0.30; p 2 = 0.16; p 1 as an independent variable to the severity model further increased its explanatory power (R2 = 0.25. Conclusions Multivariate models covering a range of individual and environmental factors explained nearly a third of FEV1 variability and, taking into account lung function, one quarter of variability in asthma severity. These data support an integrated approach to modeling adult asthma outcomes, including both the physical and the social environment.

  17. Risk factors for acute asthma in tropical America: a case-control study in the City of Esmeraldas, Ecuador.

    Science.gov (United States)

    Ardura-Garcia, Cristina; Vaca, Maritza; Oviedo, Gisela; Sandoval, Carlos; Workman, Lisa; Schuyler, Alexander J; Perzanowski, Matthew S; Platts-Mills, Thomas A E; Cooper, Philip J

    2015-08-01

    Despite the high asthma rates described in Latin America, asthma risk factors in poor urban settings are not well established. We investigated risk factors for acute asthma among Ecuadorian children. A matched case-control study was carried out in a public hospital serving a coastal city. Children with acute asthma were age- and sex-matched to non-asthmatics. A questionnaire was administered, and blood, as well as stool, and nasopharyngeal swabs were collected. Sixty cases and 119 controls aged 5-15 were evaluated. High proportions of cases were atopic with population-attributable fractions for atopy of 68.5% for sIgE and 57.2% for SPT. Acute asthma risk increased with greater titers of mite IgE (3.51-50 kU/l vs. 50kU/l vs. Asthma risk was significantly independently associated with bronchiolitis (adj. OR: 38.9, 95% CI 3.26-465), parental educational level (adj. OR 1.26, 95% CI: 1.08-1.46), and presence of sIgE (adj. OR: 36.7, 95% CI: 4.00-337), while a reduced risk was associated with current contact with pets (adj. OR: 0.07, 95% CI: 0.01-0.56). Rhinovirus infection was more frequent in cases (cases 35.6% vs. controls 7.8%, p = 0.002). None of the cases were on maintenance therapy with inhaled corticosteroids and most relied on emergency department for control. A high proportion of children presenting to a public hospital with acute asthma were allergic to mite, particularly at high IgE titer. Poor asthma control resulted in overuse of emergency care. © 2015 The Authors. Pediatric Allergy and Immunology Published by John Wiley & Sons Ltd.

  18. Pilot study of personality traits assessed by the Karolinska Scales of Personality (KSP) in asthma, atopy, and rhinitis.

    Science.gov (United States)

    Runeson, Roma; Wahlstedt, Kurt; Norbäck, Dan

    2011-12-01

    Asthma and atopy are common diseases. To study associations between personality and asthma, atopy, rhinitis, and personality traits were measured on the Karolinska Scales of Personality for 193 persons working in 19 buildings with suspected indoor air problems. In addition, information on history of atopy, asthma, and rhinitis was collected by postal questionnaire. In analyses, asthma was associated with higher impulsiveness scores, and atopy in non-asthmatics was associated with higher social desirability scores and lower irritability, guilt, and impulsiveness scores. Non-atopic rhinitis was associated with scores on several anxiety-related scales, while atopic rhinitis was not associated with scores on the Karolinska Scales of Personality. This exploration implies that asthma, atopy, and rhinitis may be associated with various but different personality trait scores. The finding of such personality trait associations in persons with non-asthmatic atopy raises the question of a potential role of an emotional conflict in atopy and the role of personality in asthma, atopy, and rhinitis.

  19. Long-term exposure to air pollution and asthma hospitalisations in older adults: a cohort study

    DEFF Research Database (Denmark)

    Andersen, Zorana Jovanovic; Bønnelykke, Klaus; Hvidberg, Martin

    2012-01-01

    Exposure to air pollution in early life contributes to the burden of childhood asthma, but it is not clear whether long-term exposure to air pollution can lead to asthma onset or progression in adulthood.......Exposure to air pollution in early life contributes to the burden of childhood asthma, but it is not clear whether long-term exposure to air pollution can lead to asthma onset or progression in adulthood....

  20. Asthma Is More Severe in Older Adults

    Science.gov (United States)

    Dweik, Raed A.; Comhair, Suzy A.; Bleecker, Eugene R.; Moore, Wendy C.; Peters, Stephen P.; Busse, William W.; Jarjour, Nizar N.; Calhoun, William J.; Castro, Mario; Chung, K. Fan; Fitzpatrick, Anne; Israel, Elliot; Teague, W. Gerald; Wenzel, Sally E.; Love, Thomas E.; Gaston, Benjamin M.

    2015-01-01

    Background Severe asthma occurs more often in older adult patients. We hypothesized that the greater risk for severe asthma in older individuals is due to aging, and is independent of asthma duration. Methods This is a cross-sectional study of prospectively collected data from adult participants (N=1130; 454 with severe asthma) enrolled from 2002 – 2011 in the Severe Asthma Research Program. Results The association between age and the probability of severe asthma, which was performed by applying a Locally Weighted Scatterplot Smoother, revealed an inflection point at age 45 for risk of severe asthma. The probability of severe asthma increased with each year of life until 45 years and thereafter increased at a much slower rate. Asthma duration also increased the probability of severe asthma but had less effect than aging. After adjustment for most comorbidities of aging and for asthma duration using logistic regression, asthmatics older than 45 maintained the greater probability of severe asthma [OR: 2.73 (95 CI: 1.96; 3.81)]. After 45, the age-related risk of severe asthma continued to increase in men, but not in women. Conclusions Overall, the impact of age and asthma duration on risk for asthma severity in men and women is greatest over times of 18-45 years of age; age has a greater effect than asthma duration on risk of severe asthma. PMID:26200463

  1. Asthma in elite athletes: how do we manage asthma-like symptoms and asthma in elite athletes?

    DEFF Research Database (Denmark)

    Lund, Thomas Kromann

    2009-01-01

    . Elite athletes with physician-diagnosed asthma seem to have less airway reactivity and fewer sputum eosinophils than non-athletes with physician-diagnosed asthma, but more studies are needed to further investigate if and how the asthma phenotype of elite athletes differs from that of classical asthma....

  2. Declines with Age in Childhood Asthma Symptoms and Health Care Use: An Adjustment for Evaluations

    Science.gov (United States)

    Ko, Yi-An; Song, Peter X. K.; Clark, Noreen M.

    2014-01-01

    Rationale: Asthma is a variable condition with an apparent tendency for a natural decline in asthma symptoms and health care use occurring as children age. As a result, asthma interventions using a pre-post design may overestimate the intervention effect when no proper control group is available. Objectives: Investigate patterns of natural decline…

  3. Airway Epithelial Changes in Smokers but Not in Ex-Smokers with Asthma

    NARCIS (Netherlands)

    Broekema, Martine; ten Hacken, Nick H. T.; Volbeda, Franke; Lodewijk, Monique E.; Hylkema, Machteld N.; Postma, Dirkje S.; Timens, Wim

    2009-01-01

    Rationale: Smoking has detrimental effects on asthma outcome, such as increased cough, wheezing, sputum production, and frequency of asthma attacks. This results in accelerated lung function decline. The underlying pathological process of smoke-induced deterioration of asthma is unknown. Objectives:

  4. Conceptual design studies for the European DEMO divertor: Rationale and first results

    International Nuclear Information System (INIS)

    You, J.H.; Mazzone, G.; Visca, E.; Bachmann, Ch.; Autissier, E.; Barrett, T.; Cocilovo, V.; Crescenzi, F.; Domalapally, P.K.; Dongiovanni, D.; Entler, S.; Federici, G.; Frosi, P.; Fursdon, M.; Greuner, H.; Hancock, D.; Marzullo, D.; McIntosh, S.; Müller, A.V.; Porfiri, M.T.

    2016-01-01

    Highlights: • A brief overview is given on the overall R&D activities of the work package Divertor which is a project of the EUROfusion Consortium. • The rationale of the hydraulic, thermal and structural design scheme is described. • The first results obtained for the preliminary DEMO divertor cassette model are presented. - Abstract: In the European fusion roadmap, reliable power handling has been defined as one of the most critical challenges for realizing a commercially viable fusion power. In this context, the divertor is the key in-vessel component, as it is responsible for power exhaust and impurity removal for which divertor target is subjected to very high heat flux loads. To this end, an integrated R&D project was launched in the EUROfusion Consortium in order to deliver a holistic conceptual design solution together with the core technologies for the entire divertor system of a DEMO reactor. The work package ‘Divertor’ consists of two project areas: ‘Cassette design and integration’ and ‘Target development’. The essential mission of the project is to develop and verify advanced design concepts and the required technologies for a divertor system being capable of meeting the physical and system requirements defined for the next-generation European DEMO reactor. In this contribution, a brief overview is presented of the works from the first project year (2014). Focus is put on the loads specification, design boundary conditions, materials requirements, design approaches, and R&D strategy. Initial ideas and first estimates are presented.

  5. Conceptual design studies for the European DEMO divertor: Rationale and first results

    Energy Technology Data Exchange (ETDEWEB)

    You, J.H., E-mail: you@ipp.mpg.de [Max Planck Institute for Plasma Physics, Boltzmann Str. 2, 85748 Garching (Germany); Mazzone, G.; Visca, E. [ENEA, Unità Tecnica Fusione, ENEA C. R. Frascati, via E. Fermi 45, 00044 Frascati (Italy); Bachmann, Ch. [EUROfusion PMU, c/o IPP, Boltzmann Str. 2, 85748 Garching (Germany); Autissier, E. [CEA, IRFM, F-13108 Saint Paul Lez Durance (France); Barrett, T. [CCFE, Culham Science Centre, Abingdon OX14 3DB (United Kingdom); Cocilovo, V.; Crescenzi, F. [ENEA, Unità Tecnica Fusione, ENEA C. R. Frascati, via E. Fermi 45, 00044 Frascati (Italy); Domalapally, P.K. [Research Cnter Rez, Hlavní 130, 250 68 Husinec–Řež (Czech Republic); Dongiovanni, D. [ENEA, Unità Tecnica Fusione, ENEA C. R. Frascati, via E. Fermi 45, 00044 Frascati (Italy); Entler, S. [Institute of Plasma Physics CAS, Za Slovankou 3, 182 00 Praha 8 (Czech Republic); Federici, G. [EUROfusion PMU, c/o IPP, Boltzmann Str. 2, 85748 Garching (Germany); Frosi, P. [ENEA, Unità Tecnica Fusione, ENEA C. R. Frascati, via E. Fermi 45, 00044 Frascati (Italy); Fursdon, M. [CCFE, Culham Science Centre, Abingdon OX14 3DB (United Kingdom); Greuner, H. [Max Planck Institute for Plasma Physics, Boltzmann Str. 2, 85748 Garching (Germany); Hancock, D. [CCFE, Culham Science Centre, Abingdon OX14 3DB (United Kingdom); Marzullo, D. [CREATE, University of Naples Federico II, P.le Tecchio 80, 80125 Napoli (Italy); McIntosh, S. [CCFE, Culham Science Centre, Abingdon OX14 3DB (United Kingdom); Müller, A.V. [Max Planck Institute for Plasma Physics, Boltzmann Str. 2, 85748 Garching (Germany); Porfiri, M.T. [ENEA, Unità Tecnica Fusione, ENEA C. R. Frascati, via E. Fermi 45, 00044 Frascati (Italy); and others

    2016-11-01

    Highlights: • A brief overview is given on the overall R&D activities of the work package Divertor which is a project of the EUROfusion Consortium. • The rationale of the hydraulic, thermal and structural design scheme is described. • The first results obtained for the preliminary DEMO divertor cassette model are presented. - Abstract: In the European fusion roadmap, reliable power handling has been defined as one of the most critical challenges for realizing a commercially viable fusion power. In this context, the divertor is the key in-vessel component, as it is responsible for power exhaust and impurity removal for which divertor target is subjected to very high heat flux loads. To this end, an integrated R&D project was launched in the EUROfusion Consortium in order to deliver a holistic conceptual design solution together with the core technologies for the entire divertor system of a DEMO reactor. The work package ‘Divertor’ consists of two project areas: ‘Cassette design and integration’ and ‘Target development’. The essential mission of the project is to develop and verify advanced design concepts and the required technologies for a divertor system being capable of meeting the physical and system requirements defined for the next-generation European DEMO reactor. In this contribution, a brief overview is presented of the works from the first project year (2014). Focus is put on the loads specification, design boundary conditions, materials requirements, design approaches, and R&D strategy. Initial ideas and first estimates are presented.

  6. Arginase 1 and arginase 2 variations associate with asthma, asthma severity and beta(2) agonist and steroid response

    NARCIS (Netherlands)

    Vonk, Judith M.; Postma, Dirkje S.; Maarsingh, Harm; Bruinenberg, Marcel; Koppelman, Gerard H.; Meurs, Herman

    Rationale Arginase probably plays an important role in asthma development, severity and progression. Polymorphisms in arginase 1 and arginase 2 genes have been associated with childhood asthma and FEV1 reversibility to beta(2) agonists. Objectives We investigated the association between arginase 1

  7. Comparing Global Initiative for Asthma (GINA) criteria with the Childhood Asthma Control Test (C-ACT) and Asthma Control Test (ACT)

    NARCIS (Netherlands)

    Koolen, B.B.; Pijnenburg, M.W.; Brackel, H.J.; Landstra, A.M.; Berg, N.J. van den; Merkus, P.J.F.M.; Hop, W.C.J.; Vaessen-Verberne, A.A.

    2011-01-01

    Several tools are useful in detecting uncontrolled asthma in children. The aim of this study was to compare Global Initiative for Asthma (GINA) guidelines with the Childhood Asthma Control Test (C-ACT) and the Asthma Control Test (ACT) in detecting uncontrolled asthma in children. 145 children with

  8. Studying the effects of classic hallucinogens in the treatment of alcoholism: rationale, methodology, and current research with psilocybin.

    Science.gov (United States)

    Bogenschutz, Michael P

    2013-03-01

    Recent developments in the study of classic hallucinogens, combined with a re-appraisal of the older literature, have led to a renewal of interest in possible therapeutic applications for these drugs, notably their application in the treatment of addictions. This article will first provide a brief review of the research literature providing direct and indirect support for the possible therapeutic effects of classic hallucinogens such as psilocybin and lysergic acid diethylamide (LSD) in the treatment of addictions. Having provided a rationale for clinical investigation in this area, we discuss design issues in clinical trials using classic hallucinogens, some of which are unique to this class of drug. We then discuss the current status of this field of research and design considerations in future randomized trials.

  9. A Randomized trial of an Asthma Internet Self-management Intervention (RAISIN): study protocol for a randomized controlled trial.

    Science.gov (United States)

    Morrison, Deborah; Wyke, Sally; Thomson, Neil C; McConnachie, Alex; Agur, Karolina; Saunderson, Kathryn; Chaudhuri, Rekha; Mair, Frances S

    2014-05-24

    The financial costs associated with asthma care continue to increase while care remains suboptimal. Promoting optimal self-management, including the use of asthma action plans, along with regular health professional review has been shown to be an effective strategy and is recommended in asthma guidelines internationally. Despite evidence of benefit, guided self-management remains underused, however the potential for online resources to promote self-management behaviors is gaining increasing recognition. The aim of this paper is to describe the protocol for a pilot evaluation of a website 'Living well with asthma' which has been developed with the aim of promoting self-management behaviors shown to improve outcomes. The study is a parallel randomized controlled trial, where adults with asthma are randomly assigned to either access to the website for 12 weeks, or usual asthma care for 12 weeks (followed by access to the website if desired). Individuals are included if they are over 16-years-old, have a diagnosis of asthma with an Asthma Control Questionnaire (ACQ) score of greater than, or equal to 1, and have access to the internet. Primary outcomes for this evaluation include recruitment and retention rates, changes at 12 weeks from baseline for both ACQ and Asthma Quality of Life Questionnaire (AQLQ) scores, and quantitative data describing website usage (number of times logged on, length of time logged on, number of times individual pages looked at, and for how long). Secondary outcomes include clinical outcomes (medication use, health services use, lung function) and patient reported outcomes (including adherence, patient activation measures, and health status). Piloting of complex interventions is considered best practice and will maximise the potential of any future large-scale randomized controlled trial to successfully recruit and be able to report on necessary outcomes. Here we will provide results across a range of outcomes which will provide estimates of

  10. Understanding mild persistent asthma in children

    DEFF Research Database (Denmark)

    Bisgaard, Hans; Szefler, Stanley J

    2005-01-01

    Limitations in asthma prevalence studies and difficulties in diagnosing pediatric asthma lead to uncertainty over the full extent of mild persistent asthma in children and adolescents. Although recent surveys have reported that the majority of pediatric patients with asthma in the United States...... and Europe have symptoms consistent with mild disease, these surveys have limitations in design. Thus, the true prevalence of mild asthma remains unknown. It is unclear whether children with mild persistent asthma progress to more severe asthma, but the risk of severe asthma exacerbations seems...... to be unrelated to the symptom severity. Clinical studies restricted to pediatric patients with mild asthma are limited, but available data do suggest substantial morbidity of mild persistent asthma in this population and support inhaled corticosteroid intervention. There is a need for further investigation...

  11. The Salford Lung Study protocol: a pragmatic, randomised phase III real-world effectiveness trial in asthma.

    Science.gov (United States)

    Woodcock, Ashley; Bakerly, Nawar Diar; New, John P; Gibson, J Martin; Wu, Wei; Vestbo, Jørgen; Leather, David

    2015-12-10

    Novel therapies need to be evaluated in normal clinical practice to allow a true representation of the treatment effectiveness in real-world settings. The Salford Lung Study is a pragmatic randomised controlled trial in adult asthma, evaluating the clinical effectiveness and safety of once-daily fluticasone furoate (100 μg or 200 μg)/vilanterol 25 μg in a novel dry-powder inhaler, versus existing asthma maintenance therapy. The study was initiated before this investigational treatment was licensed and conducted in real-world clinical practice to consider adherence, co-morbidities, polypharmacy, and real-world factors. Asthma Control Test at week 24; safety endpoints include the incidence of serious pneumonias. The study utilises the Salford electronic medical record, which allows near to real-time collection and monitoring of safety data. The Salford Lung Study is the world's first pragmatic randomised controlled trial of a pre-licensed medication in asthma. Use of patients' linked electronic health records to collect clinical endpoints offers minimal disruption to patients and investigators, and also ensures patient safety. This highly innovative study will complement standard double-blind randomised controlled trials in order to improve our understanding of the risk/benefit profile of fluticasone furoate/vilanterol in patients with asthma in real-world settings. Clinicaltrials.gov, NCT01706198; 04 October 2012.

  12. European birth cohort studies on asthma and atopic diseases I

    DEFF Research Database (Denmark)

    Keil, T; Kulig, M; Simpson, A

    2006-01-01

    , recruitment process and follow-up rates. A subsequent review (part II) will compare outcome and exposure parameters. METHODS: For each birth cohort, we collected detailed information regarding recruitment process, study setting, baseline data (pregnancy, birth, parents/siblings) as well as follow-up rates...

  13. Enzyme-potentiated desensitization in children with asthma and mite allergy: a double-blind study.

    Science.gov (United States)

    Cantani, A; Ragno, V; Monteleone, M A; Lucenti, P; Businco, L

    1996-01-01

    The aim of this study was to evaluate the efficacy and safety of enzyme-potentiated desensitization (EPD) in children with asthma. Twenty asthmatic children (14 males and 6 females; median age: 8.5 years) were included in the study. They had positive skin tests to Dermatophagoides pteronyssinus (Dpt), no history of other allergy and had suffered from asthma for at least two years. The children were examined before starting the trial, at the first EPD dose, after 8 weeks, at the second EPD dose and 3 months after the second EPD dose. Blood samples for PRIST and RAST were drawn before the first and at the second EPD dose, and at the last follow-up. Conjunctival provocation tests (CPT) and skin test endpoint determinations were performed with dilutions of a freeze-dried Dpt extract (10-100,000 SQ-U/ml) at the start of the trial and at the last follow-up. Parents kept a diary record of the days with asthma and daily drug usage. The children were randomized to receive either two intradermal placebo injections or the active material with an 8-week interval (November 1991 and January 1992). Ten children received EPD and 10 children placebo. The intradermal injection of EPD (0.05 ml) contained 0.01 ml of beta-glucuronidase (40 Fishman units) and 0.04 ml of a mixture of inhalant allergens (1 Noon unit). The placebo injection consisted of buffer solution only. The EPD-treated children had significantly fewer days with asthma (p = 0.00000). In addition, the EPD-treated children used significantly less medication for the management of asthma attacks (p = 0.00000). At the start of the trial, three out of 10 children in the EPD group and two out of 10 in the placebo group reacted only to the highest dose of allergen used in the CPT (100,000 SQ/ml) (NS). At the last follow-up, the threshold dose in the CPT was 100,000 SQ/ml or more in nine out of 10 children in the EPD group and in four out of 10 children of the placebo group (p = 0.0349). At the last follow-up, one child in the

  14. Characteristics and Prognosis of Never-Smokers and Smokers with Asthma in the Copenhagen General Population Study. A Prospective Cohort Study.

    Science.gov (United States)

    Çolak, Yunus; Afzal, Shoaib; Nordestgaard, Børge G; Lange, Peter

    2015-07-15

    Asthma is associated with complications, cardiovascular comorbidities, and higher mortality in some individuals. To test the hypothesis that, among individuals with asthma, never-smokers have different characteristics and a better prognosis than smokers. We recruited 94,079 individuals aged 20-100 years from the Copenhagen General Population Study, a prospective cohort study. Among these individuals, 5,691 (6%) had self-reported asthma (2,304 never-smokers, 2,467 former smokers, and 920 current smokers). We examined respiratory symptoms, lung function, and levels of inflammatory and allergic biomarkers in systemic circulation. Furthermore, we assessed prospectively the risk of asthma or chronic obstructive pulmonary disease (COPD) exacerbations, pneumonias, lung cancer, ischemic heart disease, ischemic stroke, and all-cause mortality during 4.5 years of follow-up. Compared with never-smokers without asthma, individuals with asthma had more respiratory symptoms and airflow limitation and higher levels of inflammatory and allergic biomarkers, which were most pronounced in smokers. Among individuals with asthma compared with never-smokers without asthma, multivariable adjusted hazard ratios for asthma exacerbations were 11 (95% confidence interval: 5.8-22) in never-smokers, 13 (6.2-29) in former smokers, and 18 (8.2-39) in current smokers. The corresponding values for other endpoints were, respectively, 8.9 (2.1-38), 23 (8.8-58), and 36 (12-105) for COPD exacerbations; 1.5 (0.9-2.2), 1.6 (1.0-2.4), and 2.4 (1.6-3.7) for pneumonias; 0.6 (0.1-5.1), 4.0 (1.3-12), and 13 (4.3-41) for lung cancer; 1.2 (0.9-1.6), 1.5 (1.2-2.0), and 2.0 (1.4-2.9) for ischemic heart disease; 1.4 (0.9-2.1), 1.2 (0.8-1.9), and 3.0 (1.7-5.3) for ischemic stroke; and 0.9 (0.6-1.3), 1.5 (1.1-2.0), and 2.7 (1.9-3.7) for all-cause mortality. Never-smokers with asthma had an increased risk of asthma and COPD exacerbations, and possibly pneumonias. Importantly, the risks for lung cancer

  15. An association study of 13 SNPs from seven candidate genes with pediatric asthma and a preliminary study for genetic testing by multiple variants in Taiwanese population.

    Science.gov (United States)

    Wang, Jiu-Yao; Liou, Ya-Huei; Wu, Ying-Jye; Hsiao, Ya-Hsin; Wu, Lawrence Shih-Hsin

    2009-03-01

    Asthma is one of the most common chronic diseases in children. It is caused by complex interactions between various genetic factors and exposures to environmental allergens and irritants. Because of the heterogeneity of the disease and the genetic and cultural differences among different populations, a proper association study and genetic testing for asthma and susceptibility genes is difficult to perform. We assessed 13 single-nucleotide polymorphisms (SNPs) in seven well-known asthma susceptibility genes and looked for association with pediatric asthma using 449 asthmatic subjects and 512 non-asthma subjects in Taiwanese population. CD14-159 C/T and MS4A2 Glu237Gly were identified to have difference in genotype/allele frequencies between the control group and asthma patients. Moreover, the genotype synergistic analysis showed that the co-contribution of two functional SNPs was riskier or more protective from asthma attack. Our study provided a genotype synergistic method for studying gene-gene interaction on polymorphism basis and genetic testing using multiple polymorphisms.

  16. Rationale, design and baseline results of the Treatment Optimisation in Primary care of Heart failure in the Utrecht region (TOPHU) study : a cluster randomised controlled trial

    NARCIS (Netherlands)

    Valk, Mark J.; Hoes, Arno W.; Mosterd, Arend; Landman, Marcel A.; Broekhuizen, Berna D L; Rutten, Frans H.

    2015-01-01

    BACKGROUND: Heart failure (HF) is mainly detected and managed in primary care, but the care is considered suboptimal. We present the rationale, design and baseline results of the Treatment Optimisation in Primary care of Heart failure in the Utrecht region (TOPHU) study. In this study we assess the

  17. Asthma Medications and Pregnancy

    Science.gov (United States)

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

  18. Pollen concentrations and prevalence of asthma and allergic rhinitis in Italy: Evidence from the GEIRD study.

    Science.gov (United States)

    Marchetti, Pierpaolo; Pesce, Giancarlo; Villani, Simona; Antonicelli, Leonardo; Ariano, Renato; Attena, Francesco; Bono, Roberto; Bellisario, Valeria; Fois, Alessandro; Gibelli, Nadia; Nicolis, Morena; Olivieri, Mario; Pirina, Pietro; Scopano, Eugenio; Siniscalco, Consolata; Verlato, Giuseppe; Marcon, Alessandro

    2017-04-15

    Pollen exposure has acute adverse effects on sensitized individuals. Information on the prevalence of respiratory diseases in areas with different pollen concentrations is scanty. We performed an ecologic analysis to assess whether the prevalence of allergic rhinitis and asthma in young adults varied across areas with different pollen concentrations in Italy. A questionnaire on respiratory diseases was delivered to random samples of 20-44year-old subjects from six centers in 2005-2010. Data on the daily air concentrations of 7 major allergologic pollens (Poaceae, Urticaceae, Oleaceae, Cupressaceae, Coryloideae, Betula and Ambrosia) were collected for 2007-2008. Center-specific pollen exposure indicators were calculated, including the average number of days per year with pollens above the low or high concentration thresholds defined by the Italian Association of Aerobiology. Associations between pollen exposure and disease prevalence, adjusted for potential confounders, were estimated using logistic regression models with center as a random-intercept. Overall, 8834 subjects (56.8%) filled in the questionnaire. Allergic rhinitis was significantly less frequent in the centers with longer periods with high concentrations of at least one (OR per 10days=0.989, 95%CI: 0.979-0.999) or at least two pollens (OR=0.974, 95%CI: 0.951-0.998); associations with the number of days with at least one (OR=0.988, 95%CI: 0.972-1.004) or at least two (OR=0.985, 95%CI: 0.970-1.001) pollens above the low thresholds were borderline significant. Asthma prevalence was not associated with pollen concentrations. Our study does not support that the prevalence of allergic rhinitis and asthma is greater in centers with higher pollen concentrations. It is not clear whether the observed ecologic associations hold at the individual level. Copyright © 2017 Elsevier B.V. All rights reserved.

  19. Pneumonia risk in asthma patients using inhaled corticosteroids: a quasi-cohort study.

    Science.gov (United States)

    Qian, Christina J; Coulombe, Janie; Suissa, Samy; Ernst, Pierre

    2017-09-01

    Studies have linked the use of inhaled corticosteroids (ICSs) to excess pneumonia risk in chronic obstructive pulmonary disease patients. The risk in asthma patients remains unclear. The objective of the present study was to examine the risk of pneumonia with ICSs in asthma patients aged 12-35 years. We formed a cohort of asthma patients treated from 1990 to 2007 using Quebec health insurance databases. Subjects were considered currently exposed if they had had an ICS dispensed within the 60 days prior to their pneumonia index event or matched person-moment. Secondary analyses investigated the risk of pneumonia according to ICS dose and type. Rate ratios (RRs) and rate differences (RDs) were both estimated through a quasi-cohort approach. The cohort included 152 412 subjects, of whom 1928 had a pneumonia event during follow-up. There was an increased risk of pneumonia associated with current use of ICSs [RR 1.83; 95% confidence interval (CI) 1.57, 2.14] or an excess risk of 1.44 cases per 1000 person-years (RD 1.44; 95% CI 1.03, 1.85). There was an excess pneumonia risk with low doses (RR 1.60; 95% CI 1.06, 2.45), moderate doses (RR 1.53; 95% CI 1.12, 2.08) and high doses (RR 1.96; 95% CI 1.64, 2.34) of ICSs, and with budesonide (RR 2.67; 95% CI 2.05, 3.49) and fluticasone (RR 1.93; 95% CI 1.58, 2.36), specifically relative to no use. When accounting for potential protopathic bias, the risk with current use of ICSs was attenuated (RR 1.48; 95% CI 1.22, 1.78). ICS use in asthma patients appears to be associated with an increased risk of pneumonia and is present for both budesonide and fluticasone. © 2017 The British Pharmacological Society.

  20. Childhood asthma and physical activity

    DEFF Research Database (Denmark)

    Lochte, Lene; Nielsen, Kim G; Petersen, Poul Erik

    2016-01-01

    BACKGROUND: Childhood asthma is a global problem affecting the respiratory health of children. Physical activity (PA) plays a role in the relationship between asthma and respiratory health. We hypothesized that a low level of PA would be associated with asthma in children and adolescents. The obj......BACKGROUND: Childhood asthma is a global problem affecting the respiratory health of children. Physical activity (PA) plays a role in the relationship between asthma and respiratory health. We hypothesized that a low level of PA would be associated with asthma in children and adolescents......; however, there was some heterogeneity among the studies. This review reveals a critical need for future longitudinal assessments of low PA, its mechanisms, and its implications for incident asthma in children. The systematic review was prospectively registered at PROSPERO (registration number: CRD...

  1. Higher risk of developing major depression and bipolar disorder in later life among adolescents with asthma: a nationwide prospective study.

    Science.gov (United States)

    Chen, Mu-Hong; Su, Tung-Ping; Chen, Ying-Sheue; Hsu, Ju-Wei; Huang, Kai-Lin; Chang, Wen-Han; Chen, Tzeng-Ji; Bai, Ya-Mei

    2014-02-01

    Previous studies have suggested an immunological dysfunction in mood disorders, but rarely have investigated the temporal association between allergic diseases and mood disorders. Using the Taiwan National Health Insurance Research Database, we attempted to investigate the association between asthma in early adolescence and the risk of unipolar depression and bipolar disorder in later life. In all, 1453 adolescents with asthma aged between 10 and 15 years and 5812 age-/gender-matched controls were selected in 1998-2000. Subjects with unipolar depression and bipolar disorder that occurred up to the end of follow-up (December 31 2010) were identified. Adolescents with asthma had a higher incidence of major depression (2.8% vs. 1.1%, p bipolar disorder (1.0% vs. 0.3%, p adolescence was associated with an increased risk of developing major depression (hazard ratio [HR]: 1.81, 95% confidence interval [CI]: 1.14-2.89), any depressive disorder (HR: 1.74, 95% CI: 1.27-2.37), and bipolar disorder (HR: 2.27, 95% CI: 1.01-5.07), after adjusting for demographic data and comorbid allergic diseases. Adolescents with asthma had an elevated risk of developing mood disorders in later life. Further studies would be required to investigate the underlying mechanisms for this comorbid association and elucidate whether prompt intervention for asthma would decrease the risk of developing mood disorders. Copyright © 2013 Elsevier Ltd. All rights reserved.

  2. Effect of Sameera Pannaga Rasa (arsenomercurial formulation) in the management of Tamaka Shwasa (bronchial asthma) - Randomized double blind clinical study.

    Science.gov (United States)

    Mashru, Mayur; Galib, R; Shukla, Vinay J; Ravishankar, B; Prajapati, Pradeep Kumar

    2013-10-01

    Asthma represents a profound world-wide public health problem. The most effective anti-asthmatic drugs currently available include β2-agonists and glucocorticoids which can controls asthma in about 90-95% of patients. In Ayurveda, this miserable condition is comparable with Tamaka Shwasa type of Shwasa Roga. In the present study, 52 patients were treated with Sameera Pannaga Rasa at a dose of 30 mg twice a day for 4 weeks along with Nagavallidala (leaf of Piper betel Linn.) The results were assessed in terms of clinical recovery, symptomatic relief, pulmonary function improvement and on subjective and objective parameters. A significant improvement in subjective parameters, control on asthma, recurrence of asthma, increase in peak expiratory flow rate, considerable decrease in total and absolute, acute eosinophil count and erythrocyte sedimentation rate were observed. Overall marked improvement was found in 33.33%, moderate improvement in 44.44% and mild improvement in 20.00% was observed. The study reveals that Sameera Pannaga Rasa can be used as an effective drug in bronchial asthma.

  3. Asthma and Adolescents: Review of Strategies to Improve Control

    Science.gov (United States)

    Hennessy-Harstad, Ellen

    2013-01-01

    One of every 10 adolescents in the United States has asthma. Adolescents who lack asthma control are at increased risk for severe asthma episodes and death. The National Heart, Lung, and Blood Institute 2007 asthma guidelines and research studies indicated that school nurses are instrumental in assisting adolescents to monitor their asthma, learn…

  4. A genome-wide association study of atopic dermatitis identifies loci with overlapping effects on asthma and psoriasis.

    Science.gov (United States)

    Weidinger, Stephan; Willis-Owen, Saffron A G; Kamatani, Yoichiro; Baurecht, Hansjörg; Morar, Nilesh; Liang, Liming; Edser, Pauline; Street, Teresa; Rodriguez, Elke; O'Regan, Grainne M; Beattie, Paula; Fölster-Holst, Regina; Franke, Andre; Novak, Natalija; Fahy, Caoimhe M; Winge, Mårten C G; Kabesch, Michael; Illig, Thomas; Heath, Simon; Söderhäll, Cilla; Melén, Erik; Pershagen, Göran; Kere, Juha; Bradley, Maria; Lieden, Agne; Nordenskjold, Magnus; Harper, John I; McLean, W H Irwin; Brown, Sara J; Cookson, William O C; Lathrop, G Mark; Irvine, Alan D; Moffatt, Miriam F

    2013-12-01

    Atopic dermatitis (AD) is the most common dermatological disease of childhood. Many children with AD have asthma and AD shares regions of genetic linkage with psoriasis, another chronic inflammatory skin disease. We present here a genome-wide association study (GWAS) of childhood-onset AD in 1563 European cases with known asthma status and 4054 European controls. Using Illumina genotyping followed by imputation, we generated 268 034 consensus genotypes and in excess of 2 million single nucleotide polymorphisms (SNPs) for analysis. Association signals were assessed for replication in a second panel of 2286 European cases and 3160 European controls. Four loci achieved genome-wide significance for AD and replicated consistently across all cohorts. These included the epidermal differentiation complex (EDC) on chromosome 1, the genomic region proximal to LRRC32 on chromosome 11, the RAD50/IL13 locus on chromosome 5 and the major histocompatibility complex (MHC) on chromosome 6; reflecting action of classical HLA alleles. We observed variation in the contribution towards co-morbid asthma for these regions of association. We further explored the genetic relationship between AD, asthma and psoriasis by examining previously identified susceptibility SNPs for these diseases. We found considerable overlap between AD and psoriasis together with variable coincidence between allergic rhinitis (AR) and asthma. Our results indicate that the pathogenesis of AD incorporates immune and epidermal barrier defects with combinations of specific and overlapping effects at individual loci.

  5. Complementary therapy use by patients and parents of children with asthma and the implications for NHS care: a qualitative study

    Directory of Open Access Journals (Sweden)

    Sharp Debbie

    2006-06-01

    Full Text Available Abstract Background Patients are increasingly using complementary therapies, often for chronic conditions. Asthma is the most common chronic condition in the UK. Previous research indicates that some asthma patients experience gaps in their NHS care. However, little attention has been given to how and why patients and parents of children with asthma use complementary therapies and the implications for NHS care. Methods Qualitative study, comprising 50 semi-structured interviews with a purposeful sample of 22 adults and 28 children with asthma (plus a parent, recruited from a range of NHS and non-NHS settings in Bristol, England. Data analysis was thematic, drawing on the principles of constant comparison. Results A range of complementary therapies were being used for asthma, most commonly Buteyko breathing and homeopathy. Most use took place outside of the NHS, comprising either self-treatment or consultation with private complementary therapists. Complementary therapies were usually used alongside not instead of conventional asthma treatment. A spectrum of complementary therapy users emerged, including "committed", "pragmatic" and "last resort" users. Motivating factors for complementary therapy use included concerns about conventional NHS care ("push factors" and attractive aspects of complementary therapies ("pull factors". While participants were often uncertain whether therapies had directly helped their asthma, breathing techniques such as the Buteyko Method were most notably reported to enhance symptom control and enable reduction in medication. Across the range of therapies, the process of seeking and using complementary therapies seemed to help patients in two broad ways: it empowered them to take greater personal control over their condition rather than feel dependant on medication, and enabled exploration of a broader range of possible causes of their asthma than commonly discussed within NHS settings. Conclusion Complementary therapy

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

    Directory of Open Access Journals (Sweden)

    Xiji Huang

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

  7. Genetic polymorphisms and asthma: findings from a case-control study in the Madeira island population.

    Science.gov (United States)

    Berenguer, Anabela Gonçalves; Fernandes, Ana Teresa; Oliveira, Susana; Rodrigues, Mariana; Ornelas, Pedro; Romeira, Diogo; Serrão, Tânia; Rosa, Alexandra; Câmara, Rita

    2014-09-04

    Asthma is a complex disease influenced by multiple genetic and environmental factors. While Madeira has the highest prevalence of asthma in Portugal (14.6%), the effect of both genetic and environmental factors in this population has never been assessed. We categorized 98 asthma patients according to the Global Initiative for Asthma (GINA) guidelines, established their sensitization profile, and measured their forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) indexes. Selected single nucleotide polymorphisms (SNPs) were analysed as potential markers for asthma susceptibility and severity in the interleukin 4 (IL4), interleukin 13 (IL13), beta-2-adrenergic receptor (ADRB2), a disintegrin and metalloprotease 33 (ADAM33), gasdermin-like (GSDML) and the signal transducer and activator of transcription 6 (STAT6) genes comparatively to a population reference set. Although mites are the major source of allergic sensitization, no significant difference was found amongst asthma severity categories. IL4-590*CT/TT and IL4-RP2*253183/183183 were found to predict the risk (2-fold) and severity (3 to 4-fold) of asthma and were associated with a lower FEV1 index. ADRB2-c.16*AG is a risk factor (3.5-fold), while genotype GSDML-236*TT was protective (4-fold) for moderate-severe asthma. ADAM33-V4*C was associated to asthma and mild asthma by the transmission disequilibrium test (TDT). Finally, ADAM33-V4*CC and STAT6-21*TT were associated with higher sensitization (mean wheal size ≥10 mm) to house dust (1.4-fold) and storage mite (7.8-fold). In Madeira, IL4-590C/T, IL4-RP2 253/183, GSDML-236C/T and ADAM33-V4C/G SNPs are important risk factors for asthma susceptibility and severity, with implications for asthma healthcare management.

  8. Asthma medication use before and after the onset of type 1 diabetes in children and adolescents: A population-based cohort study

    NARCIS (Netherlands)

    Ahmadizar, Fariba; Maitland-Van Der Zee, Anke-Hilse; De Boer, Anthonius; Souverein, Patrick; Arets, Hubertus

    2015-01-01

    Background: It has been reported that patients with type 1 diabetes (T1DM) have a decreased lung function. Studies on the association of T1DM and asthma in children show controversial results. Objectives: The aim of this study was to quantify asthma medication use in children and adolescents with

  9. Few Associations Found between Mold and Other Allergen Concentrations in the Home versus Skin Sensitivity from Children with Asthma after Hurricane Katrina in the Head-Off Environmental Asthma in Louisiana Study

    Directory of Open Access Journals (Sweden)

    L. F. Grimsley

    2012-01-01

    Full Text Available Mold and other allergen exposures exacerbate asthma symptoms in sensitized individuals. We evaluated allergen concentrations, skin test sensitivities, and asthma morbidity for 182 children, aged 4–12 years, with moderate to severe asthma, enrolled 18 months after Katrina, from the city of New Orleans and the surrounding parishes that were impacted by the storm, into the Head-off Environmental Asthma in Louisiana (HEAL observational study. Dust (indoor and air (indoor and outdoor samples were collected at baseline of 6 and 12 months. Dust samples were evaluated for dust mite, cockroach, mouse, and Alternaria by immunoassay. Air samples were evaluated for airborne mold spore concentrations. Overall, 89% of the children tested positive to ≥1 indoor allergen, with allergen-specific sensitivities ranging from 18% to 67%. Allergen concentration was associated with skin sensitivity for 1 of 10 environmental triggers analyzed (cat. Asthma symptom days did not differ with skin test sensitivity, and surprisingly, increased symptoms were observed in children whose baseline indoor airborne mold concentrations were below median levels. This association was not observed in follow-up assessments. The lack of relationship among allergen levels (including mold, sensitivities, and asthma symptoms points to the complexity of attempting to assess these associations during rapidly changing social and environmental conditions.

  10. Exhaled breath condensate cysteinyl leukotrienes and airway remodeling in childhood asthma: a pilot study

    Directory of Open Access Journals (Sweden)

    Kharitonov Sergei A

    2006-04-01

    Full Text Available Abstract Background It has been suggested that cysteinyl leukotrienes (cysLTs play an important role in airway remodeling. Previous reports have indicated that cysLTs augment human airway smooth muscle cell proliferation. Recently, cysLTs have been measured in exhaled breath condensate (EBC. The aim of this study was to evaluate the relationship between cysLTs in EBC and another marker of airway remodeling, reticular basement membrane (RBM thickening, in endobronchial biopsies in children. Methods 29 children, aged 4–15 years, with moderate to severe persistent asthma, who underwent bronchoscopy as part of their clinical assessment, were included. Subjects underwent spirometry and EBC collection for cysLTs analysis, followed by bronchoscopy and endobronchial biopsy within 24 hours. Results EBC cysLTs were significantly lower in asthmatic children who were treated with montelukast than in those who were not (median (interquartile range 36.62 (22.60–101.05 versus 249.1 (74.21–526.36 pg/ml, p = 0.004. There was a significant relationship between EBC cysLTs and RBM thickness in the subgroup of children who were not treated with montelukast (n = 13, r = 0.75, p = 0.003. Conclusion EBC cysLTs appear to be associated with RBM thickening in asthma.

  11. Asthma and Therapeutics: Recombinant Therapies in Asthma

    Directory of Open Access Journals (Sweden)

    Cockcroft Donald W

    2005-03-01

    Full Text Available Abstract Numerous recombinant therapies are being investigated for the treatment of asthma. This report reviews the current status of several of these novel agents. Anti-immunoglobulin (IgE (omalizumab, Xolair markedly inhibits all aspects of the allergen challenge in subjects who have reduction of free serum IgE to undetectable levels. Several clinical studies in atopic asthma have demonstrated benefit by improved symptoms and lung function and a reduction in corticosteroid requirements. Early use in atopic asthmatics may be even more effective. Several approaches target interleukin (IL-4. Soluble IL-4 receptor has been shown to effectively replace inhaled corticosteroid; further studies are under way. Recombinant anti-IL-5 and recombinant IL-12 inhibit blood and sputum eosinophils and allergen-induced eosinophilia without any effect on airway responsiveness, allergen-induced airway responses, or allergen-induced airway hyperresponsiveness. Efalizumab, a recombinant antibody that inhibits lymphocyte trafficking, is effective in psoriasis. A bronchoprovocation study showed a reduction in allergen-induced late asthmatic response and allergen-induced eosinophilia, which suggests that it should be effective in clinical asthma. These exciting novel therapies provide not only promise of new therapies for asthma but also valuable tools for investigation of asthma mechanisms.

  12. DASH for asthma: A pilot study of the DASH diet in not-well-controlled adult asthma⋆

    Science.gov (United States)

    Ma, Jun; Strub, Peg; Lavori, Phillip W.; Buist, A. Sonia; Camargo, Carlos A.; Nadeau, Kari C.; Wilson, Sandra R.; Xiao, Lan

    2014-01-01

    This pilot study aims to provide effect size confidence intervals, clinical trial and intervention feasibility data, and procedural materials for a full-scale randomized controlled trial that will determine the efficacy of Dietary Approaches to Stop Hypertension (DASH) as adjunct therapy to standard care for adults with uncontrolled asthma. The DASH diet encompasses foods (e.g., fresh fruit, vegetables, and nuts) and antioxidant nutrients (e.g., vitamins A, C, E, and zinc) with potential benefits for persons with asthma, but it is unknown whether the whole diet is beneficial. Participants (n = 90) will be randomized to receive usual care alone or combined with a DASH intervention consisting of 8 group and 3 individual sessions during the first 3 months, followed by at least monthly phone consultations for another 3 months. Follow-up assessments will occur at 3 and 6 months. The primary outcome measure is the 7-item Juniper Asthma Control Questionnaire, a validated composite measure of daytime and nocturnal symptoms, activity limitations, rescue medication use, and percentage predicted forced expiratory volume in 1 second. We will explore changes in inflammatory markers important to asthma pathophysiology (e.g., fractional exhaled nitric oxide) and their potential to mediate the intervention effect on disease control. We will also conduct pre-specified subgroup analyses by genotype (e.g., polymorphisms on the glutathione S transferase gene) and phenotype (e.g., atopy, obesity). By evaluating a dietary pattern approach to improving asthma control, this study could advance the evidence base for refining clinical guidelines and public health recommendations regarding the role of dietary modifications in asthma management. PMID:23648395

  13. Severe exacerbations and decline in lung function in asthma

    DEFF Research Database (Denmark)

    O'Byrne, Paul M; Pedersen, Søren; Lamm, Carl Johan

    2009-01-01

    RATIONALE: To evaluate the association between asthma exacerbations and the decline in lung function, as well as the potential effects of an inhaled corticosteroid, budesonide, on exacerbation-related decline in patients with asthma. OBJECTIVES: To determine whether severe asthma exacerbations...... with low-dose inhaled budesonide prevents severe asthma-related events (exacerbations requiring hospitalization or emergency treatment) and decline in lung function. MEASUREMENTS AND MAIN RESULTS: There were 315 patients who experienced at least one severe asthma exacerbation, of which 305 were analyzable...... of reduction afforded by budesonide, in patients who experienced at least one severe asthma-related event compared with those who did not, was statistically significant (P = 0.042). CONCLUSIONS: Severe asthma exacerbations are associated with a more rapid decline in lung function. Treatment with low doses...

  14. Asthma control - Practical suggestions for practicing doctors in family ...

    African Journals Online (AJOL)

    reveals that most patients still had symptoms of asthma, consisting of a cough and a ... that these older studies of asthma control may not reflect the present control .... corticosteroids (ICSs) regularly resulted in falling asthma mortality, upholds ...

  15. Children with Asthma and Sports

    Directory of Open Access Journals (Sweden)

    Selda Yuzer

    2014-06-01

    Full Text Available Asthma is one of the chronic diseases which have are widely seen among the children. The disease has recently been in the increase all over the world and affects many children. In a study conducted with International Study of Asthma and Allergies in Childhood (ISAAC method, it was found out that prevalence of childhood asthma was 17.1%. Participation in sportive activities by the children with asthma, which is today considered as a part of asthma treatment program, makes contributions to their physical, mental and psychological development and increases their quality of life. The most recommended sports for the children with asthma are swimming and water sports. Sports like tennis and volleyball are too advised. Choice of sports depends on severity of asthma, child and #8217;s choice and whether or not asthma is kept under control. Nursing approaches for the children with asthma include correction of symptoms, training of children and their families, assistance with disease adaptation, continuing asthma care at home and interventions to make children lead healthy activities of daily life of children. With protective measures to be taken by families and children; children should be encourage for sportive activities. [TAF Prev Med Bull 2014; 13(3.000: 241-244

  16. Developing core economic outcome sets for asthma studies: a protocol for a systematic review.

    Science.gov (United States)

    Hounsome, Natalia; Fitzsimmons, Deborah; Phillips, Ceri; Patel, Anita

    2017-08-11

    Core outcome sets are standardised lists of outcomes, which should be measured and reported in all clinical studies of a specific condition. This study aims to develop core outcome sets for economic evaluations in asthma studies. Economic outcomes include items such as costs, resource use or quality-adjusted life years. The starting point in developing core outcome sets will be conducting a systematic literature review to establish a preliminary list of reporting items to be considered for inclusion in the core outcome set. We will conduct literature searches of peer-reviewed studies published from January 1990 to January 2017. These will include any comparative or observational studies (including economic models) and systematic reviews reporting economic outcomes. All identified economic outcomes will be tabulated together with the major study characteristics, such as population, study design, the nature and intensity of the intervention, mode of data collection and instrument(s) used to derive an outcome. We will undertake a 'realist synthesis review' to analyse the identified economic outcomes. The outcomes will be summarised in the context of evaluation perspectives, types of economic evaluation and methodological approaches. Parallel to undertaking a systematic review, we will conduct semistructured interviews with stakeholders (including people with personal experience of asthma, health professionals, researchers and decision makers) in order to explore additional outcomes which have not been considered, or used, in published studies. The list of outcomes generated from the systematic review and interviews with stakeholders will form the basis of a Delphi survey to refine the identified outcomes into a core outcome set. The review will not involve access to individual-level data. Findings from our systematic review will be communicated to a broad range of stakeholders including clinical guideline developers, research funders, trial registries, ethics

  17. A review and rationale for studying the cardiovascular effects of drinking water arsenic in women of reproductive age

    International Nuclear Information System (INIS)

    Kwok, Richard K.

    2007-01-01

    Drinking water arsenic has been shown to be associated with a host of adverse health outcomes at exposure levels > 300 μg of As/L. However, the results are not consistent at exposures below this level. We have reviewed selected articles that examine the effects of drinking water arsenic on cardiovascular outcomes and present a rationale for studying these effects on women of reproductive age, and also over the course of pregnancy when they would potentially be more susceptible to adverse cardiovascular and reproductive outcomes. It is only recently that reproductive effects have been linked to drinking water arsenic. However, there is a paucity of information about the cardiovascular effects of drinking water arsenic on women of reproductive age. Under the cardiovascular challenge of pregnancy, we hypothesize that women with a slightly elevated exposure to drinking water arsenic may exhibit adverse cardiovascular outcomes at higher rates than in the general population. Studying sensitive clinical and sub-clinical indicators of disease in susceptible sub-populations may yield important information about the potentially enormous burden of disease related to low-level drinking water arsenic exposure

  18. Inequalities in asthma treatment among children by country of birth and ancestry: a nationwide study in Denmark.

    Science.gov (United States)

    Cantarero-Arévalo, Lourdes; Holstein, Bjørn Evald; Andersen, Anette; Kaae, Susanne; Nørredam, Marie; Hansen, Ebba Holme

    2013-11-01

    Investigations in several Western countries have reported ethnic differences in asthma prevalence and treatment among children and in some countries these differences are increasing. The aim of this study was to analyse whether there are inequalities in asthma treatment by country of birth and ancestry among children residing in Denmark, and whether this potential association may vary between different household income groups. Data were obtained by linking the Danish Civil Registration System, the Central Taxpayers' Register and the Danish National Prescription Register. the entire population of children in Denmark from 0 to 17 years of age in 2008 (n=1 209 091). Information on asthma treatment was obtained from the National Prescription Register. The analyses included multiple logistic regression models stratified by household income. Compared with ethnic Danes, immigrant children had the lowest OR for redeeming a prescription for asthma medication, both relief (OR 0.37; 95% CIs, 0.20 to 0.68) and preventive (OR 0.37; (0.22 to 0.59)). Similar associations were found among descendant children (OR for relief treatment 0.82 (0.79 to 0.89) and for preventive treatment 0.68 (0.61 to 0.75)). The pattern of the association remained after stratifying for household income. We found that, inequalities that cannot be explained by household income alone exist in treatments to prevent asthma as well as to relieve symptoms in children residing in Denmark, by country of birth and ancestry. The difference between immigrants and descendants may indicate that unfamiliarity with the Danish healthcare system is a contributory cause of the inadequate treatment of asthma.

  19. Experiences of Racism and the Incidence of Adult-Onset Asthma in the Black Women’s Health Study

    Science.gov (United States)

    Yu, Jeffrey; O’Connor, George T.; Brown, Timothy A.; Cozier, Yvette C.; Palmer, Julie R.; Rosenberg, Lynn

    2014-01-01

    Background: Chronic stress resulting from experiences of racism may increase the incidence of adult-onset asthma through effects on the immune system and the airways. We conducted prospective analyses of the relation of experiences of racism with asthma incidence in the Black Women’s Health Study, a prospective cohort of black women in the United States followed since 1995 with mailed biennial questionnaires. Methods: Among 38,142 participants followed from 1997 to 2011, 1,068 reported incident asthma. An everyday racism score was created based on five questions asked in 1997 and 2009 about the frequency in daily life of experiences of racism (eg, poor service in stores), and a lifetime racism score was based on questions about racism on the job, in housing, and by police. We used Cox regression models to derive multivariable incidence rate ratios (IRRs) and 95% CIs for categories of each racism score in relation to incident asthma. Results: The IRRs were 1.45 (95% CI, 1.19-1.78) for the highest compared with the lowest quartile of the 1997 everyday racism score (P for trend racism. Among women who reported the same levels of racism in 1997 and 2009, the IRRs for the highest categories of everyday and lifetime racism were 2.12 (95% CI, 1.55-2.91) and 1.66 (95% CI, 1.20-2.30), respectively. Conclusions: Given the high prevalence of experiences of racism and asthma in black women in the United States, a positive association between racism and asthma is of public health importance. PMID:23887828

  20. Experiences of racism and the incidence of adult-onset asthma in the Black Women's Health Study.

    Science.gov (United States)

    Coogan, Patricia F; Yu, Jeffrey; O'Connor, George T; Brown, Timothy A; Cozier, Yvette C; Palmer, Julie R; Rosenberg, Lynn

    2014-03-01

    Chronic stress resulting from experiences of racism may increase the incidence of adult-onset asthma through effects on the immune system and the airways. We conducted prospective analyses of the relation of experiences of racism with asthma incidence in the Black Women's Health Study, a prospective cohort of black women in the United States followed since 1995 with mailed biennial questionnaires. Among 38,142 participants followed from 1997 to 2011, 1,068 reported incident asthma. An everyday racism score was created based on five questions asked in 1997 and 2009 about the frequency in daily life of experiences of racism (eg, poor service in stores), and a lifetime racism score was based on questions about racism on the job, in housing, and by police. We used Cox regression models to derive multivariable incidence rate ratios (IRRs) and 95% CIs for categories of each racism score in relation to incident asthma. The IRRs were 1.45 (95% CI, 1.19-1.78) for the highest compared with the lowest quartile of the 1997 everyday racism score (P for trendracism. Among women who reported the same levels of racism in 1997 and 2009, the IRRs for the highest categories of everyday and lifetime racism were 2.12 (95% CI, 1.55-2.91) and 1.66 (95% CI, 1.20-2.30), respectively. Given the high prevalence of experiences of racism and asthma in black women in the United States, a positive association between racism and asthma is of public health importance.

  1. Work-related asthma, financial barriers to asthma care, and adverse asthma outcomes: asthma call-back survey, 37 states and District of Columbia, 2006 to 2008.

    Science.gov (United States)

    Knoeller, Gretchen E; Mazurek, Jacek M; Moorman, Jeanne E

    2011-12-01

    Proper asthma management and control depend on patients having affordable access to healthcare yet financial barriers to asthma care are common. To examine associations of work-related asthma (WRA) with financial barriers to asthma care and adverse asthma outcomes. Cross-sectional, random-digit-dial survey conducted in 37 states and District of Columbia. A total of 27,927 ever-employed adults aged ≥18 years with current asthma. Prevalence ratios (PR) for the associations of WRA with financial barriers to asthma care and of WRA with adverse asthma outcomes stratified by financial barriers. Persons with WRA were significantly more likely than those with non-WRA to have at least 1 financial barrier to asthma care [PR, 1.66; 95% confidence interval (CI), 1.43-1.92]. Individuals with WRA were more likely to experience adverse asthma outcomes such as asthma attack (PR, 1.31; 95% CI, 1.22-1.40), urgent treatment for worsening asthma (PR, 1.57; 95% CI, 1.39-1.78), asthma-related emergency room visit (PR, 1.69; 95% CI, 1.41-2.03), and very poorly controlled asthma (PR, 1.54; 95% CI: 1.36-1.75). After stratifying for financial barriers to asthma care, the associations did not change. Financial barriers to asthma care should be considered in asthma management, and individuals with WRA are more likely to experience financial barriers. However, individuals with WRA are more likely to experience adverse asthma outcomes than individuals with non-WRA, regardless of financial barriers. Additional studies are needed to identify medical, behavioral, occupational, or environmental factors associated with adverse asthma outcomes among individuals with WRA.

  2. Asthma in pregnancy: association between the Asthma Control Test and the Global Initiative for Asthma classification and comparisons with spirometry.

    Science.gov (United States)

    de Araujo, Georgia Véras; Leite, Débora F B; Rizzo, José A; Sarinho, Emanuel S C

    2016-08-01

    The aim of this study was to identify a possible association between the assessment of clinical asthma control using the Asthma Control Test (ACT) and the Global Initiative for Asthma (GINA) classification and to perform comparisons with values of spirometry. Through this cross-sectional study, 103 pregnant women with asthma were assessed in the period from October 2010 to October 2013 in the asthma pregnancy clinic at the Clinical Hospital of the Federal University of Pernambuco. Questionnaires concerning the level of asthma control were administered using the Global Initiative for Asthma classification, the Asthma Control Test validated for asthmatic expectant mothers and spirometry; all three methods of assessing asthma control were performed during the same visit between the twenty-first and twenty-seventh weeks of pregnancy. There was a significant association between clinical asthma control assessment using the Asthma Control Test and the Global Initiative for Asthma classification (pspirometry. This study shows that both the Global Initiative for Asthma classification and the Asthma Control Test can be used for asthmatic expectant mothers to assess the clinical control of asthma, especially at the end of the second trimester, which is assumed to be the period of worsening asthma exacerbations during pregnancy. We highlight the importance of the Asthma Control Test as a subjective instrument with easy application, easy interpretation and good reproducibility that does not require spirometry to assess the level of asthma control and can be used in the primary care of asthmatic expectant mothers. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  3. Does early indoor microbial exposure reduce the risk of asthma? The Prevention and Incidence of Asthma and Mite Allergy birth cohort study

    NARCIS (Netherlands)

    Douwes, J; van Strien, R; Doekes, G; Smit, Jet; Kerkhof, M; Gerritsen, J; Postma, D; Travier, N; Brunekreef, B

    Background: Exposure to microbial agents might inhibit the development of atopy and asthma. Objective: We measured the association between microbial exposure assessed at 3 months and the development of atopic sensitization and doctor-diagnosed (DD) asthma and wheeze in the first 4 years in a birth

  4. Skirting around Critical Feminist Rationales for Teaching Women in Social Studies

    Science.gov (United States)

    Schmeichel, Mardi

    2015-01-01

    Feminist practices can provide firm theoretical grounding for the kind of social studies that scholars promote, especially in relation to efforts to include women in the curriculum. However, in P-12 social studies education, neither women nor feminism receive much attention. The study described in this article was a discourse analysis of 16…

  5. Evaluation of Agreement Between Video and Written Questionnaires for Asthma Symptoms Among Children of Tehran: ISAAC Study

    Directory of Open Access Journals (Sweden)

    MR Masjedi

    2008-07-01

    Full Text Available Introduction: International study on asthma was conducted to study the prevalence of Asthma symptoms among 13-14 year old children using written and video questionnaires during the early 90's. The aim of the present study (ISAAC was to evaluate the agreement between the two questionnaires which were self-completed by the children. Methods: This study, which was a part of the third phase of International Study of Asthma and Allergy in Childhood (ISAAC and performed exactly similar to phase1, was performed by National Research Institute of Tuberculosis and Lung Diseases (NRITLD in two cities of Iran; Rasht and Tehran. All stages of the study were performed in accordance with ISAAC protocol. The present study discusses data related to children of Tehran. A total of 3100 school children aged 13-14 years were questioned about asthma symptoms using written and video questionnaires of ISAAC study. For statistical analysis, initially a descriptive study of the available data was performed. Thereafter, chance corrected agreement between the two questionnaires was evaluated using Cohen’s Kappa co-efficiency. Results: Of the total of 3100 children, 52.4% were male and 47.6% female, with a mean age of 13.6 years. Although the questions discussed in the two questionnaires were not exactly similar, the results of the video questionnaires showed a statistically significant lower positive response to asthma symptoms as compared to the written version. Kappa co-efficiency ranged between 0.06- 0.21 (mean=0.12, which is considered poor for all variables. Conclusion: Positive responses to having asthma symptoms were significantly higher using the written questionnaire compared to the video questionnaire. Similar to previous studies, agreement between the two was considered poor for all variables. Although factors such as language, culture, dwelling area, e.t.c. have special effects on results of these questionnaires, results indicate that the two questionnaires

  6. Reflexology and bronchial asthma

    DEFF Research Database (Denmark)

    Brygge, T; Heinig, J H; Collins, P

    2001-01-01

    Many asthma patients seek alternative or adjunctive therapies. One such modality is reflexology, whereby finger pressure is applied to certain parts of the body. The aim of the study was to examine the popular claim that reflexology treatment benefits bronchial asthma. Ten weeks of active...... or simulated (placebo) reflexology given by an experienced reflexologist, were compared in an otherwise blind, controlled trial of 20+20 outpatients with asthma. Objective lung function tests (peak flow morning and evening, and weekly spirometry at the clinic) did not change. Subjective scores (describing...... diaries was carried out. It was accompanied by a significant pattern compatible with subconscious unblinding, in that patients tended to guess which treatment they had been receiving. No evidence was found that reflexology has a specific effect on asthma beyond placebo influence....

  7. European Prospective Investigation into Cancer and Nutrition (EPIC) calibration study: rationale, design and population characteristics

    DEFF Research Database (Denmark)

    Slimani, N.; Kaaks, R.; Ferrari, P.

    2002-01-01

    The European Prospective Investigation into Cancer and Nutrition (EPIC), which covers a large cohort of half a million men and women from 23 European centres in 10 Western European countries, was designed to study the relationship between diet and the risk of chronic diseases, particularly cancer......, a calibration approach was developed. This approach involved an additional dietary assessment common across study populations to re-express individual dietary intakes according to the same reference scale. A single 24-hour diet recall was therefore collected, as the EPIC reference calibration method, from...... in a large multi-centre European study. These studies showed that, despite certain inherent methodological and logistic constraints, a study design such as this one works relatively well in practice. The average response in the calibration study was 78.3% and ranged from 46.5% to 92.5%. The calibration...

  8. Coexistence of asthma and polycystic ovary syndrome

    DEFF Research Database (Denmark)

    Zierau, Louise; Gade, Elisabeth Juul; Lindenberg, Svend

    2016-01-01

    Asthma may be associated with polycystic ovary syndrome (PCOS), and possibly patients with PCOS have a more severe type of asthma. The purpose of this systematic literature review is to summarize evidence of a coexistense of PCOS and asthma using the available literature. The search was completed...... on 01.01.2016. English language articles were retrieved using the search terms 'Asthma' AND 'PCOS', 'Asthma' AND 'systemic inflammation', 'Asthma' AND 'metabolic syndrome', 'asthma' AND 'gynaecology', 'PCOS' AND 'systemic inflammation', 'PCOS' AND 'metabolic syndrome', 'PCOS' AND 'allergy'. Five papers...... meeting prespecified search criteria were found of which two were registry studies of relevance. The current literature supports a coexistense of PCOS and asthma and gives us an indication of the causes for the possible link between PCOS and asthma. Further research in the area must be conducted...

  9. Learning Environments’ Activity Potential for Preschoolers (LEAPP): Study Rationale and Design

    OpenAIRE

    Tucker, Patricia; Vanderloo, Leigh M.; Newnham-Kanas, Courtney; Burke, Shauna M.; Irwin, Jennifer D.; Johnson, Andrew M.; van Zandvoort, Melissa M.

    2013-01-01

    Background The purpose of this paper is to provide an overview of the study protocol for the Learning Environments’ Activity Potential for Preschoolers (LEAPP) study, the goal of which is to describe the activity levels of preschoolers attending various early learning venues and explore which attributes of these facilities (e.g. curriculum, policies, equipment, etc.) support activity participation. Design and methods This cross-sectional study aimed to recruit approximately 30 early learning ...

  10. Prospective study of maternal alcohol intake during pregnancy or lactation and risk of childhood asthma: the Norwegian Mother and Child Cohort Study.

    Science.gov (United States)

    Magnus, Maria C; DeRoo, Lisa A; Håberg, Siri E; Magnus, Per; Nafstad, Per; Nystad, Wenche; London, Stephanie J

    2014-04-01

    Many women drink during pregnancy and lactation despite recommendations to abstain. In animals, alcohol exposure during pregnancy and lactation influences lung and immune development, plausibly increasing risk of asthma and lower respiratory tract infections (LRTIs). Studies in humans are few. In the Norwegian Mother and Child Cohort Study, we examined maternal alcohol intake during pregnancy and lactation in relation to risk of current asthma at 36 months (49,138 children), recurrent LRTIs by 36 months (39,791 children), and current asthma at 7 years (13,253 children). Mothers reported frequency and amount of alcohol intake each trimester and the first 3 months following delivery. We calculated adjusted relative risk (aRR), comparing children of drinkers to nondrinkers, using Generalized Linear Models. A total of 31.8% of mothers consumed alcohol during first trimester, 9.7% during second trimester, and 15.6% during third trimester. Infrequent and low-dose prenatal alcohol exposure showed a modest statistically significant inverse association with current asthma at 36 months (aRRs ~ 0.85). No association was seen with the highest alcohol intakes during the first trimester when alcohol consumption was most common. RRs of maternal alcohol intake during pregnancy with recurrent LRTIs were ~1, with sporadic differences in risk for some metrics of intake, but without any consistent pattern. For current asthma at 7 years, similar inverse associations were seen as with current asthma at 36 months but were not statistically significant. Among children breastfed throughout the first 3 months of life, maternal alcohol intake during this time was not significantly associated with any of the 3 outcomes. The low levels of alcohol exposure during pregnancy or lactation observed in this cohort were not associated with increased risk of asthma or recurrent LRTIs. The slight inverse associations of infrequent or low-dose prenatal alcohol exposure with asthma may not be causal

  11. The Netherlands Study of Depression and Anxiety (NESDA): rationale, objectives and methods.

    NARCIS (Netherlands)

    Penninx, B.W.J.H.; Beekman, A.T.F.; Smit, J.H.; Zitman, F.G.; Nolen, W.A.; Spinhoven, P.; Cuijpers, P.; Jong, P.J. de; Marwijk, H.W.J. van; Assendelft, W.J.J.; Meer, K. van der; Verhaak, P.; Wensing, M.; Graaf, R. de; Hoogendijk, W.J.; Ormel, J.; Dyck, R. van

    2008-01-01

    The Netherlands Study of Depression and Anxiety (NESDA) is a multi-site naturalistic cohort study to: (1) describe the long-term course and consequences of depressive and anxiety disorders, and (2) to integrate biological and psychosocial research paradigms within an epidemiological approach in

  12. The Alberta Pregnancy Outcomes and Nutrition (APrON) cohort study : rationale and methods

    NARCIS (Netherlands)

    Kaplan, Bonnie J.; Giesbrecht, Gerald F.; Leung, Brenda M. Y.; Field, Catherine J.; Dewey, Deborah; Bell, Rhonda C.; Manca, Donna P.; O'Beirne, Maeve; Johnston, David W.; Pop, Victor J.; Singhal, Nalini; Gagnon, Lisa; Bernier, Francois P.; Eliasziw, Misha; McCargar, Linda J.; Kooistra, Libbe; Farmer, Anna; Cantell, Marja; Goonewardene, Laki; Casey, Linda M.; Letourneau, Nicole; Martin, Jonathan W.

    The Alberta Pregnancy Outcomes and Nutrition (APrON) study is an ongoing prospective cohort study that recruits pregnant women early in pregnancy and, as of 2012, is following up their infants to 3 years of age. It has currently enrolled approximately 5000 Canadians (2000 pregnant women, their

  13. The Alberta Pregnancy Outcomes and Nutrition (APrON) cohort study : Rationale and methods

    NARCIS (Netherlands)

    Kaplan, B.J.; Giesbrecht, G.F.; Leung, B.M.; Field, C.J.; Dewey, D.; Bell, R.C.; Manca, D.P.; O'Beirne, M.; Johnston, D.W.; Pop, V.J.M.; Singhal, N.; Gagnon, L.; Bernier, F.P.; Eliasziw, M.; McCargar, L.J.; Kooistra, L.; Farmer, A.; Cantell, M.; Goonewardene, L.; Casey, L.M.; Letourneau, N.; Martin, J.W.

    2014-01-01

    The Alberta Pregnancy Outcomes and Nutrition (APrON) study is an ongoing prospective cohort study that recruits pregnant women early in pregnancy and, as of 2012, is following up their infants to 3 years of age. It has currently enrolled approximately 5000 Canadians (2000 pregnant women, their

  14. Ethnic variations in incidence of asthma episodes in England & Wales:national study of 502,482 patients in primary care

    Directory of Open Access Journals (Sweden)

    Sheikh Aziz

    2005-10-01

    Full Text Available Summary Background Recent studies have demonstrated marked international variations in the prevalence of asthma, but less is known about ethnic variations in asthma epidemiology within individual countries and in particular the impact of migration on risk of developing asthma. Recent within country comparisons have however revealed that despite originating from areas of the world with a low risk for developing asthma, South Asian and Afro-Caribbean people in the UK are significantly (3× and 2× respectively more likely to be admitted to hospital for asthma related problems than Whites. Methods Using data from the Fourth National Study of Morbidity Statistics in General Practice, a one-percent broadly representative prospective cohort study of consultations in general practice, we investigated ethnic variations in incident asthma consultations (defined as new or first consultations, and compared consultation rates between those born inside and outside the UK (migrant status. Logistic regression models were used to examine the combined effects of ethnicity and migration on asthma incident consultations. Results Results showed significantly lower new/first asthma consultation rates for Whites than for each of the ethnic minority groups studied (mean age-adjusted consultation rates per 1000 patient-years: Whites 26.4 (95%CI 26.4, 26.4; South Asians 30.4 (95%CI 30.3, 30.5; Afro-Caribbeans 35.1 (95%CI 34.9, 35.3; and Others 27.8 (27.7, 28.0. Within each of these ethnic groups, those born outside of the UK showed consistently lower rates of incident asthma consultations. Modelling the combined effects of ethnic and migrant status revealed that UK-born South Asians and Afro-Caribbeans experienced comparable risks for incident GP consultations for asthma to UK-born Whites. Non-UK born Whites however experienced reduced risks (adjusted OR 0.82, 95%CI 0.69, 0.97 whilst non-UK born South Asians experienced increased risks (adjusted OR 1.33, 95%CI 1.04, 1

  15. Identifying asthma and chronic obstructive pulmonary disease in patients with persistent cough presenting to general practitioners : descriptive study

    NARCIS (Netherlands)

    Thiadens, HA; de Bock, GH; Deker, FW; Huysman, JAN; Springer, MP; Postma, DS

    1998-01-01

    Objective: To determine the prevalence of asthma and chronic obstructive pulmonary disease in patients not known to have these disorders, who present in general practice with persistent cough, and to ascertain criteria to help general practitioners in diagnosis. Design: Descriptive study. Setting:

  16. Individual traffic-related air pollution and new onset adult asthma: A GIS-based pilot study

    Energy Technology Data Exchange (ETDEWEB)

    Sherson, D.; Lysbeck Hansen, C. (Hospital of Vejle, Dept. of Occupational and Environmental Medicine, (Denmark)); Solvang Jensen, S.; Hertel, O. (Univ. of Aarhus, National Environmental Research Institute (Denmark)); Baelum, J. (Odense Univ. Hospital, Dep. of Occupational and Environmental Medicine (Denmark)); Skadhauge, L. (Haderslev Hospital, Dep. of Occupational and Environmental Medicine (Denmark)); Siersted, H.C. (Odense Univ. Hospital, Dep. of Respiratory Medicine (Denmark)); Omland, OE. (Aalborg Hospital, Dep. of Occupational Medicine (Denmark)); Thomsen, G. (South-West Jutland Hospital Esbjerg, Dep. of Occupational and Environmental Medicine (Denmark)); Sigsgaard, T. (Univ. of Aarhus, Institute of Occupational and Environmental Medicine (Denmark))

    2008-03-15

    The objective of this pilot study is to investigate the relation between asthma and wheeze debut and individually estimated exposure to traffic-related air pollutants with a validated exposure system (AirGIS). A non-smoking cohort with recently acquired asthma or wheeze as well as matched controls was identified from a large cross-sectional study. All residential and working addresses with corresponding time periods for a 10 year period were successfully identified for all study participants (N=33) and exposure estimated for both urban background and street level. Individual levels of air pollutants in the years preceding debut of asthma or wheeze were analyzed using survival analysis. No significant correlations between exposure levels and onset of disease or symptom were demonstrated. A tendency towards higher levels of nitrogen oxides exposure during the year prior to debut was seen in wheeze cases. Substantial problems in determining time of onset were encountered. It is recommended that the analytic methods developed in this pilot study are used in a larger prospective cohort to investigate individual trafficrelated air pollutants as a risk factor for the development of new asthma and wheeze. (au)

  17. Comprehensive Diagnostic Assessment of Health Status of Patients with Asthma or COPD : A Delphi Panel Study among Dutch Experts

    NARCIS (Netherlands)

    van den Akker, Edmée F M M; van't Hul, Alex J.; Birnie, Erwin; Chavannes, Niels H.; Rutten-van Mölken, Maureen P M H; In't Veen, Johannes C C M

    2017-01-01

    A comprehensive diagnostic assessment is needed to improve understanding of the health status of patients with chronic obstructive pulmonary disease (COPD) or asthma. Therefore, this study investigated which components and subsequent instruments should be part of a holistic assessment in secondary

  18. Maternal hemoglobin and hematocrit levels during pregnancy and childhood lung function and asthma. The Generation R Study

    NARCIS (Netherlands)

    Pereira de Jesus, S.M.C.B. (Sabrina M. C. B.); H.T. den Dekker (Herman); J.C. de Jongste (Johan); I.K.M. Reiss (Irwin); E.A.P. Steegers (Eric); V.W.V. Jaddoe (Vincent); L. Duijts (Liesbeth)

    2018-01-01

    textabstractObjective: To examine the associations of maternal hemoglobin and hematocrit levels during pregnancy with childhood lung function and asthma, and whether adverse pregnancy outcomes and atopic predisposition modify the associations. Methods: In a population-based prospective cohort study

  19. PVC--as flooring material--and its association with incident asthma in a Swedish child cohort study.

    Science.gov (United States)

    Larsson, M; Hägerhed-Engman, L; Kolarik, B; James, P; Lundin, F; Janson, S; Sundell, J; Bornehag, C G

    2010-12-01

    The Dampness in Buildings and Health study (DBH) started in the year 2000 in Värmland, Sweden, with a baseline questionnaire sent to all children (n = 14,077) aged 1-6. Five years later, a follow-up questionnaire was sent to the children who were 1-3 years at baseline. A total of 4779 children participated in both the baseline and the follow-up studies and constitute the study population in this cohort study. The aim of this study was to examine the association between exposure to PVC-flooring in the child's and parent's bedroom in homes of children aged 1-3 and the incidence of asthma, rhinitis, and eczema during the following 5-year period. Adjusted analyses showed that the incidence of asthma among children was associated with PVC-flooring in the child's bedroom (AOR 1.52; 95% CI 0.99-2.35) and in the parent's bedroom (1.46; 0.96-2.23). The found risks were on borderline of significance and should therefore be interpreted with caution. There was further a positive relationship between the number of rooms with PVC-flooring and the cumulative incidence of asthma. PVC-flooring was found to be a stronger risk factor for incident asthma in multifamily homes when compared with single-family houses and in smoking families compared with non-smoking families and in women. These longitudinal data from the DBH study found an association between the presence of PVC-flooring in the home and incident asthma in children. However, earlier results from the DBH study have shown that PVC-flooring is one important source for phthalates in indoor dust, and exposure to such phthalates was found to be associated with asthma and allergy among children. This emphasizes the need for prospective studies that focus on the importance of prenatal and neonatal exposure to phthalates in the development of asthma and allergy in children. © 2010 John Wiley & Sons A/S.

  20. The Alberta Pregnancy Outcomes and Nutrition (APrON) cohort study: rationale and methods.

    Science.gov (United States)

    Kaplan, Bonnie J; Giesbrecht, Gerald F; Leung, Brenda M Y; Field, Catherine J; Dewey, Deborah; Bell, Rhonda C; Manca, Donna P; O'Beirne, Maeve; Johnston, David W; Pop, Victor J; Singhal, Nalini; Gagnon, Lisa; Bernier, Francois P; Eliasziw, Misha; McCargar, Linda J; Kooistra, Libbe; Farmer, Anna; Cantell, Marja; Goonewardene, Laki; Casey, Linda M; Letourneau, Nicole; Martin, Jonathan W

    2014-01-01

    The Alberta Pregnancy Outcomes and Nutrition (APrON) study is an ongoing prospective cohort study that recruits pregnant women early in pregnancy and, as of 2012, is following up their infants to 3 years of age. It has currently enrolled approximately 5000 Canadians (2000 pregnant women, their offspring and many of their partners). The primary aims of the APrON study were to determine the relationships between maternal nutrient intake and status, before, during and after gestation, and (1) maternal mood; (2) birth and obstetric outcomes; and (3) infant neurodevelopment. We have collected comprehensive maternal nutrition, anthropometric, biological and mental health data at multiple points in the pregnancy and the post-partum period, as well as obstetrical, birth, health and neurodevelopmental outcomes of these pregnancies. The study continues to follow the infants through to 36 months of age. The current report describes the study design and methods, and findings of some pilot work. The APrON study is a significant resource with opportunities for collaboration. © 2012 John Wiley & Sons Ltd.

  1. Rationale and design of the screening of pulmonary hypertension in systemic lupus erythematosus (SOPHIE) study.

    Science.gov (United States)

    Huang, Duo; Cheng, Yang-Yang; Chan, Pak-Hei; Hai, Jojo; Yiu, Kai-Hang; Tse, Hung-Fat; Wong, Ka-Lam; Fan, Katherine; Li, Ying Wah; Ng, Woon-Leung; Yim, Cheuk-Wan; Wong, Cheuk-Hon John; Tam, Lai-Shan; Wong, Priscilla C H; Wong, Chi-Yuen; Ho, Chup-Hei; Leung, Alexander M H; Mok, Chi-Chiu; Lam, Ho; Lau, Chak-Sing; Cheung, Tommy; Ho, Carmen; Law, Sharon W Y; Chan, Esther W; Yin, Li-Xue; Yue, Wen-Sheng; Mok, Toi Meng; Evora, Mario Alberto; Siu, Chung-Wah

    2018-01-01

    Current guideline-recommended screening for pulmonary hypertension in patients with systemic sclerosis has not been evaluated in systemic lupus erythematosus (SLE), which is disproportionately prevalent in Asians. This multicentre, cross-sectional screening study aims to study the prevalence of pulmonary hypertension among SLE patients using these guidelines, and identify independent predictors and develop a prediction model for pulmonary hypertension in SLE patients. SLE patients from participating centres will undergo an echocardiography- and biomarker-based pulmonary hypertension screening procedure as in the DETECT study. Standard right heart catheterisation will be provided to patients with intermediate or high echocardiographic probability of pulmonary hypertension. Those with low echocardiographic probability will rescreen within 1 year. The primary measure will be the diagnosis and types of pulmonary hypertension and prevalence of pulmonary hypertension in SLE patients. The secondary measures will be the predictors and prediction models for pulmonary hypertension in SLE patients. The estimated sample size is approximately 895 participants. The results of the SOPHIE study will be an important contribution to the literature of SLE-related pulmonary hypertension and may be immediately translatable to real clinical practice. Ultimately, this study will provide the necessary evidence for establishing universal guidelines for screening of pulmonary hypertension in SLE patients.

  2. Critical review of norovirus surrogates in food safety research: rationale for considering volunteer studies.

    Science.gov (United States)

    Richards, Gary P

    2012-03-01

    The inability to propagate human norovirus (NoV) or to clearly differentiate infectious from noninfectious virus particles has led to the use of surrogate viruses, like feline calicivirus (FCV) and murine norovirus-1 (MNV), which are propagatable in cell culture. The use of surrogates is predicated on the assumption that they generally mimic the viruses they represent; however, studies are proving this concept invalid. In direct comparisons between FCV and MNV, their susceptibility to temperatures, environmental and food processing conditions, and disinfectants are dramatically different. Differences have also been noted between the inactivation of NoV and its surrogates, thus questioning the validity of surrogates. Considerable research funding is provided globally each year to conduct surrogate studies on NoVs; however, there is little demonstrated benefit derived from these studies in regard to the development of virus inactivation techniques or food processing strategies. Human challenge studies are needed to determine which processing techniques are effective in reducing NoVs in foods. A major obstacle to clinical trials on NoVs is the perception that such trials are too costly and risky, but in reality, there is far more cost and risk in allowing millions of unsuspecting consumers to contract NoV illness each year, when practical interventions are only a few volunteer studies away. A number of clinical trials have been conducted, providing important insights into NoV inactivation. A shift in research priorities from surrogate research to volunteer studies is essential if we are to identify realistic, practical, and scientifically valid processing approaches to improve food safety.

  3. Postnatal Growth and Retinopathy of Prematurity Study: Rationale, Design, and Subject Characteristics.

    Science.gov (United States)

    Binenbaum, Gil; Tomlinson, Lauren A

    2017-02-01

    Postnatal-growth-based predictive models demonstrate strong potential for improving the low specificity of retinopathy of prematurity (ROP) screening. Prior studies are limited by inadequate sample size. We sought to study a sufficiently large cohort of at-risk infants to enable development of a model with highly precise estimates of sensitivity for severe ROP. The Postnatal Growth and ROP (G-ROP) Study was a multicenter retrospective cohort study of infants at 30 North American hospitals during 2006-2012. A total of 65 G-ROP-certified abstractors submitted data to a secure, web-based database. Data included ROP examination findings, treatments, complications, daily weight measurements, daily oxygen supplementation, maternal/infant demographics, medical comorbidities, surgical events, and weekly nutrition. Data quality was monitored with system validation rules, data audits, and discrepancy algorithms. Of 11,261 screened infants, 8334 were enrolled, and 2927 had insufficient data due to transfer, discharge, or death. Of the enrolled infants, 90% (7483) had a known ROP outcome and were included in the study. Median birth weight was 1070 g (range 310-3000g) and mean gestational age 28 weeks (range 22-35 weeks). Severe ROP (Early Treatment of Retinopathy type 1 or 2) developed in 931 infants (12.5%). Successful incorporation of a predictive model into ROP screening requires confidence that it will capture cases of severe ROP. This dataset provides power to estimate sensitivity with half-confidence interval width of less than 0.5%, determined by the high number of severe ROP cases. The G-ROP Study represents a large, diverse cohort of at-risk infants undergoing ROP screening. It will facilitate evaluation of growth-based algorithms to improve efficiency of ROP screening.

  4. Apixaban for the Secondary Prevention of Thrombosis Among Patients With Antiphospholipid Syndrome: Study Rationale and Design (ASTRO-APS).

    Science.gov (United States)

    Woller, Scott C; Stevens, Scott M; Kaplan, David A; Branch, D Ware; Aston, Valerie T; Wilson, Emily L; Gallo, Heather M; Johnson, Eric G; Rondina, Matthew T; Lloyd, James F; Evans, R Scott; Elliott, C Gregory

    2016-04-01

    Antiphospholipid syndrome (APS) is an acquired thrombophilia characterized by thrombosis, pregnancy morbidity, and the presence of characteristic antibodies. Current therapy for patients having APS with a history of thrombosis necessitates anticoagulation with the vitamin K antagonist warfarin, a challenging drug to manage. Apixaban, approved for the treatment and prevention of venous thrombosis with a low rate of bleeding observed, has never been studied among patients with APS. We report study rationale and design of Apixaban for the Secondary Prevention of Thrombosis Among Patients With Antiphospholipid Syndrome (ASTRO-APS), a prospective randomized open-label blinded event pilot study that will randomize patients with a clinical diagnosis of APS receiving therapeutic anticoagulation to either adjusted-dose warfarin or apixaban 2.5 mg twice a day. We aim to report our ability to identify, recruit, randomize, and retain patients with APS randomized to apixaban compared with warfarin. We will report clinically important outcomes of thrombosis and bleeding. All clinical outcomes will be adjudicated by a panel blinded to the treatment arm. A unique aspect of this study is the enrollment of patients with an established clinical diagnosis of APS. Also unique is our use of electronic medical record interrogation techniques to identify patients who would likely meet our inclusion criteria and use of an electronic portal for follow-up visit data capture. ASTRO-APS will be the largest prospective study to date comparing a direct oral anticoagulant with warfarin among patients with APS for the secondary prevention of thrombosis. Our inclusion criteria assure that outcomes obtained will be clinically applicable to the routine management of patients with APS receiving indefinite anticoagulation. © The Author(s) 2015.

  5. Traffic-related air pollution associated with prevalence of asthma and COPD/chronic bronchitis. A cross-sectional study in Southern Sweden

    Directory of Open Access Journals (Sweden)

    Nihlén Ulf

    2009-01-01

    Full Text Available Abstract Background There is growing evidence that air pollution from traffic has adverse long-term effects on chronic respiratory disease in children, but there are few studies and more inconclusive results in adults. We examined associations between residential traffic and asthma and COPD in adults in southern Sweden. A postal questionnaire in 2000 (n = 9319, 18–77 years provided disease status, and self-reported exposure to traffic. A Geographical Information System (GIS was used to link geocoded residential addresses to a Swedish road database and an emission database for NOx. Results Living within 100 m of a road with >10 cars/minute (compared with having no heavy road within this distance was associated with prevalence of asthma diagnosis (OR = 1.40, 95% CI = 1.04–1.89, and COPD diagnosis (OR = 1.64, 95%CI = 1.11–2.4, as well as asthma and chronic bronchitis symptoms. Self-reported traffic exposure was associated with asthma diagnosis and COPD diagnosis, and with asthma symptoms. Annual average NOx was associated with COPD diagnosis and symptoms of asthma and chronic bronchitis. Conclusion Living close to traffic was associated with prevalence of asthma diagnosis, COPD diagnosis, and symptoms of asthma and bronchitis. This indicates that traffic-related air pollution has both long-term and short-term effects on chronic respiratory disease in adults, even in a region with overall low levels of air pollution.

  6. The Scandinavian baltic pancreatic club (SBPC) database: design, rationale and characterisation of the study cohort.

    Science.gov (United States)

    Olesen, Søren S; Poulsen, Jakob L; Drewes, Asbjørn M; Frøkjær, Jens B; Laukkarinen, Johanna; Parhiala, Mikael; Rix, Iben; Novovic, Srdan; Lindkvist, Björn; Bexander, Louise; Dimcevski, Georg; Engjom, Trond; Erchinger, Friedemann; Haldorsen, Ingfrid S; Pukitis, Aldis; Ozola-Zālīte, Imanta; Haas, Stephan; Vujasinovic, Miroslav; Löhr, J Matthias; Gulbinas, Antanas; Jensen, Nanna M; Jørgensen, Maiken T; Nøjgaard, Camilla

    2017-08-01

    Chronic pancreatitis (CP) is a multifaceted disease associated with several risk factors and a complex clinical presentation. We established the Scandinavian Baltic Pancreatic Club (SBPC) Database to characterise and study the natural history of CP in a Northern European cohort. Here, we describe the design of the database and characteristics of the study cohort. Nine centres from six different countries in the Scandinavian-Baltic region joined the database. Patients with definitive or probable CP (M-ANNHEIM diagnostic criteria) were included. Standardised case report forms were used to collect several assessment variables including disease aetiology, duration of CP, preceding acute pancreatitis, as well as symptoms, complications, and treatments. The clinical stage of CP was characterised according to M-ANNNHEIM. Yearly follow-up is planned for all patients. The study cohort comprised of 910 patients (608 men: 302 women; median age 58 (IQR: 48-67) years with definite 848 (93%) or probable CP 62 (7%). Nicotine (70%) and alcohol (59%) were the most frequent aetiologies and seen in combination in 44% of patients. A history of recurrent acute pancreatitis was seen in 49% prior to the development of CP. Pain (69%) and exocrine pancreatic insufficiency (68%) were the most common complications followed by diabetes (43%). Most patients (30%) were classified as clinical stage II (symptomatic CP with exocrine or endocrine insufficiency). Less than 10% of the patients had undergone pancreatic surgery. The SBPC database provides a mean for future prospective, observational studies of CP in the Northern European continent.

  7. Rationale and design of INTERSTROKE: a global case-control study of risk factors for stroke

    DEFF Research Database (Denmark)

    O'Donnell, M; Serpault, Damien Xavier; Diener, C

    2010-01-01

    Stroke is a major global health problem. It is the third leading cause of death and the leading cause of adult disability. INTERHEART, a global case-control study of acute myocardial infarction in 52 countries (29,972 participants), identified nine modifiable risk factors that accounted for >90% ...

  8. Relationship between volition, physical activity and weight loss maintenance: Study rationale, design, methods and baseline characteristics

    DEFF Research Database (Denmark)

    Dandanell, Sune; Elbe, Anne-Marie; Pfister, Gertrud Ursula

    2017-01-01

    ) for an interdisciplinary prospective study with follow-up. The change in lifestyle and weight loss is promoted via a 3-month intensive lifestyle intervention at a private health school. The intervention consists of supervised training (1–3 hours/day), a healthy hypo-caloric diet (−500 to −700 kCal/day) and education...

  9. The Coordination and Activity Tracking in CHildren (CATCH) study: rationale and design.

    Science.gov (United States)

    Cairney, John; Missiuna, Cheryl; Timmons, Brian W; Rodriguez, Christine; Veldhuizen, Scott; King-Dowling, Sara; Wellman, Sarah; Le, Tuyen

    2015-12-21

    Past studies have found that children with Developmental Coordination Disorder (DCD) engage in less physical activity than typically developing children. This "activity deficit" may result in children with DCD being less physically fit and more likely to be overweight or obese, potentially increasing later risk for poor cardiovascular health. Unfortunately, the majority of DCD research has been limited to cross-sectional designs, leading to questions about the complex relationship among motor ability, inactivity and health-related fitness. Of the few longitudinal studies on the topic, determining precedence amongst these factors is difficult because study cohorts typically focus on mid to late childhood. By this age, both decreased physical fitness and obesity are often established. The Coordination and Activity Tracking in CHildren (CATCH) study will examine the pathways connecting DCD, physical activity, physical fitness, and body composition from early to middle childhood. The CATCH study is a prospective cohort study. We aim to recruit a cohort of 600 children aged 4 to 5 years (300 probable DCD [pDCD] and 300 controls) and test them once a year for 4 years. At Phase 1 of baseline testing, we assess motor skills, cognitive ability (IQ), basic anthropometry, flexibility and lower body muscle strength, while parents complete an interview and questionnaires regarding family demographics, their child's physical activity, and behavioural characteristics. Children who move on to Phase 2 (longitudinal cohort) have their body fat percentage, foot structure, aerobic and anaerobic fitness assessed. An accelerometer to measure physical activity is then given to the child and interested family members. The family also receives an accelerometer logbook and 3-day food dairy. At years 2 to 4, children in the longitudinal cohort will have all baseline assessments repeated (excluding the IQ test), and complete an additional measure of perceived self-efficacy. Parents will

  10. The population-based Barcelona-Asymptomatic Intracranial Atherosclerosis Study (ASIA: rationale and design

    Directory of Open Access Journals (Sweden)

    Pera Guillem

    2011-02-01

    Full Text Available Abstract Background Large-artery intracranial atherosclerosis may be the most frequent cause of ischemic stroke worldwide. Traditional approaches have attempted to target the disease when it is already symptomatic. However, early detection of intracranial atherosclerosis may allow therapeutic intervention while the disease is still asymptomatic. The prevalence and natural history of asymptomatic intracranial atherosclerosis in Caucasians remain unclear. The aims of the Barcelona-ASymptomatic Intracranial Atherosclerosis (ASIA study are (1 to determine the prevalence of ASIA in a moderate-high vascular risk population, (2 to study its prognostic impact on the risk of suffering future major ischemic events, and (3 to identify predictors of the development, progression and clinical expression of this condition. Methods/Design Cross-over and cohort, population-based study. A randomly selected representative sample of 1,503 subjects with a mild-moderate-high vascular risk (as defined by a REGICOR score ≥ 5% and with neither a history of cerebrovascular nor ischemic heart disease will be studied. At baseline, all individuals will undergo extracranial and transcranial Color-Coded Duplex (TCCD ultrasound examinations to detect presence and severity of extra and intracranial atherosclerosis. Intracranial stenoses will be assessed by magnetic resonance angiography (MRA. Clinical and demographic variables will be recorded and blood samples will be drawn to investigate clinical, biological and genetic factors associated with the presence of ASIA. A long-term clinical and sonographic follow-up will be conducted thereafter to identify predictors of disease progression and of incident vascular events. Discussion The Barcelona-ASIA is a population-based study aiming to evaluate the prevalence and clinical importance of asymptomatic intracranial large-artery atherosclerosis in Caucasians. The ASIA project may provide a unique scientific resource to better

  11. The population-based Barcelona-Asymptomatic Intracranial Atherosclerosis Study (ASIA): rationale and design.

    Science.gov (United States)

    López-Cancio, Elena; Dorado, Laura; Millán, Mónica; Reverté, Silvia; Suñol, Anna; Massuet, Anna; Mataró, María; Galán, Amparo; Alzamora, Maite; Pera, Guillem; Torán, Pere; Dávalos, Antoni; Arenillas, Juan F

    2011-02-17

    Large-artery intracranial atherosclerosis may be the most frequent cause of ischemic stroke worldwide. Traditional approaches have attempted to target the disease when it is already symptomatic. However, early detection of intracranial atherosclerosis may allow therapeutic intervention while the disease is still asymptomatic. The prevalence and natural history of asymptomatic intracranial atherosclerosis in Caucasians remain unclear. The aims of the Barcelona-ASymptomatic Intracranial Atherosclerosis (ASIA) study are (1) to determine the prevalence of ASIA in a moderate-high vascular risk population, (2) to study its prognostic impact on the risk of suffering future major ischemic events, and (3) to identify predictors of the development, progression and clinical expression of this condition. Cross-over and cohort, population-based study. A randomly selected representative sample of 1,503 subjects with a mild-moderate-high vascular risk (as defined by a REGICOR score ≥ 5%) and with neither a history of cerebrovascular nor ischemic heart disease will be studied. At baseline, all individuals will undergo extracranial and transcranial Color-Coded Duplex (TCCD) ultrasound examinations to detect presence and severity of extra and intracranial atherosclerosis. Intracranial stenoses will be assessed by magnetic resonance angiography (MRA). Clinical and demographic variables will be recorded and blood samples will be drawn to investigate clinical, biological and genetic factors associated with the presence of ASIA. A long-term clinical and sonographic follow-up will be conducted thereafter to identify predictors of disease progression and of incident vascular events. The Barcelona-ASIA is a population-based study aiming to evaluate the prevalence and clinical importance of asymptomatic intracranial large-artery atherosclerosis in Caucasians. The ASIA project may provide a unique scientific resource to better understand the dynamics of intracranial atherosclerosis from

  12. The Female Athlete Body (FAB) study: Rationale, design, and baseline characteristics.

    Science.gov (United States)

    Stewart, Tiffany M; Pollard, Tarryn; Hildebrandt, Tom; Beyl, Robbie; Wesley, Nicole; Kilpela, Lisa Smith; Becker, Carolyn Black

    2017-09-01

    Eating Disorders (EDs) are serious psychiatric illnesses marked by psychiatric comorbidity, medical complications, and functional impairment. Research indicates that female athletes are often at greater risk for developing ED pathology versus non-athlete females. The Female Athlete Body (FAB) study is a three-site, randomized controlled trial (RCT) designed to assess the efficacy of a behavioral ED prevention program for female collegiate athletes when implemented by community providers. This paper describes the design, intervention, and participant baseline characteristics. Future papers will discuss outcomes. Female collegiate athletes (N=481) aged 17-21 were randomized by site, team, and sport type to either FAB or a waitlist control group. FAB consisted of three sessions (1.3h each) of a behavioral ED prevention program. Assessments were conducted at baseline (pre-intervention), post-intervention (3weeks), and six-, 12-, and 18-month follow-ups. This study achieved 96% (N=481) of target recruitment (N=500). Few group differences emerged at baseline. Total sample analyses revealed moderately low baseline instances of ED symptoms and clinical cases. Health risks associated with EDs necessitate interventions for female athletes. The FAB study is the largest existing RCT for female athletes aimed at both reduction of ED risk factors and ED prevention. The methods presented and population recruited for this study represent an ideal intervention for assessing the effects of FAB on both the aforementioned outcomes. We anticipate that findings of this study (reported in future papers) will make a significant contribution to the ED risk factor reduction and prevention literature. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Rationale and Design Issues of the Randomized Intervention for Children With Vesicoureteral Reflux (RIVUR) Study

    Science.gov (United States)

    Keren, Ron; Carpenter, Myra A.; Hoberman, Alejandro; Shaikh, Nader; Matoo, Tej K.; Chesney, Russell W.; Matthews, Ranjiv; Gerson, Arlene C.; Greenfield, Saul P.; Fivush, Barbara; McLurie, Gordon A.; Rushton, H. Gil; Canning, Douglas; Nelson, Caleb P.; Greenbaum, Lawrence; Bukowski, Timothy; Primack, William; Sutherland, Richard; Hosking, James; Stewart, Dawn; Elder, Jack; Moxey-Mims, Marva; Nyberg, Leroy

    2010-01-01

    OBJECTIVE Our goal is to determine if antimicrobial prophylaxis with trimethoprim/sulfamethoxazole prevents recurrent urinary tract infections and renal scarring in children who are found to have vesicoureteral reflux after a first or second urinary tract infection. DESIGN, PARTICIPANTS, AND METHODS The Randomized Intervention for Children With Vesicoureteral Reflux (RIVUR) study is a double-blind, randomized, placebo-controlled trial. Six hundred children aged 2 to 72 months will be recruited from both primary and subspecialty care settings at clinical trial centers throughout North America. Children who are found to have grades I to IV vesicoureteral reflux after the index febrile or symptomatic urinary tract infection will be randomly assigned to receive daily doses of either trimethoprim/sulfamethoxazole or placebo for 2 years. Scheduled follow-up contacts include in-person study visits every 6 months and telephone interviews every 2 months. Biospecimens (urine and blood) and genetic specimens (blood) will be collected for future studies of the genetic and biochemical determinants of vesicoureteral reflux, recurrent urinary tract infection, renal insufficiency, and renal scarring. RESULTS The primary outcome is recurrence of urinary tract infection. Secondary outcomes include time to recurrent urinary tract infection, renal scarring (assessed by dimercaptosuccinic acid scan), treatment failure, renal function, resource utilization, and development of antimicrobial resistance in stool flora. CONCLUSIONS The RIVUR study will provide useful information to clinicians about the risks and benefits of prophylactic antibiotics for children who are diagnosed with vesicoureteral reflux after a first or second urinary tract infection. The data and specimens collected over the course of the study will allow researchers to better understand the pathophysiology of recurrent urinary tract infection and its sequelae. PMID:19018048

  14. Air pollution and cardiovascular and respiratory disease: Rationale and methodology of CAPACITY study

    Science.gov (United States)

    Rabiei, Katayoun; Hosseini, Sayed Mohsen; Sadeghi, Erfan; Jafari-Koshki, Tohid; Rahimi, Mojtaba; Shishehforoush, Mansour; Lahijanzadeh, Ahmadreza; Sadeghian, Babak; Moazam, Elham; Mohebi, Mohammad Bagher; Ezatian, Victoria; Sarrafzadegan, Nizal

    2017-01-01

    BACKGROUND Considering the high level of air pollution and its impact on health, we aimed to study the correlation of air pollution with hospitalization and mortality of cardiovascular (CVD) and respiratory diseases (ResD) (CAPACITY) to determine the effects of air pollutants on CVD and ResD hospitalizations and deaths in Isfahan, Iran. METHODS Hourly levels of air pollutants including particulate matter (PM), carbon monoxide (CO), nitrogen dioxide (NO2), sulfur dioxide (SO2), and ozone (O3), information of CVD and ResD admissions and death certificate were obtained respectively from Department of Environment (DOE), Iran, hospitals and cemetery. Time series and case-crossover model were used to find the impact of air pollutants. This paper only summarizes the descriptive findings of the CAPACITY study. RESULTS The total number of hospitalized patients were 23781 in 2010 and 22485 in 2011. The most frequent cause of hospitalization and death was ischemic heart diseases in both years. While the mean annual levels of O3, CO, and PM10 were lower in 2011 than in 2010, NO2 and SO2 levels higher in 2011. In both years, PM10 was similarly increased during last month of fall, late spring and early summer. In 2011, the PM2.5 and PM10 monthly trend of change were similar. CONCLUSION The CAPACITY study is one of the few large-scale studies that evaluated the effects of air pollutants on a variety of CVD and ResD in a large city of Iran. This study can provide many findings that could clarify the effects of these pollutants on the incidence and burden of both disease groups. PMID:29643921

  15. Air pollution and cardiovascular and respiratory disease: Rationale and methodology of CAPACITY study.

    Science.gov (United States)

    Rabiei, Katayoun; Hosseini, Sayed Mohsen; Sadeghi, Erfan; Jafari-Koshki, Tohid; Rahimi, Mojtaba; Shishehforoush, Mansour; Lahijanzadeh, Ahmadreza; Sadeghian, Babak; Moazam, Elham; Mohebi, Mohammad Bagher; Ezatian, Victoria; Sarrafzadegan, Nizal

    2017-11-01

    Considering the high level of air pollution and its impact on health, we aimed to study the correlation of air pollution with hospitalization and mortality of cardiovascular (CVD) and respiratory diseases (ResD) (CAPACITY) to determine the effects of air pollutants on CVD and ResD hospitalizations and deaths in Isfahan, Iran. Hourly levels of air pollutants including particulate matter (PM), carbon monoxide (CO), nitrogen dioxide (NO2), sulfur dioxide (SO2), and ozone (O3), information of CVD and ResD admissions and death certificate were obtained respectively from Department of Environment (DOE), Iran, hospitals and cemetery. Time series and case-crossover model were used to find the impact of air pollutants. This paper only summarizes the descriptive findings of the CAPACITY study. The total number of hospitalized patients were 23781 in 2010 and 22485 in 2011. The most frequent cause of hospitalization and death was ischemic heart diseases in both years. While the mean annual levels of O3, CO, and PM10 were lower in 2011 than in 2010, NO2 and SO2 levels higher in 2011. In both years, PM10 was similarly increased during last month of fall, late spring and early summer. In 2011, the PM2.5 and PM10 monthly trend of change were similar. The CAPACITY study is one of the few large-scale studies that evaluated the effects of air pollutants on a variety of CVD and ResD in a large city of Iran. This study can provide many findings that could clarify the effects of these pollutants on the incidence and burden of both disease groups.

  16. Air pollution and cardiovascular and respiratory disease: Rationale and methodology of CAPACITY study

    Directory of Open Access Journals (Sweden)

    Katayoun Rabiei

    2017-11-01

    Full Text Available BACKGROUND: Considering the high level of air pollution and its impact on health, we aimed to study the correlation of air pollution with hospitalization and mortality of cardiovascular (CVD and respiratory diseases (ResD (CAPACITY to determine the effects of air pollutants on CVD and ResD hospitalizations and deaths in Isfahan, Iran.METHODS: Hourly levels of air pollutants including particulate matter (PM, carbon monoxide (CO, nitrogen dioxide (NO2, sulfur dioxide (SO2, and ozone (O3, information of CVD and ResD admissions and death certificate were obtained respectively from Department of Environment (DOE, Iran, hospitals and cemetery. Time series and case-crossover model were used to find the impact of air pollutants. This paper only summarizes the descriptive findings of the CAPACITY study.RESULTS: The total number of hospitalized patients were 23781 in 2010 and 22485 in 2011. The most frequent cause of hospitalization and death was ischemic heart diseases in both years. While the mean annual levels of O3, CO, and PM10 were lower in 2011 than in 2010, NO2 and SO2 levels higher in 2011. In both years, PM10 was similarly increased during last month of fall, late spring and early summer. In 2011, the PM2.5 and PM10 monthly trend of change were similar.CONCLUSION: The CAPACITY study is one of the few large-scale studies that evaluated the effects of air pollutants on a variety of CVD and ResD in a large city of Iran. This study can provide many findings that could clarify the effects of these pollutants on the incidence and burden of both disease groups. 

  17. Rationale and design of INTERSTROKE: a global case-control study of risk factors for stroke

    DEFF Research Database (Denmark)

    O'Donnell, M; Serpault, Damien Xavier; Diener, C

    2010-01-01

    with a first stroke within 72 h of hospital presentation in whom CT or MRI is performed. Proxy respondents are used for cases unable to communicate. Etiological and topographical stroke subtype is documented for all cases. Controls are hospital- and community-based, matched for gender, ethnicity and age (+/-5...... years). A questionnaire (cases and controls) is used to acquire information on known and proposed risk factors for stroke. Cardiovascular (e.g. blood pressure) and anthropometric (e.g. waist-to-hip ratio) measurements are obtained at the time of interview. Nonfasting blood samples and random urine......-income countries is inadequate, where a very large burden of stroke occurs. Accordingly, a similar epidemiological study is required for stroke, to inform effective population-based strategies to reduce the risk of stroke. Methods: INTERSTROKE is an international, multicenter case-control study. Cases are patients...

  18. Rationale, design and objectives of ARegPKD, a European ARPKD registry study.

    Science.gov (United States)

    Ebner, Kathrin; Feldkoetter, Markus; Ariceta, Gema; Bergmann, Carsten; Buettner, Reinhard; Doyon, Anke; Duzova, Ali; Goebel, Heike; Haffner, Dieter; Hero, Barbara; Hoppe, Bernd; Illig, Thomas; Jankauskiene, Augustina; Klopp, Norman; König, Jens; Litwin, Mieczyslaw; Mekahli, Djalila; Ranchin, Bruno; Sander, Anja; Testa, Sara; Weber, Lutz Thorsten; Wicher, Dorota; Yuzbasioglu, Ayse; Zerres, Klaus; Dötsch, Jörg; Schaefer, Franz; Liebau, Max Christoph

    2015-02-18

    Autosomal recessive polycystic kidney disease (ARPKD) is a rare but frequently severe disorder that is typically characterized by cystic kidneys and congenital hepatic fibrosis but displays pronounced phenotypic heterogeneity. ARPKD is among the most important causes for pediatric end stage renal disease and a leading reason for liver-, kidney- or combined liver kidney transplantation in childhood. The underlying pathophysiology, the mechanisms resulting in the observed clinical heterogeneity and the long-term clinical evolution of patients remain poorly understood. Current treatment approaches continue to be largely symptomatic and opinion-based even in most-advanced medical centers. While large clinical trials for the frequent and mostly adult onset autosomal dominant polycystic kidney diseases have recently been conducted, therapeutic initiatives for ARPKD are facing the challenge of small and clinically variable cohorts for which reliable end points are hard to establish. ARegPKD is an international, mostly European, observational study to deeply phenotype ARPKD patients in a pro- and retrospective fashion. This registry study is conducted with the support of the German Society for Pediatric Nephrology (GPN) and the European Study Consortium for Chronic Kidney Disorders Affecting Pediatric Patients (ESCAPE Network). ARegPKD clinically characterizes long-term ARPKD courses by a web-based approach that uses detailed basic data questionnaires in combination with yearly follow-up visits. Clinical data collection is accompanied by associated biobanking and reference histology, thus setting roots for future translational research. The novel registry study ARegPKD aims to characterize miscellaneous subcohorts and to compare the applied treatment options in a large cohort of deeply characterized patients. ARegPKD will thus provide evidence base for clinical treatment decisions and contribute to the pathophysiological understanding of this severe inherited disorder.

  19. Rationale and methods for an epidemiologic study of cancer among Seventh-Day Adventists.

    Science.gov (United States)

    Phillips, R L; Kuzma, J W

    1977-12-01

    Considerable evidence was found that Adventists are a low-risk population to develop cancer of many sites. Adventists have numerous unique life-style and dietary habits with great variability within the population in adherence to these practices as well as considerable variation in duration of exposure to these characteristics. Thus this study population will likely be extremely productive in identifying dietary habits or other life-style characteristics that are etiologically related to various cancer sites.

  20. Rationale, design and methods of the HEALTHY study nutrition intervention component.

    Science.gov (United States)

    Gillis, B; Mobley, C; Stadler, D D; Hartstein, J; Virus, A; Volpe, S L; El ghormli, L; Staten, M A; Bridgman, J; McCormick, S

    2009-08-01

    The HEALTHY study was a randomized, controlled, multicenter and middle school-based, multifaceted intervention designed to reduce risk factors for the development of type 2 diabetes. The study randomized 42 middle schools to intervention or control, and followed students from the sixth to the eighth grades. Here we describe the design of the HEALTHY nutrition intervention component that was developed to modify the total school food environment, defined to include the following: federal breakfast, lunch, after school snack and supper programs; a la carte venues, including snack bars and school stores; vending machines; fundraisers; and classroom parties and celebrations. Study staff implemented the intervention using core and toolbox strategies to achieve and maintain the following five intervention goals: (1) lower the average fat content of foods, (2) increase the availability and variety of fruits and vegetables, (3) limit the portion sizes and energy content of dessert and snack foods, (4) eliminate whole and 2% milk and all added sugar beverages, with the exception of low fat or nonfat flavored milk, and limit 100% fruit juice to breakfast in small portions and (5) increase the availability of higher fiber grain-based foods and legumes. Other nutrition intervention component elements were taste tests, cafeteria enhancements, cafeteria line messages and other messages about healthy eating, cafeteria learning laboratory (CLL) activities, twice-yearly training of food service staff, weekly meetings with food service managers, incentives for food service departments, and twice yearly local meetings and three national summits with district food service directors. Strengths of the intervention design were the integration of nutrition with the other HEALTHY intervention components (physical education, behavior change and communications), and the collaboration and rapport between the nutrition intervention study staff members and food service personnel at both school

  1. ACCISS study rationale and design: activating collaborative cancer information service support for cervical cancer screening

    Directory of Open Access Journals (Sweden)

    Bullard Emily

    2009-12-01

    Full Text Available Abstract Background High-quality cancer information resources are available but underutilized by the public. Despite greater awareness of the National Cancer Institute's Cancer Information Service among low-income African Americans and Hispanics compared with Caucasians, actual Cancer Information Service usage is lower than expected, paralleling excess cancer-related morbidity and mortality for these subgroups. The proposed research examines how to connect the Cancer Information Service to low-income African-American and Hispanic women and their health care providers. The study will examine whether targeted physician mailing to women scheduled for colposcopy to follow up an abnormal Pap test can increase calls to the Cancer Information Service, enhance appropriate medical follow-up, and improve satisfaction with provider-patient communication. Methods/Design The study will be conducted in two clinics in ethnically diverse low-income communities in Chicago. During the formative phase, patients and providers will provide input regarding materials planned for use in the experimental phase of the study. The experimental phase will use a two-group prospective randomized controlled trial design. African American and Hispanic women with an abnormal Pap test will be randomized to Usual Care (routine colposcopy reminder letter or Intervention (reminder plus provider recommendation to call the Cancer Information Service and sample questions to ask. Primary outcomes will be: 1 calls to the Cancer Information Service; 2 timely medical follow-up, operationalized by whether the patient keeps her colposcopy appointment within six months of the abnormal Pap; and 3 patient satisfaction with provider-patient communication at follow-up. Discussion The study examines the effectiveness of a feasible, sustainable, and culturally sensitive strategy to increase awareness and use of the Cancer Information Service among an underserved population. The goal of linking a

  2. A human dietary arachidonic acid supplementation study conducted in a metabolic research unit: rationale and design.

    Science.gov (United States)

    Nelson, G J; Kelley, D S; Emken, E A; Phinney, S D; Kyle, D; Ferretti, A

    1997-04-01

    While there are many reports of studies that fed arachidonic acid (AA) to animals, there are very few reports of AA feeding to humans under controlled conditions. This 130-d study was conceived as a controlled, symmetrical crossover design with healthy, adult male volunteers. They lived in the metabolic research unit (MRU) of the Western Human Nutrition Research (WHNRC) for the entire study. All food was prepared by the WHNRC kitchen. The basal (low-AA) diet consisted of natural foods (30 en% fat, 15 en% protein, and 55 en% carbohydrate), containing 210 mg/d of AA, and met the recommended daily allowance for all nutrients. The high-AA (intervention) diet was similar except that 1.5 g/d of AA in the form of a triglyceride containing 50% AA replaced an equal amount of high-oleic safflower oil in the basal diet. The subjects (ages 20 to 39) were within -10 to +20% of ideal body weight, nonsmoking, and not allowed alcohol in the MRU. Their exercise level was constant, and their body weights were maintained within 2% of entry level. Subjects were initially fed the low-AA diet for 15 d. On day 16, half of the subjects (group A) wee placed on the high-AA diet, and the other group (B) remained on the low-AA diets. On day 65, the two groups switched diets. On day 115, group B returned to the low-AA diet. This design, assuming no carryover effect, allowed us to merge the data from the two groups, with the data comparison days being 65 (low-AA) and 115 (high-AA) for group B and 130 (low-AA) and 65 (high-AA) for group A. The main indices studied were the fatty acid composition of the plasma, red blood cells, platelets, and adipose tissue; in vitro platelet aggregation, bleeding times, clotting factors; immune response as measured by delayed hypersensitivity skin tests, cellular proliferation of peripheral blood mononuclear cells in response to various mitogens and antigens, natural killer cell activity, and response to measles/mumps/rubella and influenza vaccines; the

  3. ACCISS study rationale and design: activating collaborative cancer information service support for cervical cancer screening.

    Science.gov (United States)

    Cofta-Woerpel, Ludmila; Randhawa, Veenu; McFadden, H Gene; Fought, Angela; Bullard, Emily; Spring, Bonnie

    2009-12-02

    High-quality cancer information resources are available but underutilized by the public. Despite greater awareness of the National Cancer Institute's Cancer Information Service among low-income African Americans and Hispanics compared with Caucasians, actual Cancer Information Service usage is lower than expected, paralleling excess cancer-related morbidity and mortality for these subgroups. The proposed research examines how to connect the Cancer Information Service to low-income African-American and Hispanic women and their health care providers. The study will examine whether targeted physician mailing to women scheduled for colposcopy to follow up an abnormal Pap test can increase calls to the Cancer Information Service, enhance appropriate medical follow-up, and improve satisfaction with provider-patient communication. The study will be conducted in two clinics in ethnically diverse low-income communities in Chicago. During the formative phase, patients and providers will provide input regarding materials planned for use in the experimental phase of the study. The experimental phase will use a two-group prospective randomized controlled trial design. African American and Hispanic women with an abnormal Pap test will be randomized to Usual Care (routine colposcopy reminder letter) or Intervention (reminder plus provider recommendation to call the Cancer Information Service and sample questions to ask). Primary outcomes will be: 1) calls to the Cancer Information Service; 2) timely medical follow-up, operationalized by whether the patient keeps her colposcopy appointment within six months of the abnormal Pap; and 3) patient satisfaction with provider-patient communication at follow-up. The study examines the effectiveness of a feasible, sustainable, and culturally sensitive strategy to increase awareness and use of the Cancer Information Service among an underserved population. The goal of linking a public service (the Cancer Information Service) with real

  4. Maternal hemoglobin and hematocrit levels during pregnancy and childhood lung function and asthma. The Generation R Study.

    Science.gov (United States)

    Pereira de Jesus, Sabrina M C B; den Dekker, Herman T; de Jongste, Johan C; Reiss, Irwin K; Steegers, Eric A; Jaddoe, Vincent W V; Duijts, Liesbeth

    2018-02-01

    To examine the associations of maternal hemoglobin and hematocrit levels during pregnancy with childhood lung function and asthma, and whether adverse pregnancy outcomes and atopic predisposition modify the associations. In a population-based prospective cohort study among 3672 subjects, we measured maternal hemoglobin and hematocrit levels in early pregnancy, and lung function by spirometry and current asthma by questionnaire at age 10 years. Higher maternal hematocrit levels, both continuously and categorized into clinical cut-offs, were associated with lower forced expiratory flow at 75% of forced vital capacity (FEF 75 ) in children (Z-score (95%CI): -0.04 (-0.07, -0.01), per increase of 1 SDS in hematocrit level; Z-score (95%CI) difference: -0.11 (-0.20, -0.03) compared with normal hematocrit levels, respectively), taking lifestyle and socio-economic factors into account. Adverse pregnancy outcomes and atopic predisposition did not modify the results. No associations of maternal hemoglobin and hematocrit with current asthma were observed. Higher maternal hematocrit levels during pregnancy are associated with lower childhood lung function but not with risk of asthma. Adverse pregnancy outcomes and atopic predisposition do not modify these associations. Underlying mechanisms need to be further studied. © 2017 Wiley Periodicals, Inc.

  5. Diagnosis of asthma - new theories.

    Science.gov (United States)

    Löwhagen, Olle

    2015-01-01

    Recent studies have shown a remarkably high frequency of poorly controlled asthma. Several reasons for this treatment failure have been discussed, however, the basic question of whether the diagnosis is always correct has not been considered. Follow-up studies have shown that in many patients asthma cannot be verified despite ongoing symptoms. Mechanisms other than bronchial obstruction may therefore be responsible. The current definition of asthma may also include symptoms that are related to mechanisms other than bronchial obstruction, the clinical hallmark of asthma. Based on a review of the four cornerstones of asthma - inflammation, hyperresponsiveness, bronchial obstruction and symptoms - the aim was to present some new aspects and suggestions related to the diagnosis of adult non-allergic asthma. Recent studies have indicated that "classic" asthma may sometimes be confused with asthma-like disorders such as airway sensory hyperreactivity, small airways disease, dysfunctional breathing, non-obstructive dyspnea, hyperventilation and vocal cord dysfunction. This confusion may be one explanation for the high proportion of misdiagnosis and treatment failure. The current diagnosis, focusing on bronchial obstruction, may be too "narrow". As there may be common mechanisms a broadening to include also non-obstructive disorders, forming an asthma syndrome, is suggested. Such broadening requires additional diagnostic steps, such as qualitative studies with analysis of reported symptoms, non-effort demanding methods for determining lung function, capsaicin test for revealing airway sensory hyperreactivity, careful evaluation of the therapeutic as well as diagnostic effect of corticosteroids and testing of suggested theories.

  6. Asthma exacerbation and proximity of residence to major roads: a population-based matched case-control study among the pediatric Medicaid population in Detroit, Michigan

    Directory of Open Access Journals (Sweden)

    Wahl Robert

    2011-04-01

    Full Text Available Abstract Background The relationship between asthma and traffic-related pollutants has received considerable attention. The use of individual-level exposure measures, such as residence location or proximity to emission sources, may avoid ecological biases. Method This study focused on the pediatric Medicaid population in Detroit, MI, a high-risk population for asthma-related events. A population-based matched case-control analysis was used to investigate associations between acute asthma outcomes and proximity of residence to major roads, including freeways. Asthma cases were identified as all children who made at least one asthma claim, including inpatient and emergency department visits, during the three-year study period, 2004-06. Individually matched controls were randomly selected from the rest of the Medicaid population on the basis of non-respiratory related illness. We used conditional logistic regression with distance as both categorical and continuous variables, and examined non-linear relationships with distance using polynomial splines. The conditional logistic regression models were then extended by considering multiple asthma states (based on the frequency of acute asthma outcomes using polychotomous conditional logistic regression. Results Asthma events were associated with proximity to primary roads with an odds ratio of 0.97 (95% CI: 0.94, 0.99 for a 1 km increase in distance using conditional logistic regression, implying that asthma events are less likely as the distance between the residence and a primary road increases. Similar relationships and effect sizes were found using polychotomous conditional logistic regression. Another plausible exposure metric, a reduced form response surface model that represents atmospheric dispersion of pollutants from roads, was not associated under that exposure model. Conclusions There is moderately strong evidence of elevated risk of asthma close to major roads based on the results obtained

  7. Asthma exacerbation and proximity of residence to major roads: a population-based matched case-control study among the pediatric Medicaid population in Detroit, Michigan

    Science.gov (United States)

    2011-01-01

    Background The relationship between asthma and traffic-related pollutants has received considerable attention. The use of individual-level exposure measures, such as residence location or proximity to emission sources, may avoid ecological biases. Method This study focused on the pediatric Medicaid population in Detroit, MI, a high-risk population for asthma-related events. A population-based matched case-control analysis was used to investigate associations between acute asthma outcomes and proximity of residence to major roads, including freeways. Asthma cases were identified as all children who made at least one asthma claim, including inpatient and emergency department visits, during the three-year study period, 2004-06. Individually matched controls were randomly selected from the rest of the Medicaid population on the basis of non-respiratory related illness. We used conditional logistic regression with distance as both categorical and continuous variables, and examined non-linear relationships with distance using polynomial splines. The conditional logistic regression models were then extended by considering multiple asthma states (based on the frequency of acute asthma outcomes) using polychotomous conditional logistic regression. Results Asthma events were associated with proximity to primary roads with an odds ratio of 0.97 (95% CI: 0.94, 0.99) for a 1 km increase in distance using conditional logistic regression, implying that asthma events are less likely as the distance between the residence and a primary road increases. Similar relationships and effect sizes were found using polychotomous conditional logistic regression. Another plausible exposure metric, a reduced form response surface model that represents atmospheric dispersion of pollutants from roads, was not associated under that exposure model. Conclusions There is moderately strong evidence of elevated risk of asthma close to major roads based on the results obtained in this population

  8. ENabling Reduction of Low-grade Inflammation in SEniors Pilot Study: Concept, Rationale, and Design.

    Science.gov (United States)

    Manini, Todd M; Anton, Stephen D; Beavers, Daniel P; Cauley, Jane A; Espeland, Mark A; Fielding, Roger A; Kritchevsky, Stephen B; Leeuwenburgh, Christiaan; Lewis, Kristina H; Liu, Christine; McDermott, Mary M; Miller, Michael E; Tracy, Russell P; Walston, Jeremy D; Radziszewska, Barbara; Lu, Jane; Stowe, Cindy; Wu, Samuel; Newman, Anne B; Ambrosius, Walter T; Pahor, Marco

    2017-09-01

    To test two interventions to reduce interleukin (IL)-6 levels, an indicator of low-grade chronic inflammation and an independent risk factor for impaired mobility and slow walking speed in older adults. The ENabling Reduction of low-Grade Inflammation in SEniors (ENRGISE) Pilot Study was a multicenter, double-blind, placebo-controlled randomized pilot trial of two interventions to reduce IL-6 levels. Five university-based research centers. Target enrollment was 300 men and women aged 70 and older with an average plasma IL-6 level between 2.5 and 30 pg/mL measured twice at least 1 week apart. Participants had low to moderate physical function, defined as self-reported difficulty walking one-quarter of a mile or climbing a flight of stairs and usual walk speed of less than 1 m/s on a 4-m usual-pace walk. Participants were randomized to losartan, omega-3 fish oil (ω-3), combined losartan and ω-3, or placebo. Randomization was stratified depending on eligibility for each group. A titration schedule was implemented to reach a dose that was safe and effective for IL-6 reduction. Maximal doses were 100 mg/d for losartan and 2.8 g/d for ω-3. IL-6, walking speed over 400 m, physical function (Short Physical Performance Battery), other inflammatory markers, safety, tolerability, frailty domains, and maximal leg strength were measured. Results from the ENRGISE Pilot Study will provide recruitment yields, feasibility, medication tolerance and adherence, and preliminary data to help justify a sample size for a more definitive randomized trial. The ENRGISE Pilot Study will inform a larger subsequent trial that is expected to have important clinical and public health implications for the growing population of older adults with low-grade chronic inflammation and mobility limitations. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

  9. The Rationale for Comparative Effectiveness of Tourist Potential Realization (Case Study of the Volga Region

    Directory of Open Access Journals (Sweden)

    Anna Nikolaevna Polukhina

    2016-11-01

    Full Text Available The article presents the analysis of long-term tourism development programs of the Volga Region. Great attention is given to the sector’s financing measures set out in development programs. Domestic and foreign tourist potential assessment methods are analyzed. Tourist potential dynamics of the Volga Region is studied based on expert opinion. Using econometric approach the authors study the correlation between tourism investments and incomes of the Volga Region for the past six years – from 2009 to 2014. The analysis was carried out using statistics provided by the Russian Tourism Association and the Federal State Statistics Service of the Russian Federation by category of profitability from paid tourist services and from hospitality and catering services. The conducted analysis helped construct the figures showing the differentiation of the Volga regions by tourism investment efficiency and tourist potential realization. It is shown that tourist potential of the territories and its realization are highly differentiated. The sub-regions of the Volga Region are divided into groups according to the effectiveness of potential realization. The effectiveness of implementation of natural recreational and historical and cultural potential is higher in the sub-regions where places of tourist accommodation and entertainment are developed enough, effective mechanisms for programs implementation control are formed and the indicators of expected effectiveness of measures implementation are elaborated. The study has revealed the need for the development of common indicators of expected final results of tourism development programs. The use of a unified system of standardized indicators should become the principle of monitoring the implementation of regional tourism development programs. Data obtained by the research will be useful for the improvement of the existing regional tourism development programs

  10. The Biomarkers of Exposure and Effect in Agriculture (BEEA) Study: Rationale, Design, Methods, and Participant Characteristics.

    Science.gov (United States)

    Hofmann, Jonathan N; Beane Freeman, Laura E; Lynch, Charles F; Andreotti, Gabriella; Thomas, Kent W; Sandler, Dale P; Savage, Sharon A; Alavanja, Michael C

    2015-01-01

    Agricultural exposures including pesticides, endotoxin, and allergens have been associated with risk of various cancers and other chronic diseases, although the biological mechanisms underlying these associations are generally unclear. To facilitate future molecular epidemiologic investigations, in 2010 the study of Biomarkers of Exposure and Effect in Agriculture (BEEA) was initiated within the Agricultural Health Study, a large prospective cohort in Iowa and North Carolina. Here the design and methodology of BEEA are described and preliminary frequencies for participant characteristics and current agricultural exposures are reported. At least 1,600 male farmers over 50 years of age will be enrolled in the BEEA study. During a home visit, participants are asked to complete a detailed interview about recent agricultural exposures and provide samples of blood, urine, and (since 2013) house dust. As of mid-September 2014, in total, 1,233 participants have enrolled. Most of these participants (83%) were still farming at the time of interview. Among those still farming, the most commonly reported crops were corn (81%) and soybeans (74%), and the most frequently noted animals were beef cattle (35%) and hogs (13%). There were 861 (70%) participants who reported occupational pesticide use in the 12 months prior to interview; among these participants, the most frequently noted herbicides were glyphosate (83%) and 2,4-D (72%), and most commonly reported insecticides were malathion (21%), cyfluthrin (13%), and permethrin (12%). Molecular epidemiologic investigations within BEEA have the potential to yield important new insights into the biological mechanisms through which these or other agricultural exposures influence disease risk.

  11. Children, parents, and pets exercising together (CPET randomised controlled trial: study rationale, design, and methods

    Directory of Open Access Journals (Sweden)

    Yam Philippa S

    2012-03-01

    Full Text Available Abstract Background Objectively measured physical activity is low in British children, and declines as childhood progresses. Observational studies suggest that dog-walking might be a useful approach to physical activity promotion in children and adults, but there are no published public health interventions based on dog-walking with children. The Children, Parents, and Pets Exercising Together Study aims to develop and evaluate a theory driven, generalisable, family-based, dog walking intervention for 9-11 year olds. Methods/design The Children, Parents, and Pets Exercising Together Study is an exploratory, assessor-blinded, randomised controlled trial as defined in the UK MRC Framework on the development and evaluation of complex interventions in public health. The trial will follow CONSORT guidance. Approximately 40 dog-owning families will be allocated randomly in a ratio of 1.5:1 to receive a simple behavioural intervention lasting for 10 weeks or to a 'waiting list' control group. The primary outcome is change in objectively measured child physical activity using Actigraph accelerometry. Secondary outcomes in the child, included in part to shape a future more definitive randomised controlled trial, are: total time spent sedentary and patterning of sedentary behaviour (Actigraph accelerometry; body composition and bone health from dual energy x-ray absorptiometry; body weight, height and BMI; and finally, health-related quality of life using the PedsQL. Secondary outcomes in parents and dogs are: changes in body weight; changes in Actigraph accelerometry measured physical activity and sedentary behaviour. Process evaluation will consist of assessment of simultaneous child, parent, and dog accelerometry data and brief interviews with participating families. Discussion The Children, Parents, and Pets Exercising Together trial should be the first randomised controlled study to establish and evaluate an intervention aimed at dog-based physical

  12. Children, parents, and pets exercising together (CPET) randomised controlled trial: study rationale, design, and methods.

    Science.gov (United States)

    Yam, Philippa S; Morrison, Ryan; Penpraze, Viki; Westgarth, Carri; Ward, Dianne S; Mutrie, Nanette; Hutchison, Pippa; Young, David; Reilly, John J

    2012-03-19

    Objectively measured physical activity is low in British children, and declines as childhood progresses. Observational studies suggest that dog-walking might be a useful approach to physical activity promotion in children and adults, but there are no published public health interventions based on dog-walking with children. The Children, Parents, and Pets Exercising Together Study aims to develop and evaluate a theory driven, generalisable, family-based, dog walking intervention for 9-11 year olds. The Children, Parents, and Pets Exercising Together Study is an exploratory, assessor-blinded, randomised controlled trial as defined in the UK MRC Framework on the development and evaluation of complex interventions in public health. The trial will follow CONSORT guidance. Approximately 40 dog-owning families will be allocated randomly in a ratio of 1.5:1 to receive a simple behavioural intervention lasting for 10 weeks or to a 'waiting list' control group. The primary outcome is change in objectively measured child physical activity using Actigraph accelerometry. Secondary outcomes in the child, included in part to shape a future more definitive randomised controlled trial, are: total time spent sedentary and patterning of sedentary behaviour (Actigraph accelerometry); body composition and bone health from dual energy x-ray absorptiometry; body weight, height and BMI; and finally, health-related quality of life using the PedsQL. Secondary outcomes in parents and dogs are: changes in body weight; changes in Actigraph accelerometry measured physical activity and sedentary behaviour. Process evaluation will consist of assessment of simultaneous child, parent, and dog accelerometry data and brief interviews with participating families. The Children, Parents, and Pets Exercising Together trial should be the first randomised controlled study to establish and evaluate an intervention aimed at dog-based physical activity promotion in families. It should advance our

  13. Evolving Concepts of Asthma

    Science.gov (United States)

    Ray, Anuradha; Wenzel, Sally E.

    2015-01-01

    Our understanding of asthma has evolved over time from a singular disease to a complex of various phenotypes, with varied natural histories, physiologies, and responses to treatment. Early therapies treated most patients with asthma similarly, with bronchodilators and corticosteroids, but these therapies had varying degrees of success. Similarly, despite initial studies that identified an underlying type 2 inflammation in the airways of patients with asthma, biologic therapies targeted toward these type 2 pathways were unsuccessful in all patients. These observations led to increased interest in phenotyping asthma. Clinical approaches, both biased and later unbiased/statistical approaches to large asthma patient cohorts, identified a variety of patient characteristics, but they also consistently identified the importance of age of onset of disease and the presence of eosinophils in determining clinically relevant phenotypes. These paralleled molecular approaches to phenotyping that developed an understanding that not all patients share a type 2 inflammatory pattern. Using biomarkers to select patients with type 2 inflammation, repeated trials of biologics directed toward type 2 cytokine pathways saw newfound success, confirming the importance of phenotyping in asthma. Further research is needed to clarify additional clinical and molecular phenotypes, validate predictive biomarkers, and identify new areas for possible interventions. PMID:26161792

  14. Diet and lifestyle intervention among patients with colorectal adenomas: rationale and design of a Malaysian study.

    Science.gov (United States)

    Kandiah, Mirnalini; Ramadas, Amutha; Shariff, Zalilah Mohd; Yusof, Rokiah Mohd; Gul, Yunus Gul Alif

    2005-01-01

    Comprehensive evaluation of the large body of consistent evidence from laboratory, epidemiologic and clinical studies has led to the conclusion that modification of the dietary and lifestyle patterns of populations has considerable potential for reducing cancer risk. This paper describes a randomized-controlled trial involving a diet and lifestyle intervention for patients with history of colorectal adenomas. The primary aim of this trial is to evaluate the effectiveness of the intervention with reference to recurrence of adenomatous polyps over a two year period--the first year being the intervention period and the second year of the study allowing for post-intervention follow-up. Subjects found to fit the inclusion criteria are recruited and randomized to two groups: the intervention group and the control group. The intervention group subjects will attend a monthly lecture-discussion session for 10 months and small group counseling on modification of lifestyle behavior and diet as well as receive educational materials which were adapted from the WCRF Diet and Health Recommendations for Cancer Prevention. Control subjects will be provided with the usual care given to such patients. One hundred and sixteen patients who were diagnosed with colorectal adenomatous polyps in the previous twelve months at the Hospital Kuala Lumpur have already been enrolled in this trial. Baseline data collection is on-going.

  15. Study protocol for improving asthma outcomes through cross-cultural communication training for physicians: a randomized trial of physician training.

    Science.gov (United States)

    Patel, Minal R; Thomas, Lara J; Hafeez, Kausar; Shankin, Matthew; Wilkin, Margaret; Brown, Randall W

    2014-06-16

    Massive resources are expended every year on cross-cultural communication training for physicians. Such training is a focus of continuing medical education nationwide and is part of the curriculum of virtually every medical school in America. There is a pressing need for evidence regarding the effects on patients of cross-cultural communication training for physicians. There is a need to understand the added benefit of such training compared to more general communication. We know of no rigorous study that has assessed whether cross-cultural communication training for physicians results in better health outcomes for their patients. The current study aims to answer this question by enhancing the Physician Asthma Care Education (PACE) program to cross cultural communication (PACE Plus), and comparing the effect of the enhanced program to PACE on the health outcomes of African American and Latino/Hispanic children with asthma. A three-arm randomized control trial is used to compare PACE Plus, PACE, and usual care. Both PACE and PACE Plus are delivered in two, two-hour sessions over a period of two weeks to 5-10 primary care physicians who treat African American and Latino/Hispanic children with asthma. One hundred twelve physicians and 1060 of their pediatric patients were recruited who self-identify as African American or Latino/Hispanic and experience persistent asthma. Physicians were randomized into receiving either the PACE Plus or PACE intervention or into the control group. The comparative effectiveness of PACE and PACE Plus on clinician's therapeutic and communication practices with the family/patient, children's urgent care use for asthma, asthma control, and quality of life, and parent/caretaker satisfaction with physician performance will be assessed. Data are collected via telephone survey and medical record review at baseline, 9 months following the intervention, and 21 months following the intervention. This study aims to reduce disparities in asthma

  16. Design, rationale, and baseline demographics of SEARCH I: a prospective cluster-randomized study

    Directory of Open Access Journals (Sweden)

    Albers F

    2012-07-01

    Full Text Available Frank Albers,1 Asif Shaikh,2 Ahmar Iqbal,31Medical Affairs Respiratory, 2Clinical Development and Medical Affairs, Field Based Medicine-Respiratory, Boehringer Ingelheim Pharmaceuticals, Inc, Ridgefield, CT, USA; 3Respiratory Medical Affairs, Pfizer Inc, New York, NY, USAAbstract: Questionnaires are available to identify patients at risk for several chronic diseases, including COPD, but are infrequently utilized in primary care. COPD is often underdiagnosed, while at the same time the US Preventive Services Task Force recommends against spirometric screening for COPD in asymptomatic adults. Use of a symptom-based questionnaire and subsequent handheld spirometric device depending on the answers to the questionnaire is a promising approach to identify patients at risk for COPD. Screening, Evaluating and Assessing Rate CHanges of diagnosing respiratory conditions in primary care 1 (SEARCH I was a prospective cluster-randomized study in 168 US primary care practices evaluating the effect of the COPD-Population Screener (COPD-PS™ questionnaire. The effect of this questionnaire alone or sequentially with the handheld copd-6TM device was evaluated on new diagnoses of COPD and on respiratory diagnostic practice patterns (including referrals for pulmonary function testing, referrals to pulmonologists, new diagnoses of COPD, and new respiratory medication prescriptions. Participating practices entered a total of 9704 consecutive consenting subjects aged ≥ 40 years attending primary care clinics. Study arm results were compared for new COPD diagnosis rates between usual care and (1 COPD-PS plus copd-6 and (2 COPD-PS alone. A cluster-randomization design allowed comparison of the intervention effects at the practice level instead of individuals being the subjects of the intervention. Regional principal investigators controlled the flow of study information to sub-investigators at participating practices to reduce observation bias (Hawthorne effect. The

  17. Rationale and design of the BUDAPEST-CRT Upgrade Study: a prospective, randomized, multicentre clinical trial.

    Science.gov (United States)

    Merkely, Bela; Kosztin, Annamaria; Roka, Attila; Geller, Laszlo; Zima, Endre; Kovacs, Attila; Boros, Andras Mihaly; Klein, Helmut; Wranicz, Jerzy K; Hindricks, Gerhard; Clemens, Marcell; Duray, Gabor Z; Moss, Arthur J; Goldenberg, Ilan; Kutyifa, Valentina

    2017-09-01

    There is lack of conclusive evidence from randomized clinical trials on the efficacy and safety of upgrade to cardiac resynchronization therapy (CRT) in patients with implanted pacemakers (PM) or defibrillators (ICD) with reduced left ventricular ejection fraction (LVEF) and chronic heart failure (HF). The BUDAPEST-CRT Upgrade Study was designed to compare the efficacy and safety of CRT upgrade from conventional PM or ICD therapy in patients with intermittent or permanent right ventricular (RV) septal/apical pacing, reduced LVEF, and symptomatic HF. The BUDAPEST-CRT study is a prospective, randomized, multicentre, investigator-sponsored clinical trial. A total of 360 subjects will be enrolled with LVEF ≤ 35%, NYHA functional classes II-IVa, paced QRS ≥ 150 ms, and a RV pacing ≥ 20%. Patients will be followed for 12 months. Randomization is performed in a 3:2 ratio (CRT-D vs. ICD). The primary composite endpoint is all-cause mortality, a first HF event, or less than 15% reduction in left ventricular (LV) end-systolic volume at 12 months. Secondary endpoints are all-cause mortality, all-cause mortality or HF event, and LV volume reduction at 12 months. Tertiary endpoints include changes in quality of life, NYHA functional class, 6 min walk test, natriuretic peptides, and safety outcomes. The results of our prospective, randomized, multicentre clinical trial will provide important information on the role of cardiac resynchronization therapy with defibrillator (CRT-D) upgrade in patients with symptomatic HF, reduced LVEF, and wide-paced QRS with intermittent or permanent RV pacing. NCT02270840. © The Author 2016. Published by Oxford University Press on behalf of the European Society of Cardiology.

  18. A Multi-site, Two-Phase, Prescription Opioid Addiction Treatment Study (POATS): Rationale, Design, and Methodology

    Science.gov (United States)

    Weiss, Roger D.; Potter, Jennifer Sharpe; Provost, Scott E.; Huang, Zhen; Jacobs, Petra; Hasson, Albert; Lindblad, Robert; Connery, Hilary Smith; Prather, Kristi; Ling, Walter

    2010-01-01

    The National Institute on Drug Abuse Clinical Trials Network launched the Prescription Opioid Addiction Treatment Study (POATS) in response to rising rates of prescription opioid dependence and gaps in understanding the optimal course of treatment for this population. POATS employed a multi-site, two-phase adaptive, sequential treatment design to approximate clinical practice. The study took place at 10 community treatment programs around the United States. Participants included men and women age ≥18 who met Diagnostic and Statistical Manual, 4th Edition criteria for dependence upon prescription opioids, with physiologic features; those with a prominent history of heroin use (according to pre-specified criteria) were excluded. All participants received buprenorphine/naloxone (bup/nx). Phase 1 consisted of 4 weeks of bup/nx treatment, including a 14-day dose taper, with 8 weeks of follow-up. Phase 1 participants were monitored for treatment response during these 12 weeks. Those who relapsed to opioid use, as defined by pre-specified criteria, were invited to enter Phase 2; Phase 2 consisted of 12 weeks of bup/nx stabilization treatment, followed by a 4-week taper and 8 weeks of post-treatment follow-up. Participants were randomized at the beginning of Phase 1 to receive bup/nx, paired with either Standard Medical Management (SMM) or Enhanced Medical Management (EMM; defined as SMM plus individual drug counseling). Eligible participants entering Phase 2 were re-randomized to either EMM or SMM. POATS was developed to determine what benefit, if any, EMM offers over SMM in short-term and longer-term treatment paradigm. This paper describes the rationale and design of the study. PMID:20116457

  19. Early incidence of occupational asthma among young bakers, pastry-makers and hairdressers: design of a retrospective cohort study.

    Science.gov (United States)

    Rémen, Thomas; Coevoet, Vincent; Acouetey, Dovi-Stéphanie; Guéant, Jean-Louis; Guéant-Rodriguez, Rosa-Maria; Paris, Christophe; Zmirou-Navier, Denis

    2010-04-26

    Occupational exposures are thought to be responsible for 10-15% of new-onset asthma cases in adults, with disparities across sectors. Because most of the data are derived from registries and cross-sectional studies, little is known about incidence of occupational asthma (OA) during the first years after inception of exposure. This paper describes the design of a study that focuses on this early asthma onset period among young workers in the bakery, pastry making and hairdressing sectors in order to assess early incidence of OA in these "at risk" occupations according to exposure duration, and to identify risk factors of OA incidence. The study population is composed of subjects who graduated between 2001 and 2006 in these sectors where they experience exposure to organic or inorganic allergenic or irritant compounds (with an objective of 150 subjects by year) and 250 young workers with no specific occupational exposure. A phone interview focusing on respiratory and 'Ear-Nose-Throat' (ENT) work-related symptoms screen subjects considered as "possibly OA cases". Subjects are invited to participate in a medical visit to complete clinical and lung function investigations, including fractional exhaled nitric oxide (FENO) and carbon monoxide (CO) measurements, and to collect blood samples for IgE (Immunoglobulin E) measurements (total IgE and IgE for work-related and common allergens). Markers of oxidative stress and genetic polymorphisms exploration are also assessed. A random sample of 200 "non-cases" (controls) is also visited, following a nested case-control design. This study may allow to describ a latent period between inception of exposure and the rise of the prevalence of asthma symptoms, an information that would be useful for the prevention of OA. Such a time frame would be suited for conducting screening campaigns of this emergent asthma at a stage when occupational hygiene measures and adapted therapeutic interventions might be effective. Clinical trial

  20. Danish pain specialists' rationales behind the choice of fentanyl transdermal patches and oral transmucosal systems-A Delphi study

    DEFF Research Database (Denmark)

    Jacobsen, Ramune; Møldrup, Claus; Christrup, Lona

    2009-01-01

    survey. Response rates were 45% in the brainstorming and 88% in the rating phases, respectively. Statistical analysis with SPSS for Windows 15.00 included descriptive statistics and factor analysis. Results. The most important rationale to choose fentanyl patches was that patients' clinical condition did...

  1. Nature of Science Progression in School Year 1-9: a Case Study of Teachers' Suggestions and Rationales

    Science.gov (United States)

    Leden, Lotta; Hansson, Lena

    2017-07-01

    The inclusion of nature of science (NOS) in science education has for a long time been regarded as crucial. There is, however, a lack of research on appropriate NOS aspects for different educational levels. An even more neglected area of research is that focusing on teachers' perspectives on NOS teaching at different levels. The aim of this article is to examine NOS progression in the light of teachers' suggestions and rationales. In order to obtain teachers' informed perspectives, we chose to involve six teachers (teaching grades 1-9) in a 3-year research project. They took part in focus group discussions about NOS and NOS teaching as well as implemented jointly planned NOS teaching sessions. Data that this article builds on was collected at the end of the project. The teachers' suggestions for NOS progression often relied on adding more NOS issues at every stage, thereby creating the foundations of a broader but not necessarily deeper understanding of NOS. Five rationales, for if/when specific NOS issues are appropriate to introduce, emerged from the analysis of the teacher discussions. Some of these rationales, including practice makes perfect and increasing levels of depth can potentially accommodate room for many NOS issues in the science classroom, while maturity and experience instead has a restricting effect on NOS teaching. Also, choice of context and teaching approaches play an important role in teachers' rationales for whether specific NOS issues should be included or not at different stages. The article discusses the implications for teacher education and professional development.

  2. The role of trait mindfulness in quality of life and asthma control among adolescents with asthma.

    Science.gov (United States)

    Cillessen, Linda; van de Ven, Monique O; Karremans, Johan C

    2017-08-01

    The current study focused on the role of trait mindfulness in asthma-related quality of life (QoL) and asthma control in adolescent asthma patients. Furthermore, potential underlying mechanisms (general and asthma-specific stress) of this relationship were investigated. In this cross-sectional study, questionnaire data of 94 adolescents with asthma that were prescribed daily asthma medication were included. Two Structural Equation Models (SEMs), a direct model and an indirect model, were tested. We found that trait mindfulness was directly related to asthma-related QoL, but not to asthma control. The relationship between trait mindfulness and asthma-related QoL was explained by asthma-specific, but not by general stress. Furthermore, an indirect relation from mindfulness to asthma control via asthma-specific stress was found. Cross-sectional evidence for a relation between mindfulness and asthma-related QoL is found. These findings may point to the possibility that an intervention aimed at increasing mindfulness could be a promising tool to improve asthma-related QoL in adolescents via a decrease in asthma-specific stress. Copyright © 2017. Published by Elsevier Inc.

  3. Rationale and design of South Asian Birth Cohort (START: a Canada-India collaborative study

    Directory of Open Access Journals (Sweden)

    Anand Sonia S

    2013-01-01

    Full Text Available Abstract Background People who originate from the Indian subcontinent (South Asians suffer among the highest rates of type 2 diabetes in the world. Prior evidence suggests that metabolic risk factors develop early in life and are influenced by maternal and paternal behaviors, the intrauterine environment, and genetic factors. The South Asian Birth Cohort Study (START will investigate the environmental and genetic basis of adiposity among 750 South Asian offspring recruited from highly divergent environments, namely, rural and urban India and urban Canada. Methods Detailed information on health behaviors including diet and physical activity, and blood samples for metabolic parameters and DNA are collected from pregnant women of South Asian ancestry who are free of significant chronic disease. They also undergo a provocative test to diagnose impaired glucose tolerance and gestational diabetes. At delivery, cord blood and newborn anthropometric indices (i.e. birth weight, length, head circumference and skin fold thickness are collected. The mother and growing offspring are followed prospectively and information on the growth trajectory, adiposity and health behaviors will be collected annually up to age 3 years. Our aim is to recruit a minimum of 750 mother-infant pairs equally divided between three divergent environments: rural India, urban India, and Canada. Summary The START cohort will increase our understanding of the environmental and genetic determinants of adiposity and related metabolic abnormalities among South Asians living in India and Canada.

  4. Canadian Alliance for Healthy Hearts and Minds: First Nations Cohort Study Rationale and Design.

    Science.gov (United States)

    Anand, Sonia S; Abonyi, Sylvia; Arbour, Laura; Brook, Jeff; Bruce, Sharon; Castleden, Heather; Desai, Dipika; de Souza, Russell J; Harris, Stewart; Irvine, James; Lai, Christopher; Lewis, Diana; Oster, Richard T; Poirier, Paul; Toth, Ellen L; Bannon, Karen; Chrisjohn, Vicky; Davis, Albertha D; L'Hommecourt, Jean; Littlechild, Randy; McMullin, Kathleen; McIntosh, Sarah; Morrison, Julie; Picard, Manon; Landing First Nation, Pictou; M Thomas, Melissa; Tusevljak, Natasa; Friedrich, Matthias G; Tu, Jack V

    2018-01-01

    This is the first national indigenous cohort study in which a common, in-depth protocol with a common set of objectives has been adopted by several indigenous communities across Canada. The overarching objective of the Canadian Alliance for Healthy Hearts and Minds (CAHHM) cohort is to investigate how the community-level environment is associated with individual health behaviors and the presence and progression of chronic disease risk factors and chronic diseases such as cardiovascular disease (CVD) and cancer. CAHHM aims to recruit approximately 2,000 First Nations indigenous individuals from up to nine communities across Canada and have participants complete questionnaires, blood collection, physical measurements, cognitive assessments, and magnetic resonance imaging (MRI). Through individual- and community-level data collection, we will develop an understanding of the specific role of the socioenvironmental, biological, and contextual factors have on the development of chronic disease risk factors and chronic diseases. Information collected in the indigenous cohort will be used to assist communities to develop local management strategies for chronic disease, and can be used collectively to understand the contextual, environmental, socioeconomic, and biological determinants of differences in health status in harmony with First Nations beliefs and reality.

  5. Alpha-hydroxyacid chemical peeling agents: case studies and rationale for safe and effective use.

    Science.gov (United States)

    Briden, M Elizabeth

    2004-02-01

    Chemical peeling is an in-office procedure that involves the application of a chemical agent to the skin to induce controlled destruction or exfoliation of old skin and stimulation of new epidermal growth with more evenly distributed melanin. When peel agents reach the dermal layer, important wound-healing activities occur that cause skin remodeling and skin smoothing, both antiaging benefits. There are a number of key factors in selecting a peeling agent and procedure, and each is discussed. Variables to consider are the peeling agent and its formulation, the concentration of the agent, the patient's skin type, the site to be peeled, the skin preparation procedure prior to and immediately preceding the application of the agent, the application method, the duration of contact, and the patient's medical history and lifestyle. Various types of peels are discussed. Of particular interest are superficial chemical peels, which offer great flexibility over a range of skin types and conditions with minimal to no "downtime." Alpha-hydroxyacid (AHA) peels are superficial and can be combined with other cosmetic procedures in the office to maximize benefits. In addition, AHA peels work well when combined with supportive homecare products including AHAs or polyhydroxy acids (PHAs), topical retinoids, and antiacne/antirosacea treatments. Case studies are presented of patients using AHA peels for the treatment of acne and hyperpigmentation in a variety of skin types, including Asian skin.

  6. The Japan Statin Treatment Against Recurrent Stroke (J-STARS) Echo Study: Rationale and Trial Protocol.

    Science.gov (United States)

    Toyoda, Kazunori; Minematsu, Kazuo; Yasaka, Masahiro; Nagai, Yoji; Hosomi, Naohisa; Origasa, Hideki; Kitagawa, Kazuo; Uchiyama, Shinichiro; Koga, Masatoshi; Matsumoto, Masayasu

    2017-03-01

    The preventive effect of 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors (statins) on progression of carotid intima-media complex thickness (IMT) has been shown exclusively in nonstroke Western patients. The Japan Statin Treatment Against Recurrent Stroke (J-STARS) Echo Study aims to determine the effect of pravastatin on carotid IMT in Japanese patients with hyperlipidemia who developed noncardioembolic ischemic stroke. This is a substudy of the J-STARS, a multicenter, randomized, open-label, blinded-end point, parallel-group trial to examine whether pravastatin reduces stroke recurrence in patients with noncardioembolic stroke. The patients are randomized to receive pravastatin (10 mg daily) or not to receive any statins. Carotid ultrasonography is performed by well-trained certified examiners in each participating institute, and the recorded data are measured centrally. The primary outcome is change in the IMT of the distal wall in a consecutive 2-cm section on the central side of the common carotid artery bifurcation over 5 years of observation. The trial may help determine if the usual dose of pravastatin for daily clinical practice in Japan can affect carotid IMT in Japanese patients with noncardioembolic stroke. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  7. The healthy worker effect in asthma: work may cause asthma, but asthma may also influence work.

    Science.gov (United States)

    Le Moual, Nicole; Kauffmann, Francine; Eisen, Ellen A; Kennedy, Susan M

    2008-01-01

    Despite the increasing attention to the relationship between asthma and work exposures, occupational asthma remains underrecognized and its population burden underestimated. This may be due, in part, to the fact that traditional approaches to studying asthma in populations cannot adequately take into account the healthy worker effect (HWE). The HWE is the potential bias caused by the phenomenon that sicker individuals may choose work environments in which exposures are low; they may be excluded from being hired; or once hired, they may seek transfer to less exposed jobs or leave work. This article demonstrates that population- and workplace-based asthma studies are particularly subject to HWE bias, which leads to underestimates of relative risks. Our objective is to describe the HWE as it relates to asthma research, and to discuss the significance of taking HWE bias into account in designing and interpreting asthma studies. We also discuss the importance of understanding HWE bias for public health practitioners and for clinicians. Finally, we emphasize the timeliness of this review in light of the many longitudinal "child to young adult" asthma cohort studies currently underway. These prospective studies will soon provide an ideal opportunity to examine the impact of early workplace environments on asthma in young adults. We urge occupational and childhood asthma epidemiologists collaborate to ensure that this opportunity is not lost.

  8. Health-related quality of life in asthma studies. Can we combine data from different countries?

    Science.gov (United States)

    Ståhl, E; Postma, D S; Juniper, E F; Svensson, K; Mear, I; Löfdahl, C-G

    2003-01-01

    The aim was to compare health-related quality of life (HRQL) in patients with asthma from 4 countries, and to investigate the correlations between HRQL and clinical indices.341 patients; 140 (Sweden), 54 (Norway), 65 (the Netherlands) and 82 (Greece) were treated with formoterol fumarate 4.5 microg or with terbutaline sulphate 0.5mg for 12 weeks inhaled 'on demand' via Turbuhaler. The Asthma Quality of Life Questionnaire (AQLQ) and clinical indices were assessed. The mean baseline AQLQ overall scores in Sweden (4.97), in the Netherlands (5.04), in Norway (4.68) and in Greece (4.68) were in the same range, however, with a significant difference between the four countries (p=0.038). When comparing AQLQ, activity limitation and symptoms domains, the differences between the countries were not statistically significant. The cross-sectional correlations between AQLQ overall score and the clinical indices were similar in all four countries. The magnitude of change in AQLQ was consistent with the other clinical variables. The correlations between change in AQLQ overall score and change in clinical indices were low to medium in all countries. In conclusion, the consistency of cross-sectional correlations between the AQLQ overall and clinical indices across countries supports the validity of translations of the AQLQ used in this study. There were differences in baseline values between the countries. The treatment response in AQLQ differed to the same extent as other clinical indices. When combining HRQL data from different countries, there might be cultural, gender and socio-economic differences, explaining different responses to treatment.

  9. Childhood asthma in Beijing, China: A population-based case-control study

    Energy Technology Data Exchange (ETDEWEB)

    Zheng, T.Z.; Niu, S.R.; Lu, B.Y.; Fan, X.E.; Sun, F.Y.; Wang, J.P.; Zhang, Y.W.; Zhang, B.; Owens, P.; Hao, L.Y.; Li, Y.D.; Leaderer, B. [Yale School of Medicine, New Haven, CT (United States). Dept. of Epidemiology & Public Health

    2002-11-15

    A population-based case-control study was conducted in Shunyi County, People's Republic of China, in January 1999 and March 2001 to investigate the risk factors for childhood asthma. An increased risk of childhood asthma was associated with smoking by relatives in front of the mother while she was pregnant with the child (odds ratio (OR) = 1.3, 95% confidence interval (CI): 1.0, 1.6) and with smoking by relatives in front of the child (OR = 1.4, 95% CI: 1.1, 1.9). The risk increased with the increasing number of smokers and the total minutes of smoking by relatives in front of both the child and the mother while she was pregnant with the child. An increased risk was observed for use of coal for heating (OR = 1.5, 95% CI: 1.1, 1.9). Those who reported using coal for cooking without ventilation also had an increased risk (OR = 2.3, 95% CI: 1.5, 3.5). An increased risk was observed for those who reported having molds or fungi on the ceilings of their houses (OR = 1.8, 95% CI: 1.1, 2.9) or inside the child's room (OR 1.8, 95% CI: 1.0, 3.2). An increased risk was also found for those having both a dog and a cat as pets (OR 1.5, 95% CI: 1.0, 2.3) or for finding both cockroaches and rats inside their houses (OR = 1.8, 95% CI: 1.2, 2.8).

  10. PROspective Multicenter Imaging Study for Evaluation of chest pain: rationale and design of the PROMISE trial.

    Science.gov (United States)

    Douglas, Pamela S; Hoffmann, Udo; Lee, Kerry L; Mark, Daniel B; Al-Khalidi, Hussein R; Anstrom, Kevin; Dolor, Rowena J; Kosinski, Andrzej; Krucoff, Mitchell W; Mudrick, Daniel W; Patel, Manesh R; Picard, Michael H; Udelson, James E; Velazquez, Eric J; Cooper, Lawton

    2014-06-01

    Suspected coronary artery disease (CAD) is one of the most common, potentially life-threatening diagnostic problems clinicians encounter. However, no large outcome-based randomized trials have been performed to guide the selection of diagnostic strategies for these patients. The PROMISE study is a prospective, randomized trial comparing the effectiveness of 2 initial diagnostic strategies in patients with symptoms suspicious for CAD. Patients are randomized to either (1) functional testing (exercise electrocardiogram, stress nuclear imaging, or stress echocardiogram) or (2) anatomical testing with ≥64-slice multidetector coronary computed tomographic angiography. Tests are interpreted locally in real time by subspecialty certified physicians, and all subsequent care decisions are made by the clinical care team. Sites are provided results of central core laboratory quality and completeness assessment. All subjects are followed up for ≥1 year. The primary end point is the time to occurrence of the composite of death, myocardial infarction, major procedural complications (stroke, major bleeding, anaphylaxis, and renal failure), or hospitalization for unstable angina. More than 10,000 symptomatic subjects were randomized in 3.2 years at 193 US and Canadian cardiology, radiology, primary care, urgent care, and anesthesiology sites. Multispecialty community practice enrollment into a large pragmatic trial of diagnostic testing strategies is both feasible and efficient. The PROMISE trial will compare the clinical effectiveness of an initial strategy of functional testing against an initial strategy of anatomical testing in symptomatic patients with suspected CAD. Quality of life, resource use, cost-effectiveness, and radiation exposure will be assessed. Copyright © 2014 Mosby, Inc. All rights reserved.

  11. Relationship between volition, physical activity and weight loss maintenance: Study rationale, design, methods and baseline characteristics.

    Science.gov (United States)

    Dandanell, Sune; Elbe, Anne-Marie; Pfister, Gertrud; Elsborg, Peter; W Helge, Jørn

    2017-05-01

    To investigate the relationship between volition, physical activity and weight loss maintenance. We recruited 84 sedentary (maximal oxygen uptake: 25 ± 5 ml/min), overweight and obese (Body mass index (BMI) 38 ± 7 m/h 2 , fat 44 ± 7 %) women ( n = 55) and men ( n = 29) for an interdisciplinary prospective study with follow-up. The change in lifestyle and weight loss is promoted via a 3-month intensive lifestyle intervention at a private health school. The intervention consists of supervised training (1-3 hours/day), a healthy hypo-caloric diet (-500 to -700 kCal/day) and education in healthy lifestyle in classes/groups. The participants' body weight and composition (Dual Energy X-ray absorptiometry), volitional skills (questionnaire), physical activity level (heart rate accelerometer/questionnaire) and maximal oxygen uptake (indirect calorimetry) are to be monitored before, after, and 3 and 12 months after the intervention. At the 12-month follow-up, three different groups will be established: Clinical weight loss maintenance (> 10% weight loss from baseline), moderate weight loss maintenance (1-10% weight loss) and no weight loss (or weight regain). A linear mixed model analysis will be used to compare levels of volitional skills, physical activity and maximal oxygen uptake over time, between the three groups. Correlational analyses will be used to investigate possible associations between volition, maximal oxygen uptake, physical activity level and weight loss maintenance. If specific volitional skills are identified as predictors of adherence to physical activity and success in clinical weight loss maintenance, these can be trained in future intensive lifestyle interventions in order to optimize the success rate.

  12. Texas Medication Algorithm Project, phase 3 (TMAP-3): rationale and study design.

    Science.gov (United States)

    Rush, A John; Crismon, M Lynn; Kashner, T Michael; Toprac, Marcia G; Carmody, Thomas J; Trivedi, Madhukar H; Suppes, Trisha; Miller, Alexander L; Biggs, Melanie M; Shores-Wilson, Kathy; Witte, Bradley P; Shon, Steven P; Rago, William V; Altshuler, Kenneth Z

    2003-04-01

    Medication treatment algorithms may improve clinical outcomes, uniformity of treatment, quality of care, and efficiency. However, such benefits have never been evaluated for patients with severe, persistent mental illnesses. This study compared clinical and economic outcomes of an algorithm-driven disease management program (ALGO) with treatment-as-usual (TAU) for adults with DSM-IV schizophrenia (SCZ), bipolar disorder (BD), and major depressive disorder (MDD) treated in public mental health outpatient clinics in Texas. The disorder-specific intervention ALGO included a consensually derived and feasibility-tested medication algorithm, a patient/family educational program, ongoing physician training and consultation, a uniform medical documentation system with routine assessment of symptoms and side effects at each clinic visit to guide ALGO implementation, and prompting by on-site clinical coordinators. A total of 19 clinics from 7 local authorities were matched by authority and urban status, such that 4 clinics each offered ALGO for only 1 disorder (SCZ, BD, or MDD). The remaining 7 TAU clinics offered no ALGO and thus served as controls (TAUnonALGO). To determine if ALGO for one disorder impacted care for another disorder within the same clinic ("culture effect"), additional TAU subjects were selected from 4 of the ALGO clinics offering ALGO for another disorder (TAUinALGO). Patient entry occurred over 13 months, beginning March 1998 and concluding with the final active patient visit in April 2000. Research outcomes assessed at baseline and periodically for at least 1 year included (1) symptoms, (2) functioning, (3) cognitive functioning (for SCZ), (4) medication side effects, (5) patient satisfaction, (6) physician satisfaction, (7) quality of life, (8) frequency of contacts with criminal justice and state welfare system, (9) mental health and medical service utilization and cost, and (10) alcohol and substance abuse and supplemental substance use information

  13. A Pilot Study: Effects of Dietary Supplementation with α-Linolenic Acid-Enriched Perilla Seed Oil on Bronchial Asthma

    Directory of Open Access Journals (Sweden)

    Kozo Ashida

    1997-01-01

    Full Text Available N-3 fatty acids, such as fish oil, have been reported to have some beneficial effects in patients with bronchial asthma. The effects of dietary supplementation with perilla seed oil rich in a-linolenic acid (α-LNA, parent n-3 fatty acid, were studied in five patients with asthma. The symptoms of asthma and mean peak flow rates (PFR both early in the morning and in the evening were improved 2 weeks after dietary supplementation and the increases in PFR were significant (P<0.05. The generation of leukotriene B4 (LTB4 by peripheral leukocytes stimulated with the Ca2+ ionophore A23187 was significantly suppressed from 77.6 to 41.6 ng/5Xl06 cells by dietary supplementation (P<0.05. The generation of leukotriene C4 (LTC4 by leukocytes was also significantly suppressed from 64.0 to 38.8 ng/5x106 cells after supplementation with perilla seed oil (P<0.05. These results suggest that dietary supplementation with perilla seed oil is beneficial for the treatment of asthma.

  14. Study design, objectives, hypotheses, main findings, health consequences for the population exposed, rationale of future research

    Energy Technology Data Exchange (ETDEWEB)

    Trnovec, T.; Kocan, A. [Slovak Medical Univ., Bratislava (Slovakia); Bencko, V. [Charles Univ., Prague (Czech Republic); Langer, P. [Institute of Experimental Endocrinology SAS, Bratislava (Slovakia); Berg, M. van den [Rijksuniversiteit Utrecht (Netherlands); Bergman, A. [Stockholm Univ. (Sweden); Hustak, M. [Air Force Military Hospital, Kosics (Slovakia)

    2004-09-15

    In Slovakia, the Chemko Chemical Company, based in Strazske, in the Michalovce district, produced PCBs between 1959 and 1984, in the amount of more than 21,000 tons of commercial mixtures (Delor 103, 104, 105, 106, Delotherm DK and DH, Hydelor 137). PCBs were used for similar industrial purposes as in the west. Improper disposal from the Chemko plant via release of effluent directly into the Laborec River resulted in long-term contamination of sediment. As a result eastern Slovakia, the Michalovce district in particular, is recognized as one of the areas all over the world most heavily polluted with PCBs. Historical studies show that blood and adipose PCB levels were higher in Czechoslovakia than elsewhere in the 1970's and 1980's. Current data indicate that persons who eat locally raised food - pork, beef, poultry, eggs - in this district have elevated serum concentrations of PCBs. Environmental exposure to organochlorines in the Michalovce district indicate association with higher rates of certain cancers, but an inverse association with risk of breast cancer. An increased prevalence of thyroid disorders in the polluted area was also reported. This ''experimental setting in nature'' has attracted international scientific teams and two projects in the area are ongoing: Evaluating Human Health Risk from Low-dose and Long-term PCB Exposure, 5{sup th} FP Project QLK4-2000-00488, 2001- 2004; PCBRISK (http://www.pcbrisk.sk/) and Early Childhood Development and PCB Exposures in Slovakia, NCI/NIH, R01-CA96525 University of California, Davis, USA. This paper is serving as an introduction to papers of a session reporting on various health outcomes associated with PCB exposure. The objectives of the PCBRISK project were targeted at an evaluation of the human health risks of low-dose and long-term exposure to a group of persistent organochlorine pollutants, including polychlorinated biphenyls (PCBs) and their metabolites, organochlorine

  15. Security controls in an integrated Biobank to protect privacy in data sharing: rationale and study design.

    Science.gov (United States)

    Takai-Igarashi, Takako; Kinoshita, Kengo; Nagasaki, Masao; Ogishima, Soichi; Nakamura, Naoki; Nagase, Sachiko; Nagaie, Satoshi; Saito, Tomo; Nagami, Fuji; Minegishi, Naoko; Suzuki, Yoichi; Suzuki, Kichiya; Hashizume, Hiroaki; Kuriyama, Shinichi; Hozawa, Atsushi; Yaegashi, Nobuo; Kure, Shigeo; Tamiya, Gen; Kawaguchi, Yoshio; Tanaka, Hiroshi; Yamamoto, Masayuki

    2017-07-06

    With the goal of realizing genome-based personalized healthcare, we have developed a biobank that integrates personal health, genome, and omics data along with biospecimens donated by volunteers of 150,000. Such a large-scale of data integration involves obvious risks of privacy violation. The research use of personal genome and health information is a topic of global discussion with regard to the protection of privacy while promoting scientific advancement. The present paper reports on our plans, current attempts, and accomplishments in addressing security problems involved in data sharing to ensure donor privacy while promoting scientific advancement. Biospecimens and data have been collected in prospective cohort studies with the comprehensive agreement. The sample size of 150,000 participants was required for multiple researches including genome-wide screening of gene by environment interactions, haplotype phasing, and parametric linkage analysis. We established the T ohoku M edical M egabank (TMM) data sharing policy: a privacy protection rule that requires physical, personnel, and technological safeguards against privacy violation regarding the use and sharing of data. The proposed policy refers to that of NCBI and that of the Sanger Institute. The proposed policy classifies shared data according to the strength of re-identification risks. Local committees organized by TMM evaluate re-identification risk and assign a security category to a dataset. Every dataset is stored in an assigned segment of a supercomputer in accordance with its security category. A security manager should be designated to handle all security problems at individual data use locations. The proposed policy requires closed networks and IP-VPN remote connections. The mission of the biobank is to distribute biological resources most productively. This mission motivated us to collect biospecimens and health data and simultaneously analyze genome/omics data in-house. The biobank also has the

  16. Do Allergies Cause Asthma?

    Science.gov (United States)

    ... Development Infections Diseases & Conditions Pregnancy & Baby Nutrition & Fitness Emotions & Behavior School & Family Life First Aid & Safety Doctors & ... Can I Deal With My Asthma? Allergy Testing Definition: Allergy-Triggered Asthma Asthma Center Asthma View more ...

  17. Do Allergies Cause Asthma?

    Science.gov (United States)

    ... for Educators Search English Español Do Allergies Cause Asthma? KidsHealth / For Parents / Do Allergies Cause Asthma? Print ... son la causa del asma? Do Allergies Cause Asthma? Allergies don't cause asthma. But kids who ...

  18. School and Asthma

    Science.gov (United States)

    ... Videos for Educators Search English Español School and Asthma KidsHealth / For Kids / School and Asthma Print en ... Let's find out. Why Do I Need an Asthma Action Plan? When you're dealing with asthma, ...

  19. Exercise and Asthma

    Science.gov (United States)

    ... Español Text Size Email Print Share Exercise and Asthma Page Content Article Body Almost every child (and ... of Pediatrics about asthma and exercise. What is asthma Asthma is the most common chronic medical problem ...

  20. Asthma and Hispanic Americans

    Science.gov (United States)

    ... and Data > Minority Population Profiles > Hispanic/Latino > Asthma Asthma and Hispanic Americans In 2015, 2.2 million Hispanics reported that they currently have asthma. Puerto Rican Americans have almost twice the asthma ...

  1. The Action to Control Cardiovascular Risk in Diabetes Memory in Diabetes Study (ACCORD-MIND): rationale, design, and methods.

    Science.gov (United States)

    Williamson, Jeff D; Miller, Michael E; Bryan, R Nick; Lazar, Ronald M; Coker, Laura H; Johnson, Janice; Cukierman, Tali; Horowitz, Karen R; Murray, Anne; Launer, Lenore J

    2007-06-18

    Type 2 diabetes mellitus and cognitive impairment are 2 of the most common chronic conditions found in persons aged > or = 60 years. Clinical studies have shown a greater prevalence of global cognitive impairment, incidence of cognitive decline, and incidence of Alzheimer disease in patients with type 2 diabetes. To date, there have been no randomized trials of the effects of long-term glycemic control on cognitive function and structural brain changes in patients with type 2 diabetes. The primary aim of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Memory in Diabetes Study (ACCORD-MIND) is to test whether there is a difference in the rate of cognitive decline and structural brain change in patients with diabetes treated with standard-care guidelines compared with those treated with intensive-care guidelines. This comparison will be made in a subsample of 2,977 patients with diabetes participating in the ongoing ACCORD trial, a clinical trial sponsored by the National Heart, Lung, and Blood Institute (NHLBI) with support from the National Institute on Aging (NIA). Data from this ACCORD substudy on the possible beneficial or adverse effects of intensive treatment on cognitive function will be obtained from a 30-minute test battery, administered at baseline and 20-month and 40-month visits. In addition, full-brain magnetic resonance imaging will be performed on 630 participants at baseline and at 40 months to assess the relation between the ACCORD treatments and structural brain changes. The general aim of ACCORD-MIND is to determine whether the intensive treatment of diabetes, a major risk factor for Alzheimer disease and vascular dementia, can reduce the early decline in cognitive function that could later evolve into more cognitively disabling conditions. This report presents the design, rationale, and methods of the ACCORD-MIND substudy.

  2. Small sustainable monetary incentives versus charitable donations to promote exercise: Rationale, design, and baseline data from a randomized pilot study.

    Science.gov (United States)

    Williams, David M; Lee, Harold H; Connell, Lauren; Boyle, Holly; Emerson, Jessica; Strohacker, Kelley; Galárraga, Omar

    2018-03-01

    Regular physical activity (PA) enhances weight-loss and reduces risk of chronic disease. However, as few as 10% of U.S. adults engage in regular PA. Incentive programs to promote PA have shown some promise, but have typically used incentives that are too large to sustain over time and have not demonstrated habit formation or been tested in community settings. This report presents the rationale and design of a randomized pilot study testing the feasibility and preliminary efficacy of small monetary incentives for PA (n=25) versus charitable donations in the same amount (n=25) versus control (n=25) over 12months among 75 low-active but otherwise healthy adults at a local YMCA. Incentives are based on YMCA attendance, which is verified by electronic swipe card data and is the primary study outcome, with self-reported minutes/week of PA assessed as a secondary outcome. Incentives are intentionally small enough-$1/session, maximum of $5/week-such that they could be indefinitely sustained by community organizations, privately-owned health clubs, healthcare organizations, or employers (e.g., employer fitness facilities). Costs of the incentive program for the sponsoring organization may be partially offset by increases in membership resulting from the appeal of the program. Moreover, if efficacious, the charitable donation incentive program may have the added benefit of building social capital for the sponsoring organization and potentially serving as a tax write-off, thus further offsetting the cost of the incentives. Findings will also have implications for the use of financially sustainable community-based incentive programs for other health-related behaviors (e.g., weight loss, smoking). Copyright © 2018 Elsevier Inc. All rights reserved.

  3. Know How to Use Your Asthma Inhaler

    Medline Plus

    Full Text Available ... Case Studies Open Airways for Schools Asthma Care Training Wee Wheezers Adventures of Puff Inner City Asthma ... Mixed Methods 5. Purpose Informs Design Other Evaluation Resources Multimedia ... USA.gov TOP

  4. Exploring asthma in the workplace: A triangulation of perspectives from management, employees and people with asthma.

    Science.gov (United States)

    Zhao, Denise H; Cheung, Janet M Y; Smith, Lorraine; Saini, Bandana

    2017-08-31

    People with asthma spend a significant amount of time in the workplace but little is known about the current state of disease management in such contexts. The aim of the current study is to explore the experiences, attitudes and perceptions of asthma across different stakeholders in the workplace to help inform potential recommendations for workplace asthma policies. Using purposive and convenience sampling methods, in-depth semi-structured interviews were conducted in Australia with 5 human resource personnel, 10 employees with asthma and 10 employees without asthma. Interviews were guided by a schedule of questions focusing on attitudes and experiences of people with asthma in the workplace, which were audio recorded, transcribed verbatim and thematically analysed. Analysis of the qualitative dataset revealed three key themes: Beliefs and Attitudes about Asthma, Asthma Solutions in the Workplace and Workplace Obstacles. Findings suggest that employees with asthma experience problems managing their asthma at work and there is a lack of workplace support in relation to asthma emergency management. Key recommendations for workplace asthma policies have been made to provide better support for employees with asthma. However, further investigation into the experience of managing asthma is required in a wider variety of occupations and work experiences to inform the development of a workplace asthma policy.

  5. Mild asthma and chronic bronchitis seem to influence functional exercise capacity: a multi-case control study.

    Science.gov (United States)

    Marcon, Alessandro; Girardi, Paolo; Ferrari, Marcello; Olivieri, Mario; Accordini, Simone; Bombieri, Cristina; Bortolami, Oscar; Braggion, Marco; Cappa, Veronica; Cazzoletti, Lucia; Locatelli, Francesca; Nicolis, Morena; Perbellini, Luigi; Sembeni, Silvia; Verlato, Giuseppe; Zanolin, Maria Elisabetta; de Marco, Roberto

    2013-01-01

    In the Genes Environment Interaction in Respiratory Diseases population-based multi-case control study, we investigated whether asthma, chronic bronchitis (CB) and rhinitis were associated with a reduced 6-minute walk distance (6MWD), and whether the 6MWD determinants were similar for subjects with/without respiratory diseases. Cases of asthma (n = 360), CB (n = 120), rhinitis (n = 203) and controls (no respiratory diseases: n = 302) were recruited. The variation in the 6MWD across the groups was analyzed by ANCOVA, adjusting for gender, age, height, weight and comorbidity. The 6MWD determinants were studied by linear regression, and heterogeneity across the cases and controls was investigated. The 6MWD differed across cases and controls (p = 0.01). It was shorter for cases of asthma (-17.1, 95% CI -28.3 to -5.8 m) and CB (-20.7, 95% CI: -36.6 to -4.8 m) than for controls (604 ± 68 m on average), but not for cases of rhinitis. The negative association between age and the 6MWD was significant for cases of CB, but not for the other groups (p = 0.001). Even at the level of severity found in the general population, asthma and CB could influence the 6MWD, which seems to reflect the functional exercise level for daily physical activities. The negative association between ageing and the 6MWD was particularly strong in subjects with CB. Our report adds to the mounting evidence that CB is not a trivial condition, especially in the ageing adult population, and it supports the importance of monitoring functional capacity and of physical reconditioning in mild asthma. Copyright © 2013 S. Karger AG, Basel.

  6. Atmospheric pollution and the prevalence of asthma: study among schoolchildren of 2 areas in Rio de Janeiro, Brazil.

    Science.gov (United States)

    Rios, José Luiz Magalhães; Boechat, José Laerte; Sant'Anna, Clemax Couto; França, Alfeu Tavares

    2004-06-01

    Air pollutants have been associated with the exacerbation of respiratory diseases. They may intensify the inflammatory allergic response and airways reactivity to inhaled allergens. However, it is still not clear if air pollution contributes to the increased prevalence of asthma. To investigate if different levels of air pollution exposure can be related to differences in the prevalence of asthma. The International Study of Asthma and Allergies in Childhood (ISAAC) protocol was used to determine and compare the prevalence of asthma among schoolchildren in 2 cities of the metropolitan region of Rio de Janeiro, Brazil, Duque de Caxias (DC) and Seropédica (SR), which have different levels of atmospheric pollution. The research involved 4,064 students aged 13 to 14 years from 49 schools in DC and 1,129 from 17 schools in SR. Air pollution was evaluated by the concentration of inhalable particulate matter (PM10). ISAAC's written questionnaire was answered by 4,040 students aged 13 to 14 years in DC and 1,080 in SR. Between 1998 and 2000, the PM10 annual arithmetic mean was 124 microg/m3 in DC and 35 microg/m3 in SR (acceptable level is up to 50 microg/m3). The prevalence of wheezing ever was 35.1% in DC and 29.9% in SR (P = .001), and the prevalence of wheezing in the last 12 months was 19.0% in DC and 15.0% in SR (P = .002). In DC, 14.5% of the adolescents presented 1 to 3 crises of wheezing in the last year, whereas in SR only 11.0% presented 1 to 3 crises (P = .003). In this study, the prevalence of asthma in adolescents was directly related to atmospheric pollution.

  7. Impact of student pharmacist-delivered asthma education on child and caregiver knowledge.

    Science.gov (United States)

    Elliott, Jennifer Padden; Marcotullio, Nicole; Skoner, David P; Lunney, Phil; Gentile, Deborah A

    2014-12-15

    To evaluate the effectiveness of asthma education delivered by student pharmacists and to assess the impact of child and caregiver baseline asthma knowledge on asthma control in children. Student pharmacists developed and implemented asthma self-management education interventions for children and their caregivers and performed asthma screenings for children at a series of asthma camps. Eighty-seven children, ages 5-17 years, and their caregivers were enrolled in this study. A previously validated asthma questionnaire was modified to assess asthma knowledge among children and adults. Asthma knowledge increased significantly in children following participation in the education intervention (pasthma. A significant association was observed between caregiver baseline asthma knowledge and better asthma control in their children (p=0.019). The results of this study demonstrate that student pharmacist-delivered asthma education can positively impact asthma knowledge in children, and that caregivers' knowledge of asthma is strongly correlated with better asthma control in their children.

  8. The association of intrafamilial violence against children with symptoms of atopic and non-atopic asthma: A cross-sectional study in Salvador, Brazil.

    Science.gov (United States)

    Bonfim, Camila Barreto; dos Santos, Darci Neves; Barreto, Maurício Lima

    2015-12-01

    This study aims to describe the types of intrafamilial violence perpetrated against children according to living conditions, family factors, and child characteristics, and to identify the association between types of intrafamilial violence and asthma symptoms in atopic and non-atopic children. A cross-sectional study was carried out with 1,370 caregivers as part of the Social Changes, Asthma and Allergy in Latin America (SCAALA) study, conducted in 2006 in Brazil. The study population was selected by random sampling. The main outcome measures were atopic and non-atopic asthma. We investigate the association between intrafamilial violence and asthma symptoms in atopic and non-atopic children. A backward multivariate logistic polytomous regression was performed to verify the main association. Nonviolent discipline (NVD) and maltreatment nonviolent discipline (MNVD) were positively associated with non-atopic asthma symptoms (NVD: odds ratio (OR)=1.95/95% confidence interval (CI)=1.17-3.25; MNVD: OR=1.95/95% CI=1.19-3.20). However, for the most severe intrafamilial violence, this association was not found after control of potential confounders. This study demonstrates the effect of types of intrafamilial violence on non-atopic asthma. Intrafamilial violence against children represents one more component in the determination of non-atopic asthma in Latin America. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  9. [A follow-up study of six years' outcome of children with asthma in urban area of Beijing].

    Science.gov (United States)

    Tian, C Y; Sha, L; Liu, C H; Luo, Y Q; Li, S; Zhao, M Y; Wang, W; Chen, Y Z

    2018-03-02

    Objective: To understand the outcome of asthma in children from urban area of Beijing and the factors associated with the outcome. Methods: A total of 497 children with asthma diagnosed in the epidemiological survey of childhood asthma in urban area of Beijing in 2010 were selected in this study. Telephone follow-up was conducted in 2016 to obtain information about asthma attack, emergency visit, hospitalization, medication and disease control, and data of comorbidities of allergic diseases from 1 year earlier. Enumeration data were compared using chi-square test, measurement data were compared by rank sum test. The multi-factor logistic regression analysis was employed for the relationship between the related factors and asthma, Kaplan-Meier survival analysis and COX regression was employed to understand the relationship between the related factors and the course of the disease. Results: Questionnaires were conducted in 366 children, of whom 66.7% (244/366) were male, and 33.3% (122/366) were female.Compared with 2010, the rate of asthma attack and emergency room visits in children in last 12 months were significantly lower (19.1%(70/366) vs . 57.1%(284/497), and 3.0% (11/366) vs .19.7% (98/497), χ(2)=125.910 and 53.352, both P0.05). The number of children with clinical remission (2 years and above) was 75.4% (276/366). The number of children without remission within 2 years was 24.6% (90/366). The majority of children without remission were less than 12 years old boys (52.4% (33/63) vs . 30.9% (56/181) , χ(2)=9.273, Pasthma (68.9%(62/90)) was higher than that of children with remission (51.8%(143/276), 17.0%(47/276), and 54.7%(151/276), respectively, χ(2)=7.013, 7.079, 5.608, respectively, all P3-6 years old vs . 0-3 years old), OR= 2.630(>6 years old vs . 0-3 years old), χ(2)=18.512, 31.371, 6.510, all Pasthma remission. COX regression analysis showed that the use of control drugs ( HR =0.705 (0.515-0.964), χ(2)=4.795, Pasthma in children in Beijing city in

  10. The Nutrition and Enjoyable Activity for Teen Girls (NEAT girls) randomized controlled trial for adolescent girls from disadvantaged secondary schools: rationale, study protocol, and baseline results

    OpenAIRE

    Okely Anthony D; Plotnikoff Ronald C; Collins Clare E; Dewar Deborah; Morgan Philip J; Lubans David R; Batterham Marijka J; Finn Tara; Callister Robin

    2010-01-01

    Abstract Background Child and adolescent obesity predisposes individuals to an increased risk of morbidity and mortality from a range of lifestyle diseases. Although there is some evidence to suggest that rates of pediatric obesity have leveled off in recent years, this has not been the case among youth from low socioeconomic backgrounds. The purpose of this paper is to report the rationale, study design and baseline findings of a school-based obesity prevention program for low-active adolesc...

  11. A population-based study of asthma, quality of life, and occupation among elderly Hispanic and non-Hispanic whites: a cross-sectional investigation

    Directory of Open Access Journals (Sweden)

    Delclos George L

    2005-09-01

    Full Text Available Abstract Background The U.S. population is aging and is expected to double by the year 2030. The current study evaluated the prevalence of asthma and its correlates in the elderly Hispanic and non-Hispanic white population. Methods Data from a sample of 3021 Hispanics and non-Hispanic White subjects, 65 years and older, interviewed as part of an ongoing cross-sectional study of the elderly in west Texas, were analyzed. The outcome variable was categorized into: no asthma (reference category, current asthma, and probable asthma. Polytomous logistic regression analysis was used to assess the relationship between the outcome variable and various socio-demographic measures, self-rated health, asthma symptoms, quality of life measures (SF-12, and various occupations. Results The estimated prevalence of current asthma and probable asthma were 6.3% (95%CI: 5.3–7.2 and 9.0% (95%CI: 7.8–10.1 respectively. The majority of subjects with current asthma (Mean SF-12 score 35.8, 95%CI: 34.2–37.4 or probable asthma (35.3, 34.0–36.6 had significantly worse physical health-related quality of life as compared to subjects without asthma (42.6, 42.1–43.1. In multiple logistic regression analyses, women had a 1.64 times greater odds of current asthma (95%CI: 1.12–2.38 as compared to men. Hay fever was a strong predictor of both current and probable asthma. The odds of current asthma were 1.78 times (95%CI: 1.24–2.55 greater among past smokers; whereas the odds of probable asthma were 2.73 times (95%CI: 1.77–4.21 greater among current smokers as compared to non-smokers. Similarly fair/poor self rated health and complaints of severe pain were independently associated with current and probable asthma. The odds of current and probable asthma were almost two fold greater for obesity. When stratified by gender, the odds were significantly greater among females (p-value for interaction term = 0.038. The odds of current asthma were significantly greater for

  12. Early diagnosis of asthma in young children by using non-invasive biomarkers of airway inflammation and early lung function measurements: study protocol of a case-control study

    Science.gov (United States)

    van de Kant, Kim DG; Klaassen, Ester MM; Jöbsis, Quirijn; Nijhuis, Annedien J; van Schayck, Onno CP; Dompeling, Edward

    2009-01-01

    Background Asthma is the most common chronic disease in childhood, characterized by chronic airway inflammation. There are problems with the diagnosis of asthma in young children since the majority of the children with recurrent asthma-like symptoms is symptom free at 6 years, and does not have asthma. With the conventional diagnostic tools it is not possible to differentiate between preschool children with transient symptoms and children with asthma. The analysis of biomarkers of airway inflammation in exhaled breath is a non-invasive and promising technique to diagnose asthma and monitor inflammation in young children. Moreover, relatively new lung function tests (airway resistance using the interrupter technique) have become available for young children. The primary objective of the ADEM study (Asthma DEtection and Monitoring study), is to develop a non-invasive instrument for an early asthma diagnosis in young children, using exhaled inflammatory markers and early lung function measurements. In addition, aetiological factors, including gene polymorphisms and gene expression profiles, in relation to the development of asthma are studied. Methods/design A prospective case-control study is started in 200 children with recurrent respiratory symptoms and 50 control subjects without respiratory symptoms. At 6 years, a definite diagnosis of asthma is made (primary outcome measure) on basis of lung function assessments and current respiratory symptoms ('golden standard'). From inclusion until the definite asthma diagnosis, repeated measurements of lung function tests and inflammatory markers in exhaled breath (condensate), blood and faeces are performed. The study is registered and ethically approved. Discussion This article describes the study protocol of the ADEM study. The new diagnostic techniques applied in this study could make an early diagnosis of asthma possible. An early and reliable asthma diagnosis at 2–3 years will have consequences for the management of

  13. Exhaled Breath Profiling Enables Discrimination of Chronic Obstructive Pulmonary Disease and Asthma

    NARCIS (Netherlands)

    Fens, Niki; Zwinderman, Aeilko H.; van der Schee, Marc P.; de Nijs, Selma B.; Dijkers, Erica; Roldaan, Albert C.; Cheung, David; Bel, Elisabeth H.; Sterk, Peter J.

    2009-01-01

    Rationale Chronic obstructive pulmonary disease (COPD) and asthma can exhibit overlapping clinical features. Exhaled air contains volatile organic compounds (VOCs) that may qualify as noninvasive biomarkers. VOC profiles can be assessed using integrative analysis by electronic nose, resulting in

  14. Chromosome 17q21 gene variants are associated with asthma and exacerbations but not atopy in early childhood

    DEFF Research Database (Denmark)

    Bisgaard, Hans; Bønnelykke, Klaus; Sleiman, Patrick M A

    2009-01-01

    RATIONALE: An asthma predisposition locus on chromosome 17q12-q21 has recently been replicated in different ethnic groups. OBJECTIVES: To characterize the asthma and atopy phenotypes in early childhood that associate with the 17q12-21 locus. METHODS: The single nucleotide polymorphism (SNP), rs......7216389, was genotyped in 376 of 411 children from the Copenhagen Prospective Study on Asthma in Childhood (COPSAC) birth cohort born to mothers with asthma together with 305 mothers and 224 fathers. Nineteen additional SNPs in the region were genotyped in the children. Investigator-diagnosed clinical...... of wheeze (hazard ratio 1.64 [1.05-2.59], P value = 0.03), asthma (hazard ratio, 1.88 [1.15-3.07], P = 0.01), and acute severe exacerbations (hazard ratio 2.66 [1.58-4.48], P value = 0.0002). The effect on wheeze and asthma was observed for early onset but not late onset of disease. The increased risk...

  15. [Survey of studies on time factor in acupoint sticking therapy for the bronchial asthma].

    Science.gov (United States)

    Huang, Dong-e; Guo, Jian-hong; Lin, Ying

    2010-02-01

    Based on the retrieval of literatures in recent fifteen years, the time factors in the acupoint sticking therapy for the bronchial asthma are analyzed and compared in terms of the stage classification of patients, timing selection of acupoint sticking therapy and medication application, and times of application. The acupoint sticking therapy is mostly practiced during remittent stage of bronchial asthma; the timing selection is mostly during the hottest period of summer, the timing selection in certain cases is the coldest period of winter or any day; the duration of medication application is not consistent; therefore, the effectiveness of these cases is different. It may be that the ef fectiveness is proportional to the times and courses of acupoint sticking therapy for the bronchial asthma. In the future, the scientific designs which involve time factor are needed to elucidate the importance of time factor in acupoint sticking therapy for the bronchial asthma.

  16. The development of criteria for limiting the non-uniform irradiation of skin: the rationale for a study of non-stochastic effects

    International Nuclear Information System (INIS)

    Wells, J.; Charles, M.W.

    1979-06-01

    Recent recommendations of the ICRP (1977) provide little guidance for the treatment of non-uniform skin exposures such as those which may occur as the result of contamination with radioactive particulates. This lack of guidance is due to a paucity of data regarding biological effects in this area. A rationale is presented for the study of the early (non-stochastic) effects of non-uniform skin irradiation. As a basis for the presentation of this rationale a framework is provided by a resume of basic biology of the skin and a review of previous experimental work in this field. Animal experiments, which are being carried out in collaboration with specialist university groups, are described both in terms of broad concept and experimental detail. The aim is to provide biological data which can provide guidance in radiological protection situations. (author)

  17. Considerations in the rationale, design and methods of the Strategic Timing of AntiRetroviral Treatment (START) study

    Science.gov (United States)

    Babiker, Abdel G; Emery, Sean; Fätkenheuer, Gerd; Gordin, Fred M; Grund, Birgit; Lundgren, Jens D; Neaton, James D; Pett, Sarah L; Phillips, Andrew; Touloumi, Giota; Vjecha, Michael J

    2012-01-01

    Background Untreated human immunodeficiency virus (HIV) infection is characterized by progressive depletion of CD4+ T lymphocyte (CD4) count leading to the development of opportunistic diseases (acquired immunodeficiency syndrome (AIDS)), and more recent data suggest that HIV is also associated with an increased risk of serious non-AIDS (SNA) diseases including cardiovascular, renal, and liver diseases and non-AIDS-defining cancers. Although combination antiretroviral treatment (ART) has resulted in a substantial decrease in morbidity and mortality in persons with HIV infection, viral eradication is not feasible with currently available drugs. The optimal time to start ART for asymptomatic HIV infection is controversial and remains one of the key unanswered questions in the clinical management of HIV-infected individuals. Purpose In this article, we outline the rationale and methods of the Strategic Timing of AntiRetroviral Treatment (START) study, an ongoing multicenter international trial designed to assess the risks and benefits of initiating ART earlier than is currently practiced. We also describe some of the challenges encountered in the design and implementation of the study and how these challenges were addressed. Methods A total of 4000 study participants who are HIV type 1 (HIV-1) infected, ART naïve with CD4 count > 500 cells/μL are to be randomly allocated in a 1:1 ratio to start ART immediately (early ART) or defer treatment until CD4 count is AIDS, SNA, or death. The study had a pilot phase to establish feasibility of accrual, which was set as the enrollment of at least 900 participants in the first year. Results Challenges encountered in the design and implementation of the study included the limited amount of data on the risk of a major component of the primary endpoint (SNA) in the study population, changes in treatment guidelines when the pilot phase was well underway, and the complexities of conducting the trial in a geographically wide

  18. Pharmacogenetics of asthma

    Science.gov (United States)

    Lima, John J.; Blake, Kathryn V.; Tantisira, Kelan G.; Weiss, Scott T.

    2009-01-01

    Purpose of review Patient response to the asthma drug classes, bronchodilators, inhaled corticosteroids and leukotriene modifiers, are characterized by a large degree of heterogeneity, which is attributable in part to genetic variation. Herein, we review and update the pharmacogenetics and pharmaogenomics of common asthma drugs. Recent findings Early studies suggest that bronchodilator reversibility and asthma worsening in patients on continuous short-acting and long-acting β-agonists are related to the Gly16Arg genotype for the ADRB2. More recent studies including genome-wide association studies implicate variants in other genes contribute to bronchodilator response heterogeneity and fail to replicate asthma worsening associated with continuous β-agonist use. Genetic determinants of the safety of long-acting β-agonist require further study. Variants in CRHR1, TBX21, and FCER2 contribute to variability in response for lung function, airways responsiveness, and exacerbations in patients taking inhaled corticosteroids. Variants in ALOX5, LTA4H, LTC4S, ABCC1, CYSLTR2, and SLCO2B1 contribute to variability in response to leukotriene modifiers. Summary Identification of novel variants that contribute to response heterogeneity supports future studies of single nucleotide polymorphism discovery and include gene expression and genome-wide association studies. Statistical models that predict the genomics of response to asthma drugs will complement single nucleotide polymorphism discovery in moving toward personalized medicine. PMID:19077707

  19. Asthma and COPD in cystic fibrosis intron-8 5T carriers. A population-based study

    DEFF Research Database (Denmark)

    Dahl, Morten; Tybjaerg-Hansen, Anne; Lange, Peter

    2005-01-01

    Carriers of cystic fibrosis intron-8 5T alleles with high exon-9 skipping could have increased annual lung function decline and increased risk for asthma or chronic obstructive pulmonary disease (COPD).......Carriers of cystic fibrosis intron-8 5T alleles with high exon-9 skipping could have increased annual lung function decline and increased risk for asthma or chronic obstructive pulmonary disease (COPD)....

  20. Moderating effect of gender on the prospective relation of physical activity with psychosocial outcomes and asthma control in adolescents: a longitudinal study

    NARCIS (Netherlands)

    Tiggelman, D.; Ven, M.O.M. van de; Schayck, C.P. van; Engels, R.C.M.E.

    2014-01-01

    Objective: Adolescents with asthma experience more psychosocial and physiological problems compared to their healthy peers. Physical activity (PA) might decrease these problems. This study was the first observational longitudinal study to examine whether habitual PA could predict changes in

  1. Asthma in patients with psoriasis

    DEFF Research Database (Denmark)

    Lønnberg, A S; Skov, L; Skytthe, A

    2015-01-01

    We read with interest the report by Fang and colleagues of the relationship between psoriasis and asthma in a large retrospective case-control study from Taiwan [1]. The study found a 1.38-fold increased risk of asthma among patients with psoriasis, and with an increasing risk according to higher...

  2. Coping with asthma in immigrant Hispanic families: a focus group study.

    Science.gov (United States)

    Mosnaim, Giselle; Kohrman, Claire; Sharp, Lisa K; Wolf, Marion E; Sadowski, Laura S; Ramos, Lori; Grammer, Leslie C

    2006-10-01

    Little is known about how childhood asthma affects immigrant Hispanic families in the United States. Qualitative research is effective for understanding the social, cultural, functional, and structural aspects of asthma in the family context. Furthermore, such knowledge is necessary to develop culturally appropriate interventions for these families. To describe participants' perceptions of their roles in caring for an asthmatic child, to compare family patterns of caring for an asthmatic child by parents' country of origin, to identify barriers to caring for an asthmatic child, and to evaluate specific coping needs of low-income immigrant Hispanic families caring for an asthmatic child. Five focus groups were conducted with low-income, immigrant, Spanish-speaking Hispanic adults caring for an asthmatic child, including community health workers, mothers, fathers, and grandparents, along with women with asthma. Audiotaped focus groups were transcribed verbatim in Spanish, forward translated into English, and back translated into Spanish. Data analysis was performed using qualitative analytic methods. Forty-one participants represented a range of countries of origin. Different themes emerged for community health workers vs parents and grandparents and for women vs men caring for a child with asthma. All the participants reported strong beliefs in using folk medicines. Barriers identified included language, culture, poverty, lack of health insurance, and poor living conditions. Results highlight the lack of asthma self-management skills, diagnostic uncertainty, and the use of folk medicine as factors that should be taken into consideration when tailoring interventions to improve asthma outcomes in this vulnerable population.

  3. The association of intrafamilial violence against children with symptoms of atopic and non-atopic asthma: A cross-sectional study in Salvador, Brazil

    OpenAIRE

    Bonfim, Camila Barreto; dos Santos, Darci Neves; Barreto, Maurício Lima

    2015-01-01

    This study aims to describe the types of intrafamilial violence perpetrated against children according to living conditions, family factors, and child characteristics, and to identify the association between types of intrafamilial violence and asthma symptoms in atopic and non-atopic children. A cross-sectional study was carried out with 1,370 caregivers as part of the Social Changes, Asthma and Allergy in Latin America (SCAALA) study, conducted in 2006 in Brazil. The study population was sel...

  4. Efficacy of omalizumab (Xolair®) in patients with moderate to severe predominately chronic oral steroid dependent asthma in Taiwan: a retrospective, population-based database cohort study.

    Science.gov (United States)

    Chen, Hao-Cheng; Huang, Chien-Da; Chang, Erin; Kuo, Han-Pin

    2016-01-08

    Omalizumab (Xolair®), a recombinant monoclonal anti-IgE antibody, has demonstrated efficacy in clinical trials conducted in patients with moderate to severe persistent allergic asthma. We aimed to investigate the efficacy, discontinuation and medical resource utilization of omalizumab in the real-life setting in Taiwan. This study was a retrospective, population-based database cohort study using the Taiwan NHIRD from 2007 to 2011 assessing the efficacy of omalizumab therapy over 4 months on changes in asthma medication, asthma control, frequency of exacerbations and hospitalization rates at baseline and after omalizumab discontinuation. There was a reduction in asthma medication post omalizumab therapy and severe exacerbations and hospitalizations from baseline (31.2%, n = 282) to the end of follow-up (11.8%, n = 144, p omalizumab, the cost of ER medical expenses decreased from New Taiwan dollars (NTD) 3934 at 2 months to NTD 2860 at 12 months. Patients who received omalizumab therapy for over 4 months were more likely to reduce the use of other asthma medications and less likely to experience an asthma exacerbation, ER visits, and hospitalization, even after the discontinuation of omalizumab. These data suggest that omalizumab has efficacy in improving health outcomes in patients with moderate to severe predominately chronic oral steroid dependent asthma in the real-life setting in Taiwan.

  5. P2X7-Regulated Protection from Exacerbations and Loss of Control Is Independent of Asthma Maintenance Therapy

    Science.gov (United States)

    Manthei, David M.; Seibold, Max A.; Ahn, Kwangmi; Bleecker, Eugene; Boushey, Homer A.; Calhoun, William J.; Castro, Mario; Chinchili, Vernon M.; Fahy, John V.; Hawkins, Greg A.; Icitovic, Nicolina; Israel, Elliot; Jarjour, Nizar N.; King, Tonya; Kraft, Monica; Lazarus, Stephen C.; Lehman, Erik; Martin, Richard J.; Meyers, Deborah A.; Peters, Stephen P.; Sheerar, Dagna; Shi, Lei; Sutherland, E. Rand; Szefler, Stanley J.; Wechsler, Michael E.; Sorkness, Christine A.; Lemanske, Robert F.

    2013-01-01

    Rationale: The function of the P2X7 nucleotide receptor protects against exacerbation in people with mild-intermittent asthma during viral illnesses, but the impact of disease severity and maintenance therapy has not been studied. Objectives: To evaluate the association between P2X7, asthma exacerbations, and incomplete symptom control in a more diverse population. Methods: A matched P2RX7 genetic case-control was performed with samples from Asthma Clinical Research Network trial participants enrolled before July 2006, and P2X7 pore activity was determined in whole blood samples as an ancillary study to two trials completed subsequently. Measurements and Main Results: A total of 187 exacerbations were studied in 742 subjects, and the change in asthma symptom burden was studied in an additional 110 subjects during a trial of inhaled corticosteroids (ICS) dose optimization. African American carriers of the minor G allele of the rs2230911 loss-of-function single nucleotide polymorphism were more likely to have a history of prednisone use in the previous 12 months, with adjustment for ICS and long-acting β2-agonists use (odds ratio, 2.7; 95% confidence interval, 1.2–6.2; P = 0.018). Despite medium-dose ICS, attenuated pore function predicted earlier exacerbations in incompletely controlled patients with moderate asthma (hazard ratio, 3.2; confidence interval, 1.1–9.3; P = 0.033). After establishing control with low-dose ICS in patients with mild asthma, those with attenuated pore function had more asthma symptoms, rescue albuterol use, and FEV1 reversal (P < 0.001, 0.03, and 0.03, respectively) during the ICS adjustment phase. Conclusions: P2X7 pore function protects against exacerbations of asthma and loss of control, independent of baseline severity and the maintenance therapy. PMID:23144325

  6. Do obese adults have a higher risk of asthma attack when exposed to indoor mold? A study based on the 2005 Behavioral Risk Factor Surveillance System.

    Science.gov (United States)

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

    2009-01-01

    Some studies show an association between asthma and obesity, but it is unknown whether exposure to mold will increase the risk of asthma attacks among obese people. This study examined whether obese adults have a higher risk of asthma attacks than non-obese adults when exposed to indoor mold. We used data from the 2005 Behavioral Risk Factor Surveillance System to conduct a cross-sectional analysis among 9,668 respondents who reported exposure to indoor mold. With exposure to indoor mold, weighted prevalence of asthma attacks among obese respondents was 11.4% (95% confidence interval [CI] 6.0, 20.6], which was 2.3 times as high as among the exposed non-obese respondents (5.0%, 95% CI 2.8, 8.8). This ratio was almost the same as the ratio of 2.0:1 between the obese respondents (5.7%, 95% CI 4.6, 7.2) and the non-obese respondents (2.8%, 95% CI 2.3, 3.9) when neither group had exposure to mold. The odds ratio of asthma attack among obese people was 3.10 (95% CI 1.10, 8.67) for those with exposure to mold and 2.21 (95% CI 1.54, 3.17) for those without exposure to mold after adjusting for age, sex, race/ethnicity, and smoking status. Our study suggests that obese adults who have been exposed to indoor mold may not necessarily have a higher risk of asthma attack than obese adults who have not been exposed, even though obesity and exposure to indoor mold are both major risk factors for asthma attack. Medical professionals should not only incorporate weight-control or weight-reduction measures as the components of asthma treatment plans, but also advise asthma patients to avoid exposure to indoor mold.

  7. Reduction in exhaled nitric oxide tracks improved patient inhaler compliance in difficult asthma-a case study.

    Science.gov (United States)

    Hunt, Eoin; Flynn, Deirdre; MacHale, Elaine; Costello, Richard W; Murphy, Desmond M

    2017-12-26

    Exhaled nitric oxide is believed be a useful surrogate for airways inflammation while non-adherence with therapy is known to be associated with worsening of asthma control. We present the case of a 49-year-old female with steroid-dependent asthma and an exacerbation rate of >20/year. She was enrolled in a 3-month-long prospective study using a validated diagnostic inhaler device that provided objective evidence of inhaler compliance. Fractional exhaled nitric oxide (FeNO), peak expiratory flow rates, asthma control questionnaires were measured throughout the study period. Peripheral eosinophil count was obtained prior to the study, during the study, and immediately afterwards. Improvement in compliance at the end of the study led to significant improvements in lung function peak expiratory flow rate (PEFR), and objective scores of asthma. There was an observed improvement in PEFR after 4 weeks, with an associated decrease in FeNO from 92 to 9 ppb that plateaued over the remainder of the study. Her eosinophil count was 0.79 × 10 9 /litre prior to starting in the study, 0.37 × 10 9 /litre after 2 months, and 0.1 × 10 9 /litre at the end of the study. We believe that this is the first case study to objectively prove that improvements in compliance can lead to dramatic reductions in the overall inflammatory airway response and in particular that improvements in patient compliance are mirrored by marked reduction in FeNO levels. These changes occurred in tandem with an observed clinical improvement in our patient.

  8. The Prevalence of Severe Asthma and Low Asthma Control Among Danish Adults

    DEFF Research Database (Denmark)

    von Bülow, Anna; Kriegbaum, Margit; Backer, Vibeke

    2014-01-01

    asthma, the extent of asthma control, and contact with specialist care. METHODS: A descriptive cross-sectional register study was performed. By using a nationwide prescription database, we identified current patients with asthma (age, 18-44 years) in 2010. Severity was classified as severe versus mild......-moderate asthma according to the level of antiasthma treatment. We investigated prescription drug use, hospitalizations, emergency department visits, and outpatient clinic visits according to severity. RESULTS: Among a nationwide population, we identified 61,583 current patients with asthma. Based on the level...... asthma and low asthma control were not managed by specialist care. Patients with severe asthma with specialist contact more frequently had impaired asthma control compared with subjects not treated by a specialist (44.4% vs 33.1%, P

  9. Causes and consequences of cerebral small vessel disease. The RUN DMC study: a prospective cohort study. Study rationale and protocol

    Directory of Open Access Journals (Sweden)

    van der Vlugt Maureen J

    2011-02-01

    Full Text Available Abstract Background Cerebral small vessel disease (SVD is a frequent finding on CT and MRI scans of elderly people and is related to vascular risk factors and cognitive and motor impairment, ultimately leading to dementia or parkinsonism in some. In general, the relations are weak, and not all subjects with SVD become demented or get parkinsonism. This might be explained by the diversity of underlying pathology of both white matter lesions (WML and the normal appearing white matter (NAWM. Both cannot be properly appreciated with conventional MRI. Diffusion tensor imaging (DTI provides alternative information on microstructural white matter integrity. The association between SVD, its microstructural integrity, and incident dementia and parkinsonism has never been investigated. Methods/Design The RUN DMC study is a prospective cohort study on the risk factors and cognitive and motor consequences of brain changes among 503 non-demented elderly, aged between 50-85 years, with cerebral SVD. First follow up is being prepared for July 2011. Participants alive will be included and invited to the research centre to undergo a structured questionnaire on demographics and vascular risk factors, and a cognitive, and motor, assessment, followed by a MRI protocol including conventional MRI, DTI and resting state fMRI. Discussion The follow up of the RUN DMC study has the potential to further unravel the causes and possibly better predict the consequences of changes in white matter integrity in elderly with SVD by using relatively new imaging techniques. When proven, these changes might function as a surrogate endpoint for cognitive and motor function in future therapeutic trials. Our data could furthermore provide a better understanding of the pathophysiology of cognitive and motor disturbances in elderly with SVD. The execution and completion of the follow up of our study might ultimately unravel the role of SVD on the microstructural integrity of the white

  10. Causes and consequences of cerebral small vessel disease. The RUN DMC study: a prospective cohort study. Study rationale and protocol.

    Science.gov (United States)

    van Norden, Anouk Gw; de Laat, Karlijn F; Gons, Rob Ar; van Uden, Inge Wm; van Dijk, Ewoud J; van Oudheusden, Lucas Jb; Esselink, Rianne Aj; Bloem, Bastiaan R; van Engelen, Baziel Gm; Zwarts, Machiel J; Tendolkar, Indira; Olde-Rikkert, Marcel G; van der Vlugt, Maureen J; Zwiers, Marcel P; Norris, David G; de Leeuw, Frank-Erik

    2011-02-28

    Cerebral small vessel disease (SVD) is a frequent finding on CT and MRI scans of elderly people and is related to vascular risk factors and cognitive and motor impairment, ultimately leading to dementia or parkinsonism i