Increasing prevalence of asthma in UK primary care during the 1990s.

Strachan D.

Worldwide Epidemiology, GlaxoSmithKline Research and Development, Greenford, Middlesex, UK. joan.b.soriano gsk.com

OBJECTIVE: To estimate recent prevalence trends of physician-diagnosed asthma in primary care in the UK, and to test the hypothesis that the asthma epidemic in the UK peaked in the mid-1990s and is currently declining. METHODS: A retrospective cohort of asthma patients was obtained from the General Practice Research Database (GPRD). From January 1990 to February 1999, asthmatics were followed up to death, censoring or mention of chronic obstructive pulmonary disease (COPD) in their clinical record. Prevalence rates of ever and managed asthma were obtained by sex, age and calendar year. RESULTS AND CONCLUSION: From 1990 to 1998, annual prevalence rates of managed physician-diagnosed asthma in women rose from 3.01% (95%CI 2.99-3.03) to 5.14% (95%CI 5.10-5.18), and in men from 3.44% (95%CI 3.41-3.46) to 5.06% (95 %CI 5.02-5.10) (P for trend <0.01 in both). In 1998, prevalence rates of managed asthma in children aged 5-14 affected 7.86% (95%CI 7.71-8.00) of girls and 10.30% (95%CI 10.15-10.47) of boys. Increasing prevalence rates in adult asthma (maximum 4.11% in 1998, 95%CI 4.03-4.19) and elderly asthma (maximum 3.37% in 1998, 95%CI 3.29-3.46) were observed as well in 1998. The study shows that the burden of asthma in UK primary care during the 1990s was still increasing.

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Lack of essential asthma medications in primary care centres in Kuwait.

Al-Yousifi K.

Department of Medicine, Kuwait University, Safat, Kuwait. nasser_beh hsc.kuniv.edu.kw

SETTING: Asthma is a common chronic disease that can affect any age group. Available, affordable and effective asthma medications are essential to achieve good asthma control. OBJECTIVES: To determine the availability of essential asthma medications in primary care centres and the cost of a year's supply in Kuwait. METHODS: A telephone survey was conducted in 36 centres. The cost of asthma medication was calculated based on estimated annual needs for the different grades of asthma severity. RESULTS: None of the centres surveyed had adequate asthma medication: 12 (33%) had just adequate and 24 (67%) had below adequate supplies. All had intravenous hydrocortisone and nebulised bronchodilators, but none had high-dose inhaled steroids; 24 (67%) had neither oral steroids nor salbutamol inhalers. All had oral bronchodilators, aminophylline and theophylline. Family medical centres had more asthma medications. The annual cost of treating a case of moderate asthma in Kuwait is 562 US dollars. CONCLUSION: Most of the primary care centres in Kuwait lack essential asthma medications. This creates over-reliance on hospital emergency departments and affects asthma management.

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[Changes of serum interleukin (IL)-12 and IL-13 in asthmatic patients and regulatory effects of glucocorticoids on them]

[Article in Chinese]

Liu CH.

Department of Respiratory Disease, The Qilu Hospital of Shandong University, Jinan 250012, China.

OBJECTIVE: To observe the changes of serum interleukin (IL)-12, IL-13 and lung function in asthmatic patients and to evaluate the influence of glucocorticoid on them. METHODS: The serum samples were obtained from (1) 25 asthmatic patients with acute asthma attack before and after one week course of oral prednisone, (2) 20 asthmatic patients in remission stage, and (3) 15 healthy volunteers. Serum IL-12 and IL-13 were determined with sandwich ELISA. Lung ventilatory function forced expiratory volume in one second (FEV(1)) and respiratory impedance airway resistance (R(5)) were measured in all patients. RESULTS: (1) Serum level of IL-12 in asthma attack group was significantly lower than that in asthma remission group (P < 0.05); both were significantly lower than that in normal control group (P < 0.01); in asthma attack group IL-12 level after prednisone treatment was significantly higher than that before treatment (P < 0.01). (2) Serum level of IL-13 in asthma attack group was significantly higher than that in asthma remission group (P < 0.01); both were significantly higher than that in normal control group (P < 0.01); in asthma attack group IL-13 level after prednisone treatment was significantly lower than that before treatment (P < 0.01). Correlation analysis showed that the serum level of IL-12 was positively correlated to FEV(1) and negatively correlated to R(5) and to serum level of IL-13 (r(1) = 0.458, r(2) = -0.516, and r(3) = -0.549, respectively; P < 0.05 and P < 0.01); the serum level of IL-13 was negatively correlated to FEV(1) and positively correlated to R(5) (r(1) = -0.493, and r(2) = 0.528, respectively; P < 0.05). CONCLUSION: The secretion of IL-12 and IL-13 was impaired in asthma with a significant increase in serum level of IL-13 and decrease in serum level of IL-12. Glucocorticoid could downregulate the serum level of IL-13 and upregulate the serum level of IL-12, redress the imbalance of IL-12/IL-13, and improve lung function in asthmatic patients.

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T cells of atopic asthmatics preferentially infiltrate into human bronchial xenografts in SCID mice.

Mizuta H.

First Department of Internal Medicine, Kumamoto University School of Medicine, Honjo, Kumamoto, Japan.

T cells play an important role in the pathogenesis of bronchial asthma. However, it is not completely known how circulating lymphocytes infiltrate into the airways of asthmatic patients. Because SCID mice are unable to reject xenogenic transplants, many xenotransplant models using various human tissues have been developed. Therefore, to examine the interaction between bronchi and T lymphocytes of asthma, it may be possible to use the human bronchial xenograft and PBMC xenograft in SCID mice. We transplanted human bronchi into the subcutaneum of SCID mice and i.p. injected PBMCs that were obtained from patients with atopic asthma, atopic dermatitis and rheumatoid arthritis, and normal subjects (asthmatic, dermatitis, rheumatic, and normal huPBMC-SCID mice). There was no difference in the percentage of CD3-, CD4-, CD8-, CD25-, CD45RO-, CD103-, and cutaneous lymphocyte Ag-positive cells in PBMCs among the patients with asthma, dermatitis, rheumatoid arthritis, and normal subjects, and CD3-positive cells in peripheral blood of asthmatic, dermatitis, rheumatic, and normal huPBMC-SCID mice. The number of CD3-, CD4-, and CD8-positive cells in the xenografts of asthmatic huPBMC-SCID mice was higher than those of dermatitis, rheumatic, and normal huPBMC-SCID mice. IL-4 mRNA and IL-5 mRNA were significantly higher in the xenografts of asthmatic huPBMC-SCID mice than those in the xenografts of normal huPBMC-SCID mice, but there were no significant differences in the expressions of IL-2 mRNA or IFN-gamma mRNA between them. These findings suggest that T cells, especially Th2-type T cells, of asthmatics preferentially infiltrate into the human bronchi.

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Self-reported asthma prevalence and control among adults--United States, 2001.

.

Asthma is a chronic illness that has been increasing in prevalence in the United States since 1980. In 2000, asthma accounted for 4,487 deaths, approximately 465,000 hospitalizations, an estimated 1.8 million emergency department (ED) visits, and approximately 10.4 million physician office visits among persons of all ages. To provide prevalence data for state and local health department asthma programs, the Behavioral Risk Factor Surveillance System (BRFSS) collects data each year from the 50 states, the District of Columbia, and three U.S. territories. This report summarizes asthma prevalence data for adults collected from the 2001 BRFSS survey and from the eight states that used the adult asthma history module. Findings from BRFSS indicate that approximately 7.2% of U.S. adults have current asthma. ED visits for asthma varied more than any other characteristic among the eight states that used the adult asthma history module. In Mississippi, 67.3% of respondents with current asthma reported no ED visits during the preceding 12 months, compared with 87.6% in Washington state. Continued use of the BRFSS asthma prevalence questions and the asthma history module will allow state health departments to monitor trends in asthma prevalence and control and to direct public health asthma interventions.

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Bridging the gap between doctors' and patients' expectations of asthma management.

Fardy HJ.

Centre for Adolescent Health and Department of Respiratory Medicine, Royal Children's Hospital, Parkville, Victoria, Australia. susan.sawyer rch.org.au

OBJECTIVES: To assess the prevalence of asthma symptoms, their impact on daily activities, and perceptions of disease severity among people with asthma. METHODS: A telephone survey of 699 people with asthma was conducted in 1999 in metropolitan and nonmetropolitan New South Wales, Victoria, and Queensland, Australia. RESULTS: Forty-two percent of adults and 26% of children reported experiencing asthma symptoms at least every 2-3 days. Thirty-seven percent of adults and 26% of children reported using a reliever more than four times in the previous week. Of those for whom preventer therapy had been prescribed (61% of respondents), 30% of children and 45% of adults did not use their preventer as instructed. A high proportion of respondents reported avoiding physical and social activities because of their asthma, while 75% said asthma generally made them feel tired. Many respondents attributed frustration (61%), irritability (57%), fear (38%), and worry (43%) to their asthma. Only 50% of respondents had been reviewed by a general practitioner for asthma in the past year. Respondents generally underestimated the severity of their asthma, compared with symptom frequencies reported. CONCLUSIONS: The Living with Asthma Survey suggests that national asthma management goals are not being achieved in a high proportion of patients, with evidence for both underprescribing and underusage of preventer medication. Achieving closer alignment between medical and patient perspectives is an important goal of asthma education and management in order to help bridge the gap between current concepts of best practice and the reality of persistently poor asthma outcomes.

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Asthma and panic attacks among youth in the community.

Hoven CW.

Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York 10032, USA. rdg66 columbia.edu

OBJECTIVE: To determine the association between asthma and panic attacks among youth in the community. METHOD: Data were drawn from the Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study (n = 1285), a community-based sample of youth age 9-17 in the United States. Multivariate logistic regression analyses were used to determine the association between asthma and both panic attacks and panic disorder, adjusting for differences in sociodemographic characteristics and comorbid mental disorders. RESULTS: Asthma was associated with a significantly increased likelihood of panic attacks [OR= 1.5 (1.01, 2.2)]. This effect was specific and persisted after adjusting for differences in demographics and psychiatric comorbidity. Severe asthma was associated with an even greater likelihood of panic attacks [OR = 2.2 (1.3, 4.0)]. There was a dose-response relationship between number of panic symptoms during a panic attack and the likelihood of asthma [OR = 1.2 (1.1, 1.3)] and severe asthma [OR = 1.3 (1.1, 1.4)], which remained significant after adjusting for differences in sociodemographic characteristics and comorbid mental disorders. CONCLUSIONS: These data suggest a significant association between asthma, severe asthma, and panic attacks among youth in the community. Replication of these findings is needed, as are future studies that investigate the nature of these links. In light of the increasing prevalence of asthma and hospitalization for asthma among youth in the United States and worldwide, these associations may be worthwhile to consider in future investigations.

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Analysis of sputum cell counts during spontaneous moderate exacerbations of asthma in comparison to the stable phase.

Paggiaro PL.

Cardiothoracic Department, University of Pisa, Pisa, Italy.

BACKGROUND: Acute airway inflammation is considered to characterize asthma exacerbations, but its specific cellular pattern has not yet been completely evaluated. AIM: To evaluate the prevalence of sputum eosinophilia during acute asthma exacerbations of moderate severity, compared with a stable phase of the disease, and to assess the concordance between changes in pulmonary function and sputum eosinophilia in the period between exacerbation and post exacerbation. METHODS: We compared sputum and blood inflammatory cell counts in 29 asthmatic subjects during a spontaneous moderate exacerbation of asthma (visit 1) with sputum and blood cell counts measured 4 weeks after the resolution of asthma exacerbation (visit 2). At visit 1, all subjects required an appropriate 1 week treatment with oral corticosteroids. RESULTS: At visit 1, all subjects were able to collect spontaneous sputum, whereas at visit 2 sputum was induced by inhalation of hypertonic saline (NaCl 3, 4, and 5%, 10 minutes each) with beta2-agonist pretreatment. Asthma exacerbation was accompanied by a significant increase in sputum eosinophil percentages compared with levels after exacerbation [25% (1-78) versus 4% (0-23), p<0.05). Only four subjects showed low sputum eosinophil percentages during exacerbation, and these showed no differences in main clinical findings with respect to subjects with sputum eosinophilia. At visit 2, the stability of asthma was assessed on the basis of PEF, FEV1, symptoms, and use of rescue beta2-agonist. Asthma was defined as stable in 21 out of 29 subjects. Sputum eosinophil percentages fell significantly between visit 1 and visit 2 in both stable and unstable patients, but at visit 2 sputum eosinophil percentages were still high in subjects with unstable asthma. In patients who proved to be stable at visit 2, there was a significant correlation between the changes recorded in sputum eosinophil percentages and in FEV1 between the two visits (rho: 0.723, p<0.001). CONCLUSION: Sputum cosinophil but not neutrophil percentages increase in most asthmatic subjects during moderate exacerbation of asthma. Changes in the degree of airway eosinophilic inflammation are related to changes in the severity of airway obstruction during asthma exacerbation.

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