Effects of atmospheric sulphur dioxide and particulate matter concentrations on emergency room admissions due to asthma in Ankara.

Bircan A.

Ataturk Training and Research Hospiatal for Chest Disease and Thoracic Surgery, Ankara, Turkey. bahadir.berktas isbank.net.tr

Recent studies have associated short-term exposure to respirable particulate matter (PM(10)) and sulphur dioxide (SO(2)) with peak flow decrements, increased symptoms of respiratory irritation, increased use of asthma medications, and increased admission and hospitalization for asthma. To further delineate the association between SO(2), PM(10) exposure and asthmatic response, we compiled daily records of asthma emergency room visits from our hospital and data of meteorological conditions, SO(2) and PM(10) concentrations in Ankara area. Weekly averages of daily counts of emergency room visits for asthma were significantly associated with average weekly SO(2) and PM(10) exposure on previous week (r= 0.328, p= 0.017 and r= 0.355, p= 0.009 respectively). Admission to emergency room for asthma count was also negatively correlated with ambient temperature (r= -0.496, p= 0.0001) and strong wind existence (X(2)= 3.930, p= 0.047) on previous days. It was also positively correlated with ambient relative humidity (r= 0.531, p= 0.0001). We observed that numbers of emergency visits due to asthma were higher in winter months, April and September. In winter and early spring period there was concordance between asthma emergency admissions with air pollutants levels. During this period ambient temperatures were low as well. There were two discordance points in monthly variation of air pollution and asthma visits. We thought that first asthma visits peak was related to allergic pollens during April and second peak was due to opening of schools and increasing of respiratory infections for this reason during September. The general pattern of our results confirms that even low levels of air pollution encountered in Ankara are linked to short-term increases in the number of people visiting emergency department for asthma.

Online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15143399&dopt=Abstract asthma, asthma drug, asthma medicine




The prevalence of reversible airflow obstruction and/or methacholine hyperreactivity in random adult asthma patients identified by administrative data.

Zeiger R.

Department of Allergy, Kaiser Permanente Southern California, San Diego Medical Center, CA, USA. eric.m.macy kp.org

BACKGROUND: Asthma is a chronic inflammatory lung disease. It is commonly diagnosed and treated on the basis of clinical impression, although national guidelines recommend documenting reversible airflow obstruction. OBJECTIVES: Determine the frequency of reversible airflow obstruction, and/or methacholine hyperreactivity during 2003 in a well-characterized population with a low-risk asthma diagnosis during 2001. METHODS: Of a total population of 7460 low-risk adult (18-64 years) asthma patients (no hospitalizations or emergency department visits; < 3 oral steroid courses; < 12 beta-agonist canisters; and < 3 prescibers, all in prior 12 months) cared for by a large health care program, a random sample of 400 was recruited to undergo a diagnostic asthma evaluation. The evaluation included a physical examination, medical record review, questionnaires, allergy testing, spirometry for airflow obstruction and reversibility, and/or methacholine hyperreactivity. RESULTS: Of the 400 randomly selected patients, 106 (26.5%) started and 82 (77.3%) completed the asthma evaluation. Evaluated subjects were predominately female (71%), middle-aged (mean 51.0 +/- 11.0 years), diagnosed asthmatics for long duration (mean 22.1 +/- 17.5 years), and nonsmokers (88.7%). Asthma was confirmed in 62.1% (51 of 82) based on a deltaFEV1 12% or greater after albuterol (n = 38), deltaFEV1 15% or greater after Advair (n = 6), or a positive methacholine challenge (n = 7). Only 35 of 400 patients (8.7%) ever had reversibility measured in their medical record. Of these, only 12 (34.3%) had a deltaFEV1 12% or greater after albuterol. Reversibility was confirmed in all six who had asthma evaluations. CONCLUSIONS: More than one third of low-risk adult asthmatics cannot be confirmed to have asthma 2 years later. Spirometry that documented reversibility in the medical record accurately predicted asthma confirmation. Physicians should more widely perform spirometry with reversibility to establish the diagnosis of asthma as recommended by national asthma guidelines.

Online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15962880&dopt=Abstract asthma, asthma drug, asthma medicine




Remodelling of airway smooth muscle in asthma: what sort do you have?

James A.

West Australian Sleep Disorders Research Institute, School of Medicine and Pharmacology, University of Western Australia, Nedlands, WA, Australia.

Summary Background Shortening of smooth muscle around airways is the basis of symptoms and abnormal lung function in asthma. The airway wall is increased in thickness in small and large airways asthma, in relation to the clinical severity of asthma and the airway smooth muscle layer is the main contributor to this thickening. The relative contributions of more airway smooth muscle cells, bigger cells or more extracellular matrix to the increased thickness of the smooth muscle layer in asthma is not clear and has been examined in only a small number of cases, Studies of the natural history of asthma suggest that the clinical severity of asthma is relatively constant over time, deficits in lung function compared with nonasthmatic subjects occur early in the course of the disease and the decline in lung function with age is increased in asthma. Hypothesis The observations from studies of the quantitative pathology and the natural history of asthma might be combined in the hypothesis that the severity of asthma is determined early (in its natural history) and is related mainly to increased volume density of airways smooth muscle cells (hyperplasia) and that later deposition of extracellular matrix from larger, hypertrophic smooth muscle cells results in fixed and increasing deficits in lung function. Speculation The relative contribution of more smooth muscle cells, bigger cells and extracellular matrix will be determined by unbiased stereological measurements in many cases of asthma of varying severity. The outcomes of such studies will be methods of monitoring and of treatment that will be tailored to the sort of smooth muscle modelling that is present in individual cases.

Online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15969657&dopt=Abstract asthma, asthma drug, asthma medicine




Increased risk of asthma attacks and emergency visits among asthma patients with allergic rhinitis: a subgroup analysis of the improving asthma control trial.

Bjermer L.

Service des Maladies Respiratoires, Hopital Arnaud de Villeneuve, Montpellier, Cedex 5, France.

Summary Background Inadequately controlled allergic rhinitis (AR) in asthmatic patients can contribute towards increased asthma exacerbations and poorer symptom control, which may increase medical resource use. We assessed asthma-related medical resource use and attacks in asthmatic patients who did and did not have concomitant AR and were adding montelukast or salmeterol to baseline treatment with inhaled fluticasone. Methods A post hoc resource use analysis of a 52-week, double-blind multicentre clinical trial (IMPACT: IMProving Asthma Control Trial) including 1490 adults with chronic asthma, aged 15-72 years, with FEV(1) 50-90% of predicted and >/=12% increase in FEV(1) after salbutamol administration, treated with either montelukast 10 mg daily or salmeterol 50 mug twice daily in addition to fluticasone 200 mug, was undertaken. Asthma-related medical resource use included medical visits (defined as either an unscheduled visit [to a general practitioner, a specialist or a non-medical provider] or a specialist visit), emergency room visits and hospitalizations during follow-up. Asthma attacks were defined as the worsening of asthma requiring unscheduled visit, emergency visit, hospitalization or oral/intravenous/intramuscular corticosteroids. Results A self-reported history of concomitant AR was identified in 60% of the patients (n=893). Univariate analysis suggests that significantly more patients with concomitant AR experienced emergency room visits (3.6% vs. 1.7%, P=0.029) and asthma attacks (21.3% vs. 17.1%, P=0.046). Multivariate analysis adjusting for treatment group, age and baseline asthma severity confirmed these results since the presence of concomitant AR in patients with asthma increases the likelihood of emergency room visit (odds ratio (OR)=2.35, 95% confidence interval (CI)=1.12-4.80) and asthma attack (OR=1.35, 95% CI=1.03-1.77). Patients with asthma alone compared with patients with both conditions did not differ in terms of unscheduled or specialist visits and hospitalizations. Conclusions Presence of self-reported concomitant AR in patients with asthma resulted in a higher rate of asthma attacks and more emergency room visits compared with asthma patients without concomitant AR.

Online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15969661&dopt=Abstract asthma, asthma drug, asthma medicine




Safety, tolerability, and exploratory efficacy of montelukast in 6- to 24-month-old patients with asthma.

Reiss TF.

Merck Research Laboratories, Rahway NJ, USA.

OBJECTIVE: The purpose of this study was to determine the safety and tolerability profile of montelukast 4-mg oral granules compared with placebo in children aged 6-24 months with asthma.METHODS: This was a randomized, double-blind, placebo-controlled, parallel-group study. Children 6-24 months of age at first visit with a history of at least three episodes of physician-diagnosed asthma or 'asthma-like' symptoms and in need of controller therapy were randomized to either montelukast 4-mg oral granules or placebo once daily in the evening for 6 weeks. The primary variables were the frequency of clinical and laboratory adverse experiences. The exploratory efficacy endpoints included days without beta-agonist use, beta-agonist use per day, unscheduled physician or hospital visits for asthma, oral corticosteroid rescues for asthma, asthma attacks, discontinuation due to worsening of asthma, and total blood peripheral eosinophil counts.RESULTS: The most common clinical adverse experiences were upper respiratory tract infection, asthma, fever, diarrhea, and vomiting occurring with similar frequencies between treatment groups. There were no clinically meaningful differences between the two treatment groups in clinical or laboratory adverse experiences and no significant differences in frequency of patients with elevated serum transaminases. Differences between the montelukast and placebo treatment groups in the exploratory efficacy endpoints of days without beta-agonist use, oral corticosteroid rescues, emergency care, asthma attacks, and discontinuations due to worsening asthma were not significant.CONCLUSIONS: Montelukast, 4-mg oral granules, was well tolerated over 6 weeks of treatment in children aged 6-24 months with asthma.

Online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15969897&dopt=Abstract asthma, asthma drug, asthma medicine




Gaps in Enrollment From a Medicaid Managed Care Program: Effects on Emergency Department Visits and Hospitalizations for Children With Asthma.

Ray WA.

From the *Division of General Pediatrics, daggerDepartment of Biostatistics, double daggerCenter for Patient and Professional Advocacy, and section signDivision of Pharmacoepidemiology, Department of Preventive Medicine, Vanderbilt Children's Hospital, Nashville, Tennessee; and paragraph signGeriatric Research, Education and Clinical Center, Nashville Veterans Administration Medical Center, Nashville, Tennessee.

BACKGROUND:: For high-risk children with asthma enrolled in Medicaid, loss of Medicaid coverage is a potential threat to access to quality asthma care. OBJECTIVE:: We sought to quantify the effect of gaps in enrollment on emergency department visits and hospitalizations for children with asthma in TennCare, Tennessee's managed care program for Medicaid-eligible and uninsured children. METHODS:: Children with asthma were identified from a research database of files maintained by the state. Gaps in enrollment in the state insurance program were measured between 1998 and 2002. Children with gaps were compared with children without gaps with respect to emergency department visits and hospitalizations for asthma, respiratory illnesses, croup, and other diagnoses. RESULTS:: Among children who met study definitions of asthma, 2373 experienced a gap in enrollment during the study period (10.4%). The rate of hospitalizations and emergency department visits for children with gaps (7402/10,000 person years) was significantly lower than the rate of study events for children with no gaps (9230/10,000 person years) (adjusted incidence rate ratio 0.88; 95% confidence interval 0.81-0.96). The rate of hospitalizations for asthma and other respiratory conditions was not different between the 2 groups; however, there was a significantly lower rate of hospitalizations for other reasons for children with gaps (adjusted incidence rate ratio 0.59; 95% confidence interval 0.41-0.86). CONCLUSIONS:: Children with asthma who had gaps in a Medicaid managed care insurance program had no increase in asthma related emergency department visits and hospitalizations. Children who had gaps did have fewer nonrespiratory emergency department visits and hospitalizations than their nongap counterparts. Further study is needed to explore the reasons for this unexpected finding.

Online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15970788&dopt=Abstract asthma, asthma drug, asthma medicine




Association analysis of cysteinyl-leukotriene receptor 2 (CYSLTR2) polymorphisms with aspirin intolerance in asthmatics.

Shin HD.

aAsthma Genome Research Group, Soonchunhyang University Hospital, Seoul, Korea bAjuo University Hospital, Suwon, Korea cDepartment of Genetic Epidemiology, SNP Genetics, In, 11th Floor, MaeHun B/D, 13 Chongro 4 Ga, Chongro-Gu, Seoul, Korea 110-834.

OBJECTIVES AND METHODS: The cysteinyl leukotriene receptor 2 (CYSLTR2) gene on chromosome 13q14.12-q21.1 encodes a receptor for CYSLTs, potent biological mediators in the pathogenesis of asthma, particularly that associated with aspirin intolerance (AIA). In an effort to discover additional polymorphism(s), the variant(s) of which have been implicated in asthma and aspirin intolerance, we scrutinized genetic polymorphisms of the CYSLTR2 gene, and evaluated this locus as a potential candidate for asthma. RESULTS: DNA sequencing in 24 Koreans of the 5-kb region of the CYSLTR2 gene, including the approximately 1500-bp promoter region, revealed four sequence variants: one in the 5'-flanking region (c.-819T>G), two in the 3'-flanking region (c.2078C>T and c.2534A>G), and one downstream of the gene (c.2545+297A>G). The SNP frequencies were 0.499 (c.-819T>G), 0.351 (c.2078C>T), 0.429 (c.2534A>G), and 0.088 (c.2545+297A>G), and five haplotypes were constructed. The SNPs and haplotypes were not associated with risk of asthma development, but were significantly associated with aspirin intolerance. The frequencies of rare alleles on c.-819T>G, c.2078C>T, and c.2534A>G were higher in subjects with AIA than in subjects with aspirin-tolerant asthma (P=0.013-0.031). Asthmatics who had rare alleles for c.-819T>G, c.2078C>T or c.2534A>G exhibited a more pronounced fall in FEV1 after aspirin provocation than did those who carried the common allele (P=0.03-0.009). Asthmatics carrying ht2 (TTGA) also showed a more pronounced decrease in FEV1% after aspirin provocation than those carrying ht1 (GCGA) (P=0.006). These associations were even stronger when combined with LTC4S polymorphisms (-444A>C [c.-444A>C]) gene. CONCLUSION: CYSLTR2 polymorphisms are associated with aspirin intolerance in asthmatics.

Online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15970796&dopt=Abstract asthma, asthma drug, asthma medicine




Improving asthma treatment in a managed care population.

Bauer BJ.

From Health Management Programs, ConnectiCare, Inc & Affiliates, Farmington, CT 06032, USA. sdelaronde connecticare.com

OBJECTIVE: To identify and educate members of ConnectiCare, Inc & Affiliates, a regional managed care organization, who were not using asthma medications as recommended by the National Heart, Lung, and Blood Institute, by means of a nurse-administered 6-month telephonic case management intervention called the Asthma Treatment Awareness Project. STUDY DESIGN: A randomized controlled design was used to evaluate intervention and control groups. Self-selected members who opted in, opted out, or did not respond to an invitation to participate were included in the analysis. METHODS: Changes in asthma medication use, physician office visits, emergency department visits, hospitalizations, and quality of life were measured. A change in asthma medication use was measured using an asthma medication index ranging from 0 to 1.00, with a higher score indicating a better prescribing pattern. RESULTS: There was significant improvement in asthma medication use for all groups, but the asthma medication index increase of 0.176 for the intervention group was nearly 2 times the 0.091 increase for the control group. This difference remained significant (P = .04) after using analysis of variance to control for age and the preintervention asthma medication index. There was also a significant increase in overall quality of life for the intervention group (P = .04) but not for the control group. CONCLUSION: Individualized telephonic case management from a specially trained registered nurse may be effective in improving asthma medication use and quality of life in subjects that do not use asthma medications according to National Heart, Lung, and Blood Institute guidelines.

Online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15974555&dopt=Abstract asthma, asthma drug, asthma medicine