Cockroach hypersensitivity in asthmatics in Lagos, Nigeria.

Bandele EO.

Department of Medicine, College of Medicine, Lagos University Teaching Hospital, PMB 12003, Lagos, Nigeria.

BACKGROUND: Cockroach allergy occurs frequently in asthmatics in urban areas, where the level of cockroach infestation is usually high. The prevalence of cockroach allergy, as well as the effect of associated factors on cockroach sensitisation in Nigeria is largely unknown. OBJECTIVE: To determine the prevalence of cockroach allergy in asthmatics in Lagos. DESIGN: A prospective case-control study. SETTING: Medical outpatient department of the Lagos University Teaching Hospital, Lagos, Nigeria. SUBJECTS: Two hundred and two patients with confirmed bronchial asthma and one hundred non-asthmatic control subjects took part in the study. INTERVENTION: The cockroach allergen was administered on all the subjects using skin prick technique. MAIN OUTCOME MEASURES: The provocation of a skin reaction (wcal) fifteen minutes after administering the cockroach antigen. RESULTS: Amongst the asthmatic patients 90 (44.6%) had positive skin tests to the cockroach allergen, compared to nine (9%) of the control subjects. There was a male preponderance of cockroach sensitivity amongst the asthmatic patients even though the difference between both sexes was not significant. Other highlights of the study included the fact that cockroach sensitivity was related to age, duration of asthma, nocturnal asthmatic attacks, frequency of attacks, and the levels of infestation. There was an insignificant relationship between cockroach sensitivity and the location of residences as well as the income status of the respondents. CONCLUSION: There is the need for more studies on cockroach allergy in asthmatics in our environment.

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Nebulized beta2-agonist use in high-risk inner-city adults with asthma.

Rand CS.

Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. jkrishn2 jhmi.edu

Nebulizer use has been linked to worse asthma outcomes, but the precise reason(s) for this relationship is not known. We assessed the frequency of nebulized beta2-agonist use in high-risk inner-city adults with asthma and compared asthma self-management practices according to nebulizer use in this population. This was a cross-sectional study conducted over 6 weeks from July to August 2000. A convenience sample (N=50) was recruited from an inner-city emergency department (ED). Adults (age > or = 18 years) were eligible if they had a physician diagnosis of acute asthma exacerbation. Data regarding asthma symptoms, acute care utilization, use of nebulized beta2-agonist for symptom relief, and indicators of asthma self-management (physician for asthma care, use of controller medications, current cigarette smoking, and substance use) were collected by an interviewer-administered survey. Nebulized beta2-agonist use was reported by 54.0% of patients during the 30 days before their ED visit. Nebulizer users reported more severe asthma symptoms (96.3% vs. 73.9% with moderate or severe persistent asthma, p=0.02) than nonusers. Nebulizer users were more likely to have a physician for asthma care (85.2% vs. 56.5%, p=0.02), have more frequent care from their physicians in the past 12 months (e.g., >3 visits: 59.3% vs. 30.4%, p=0.02), and notify their physician during their asthma exacerbation (39.1% vs. 7.7%, p=0.04). Compared with nonusers, nebulizer users reported better care across other indicators of care, though differences between groups were not significant. After accounting for symptom severity, results were largely unchanged. If these findings are confirmed in other studies with larger numbers of patients, we conclude that the relationship between nebulizer use and higher asthma morbidity largely represents preferential use of nebulizers by patients with more symptomatic disease.

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Determinants of dyspnea in patients with different grades of stable asthma.

Martinez-Frances M.

Service of Pneumology, Sagunt Hospital, Port Sagunt, Valencia, Spain. emm01v nacom.es

Dyspnea is a main feature of symptomatology in asthma, and its perception does not necessarily correlates well with airway obstruction. The aim of this study was twofold: (1) to identify factors determining the subjective degree of dyspnea in patients with different grades of stable bronchial asthma and (2) to compare various clinical methods existing for grading dyspnea. The investigation comprised 153 outpatients with stable asthma. The parameters studied were the following: demographic characteristic of subjects, baseline dyspnea score by means of three clinical instruments (baseline dyspnea index [BDI], Medical Research Council [MRC] scale, and modified Borg scale), asthma severity, standard measures of physiologic lung function, anxiety, depression, subconscious illness attention, and asthma-related quality of life (HRQOL). The dyspnea scores were all significantly interrelated (r=0.77-0.85, p<0.001). The three clinical scales for grading dyspnea were significantly correlated with the same parameters: airflow obstruction, lung hyperinflation, emotional factors, HRQOL, age, age at asthma onset, asthma duration, female gender, clinical severity, and lower economical, and educational levels. Multiple regression analysis showed that independent factors determining clinical dyspnea scores were: age, airway obstruction, and emotional status. Moreover, in patients with severe asthma, lung hyperinflation helped to explain the individual dyspnea score. These data suggest that clinical methods are appropriate for evaluating the impact of dyspnea on daily activities of asthmatic patients. BDI, MRC, and Borg clinical dyspnea scales showed similarly information in subjects with asthma. Independently of asthma severity, older age, airway obstruction, and psychological disturbance were associated with higher degree of dyspnea. However, if subjects had severe airway obstruction, lung hyperinflation was a major determinant of baseline dyspnea score.

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Asthmatic airway inflammation is more closely related to airway hyperresponsiveness to hypertonic saline than to methacholine.

Lee HC.

Departments of Internal Medicine and Microbiology, Chonnam National University Medical School, Gwangju, Korea. ischoi chonnam.chonnam.ac.kr

BACKGROUND: Airway hyperresponsiveness (AHR) to direct stimuli, such as methacholine (MCh), is observed not only in asthma but other diseases. AHR to indirect stimuli is suggested to be more specific for asthma. The purpose of this study was to determine whether asthmatic airway inflammation is more closely related to AHR to hypertonic saline (HS), an indirect stimulus, than to MCh. METHODS: Sixty-four consecutive adult patients with suspected asthma (45 asthma and 19 non-asthma) performed a combined bronchial challenge and sputum induction with 4.5% saline, and MCh challenge on the next day. RESULTS: Both HS-PD15 and MCh-PC20 were significantly lower in asthma patients than in non-asthma patients. However, the sensitivity/specificity for asthma was 48.9%/100%, respectively, in the HS test and 82.2%/84.2%, respectively, in the MCh test. There was a significant relationship between HS-PD15 and MCh-PC20 and only 52.9% of patients with MCh-PC20 < or = 4 mg/mL showed HS-AHR, but 4 patients with HS-AHR showed MCh-PC20 > 4 mg/mL. There were significant correlations between both HS-PD15 and MCh-PC20 and FEV1, or sputum eosinophils, but FEV1 was more closely related to MCh-PC20 (r = 0.478, p < 0.01) than to HS-PD15 (r = 0.278, p < 0.05), and sputum eosinophils were more closely related to HS-PD15 (r = -0.324, p < 0.01) than to MCh-PC20 (r = -0.317, p < 0.05). Moreover, the IL-5 level (r = 0.285, p < 0.05) and IFN-gamma/IL-5 ratio (r = 0.293, p < 0.05) in sputum were significantly related to HS-PD15, but not to MCh-PC20. CONCLUSION: HS-AHR may reflect allergic asthmatic airway inflammation more closely than MCh-AHR.

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Lung function in asthma: relation to clinics, challenge tests and immunotherapy.

Palma-Carlos ML.

I Medical Clinic, Immunology-Hematology Center-Faculty of Medicine, Lisbon University, Portugal.

BACKGROUND: In the last few years the consensus on asthma, guidelines and GINA have introduced a classification based on clinical criteria, PFR or FEV1 values and reversibility. However the relation of clinical classification with the functional data is not well defined. PURPOSE: To correlate the clinical evaluation of asthma with the most usual parameters of larger and smaller airways bronchial obstruction, PFR and FEV1.n MATERIAL AND METHODS: 153 patients have been studied by spirometry on absence of bronchodilator or anti inflammatory therapy in the last few days. Clinically, they were classified following the 2002 revised strategy for asthma management (NIH), 66 as mild intermitent, 61 mild persistent and 26 moderate persistent asthmas. RESULTS: In mild intermitent asthma PFR was decreased in 53 patients (80.3%) and FEV1 in 51 (77.2%). In mild persistent PFR and FEV1 were decreased in 59 (96.7%). In medium persistent asthma PFR was decreased in 25 (96.0%) and FEV1 in 24 (92%). The values of PFR and FEV1 were statistically different in intermitent and persistent asthma. For PFR square chi X2 = 8.91, p < 0.01 and for FEV1 X2 = 9.0 p < 0.01. In contrast there were no statistically differences between mild and moderate persistent asthmas. For PFR X2 = 0.02 p < 0.8 and for FEV1 X2 = 0.039, p < 0.9 (tables 1, 2, 3, 4). DISCUSSION: The occurrence of 77.2% and 80.3% of decreased FEV1 and PFR values in non dyspnea as reported by the patients. There were also no functional differences between patients in the different groups of persistent asthma. Clinical and functional data must be correlated, case by case in order to establish a correct classification of asthmatic patients and improve therapy and the relation between lung function and clinic reevaluate.

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Home asthma management for rural families.

Fouladi RT.

School of Nursing, University of Texas at Austin, TX, USA. s.horner mail.utexas.edu

ISSUES AND PURPOSE: To assess home asthma management among rural families with a school-age child who has asthma. DESIGN AND METHODS: Exploratory analysis of baseline data of a tri-ethnic sample of rural families with school-age children who have asthma. RESULTS: Parents and children enact a moderate amount of asthma management behaviors. Preventive behaviors were correlated with the Asthma Behavior Inventory and treatment behaviors were correlated with the child's asthma severity. Factors that could affect asthma management include no insurance, no visits to providers in 12 months, or no asthma medications. PRACTICE IMPLICATIONS: Nurses must use every contact with families to assess their asthma management and availability of resources, and to determine the fit between asthma severity and the asthma management plan.

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Asthma and the risk of panic attacks among adults in the community.

Eaton WW.

Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.

OBJECTIVE: The study was designed to determine the association between self-reported asthma and the risk, persistence and severity of panic attacks among adults in the community. METHOD: Data were drawn from waves 1 and 2 of the Baltimore site of the Epidemiologic Catchment Area (ECA) Study (N = 2768), which included self-report information on asthma, treatment for asthma and panic attacks in 1981 and 1982. Multiple logistic regression analyses were used to calculate odds ratios comparing the prevalence of panic attack at baseline and follow-up by asthma status at baseline. Linear regression analyses were used to examine the relationship between self-reported asthma status and the number of panic symptoms during a panic attack. RESULTS: Self-report asthma was associated with significantly increased likelihood of having panic attacks at baseline (1981) (12.1% v. 7.3%, P < 0.05) and of having panic attacks at both baseline and follow-up (15.9% v. 7.3%, P < 0.05), compared to those without asthma at baseline. Adults receiving treatment for asthma at baseline had an increased risk of incident panic attacks at follow-up (OR = 2.65 (1.11, 6.34)) and at baseline and follow-up (OR = 5.88 (2.21, 15.62)), though untreated asthma did not appear to increase risk of incident panic at follow-up. Similarly, the risk of panic at follow-up was not increased among those with asthma at baseline who did not report asthma at follow-up, compared with those without asthma at baseline. Treated asthma was associated with having more panic symptoms during panic attacks, compared to those without asthma (P < 0.001). CONCLUSION: These findings are consistent with and extend previous results suggesting that self-reported asthma is associated with an increased risk of panic attacks among adults in the general population, and that there is a consistent relation between severity and persistence of asthma and panic attacks. The lack of association between remitted asthma and panic attack may reveal a need for further research to determine whether asthma may be a causal risk factor for panic attacks, or whether a third factor (genetic or environmental) may be associated with increased risk of the cooccurrence of asthma and panic attacks. Replication of these results using alternative methodology with corroborative data on asthma and panic attacks is needed next.

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Idiopathic chronic eosinophilic pneumonia and asthma: how do they influence each other?

Groupe d'Etudes et de Recherche sur les Maladies Orphelines Pulmonaires.

Centre d'Etudes et de Recherche sur les Maladies Orphelines Pulmonaires, Hopital Cardiovasculaire et Pneumologique Louis Pradel, Universite Claude Bernard, Hospices Civils de Lyon, France.

Since idiopathic chronic eosinophilic pneumonia (ICEP) and asthma are frequently associated, their possible reciprocal influence on clinical presentation and evolution were investigated. The clinical and follow-up features of 53 cases of ICEP, of which 41 (77%) had asthma, were reviewed retrospectively. Asthma preceded the diagnosis of ICEP in 26 patients, was contemporaneous in eight patients, and developed 17 +/- 12 months after ICEP in seven patients. Presentation of ICEP was similar in asthmatics and nonasthmatics with the exception of a higher level of total immunoglobulin E in the former group. Patients with asthma at the time of diagnosis of ICEP were more likely to remain free of relapse of ICEP (56 versus 23%) and had a lower number of relapses per year of follow-up (median 0 versus 0.24). Moreover, they were treated more frequently with long-term inhaled corticosteroids (88 versus 31%) at last follow-up. Asthma got worse after the diagnosis of ICEP and frequently required long-term oral corticosteroids. To conclude, among patients with idiopathic chronic eosinophilic pneumonia, asthmatics have a lower frequency of relapse than nonasthmatics, possibly because of a higher use of inhaled corticosteroids. The occurrence of idiopathic chronic eosinophilic pneumonia in asthmatics is often associated with the development of severe asthma.

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