Psychopathology and quality of life for adolescents with asthma and their parents.

Scheinmann P.

Department of Child and Adolescent Psychiatry, Groupe Hospitalier Necker-Enfants Malades, France.

Asthma is known to have a direct impact on the quality of life of children with asthma and their families as a consequence of the attacks on day-to-day life. Psychopathological factors may be associated with poor quality of life by modulating the handicap and the patient's experience of it. The authors' objective was to evaluate the relationship between emotional and behavioral problems and quality of life, as assessed by the Pediatric Asthma Quality of Life Questionnaire and the Pediatric Asthma Caregiver's Quality of Life Questionnaire. The study group consisted of 100 adolescent outpatients with asthma who were undergoing regular checkups: 70 boys and 30 girls, ages 12 to 19. They were evaluated by means of self-administered questionnaires completed by their parents. Path analysis was used to propose a model of relationships between psychopathology and quality of life. The quality of life of the children with asthma and their parents was clearly associated with the presence or absence of psychological problems in the patients. Emotional problems were associated with the quality of life of both the patients and their parents; behavioral problems had a smaller effect on the quality of life of the parents only. The authors proposed a structural model of the quality of life of adolescents with asthma and their parents in which quality of life is dependent on psychological variables and is responsible for emotional problems. Multivariate analyses indicated that the quality of life of the children with asthma and their parents and the correlation between quality of life and psychopathology depended little on medical variables such as the duration of illness, its pretreatment severity, or hospitalizations in the past year. In contrast, the quality of life of the parents depended on that of the children and vice versa. This study showed that scores on the Pediatric Asthma Quality of Life Questionnaire and the Pediatric Asthma Caregiver's Quality of Life Questionnaire reflected not only the medical status of the patients but also psychological variables, which appeared to be a consequence of the functional handicap associated with asthma. Patients who assess the quality of their lives as poor would benefit from psychological evaluation and support.

Online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12832598&dopt=Abstract asthma, asthma drug, asthma medicine




Mirth-triggered asthma: is laughter really the best medicine?

Henry RL.

School of Women's and Children's Health, University of New South Wales, New South Wales, Australia.

Mirthful emotions such as laughter and excitement are unrecognized but perhaps important triggers of asthma. Our study aimed to explore the prevalence, mechanisms, and associations of mirth-triggered asthma (MTA) in children. Our MTA prevalence questionnaire was given to 285 children who presented to the Emergency Department of Sydney Children's Hospital (SCH) with an acute episode of asthma. Our MTA profile questionnaire study was a cross-sectional study of 541 children with asthma. The parents completed a questionnaire regarding their child's asthma. In our laughter diary study, diary cards were given to the parents of 21 children with asthma. The diary required details regarding the mirthful stimulus, symptoms of asthma, and recording of peak expiratory flow (PEF) measurements. Of the selected cohort, 31.9% had mirth-triggered asthma. In the cross-sectional study, mirth-triggered asthma was more common: with increasing age (P = 0.02); in those who in the last 3 months had taken more doses of salbutamol (P = 0.005), and who had more wheeze, nocturnal symptoms, and early morning symptoms (P < 0.0005); and in those who reported exercise-induced asthma (P < 0.0005). Laughter was more commonly reported as a trigger than excitement; cough was the most prominent symptom; and symptoms mostly occurred within 2 min of the mirthful stimulus. In the laughter diary study, 59 of 130 recorded events described symptoms of asthma. Mirth while watching a film led to PEF of 73% of baseline, compared with 81% for mirth with exertional play, and 95% for mirth with nonexertional play (P = 0.01). Mirth-triggered asthma is common, and is an indicator of suboptimal asthma control. Copyright 2003 Wiley-Liss, Inc.

Online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12833489&dopt=Abstract asthma, asthma drug, asthma medicine




Asthma mortality in the Danish child population: risk factors and causes of asthma death.

Juel K.

Department of Paediatrics, Gentofte University Hospital, Copenhagen, Denmark. mejo fa.dk

Child death due to asthma is a rare and potentially preventable event. We investigated possible risk factors for death due to asthma in children and adolescents, as a step towards preventing or minimizing asthma death in this age group, and improving asthma management and care. We reviewed all 108 cases of asthma death in 1-19-year-olds in Denmark, 1973-1994. Copies of death certificates, hospital records, information from general practitioners, and autopsy records were obtained. The information was assessed with particular reference to: features and duration of asthma before death; severity of asthma; time and place of death; long-term and ongoing medical treatment; quality of medical care; circumstances of final illness; and medical treatment during the final episode of asthma. Age groups of 1-4 years, 5-14 years, and 15-19 years were analyzed separately and in aggregate. Death occurred predominantly in the 15-19-year age group. Generally, significantly more patients died in the summer. These patients were more atopic, had fewer asthma symptoms, and did not have regular asthma consultations. Nearly all patients had early-onset asthma. The 1-4-year age group was characterized by severe asthma. Major risk factors (all age groups) were: gradual deterioration during the last month; length of final attack (>3 hr); and delay in seeking medical help during the final attack. None of the children died during their first attack. Nonadherence was most frequent among the 15-19-year-olds. All asthmatic children and young adults should regularly receive medical care and assessment, even if they suffer only a few symptoms. This study underlines the need for ongoing education of the patient's family, the patient, and doctors on long-term management and management of acute attacks. Copies of clearly written individual plans for periods with increasing symptoms should be supplied to the patient/family and, where appropriate, to their general practitioners. The object of these measures is that the patient and parents/family learn to recognize the signs of deterioration and to act on them. Copyright 2003 Wiley-Liss, Inc.

Online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12833494&dopt=Abstract asthma, asthma drug, asthma medicine




Asthma management by an inpatient asthma care team.

Bahrainwala AH.

Children's Hospital of Michigan, Detroit, MI, USA.

Recent surveillance data indicates that asthma continues to be a major health problem affecting children and African Americans disproportionately in terms of prevalence, emergency department visits, and hospitalization rates (Centers for Disease Control [CDC], 2002). Death rates due to asthma also remain higher in African Americans as compared to Caucasians. At Children's Hospital of Michigan, the Inpatient Asthma Service manages the majority of children hospitalized for asthma. An allergy/asthma specialist and a pediatric nurse trained in asthma management (asthma nurse specialist [ANS]) direct this service, which provides standardized inpatient asthma management according to current asthma care guidelines and asthma education to patients and their families before discharge, encourages referrals to the outpatient allergy/asthma clinic for further asthma management and education, and addresses other medical or social needs related to asthma care. The positive outcomes measured were a decreased length of hospital stay (LOS) by 12 hours per hospital admission and average cost savings of $300,000 annually for the hospital. Other positive outcomes included improved patient and family understanding of asthma and improved coordination of care. The asthma nurse specialists have had the benefit of further developing their pediatric asthma assessment, teaching, and communication skills.

Online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12836993&dopt=Abstract asthma, asthma drug, asthma medicine




Rural elementary school teachers' intent to manage children with asthma symptoms.

Rodehorst TK.

University of Nebraska Medical Center College of Nursing, Scottsbluff, NE, USA.

A study of 212 rural elementary school teachers sought to determine the relationships among the variables of their general knowledge about asthma, attitude toward asthma, self-efficacy in helping children with asthma manage their asthma, and social support for initial management of children's asthma with the teachers' intent to manage children who present with signs and symptoms of asthma in the classroom. The situational variables of number of years teaching experience, number of children with asthma that teachers have had in their classroom during their teaching profession, and whether or not the teacher had asthma or knew of someone with asthma also were explored in relation to intent to manage asthma. Results indicate that although teachers had a favorable attitude toward asthma and were tolerant of students with asthma, their knowledge about asthma was low. Because asthma can be life-threatening, it is essential to assist those involved in monitoring and managing children with asthma to provide timely, appropriate care. In this way, the goal of having a child with asthma live as normal a life as possible, including all school activities, can be realized.

Online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12836994&dopt=Abstract asthma, asthma drug, asthma medicine




Childhood cough variant asthma and its relationship to classic asthma.

Morikawa A.

Department of Pediatrics, Gunma University School of Medicine, Maebashi, Japan. mochihi med.gunma-u.ac.jp

BACKGROUND: In pediatrics, some patients with chronic cough who have no evidence of a causative disease are diagnosed as having cough variant asthma (CVA). The precise prognosis of infants and children with CVA, however, is still unclear. OBJECTIVE: To evaluate the relationship between CVA and classic asthma in childhood. METHODS: To diagnose CVA, we performed a methacholine inhalation challenge with use of a transcutaneous oxygen pressure (tcPO2) monitoring system in 100 children with chronic cough, and 75 children (45 boys and 30 girls; mean age, 5.7 years) were diagnosed as having CVA. These patients underwent follow-up monitoring for more than 3 years to ascertain whether classic asthma developed. For comparison, 53 age-matched children with classic asthma (30 boys and 23 girls; mean age, 5.6 years) and 30 age-matched control subjects (12 boys and 18 girls; mean age, 5.5 years) also participated in this study. Consecutive doses of methacholine were doubled until a 10% decrease in tcPO2 from the baseline was reached. The cumulative dose of methacholine at the inflection point of tcPO2 (Dmin-PO2) was considered to represent the sensitivity of tcPO2 to inhaled methacholine. RESULTS: After 3 years or more of follow-up assessments, 52 of the 75 patients answered our questionnaire. Of the responding patients, 28 had been diagnosed as having classic asthma. A significant difference was noted in the age at onset of CVA between the children in whom classic asthma developed (the asthma-developed group) and those in whom classic asthma did not develop (the asthma-free group). No statistically significant differences in Dmin-PO2 between the asthma-developed group and the asthma-free group or between the girls and the boys, however, were foun CONCLUSIONS: This study showed that 75% of children with chronic cough had CVA, that classic asthma developed in 54% of the children with CVA, and that it is not the severity of bronchial hyperresponsiveness in CVA but the age at onset of CVA that is a risk factor for the development of classic asthma in childhood CVA.

Online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12839325&dopt=Abstract asthma, asthma drug, asthma medicine




[Factors predicting the severity and the degree of symptom control of asthma in a recently diagnosed cohort of adult patients (A.S.M.A study)]

[Article in French]

Neukirch F.

SEPIA-Sante, bureau d'etudes en Epidemiologie et Biostatistiques. sepia sepia-sante.com

INTRODUCTION: The aim of this cohort study was to describe the evolution of recently diagnosed (<12 months) asthma, and to identify outcome predictive factors. This paper describes the evolution of an adult cohort and the factors related to asthma severity and control. METHODS: In 1995, 251 chest specialists from throughout France, recruited 347 asthmatic adults (subjects with severe asthma were excluded). 220 eligible patients were examined every four months over a three year period. Data (socio-demographic characteristics, asthma history, results of atopy testing and lung function tests, treatment, drug compliance, respiratory infections, changes in lifestyle and environment, and major life events) were collected by means of detailed standardised questionnaires completed by physicians. Asthma severity, recorded one year after study inclusion, and asthma control, assessed at each follow-up visit in the second and third year, were defined according to the international guidelines. RESULTS: The clinical status of these adult patients generally improved rapidly. Asthma severity correlated closely with allergy, with a history of childhood asthma and with sensitisation to indoor allergens. After adjusting for severity, poor asthma control was associated with poor compliance, with respiratory infections, and, to a lesser extent, with animals inside the home. CONCLUSIONS: This cohort study highlights the association of asthma severity with allergy, and of poor asthma control with poor compliance and respiratory infections.

Online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12844016&dopt=Abstract asthma, asthma drug, asthma medicine




Non-Hodgkin's lymphoma among asthmatics exposed to pesticides.

Blair A.

Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics National Cancer Institute, National Institutes of Health, Rockville, MD 20852, USA. Leewj mail.nih.gov

We conducted a pooled analysis of population-based case-control studies in Iowa, Minnesota and Nebraska to investigate whether asthma modifies risk of non-Hodgkin's lymphoma (NHL) associated with pesticide exposures. Cases (n = 872) diagnosed with NHL from 1980 to 1986 and frequency-matched controls (n = 2,381) randomly selected from the same geographic areas as the cases were included. Information on use of pesticides and history of asthma was based on interviews. Unconditional logistic regression was used to calculate ORs, adjusted for age, state and vital status. Of all subjects, 177 (45 cases, 132 controls) reported having been told by their doctor that they had asthma. Subjects with an asthma history had a nonsignificantly lower risk of NHL than nonasthmatics (OR = 0.6, 95% CI 0.3-1.4), and there was no main effect of pesticide exposure (OR = 1.0, 95% CI 0.8-1.2). However, asthmatics tended to have larger ORs associated with exposure to pesticides than nonasthmatics. The OR among asthmatics was 1.8 (95% CI 1.1-3.2) for ever-use of crop insecticides, 2.7 (95% CI 1.0-7.2) for chlordane, 2.4 (95% CI 1.0-5.7) for lindane and 3.7 (95% CI 1.3-10.9) for fonofos. Among nonasthmatics, ORs were 1.1 (0.9-1.3), 1.5 (1.1-2.2), 1.3 (0.97-1.8) and 1.6 (1.0-2.4), respectively. Although there is limited power for assessing interaction, our results suggest that the risk of NHL among asthmatics with pesticide exposure may be higher than among nonasthmatics with pesticide exposure. Copyright 2004 Wiley-Liss, Inc.

Online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15197786&dopt=Abstract asthma, asthma drug, asthma medicine