Parental asthma knowledge.

Norzila MZ.

Paediatric Department, Kulliyyah of Medicine, International Islamic University Malaysia, Jalan Hospital, 25150 Kuantan, Pahang.

Asthma knowledge an important components of asthma education. OBJECTIVE: To determine the levels of asthma knowledge in parents of asthmatic children and factors that may influence it. METHODS: This is a prospective study done between March 1998 and July 1998. Sixty-seven parents were interviewed using the 31 item asthma knowledge questionnaire that had been validated and translated. The children' asthma severity was classified. The questionnaire includes bio-data of children and parents, types of medication and dosages duration of asthma, exposure to cigarette smoke, acute asthma admissions, and parent's economic status. RESULTS: The mean score for asthma knowledge was 15.5. The total score was 31. Asthma knowledge was significantly higher in parents whose children were using steroids [p = 0.03, CI (-3.58, -0.02)]. It correlated significantly with steroid dosage (r = 0.29, p = 0.02), and was significantly higher in parents of higher economic status. Parent's asthma knowledge had no association with children's asthma status, age of the child or parents, exposure to cigarette smoke, frequency of admission or asthma duration. CONCLUSION: The low asthma knowledge level indicates the need to increase the effort in educating parents. The main indicator for higher knowledge was steroid usage and dosage. Higher asthma knowledge in the high-income group was probably related to levels of education.

Online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12733173&dopt=Abstract asthma, asthma drug, asthma medicine




Parental perceptions of their child's asthma: management and medication use.

Kitzman H.

SUNY College at Brockport, New York, USA. Kathleen_Peterson-Sweeney urmc.rochester.edu

INTRODUCTION: Adequate treatment for asthma depends on accurate assessment and intervention by the parent and child and timely communication with the provider. These actions by the parent may be affected by their understanding of asthma management and their concerns about medications being prescribed. This research reports parental experiences with their children with asthma, specifically their beliefs, knowledge, and attitudes about asthma management, including medication use. METHODS: Data reported are from a study investigating parental attitudes and beliefs affecting antiinflammatory medication use in childhood asthma. These qualitative findings emerged from one-on-one semistructured qualitative interviews with 18 parents of children 2 to 18 years of age who were from diverse racial and socioeconomic backgrounds and who represented the spectrum of illness severity. RESULTS: Eight main themes within the domain of asthma management and medication use were identified: "I know my child," "trial and error," "partnership," "need for education," "negotiating responsibility," "hassles with medication administration," "preferences," and "the benefits outweigh the risks of side effects." DISCUSSION: These themes emphasize parents' need to partner with providers in their child's asthma management, as well as their need for ongoing asthma education. Parents also expressed concern about adverse effects of antiinflammatory medication but acknowledged the importance of controlling asthma symptoms. Based on these findings, systematic practice changes are recommended that provide regular opportunities for parent and child asthma education in a structured asthma wellness or "tune-up" visit.

Online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12734458&dopt=Abstract asthma, asthma drug, asthma medicine




Relationship of asthma to irritant gas exposures in pulp and paper mills.

Jones RN.

Department of Medicine, Tulane University, New Orleans, LA 70112-2699, USA.

The potential of chronic or acute irritant gas exposures to cause asthma or a variant condition, reactive airways dysfunction syndrome (RADS) was investigated by observing asthma incidence in a large working population, using person-years at risk (P-YR) to compute relative rates (RR). Health data came from employee examinations at 62 pulp and paper plants. The 39122 workers who denied asthma beginning before the observation period included: 19326 denying irritant exposures, with no gassing exposures; 19349 with self-reported irritant exposures, and no gassing; and 447 with documented gassings. Asthma was defined as self-reported asthma beginning after the start of observation. P-YR accrued from September 29, 1986, for the nonexposed and exposed workers, and from date of first gassing for gassed workers, and ended with disease onset in any who developed asthma. RR of asthma with 95% confidence intervals (CI95) were calculated for the exposed and gassed groups, relative to the nonexposed. Exposed (nongassed) workers had an elevated asthma rate, RR=1.48, CI95=1.17-1.86, after adjustment for effects of gender and number of examinations. The rate in gassed workers was not significantly elevated: RR=1.95, CI95=0.75-5.08. Of the five asthma cases occurring after gassings, none conformed to diagnostic criteria for RADS. Chronic exposures were associated with increased rate of asthma onset, which must be interpreted with caution because self-reported data defined both exposure category and disease. Documented gassings were not associated with significantly increased rate, and none of 447 gassed persons developed RADS.

Online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12735673&dopt=Abstract asthma, asthma drug, asthma medicine




Comparison of allergen-induced late inflammatory reactions in the nose and in the skin in house dust mite-allergic patients with or without asthma.

van der Zee JS.

Department of Pulmonology, Academic Medical Center, Amsterdam, The Netherlands.

BACKGROUND: It remains to be established which factors contribute to the occurrence of asthma in allergic individuals. We hypothesized that differences in the late allergic inflammatory reaction to allergen between asthmatic and non-asthmatic house dust mite-allergic individuals might contribute to the difference in the clinical presentation of allergy. AIM: To compare allergen-induced changes in parameters for cellular inflammation during the phase of the late allergic reaction in the skin and nose, in house dust mite-allergic individuals with or without asthma. MATERIAL AND METHODS: Nasal and dermal allergen challenges with house dust mite (Dermatophagoides pteronyssinus) extract were performed in 52 house dust mite-allergic individuals, of whom 26 had mild to moderate persistent asthma and 26 had perennial rhinitis without current or past asthmatic symptoms. Serial nasal lavage samples were analyzed for the presence of inflammatory cells (eosinophils and neutrophils) and soluble markers associated with cellular inflammation [interleukin-5 (IL-5), interleukin-8 (IL-8), eosinophil cationic protein (ECP) and myeloperoxidase (MPO)]. Macroscopic late phase skin reactions were studied after intracutaneous skin tests with house dust mite extract. RESULTS: Fixed dose nasal allergen provocation elicited a similar degree of immediate allergic reaction as judged by plasma protein exudation and histamine concentrations in asthma and non-asthmatic rhinitis. Subsequently, no differences between groups were found during the phase of the late allergic reaction (4-24 h) in inflammatory cell influx, plasma protein leakage, ECP or MPO. Likewise, there were no differences in levels of chemotactic cytokines IL-5 and IL-8. In agreement with the results of nasal challenge, the late skin reaction after dermal challenge with a fixed allergen dose and after an allergen dose 10,000 times above the skin threshold for an early skin reaction did not differ between the groups. CONCLUSION: House dust mite-allergic patients with or without asthma have very similar late allergic inflammatory reactions in the skin and in the nose after allergen challenge. Hence, it is unlikely that the occurrence of pulmonary symptoms in asthma is explained by a general tendency of asthmatics to have an enhanced late allergic cellular inflammatory response. Nasal and dermal allergen provocations are adequate models to study allergen-induced inflammation but probably lack the pivotal link which is essential for the development of asthma. Copyright 2003 S. Karger AG, Basel

Online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12740527&dopt=Abstract asthma, asthma drug, asthma medicine




Prevalence of asthma and asthma action plans in South Australia: population surveys from 1990 to 2001.

Ruffin RE.

University of Adelaide, Adelaide, SA, Australia. david.wilson adelaide.edu.au

OBJECTIVES: To assess trends in the prevalence of self-reported doctor-diagnosed asthma, associated asthma related morbidity, and the uptake of written asthma action plans in South Australia, 1990-2001. DESIGN, SETTING AND PARTICIPANTS: Surveys by telephone interview of the South Australian population between 1990 and 2001, and interview of participants in their own homes by trained health interviewers. MAIN OUTCOME MEASURES: Asthma prevalence, percentage of patients with written action plans, and asthma associated morbidity. RESULTS: The reported prevalence of doctor-diagnosed asthma has increased from 8% (95% CI, 6.4%-9.6%) in 1990 to 12.8% (95% CI, 11.4%-14.2%) in 2001. Morbidity, as measured by wakening at night (daily or weekly) and days lost from normal activities because of asthma, has remained constant over the decade. The percentage of patients with written asthma action plans increased to a peak of 42.3% (95% CI, 40.3%-44.3%) in 1995, but then declined to 22.2% (95% CI, 20.7%-23.7%) in 2001. CONCLUSIONS: The prevalence of asthma has increased while morbidity has remained constant, indicating that the burden of asthma has increased. The associated decline in the percentage of patients with asthma action plans in recent years is cause for concern.

Online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12741932&dopt=Abstract asthma, asthma drug, asthma medicine




Experimental rhinovirus challenges in adults with mild asthma: response to infection in relation to IgE.

Heymann PW.

Department of Pediatrics, University of Virginia Health System, Charlottesville, VA 22908-0386, USA.

BACKGROUND: Although most children and young adults with asthma are atopic, exacerbations of asthma are frequently associated with viral respiratory tract infections, especially those caused by rhinovirus (HRV). OBJECTIVE: Young atopic adults with mild asthma were evaluated before and during an experimental HRV infection to test the hypothesis that airway inflammation before virus inoculation may be a risk factor for an adverse response to HRV. METHODS: Experimental HRV infections were evaluated in 16 allergic volunteers with mild asthma and 9 nonatopic control patients (age, 18 to 30 years). Before virus inoculation, each participant was screened with tests for lung function, prick skin tests for sensitization to common aeroallergens, measurements of total serum IgE, and serum neutralizing antibody to rhinovirus-16 (the serotype used for inoculation). The response to infection was monitored for 21 days by using symptom diary cards, tests for lung function, and markers of airway inflammation in nasal washes, blood, and expired air. RESULTS: During the infection, asthmatic patients had cumulative upper and lower respiratory tract symptom scores that were significantly greater over the course of 21 days than scores from the control patients. At baseline, the asthmatic patients also had increased sensitivity to methacholine and significantly lower values for FEV(1) (percent predicted) than the control patients (geometric mean and intraquartile values: 87% [79% to 91%] for the asthmatic patients and 101% [90% to 104%] for the control patients, P <.03). Among the patients with mild asthma, 6 had levels of total serum IgE that were substantially elevated (range, 371 to 820 IU/mL) compared with 10 who had lower levels (range, 29 to 124 IU/mL). Those with high levels of IgE had significantly greater lower respiratory tract symptom scores during the initial 4 days of the infection than the low IgE group. They also had higher total blood eosinophil counts at baseline, increased eosinophil cationic protein in their nasal washes (>200 ng/mL), and augmented levels of expired nitric oxide at baseline and during peak cold symptoms. In contrast, levels of soluble intracellular adhesion molecule-1 in nasal wash supernatants from the asthmatic patients with high IgE were diminished, both at baseline and during the infection. CONCLUSIONS: The reduced lung function and increased markers of inflammation observed before virus inoculation in the asthmatic patients who had high levels of total serum IgE may be risk factors for an adverse response to infections with HRV.

Online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12743565&dopt=Abstract asthma, asthma drug, asthma medicine




Deficient prostaglandin E2 production by bronchial fibroblasts of asthmatic patients, with special reference to aspirin-induced asthma.

Szczeklik A.

Department of Medicine, Jagellonian University Medical School, Krakow, Poland.

BACKGROUND: Regulation of prostaglandin synthesis and the activation of human airway fibroblasts associated with the remodeling of the bronchi play an important role in asthma. OBJECTIVE: We sought to assess the cyclooxygenase pathways in airway fibroblasts of patients with bronchial asthma. METHODS: Generation of prostaglandin E(2) (PGE(2)) and pros-taglandin D(2) (PGD(2)) by bronchial fibroblasts was measured by means of mass spectrometry in culture supernatants, and cyclooxgenases expression was estimated by means of RT-PCR and immunoblotting. The cells were isolated from 3 groups of subjects: nonasthmatic patients (n = 10), patients with aspirin-tolerant asthma (ATA, n = 9), and patients with aspirin-intolerant asthma (AIA, n = 7). RESULTS: The cytomix (LPS, 5 square g/mL; IL-1 square, 5 ng/mL; and TNF- square, 10 ng/mL; 18 hours) stimulated the production of prostaglandins. Asthmatic patients were characterized by low capacity to produce PGE(2) after cytomix stimulation. In the nonasthmatic patient group the mean PGE(2) production was 32 +/- 33 ng/mL (35-fold of the basic production), in the ATA group it was 16 +/- 18 ng/mL (16-fold), and in the AIA group it was only 5.3 +/- 3.6 ng/mL (4-fold). The mean concentration of PGD(2) for nonasthmatic patients, patients with ATA, and patients with AIA was 0.18 +/- 0.16 ng/mL (4.7-fold of the basic production), 0.18 +/- 0.14 ng/mL (4.2-fold), and 0.235 +/- 0.19 ng/mL (1.9-fold), respectively. The observed difference was not due to insufficient cyclooxygenase 2 expression because all groups had similar levels of its mRNA and protein. The patients with AIA had low expression levels of cyclooxygenase 1 protein but not of its mRNA. The PGE(2)/PGD(2) concentration ratio increased after cytomix stimulation in all groups but was significantly less in patients with AIA than in patients with ATA. CONCLUSIONS: Our results point to a deficient PGE(2) production under proinflammatory conditions in asthmatic airways. This could weaken local defensive mechanisms and promote cysteinyl leukotriene overproduction.

Online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12743569&dopt=Abstract asthma, asthma drug, asthma medicine




Household exposure factors, asthma, and school absenteeism in a predominantly Hispanic community.

McGarvey P.

Robert Wood Johnson Medical School, Piscataway, New Jersey 08558, USA. nfreeman eohsi.rutgers.edu

The Passaic Asthma Reduction Effort (PARE) used an asthma symptom and household exposure factor questionnaire to screen 4634 elementary school children over a 4-year period in Passaic, New Jersey. During the first year, an additional 240 preschool children were also screened. Overall, 16% of the school children were reported by their parents to have been diagnosed with asthma. In all, 30% of responding families claimed to have at least one family member diagnosed with asthma and this was five times more likely if the target child had asthma. Exposures consistently associated with childhood asthma diagnosis included environmental tobacco smoke (ETS), presence of dampness/mold, roaches, and furry pets in the home. Diagnosis of asthma was primarily associated with all six symptoms used in the PARE questionnaire, and secondarily with environmental factors. Puerto Rican and black children had the highest asthma prevalence (26% and 33%), while Mexican children had the lowest (7%). Use of medications and school absenteeism among asthmatic children were associated with wheeze and night cough, but not with any specific environmental exposure. Increased school absenteeism by children undiagnosed with asthma was associated with ETS and dampness/mold in the home. Differences in asthma diagnosis and absenteeism in response to environmental factors were found across ethnic subgroups. Getting asthmatic children on medical management protocols and providing families with education about environmental risk reduction should aid in reducing morbidity in this ethnically complex population. Such coordinated efforts offer the promise of reducing school absenteeism.

Online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12743611&dopt=Abstract asthma, asthma drug, asthma medicine