Risk factors associated with hospitalizations for asthma attacks in Turkey.

Misirligil Z.

Department of Allergic Diseases, Ankara University School of Medicine, Ankara, Turkey.

The detection of factors associated with hospitalizations for asthma attacks should have a great value in the development of intervention strategies. However, these factors are unknown in Turkey. Our aim was to investigate the factors associated with hospital admissions by comparing hospitalized patients with the community control asthma patients and the relationships between serum eosinophilic cationic protein (ECP) levels and the disease severity. Eighty-one subjects hospitalized with asthma (69 women and 12 men) and 300 community control asthma patients (227 women and 73 men) were enrolled in this cross-sectional study. A questionnaire including detailed demographic and clinical data was compiled by all patients. Serum ECP levels were measured in 76, 14, and 9 patients of community control, hospitalized asthma patients, and healthy controls, respectively. Hospitalized patients were older and had longer asthma duration (p < 0.001). The significant risk factors for hospital admission for acute asthma attacks were previous severe asthma (odds ratio [OR], 12.26; 95% confidence interval [CI], 5.17-29.0), aspirin (acetylsalicylic acid) and nonsteroidal anti-inflammatory drug intolerance (OR, 3.63; 95% CI, 1.70-7.74), chronic rhinosinusitis (OR, 2.24; 95% CI, 1.16-4.33), lower educational level (OR, 2.24; 95% CI, 1.33-4.18), and lower atopy ratio (OR, 1.99; 95% CI, 1.13-3.50). These parameters were similar in patients who were hospitalized and in patients who had severe asthma of the community control. ECP levels were significantly higher in hospitalized and severe asthma patients compared with healthy controls. In conclusion, the factors associated with hospitalizations were advanced age, prolonged asthma duration, presence of severe asthma, "nonatopy," acetylsalicylic acid-nonsteroidal anti-inflammatory drug intolerance, sinusitis, and lower educational level. Further intervention strategies are needed to address these markers to prevent hospitalizations from asthma attacks.

Online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14763246&dopt=Abstract asthma, asthma drug, asthma medicine




Asthma deaths during sports: report of a 7-year experience.

D'Alonzo GE Jr.

Section of Allergy, Asthma and Immunology, Department of Pediatrics, St. Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, USA.

BACKGROUND: Asthma mortality and the mortality of athletes during sports have been described separately in detail in the medical literature. However, asthma has not been reported as a cause of death in competitive athletes. OBJECTIVE: The object of this study was to raise the awareness of physicians, coaches, trainers, and parents that children and adults can have fatal asthma exacerbations during and immediately after participating in sports. METHODS: The Temple Sports Asthma Research Center identified athletes from 1993 until 2000 who died during or after sporting activity by using the nationwide Burrell's Information Service. Once a possible asthma-related sports death was identified, the autopsy report was requested from the coroner or medical examiner, and an attempt was made to contact the family. Contact with the family was limited to information about the death, medical history, sports involvement, and any medication usage by the person who had died. Secondary sources, including news reports, were used to confirm whether the subject died of asthma during or immediately after a sporting activity. RESULTS: Two hundred sixty-three possible cases were identified. Sixty-one deaths met the criteria for study inclusion. White deaths outnumbered black deaths by 2 to 1. Deaths among male subjects predominated. Most subjects were younger than the age of 20 years, with the most prevalent age group being between 10 to 14 years old. Fifty-one percent (18 of 35) of the competitive athletes had their fatal event while participating in organized sport, 14 in a practice situation and 4 deaths during a game or meet setting. Basketball and track were the 2 most frequent activities performed at the time of the fatal event. CONCLUSION: The subjects who had fatal asthma exacerbations were usually white male subjects between the ages of 10 and 20 years. Mild intermittent or persistent asthma by history was commonly identified. Sudden fatal asthma exacerbations occur in both competitive and recreational athletes and can be precipitated by sporting activity.

Online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14767440&dopt=Abstract asthma, asthma drug, asthma medicine




Parental asthma as a risk factor for the development of early skin test sensitization in children.

Martinez FD.

Arizona Respiratory Center, Health Sciences Center, Tucson, Ariz, USA.

BACKGROUND: Recent epidemiologic evidence has challenged the paradigm suggesting a direct causal relationship between allergic sensitization and asthma. OBJECTIVE: We sought to investigate the role of a familial predisposition for asthma in the development of atopy in children. METHODS: Subjects were participants in the Tucson Children's Respiratory Study. Skin tests to aeroallergens were performed in parents and in children at ages 6, 11, and 16 years. Parents were considered asthmatic if they reported physician-confirmed asthma. Parents were divided into 4 phenotypes on the basis of skin sensitization (Skt+ or Skt-) and asthma status (As+ or As-): Skt-/As-, Skt-/As+, Skt+/As-, and Skt+/As+. RESULTS: Children's allergic sensitization differed among parental phenotypes at all ages (P <.0001). Children in the Skt+/As- and Skt+/As+ groups were significantly more likely to be allergic than children in the Skt-/As- group at all ages. Among children with allergic parents, those with at least one parent with asthma were significantly more likely to have positive skin test responses than those with nonasthmatic parents at age 6 years (52.4% vs 37.4%, P <.005) and 11 years (70.1% vs 55.6%, P <.005) but not at age 16 years (82.3% vs 75.1%, P =.180). Results were independent of wheezing in the child and of the characteristics of atopy in parents. The Skt-/As+ group had too few subjects for meaningful comparisons. CONCLUSION: Among children of atopic parents, parental asthma is a risk factor for allergic sensitization in early childhood. The strong association between allergic sensitization and asthma is at least in part explained by an increased susceptibility to allergen sensitization in subjects predisposed to asthma.

Online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14767443&dopt=Abstract asthma, asthma drug, asthma medicine




Patients attitude towards asthma in Ile-Ife.

Ndububa D.

Department of Medicine, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria.

BACKGROUND: There seems to be a paucity of data concerning the attitude of asthmatics towards asthma, its treatment and its effects on their lives in most developing countries. Inadequate attention paid to the psychological and social aspects of asthma could be a significant factor responsible for increase in morbidity and mortality from asthma despite major advances in our understanding of the pathophysiology of the disease. This study aimed at investigating the attitude of asthmatics to the disease (using an asthma dislike questionnaire) to form the basis of a more comprehensive health education programme for asthmatics. METHODS: An asthma-dislike questionnaire was administered to asthmatic patients who were invited for an Asthma Education Programme. This was done prior to the commencement of the lectures. Information elicited was on dislike of physical condition, emotional dysfunction, dislike of psychosocial effects, public-life interference and dislike of medication. RESULTS: Two-third of the asthmatics complained of interference with physical activities. Over 25% indicated being more intolerant towards others. 50% of the patients expressed the fear of dying from sudden asthmatic attack. Two-thirds of the patients expressed concern over the increasing cost of medication and adverse effects of asthma on their public lives. CONCLUSION: This study confirmed that asthma is not just a physical condition, but also has psychosocial components, which varies from person to person. The use of a biopsychosocial approach to augment asthma therapy is advocated.

Online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14768195&dopt=Abstract asthma, asthma drug, asthma medicine




Body mass index and the risk of asthma in adults.

Kattan M.

Department of Pediatrics, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1202B, New York, NY 10029, USA. elisabeth.luder mssm.edu

Asthma and obesity are both chronic conditions and their prevalences have risen in affluent societies. A positive association between asthma and being overweight or obese has been reported in children and women, but associations in men are less clearly described. The objective of this study was to explore the association between body mass index (BMI) and asthma in men and women of diverse ethnic and socioeconomic background living in New York State, USA. In this study, we analyzed cross-sectional data on 5524 subjects aged 18 years and older who were interviewed by telephone in the 1996 and 1997 New York State Behavioral Risk Factor Surveillance System. Asthma (doctor-diagnosed), and weight and height were self-reported. BMI (kg/m2) was used as a measure of adiposity. Weighted logistic regression analysis, with stratification by gender and age, was used to examine the relationship between asthma prevalence and BMI, adjusting for race/ethnicity, education, health insurance, time since last physical examination, physical activity and smoking status. The results showed that the prevalence of asthma was 4.6% (CI: 3.6-5.5%) among men and 8.1% (CI: 7.1-9.1%) among women. In women, the prevalence of asthma was significantly increased in those with a BMI 25 kg/m2 or higher (BMI 25-27.5: OR = 1.76, 95% CI: 1.06-2.94; BMI 27.5-29.9: OR = 2.45, 95% CI: 1.41-4.25; BMI > or = 30: OR = 2.67, 95% CI: 1.66-4.29) when compared to the reference category (BMI: 22-24.9 kg/m2). In men, the prevalence of asthma was increased in the lowest weight category, BMI < 22 kg/m2 (OR = 3.05, 95% CI: 1.37-6.78) and in the highest category, BMI > or = 30 kg/m2 (OR = 2.92, 95% CI: 1.39-6.14). This U-shaped association persisted when restricting the analysis to men who had never smoked and was more pronounced for those between 18 and 49 years of age. In conclusion, this cross-sectional study showed that men and women differ significantly in the association between BMI and asthma prevalence only with respect to the lowest weight category. While women had a monotonic association, men showed a U-shaped relationship, indicating that both extremes of weight are associated with a higher prevalence of asthma.

Online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14959811&dopt=Abstract asthma, asthma drug, asthma medicine




Genetic approaches to assessing evidence for a T helper type 1 cytokine defect in adult asthma.

Hakonarson H.

The Medical University of Iceland, Reykjavik, Iceland.

Recent evidence suggests that deficiency in the Th1 cytokine pathway may underlie the susceptibility to allergic asthma. This study examined whether (1) single-nucleotide polymorphisms exist in the promoter region of the two interleukin (IL)-12 subunit genes in patients with asthma; (2) messenger RNA and protein expressions of signal transducers and activators of transcription, IL-12, IFN-gamma, and their receptors are altered in asthma; and (3) linkage to genes in the Th1 pathway is present in families with asthma in Iceland. The promoter regions of the IL-12 subunit genes were sequenced in 94 patients with asthma and 94 control subjects without asthma. Linkage was examined in 169 families that included over 570 patients with asthma and 950 of their unaffected relatives. The results demonstrate no evidence of linkage to microsatellite markers in close association with genes within the Th1 pathway, and no polymorphism was detected in the promoter regions of the two IL-12 subunit genes in the cohort with asthma patients. Moreover, we found no differences in the messenger RNA or protein expression signals of genes in the IL-12 pathway between the patients and control subjects. We conclude that decrease in Th1 type cytokine response is unlikely to present a primary event in asthma.

Online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14962816&dopt=Abstract asthma, asthma drug, asthma medicine




Risk factors for an intensive care unit admission in children with asthma.

Morton J.

Department of Respiratory Medicine, Sydney Children's Hospital, Randwick, New South Wales, Australia. y.belessis unsw.edu.au

An admission to an intensive care unit (ICU) with asthma is a marker of asthma severity and may be a precursor of asthma death. The aim of this study was to investigate risk factors for acute severe asthma needing an ICU admission. We hypothesized that children admitted to the ICU represent a severe phenotype with identifiable premorbid clinical features. The study was case-control in design. One hundred and forty-one children were studied. Seventy children admitted to the ICU and 71 children admitted to the general medical ward served as cases and controls, respectively. Children were aged between 1-16 years. They underwent skin prick allergy testing, and had a nasopharyngeal aspirate and serology performed to screen for respiratory pathogens. Their parents completed an asthma and allergy symptom questionnaire and the Newcastle Asthma Knowledge Questionnaire (NAKQ). On univariate analysis, an admission to the ICU was more likely in children with 1) "frequent episodic" or "persistent" background asthma; 2) three or more previous admissions for asthma; 3) one or more asthma admissions in the previous 12 months; 4) three or more presentations to the Emergency Department (ED) in the preceding 12 months; 5) three or more positive responses on skin prick allergy testing; 6) an elevated IgE level; 7) oxygen saturation on presentation < or =91%; 8) longer duration of asthma; 9) lower level of maternal education; 10) an admission during autumn; 11) three or more siblings; and 12) being prescribed antibiotics. Risk factors that remained significant on multivariate analysis were three or more presentations to the ED in the preceding 12 months (P=0.003), an elevated IgE level (P=0.01), oxygen saturation on presentation < or =91% (P=0.003), and longer asthma duration (P=0.02). ICU patients took longer to see a doctor and to commence oral steroids. No differences were found between cases and controls in the proportion taking preventer therapy (58% vs. 52%), provided with a written asthma action plan (32% vs. 25%), or in whom spirometry or peak flow was measured (28% vs. 42%). However, rates were low in both groups. Parental asthma knowledge was generally poor. This study identified risk factors for an ICU admission in children with asthma. A potentially preventable risk factor is a history of multiple ED presentations in the past year. Specialist referral of children with multiple ED presentations may improve asthma control and reduce the risk of an ICU admission. Background asthma management remains suboptimal in children needing hospitalization. Copyright 2004 Wiley-Liss, Inc.

Online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14966813&dopt=Abstract asthma, asthma drug, asthma medicine




Infant vaccinations and childhood asthma among full-term infants.

DeStefano F.

Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate, Portland, OR 97227-1110, USA. john.mullooly kpchr.org

PURPOSE: To determine if infant vaccinations are associated with childhood asthma among full-term infants. The secondary objective was to describe relationships between characteristics of infant wheezing and childhood asthma. METHODS: We used baseline data from a study of infant wheezing that selected full-term infants born into a health maintenance organization (HMO) during 1991-1994, continuously enrolled for at least 12 months and without perinatal pulmonary or other selected conditions. Information had been abstracted for infancy (0-18 months) regarding wheezing, vaccinations and asthma risk factors. Using automated data, we identified asthma cases in 1998 among those enrolled for at least 6 months during the year. RESULTS: A total of 1778 full-term infants met our study criterion and 9% had asthma in 1998. Childhood asthma was not significantly associated with having received Hepatitis B vaccine or age at first Hepatitis B vaccine; number of whole-cell pertussis, Haemophilis influenzae type b or oral polio vaccine doses; having received measles, mumps, rubella vaccine; or total number of vaccine doses combined. Childhood asthma was significantly associated with number of infant wheezing episodes. CONCLUSIONS: Our findings do not support concerns that vaccines are associated with increased risk of asthma but confirm that frequency of infant wheezing is associated with childhood asthma.

Online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14971117&dopt=Abstract asthma, asthma drug, asthma medicine