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An integrated model of environmental factors in adult asthma lung function and disease severity: a cross-sectional study
Laura Trupin, John R Balmes, Hubert Chen, Mark D Eisner, S Katharine Hammond, Patricia P Katz, Fred Lurmann, Patricia J Quinlan, Peter S Thorne, Edward H Yelin, Paul D Blanc
Environmental Health , 2010, DOI: 10.1186/1476-069x-9-24
Abstract: Data on 176 subjects with asthma and/or rhinitis were collected via telephone interviews for sociodemographic factors and asthma severity (scored on a 0-28 point range). Dust, indoor air quality, antigen-specific IgE antibodies, and lung function (percent predicted FEV1) were assessed through home visits. Neighborhood socioeconomic status, proximity to traffic, land use, and ambient air quality data were linked to the individual-level data via residential geocoding. Multiple linear regression separately tested the explanatory power of five groups of environmental factors for the outcomes, percent predicted FEV1 and asthma severity. Final models retained all variables statistically associated (p < 0.20) with each of the two outcomes.Mean FEV1 was 85.0 ± 18.6%; mean asthma severity score was 6.9 ± 5.6. Of 29 variables screened, 13 were retained in the final model of FEV1 (R2 = 0.30; p < 0.001) and 15 for severity (R2 = 0.16; p < 0.001), including factors from each of the five groups. Adding FEV1 as an independent variable to the severity model further increased its explanatory power (R2 = 0.25).Multivariate models covering a range of individual and environmental factors explained nearly a third of FEV1 variability and, taking into account lung function, one quarter of variability in asthma severity. These data support an integrated approach to modeling adult asthma outcomes, including both the physical and the social environment.The potential relationship of environmental factors to morbidity in asthma is highly complex and difficult to study. Environmental risk factors for developing asthma (such as ambient pollution, antigens, and indoor air quality) have been given considerable research attention, particularly in the onset of childhood disease. In contrast, the role of the environment in asthma severity and disease-related quality of life for those who have established asthma has been less well studied, particularly among adults.As importantly, studies of environme
Socioeconomic and Sociodemographic Factors Associated with Asthma Related Outcomes in Early Childhood: The Generation R Study  [PDF]
Esther Hafkamp-de Groen, Agnes M. M. Sonnenschein-van der Voort, Johan P. Mackenbach, Liesbeth Duijts, Vincent W. V. Jaddoe, Henri?tte A. Moll, Albert Hofman, Johan C. de Jongste, Hein Raat
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0078266
Abstract: Rationale Few studies have analyzed the association of socioeconomic and sociodemographic factors with asthma related outcomes in early childhood, including Fraction of exhaled Nitric Oxide (FeNO) and airway resistance (Rint). We examined the association of socioeconomic and sociodemographic factors with wheezing, asthma, FeNO and Rint at age 6 years. Additionally, the role of potential mediating factors was studied. Methods The study included 6717 children participating in The Generation R Study, a prospective population-based cohort study. Data on socioeconomic and sociodemographic factors, wheezing and asthma were obtained by questionnaires. FeNO and Rint were measured at the research center. Statistical analyses were performed using logistic and linear regression models. Results At age 6 years, 9% (456/5084) of the children had wheezing symptoms and 7% (328/4953) had asthma. Children from parents with financial difficulties had an increased risk of wheezing (adjusted Odds Ratio (aOR) = 1.63, 95% Confidence Interval (CI):1.18–2.24). Parental low education, paternal unemployment and child's male sex were associated with asthma, independent of other socioeconomic or sociodemographic factors (aOR = 1.63, 95% CI:1.24–2.15, aOR = 1.85, 95% CI:1.11–3.09, aOR = 1.58, 95% CI:1.24–2.01, respectively). No socioeconomic or gender differences in FeNO were found. The risks of wheezing, asthma, FeNO and Rint measurements differed between ethnic groups (p<0.05). Associations between paternal unemployment, child's sex, ethnicity and asthma related outcomes remained largely unexplained. Conclusions This study showed differences between the socioeconomic and sociodemographic correlates of wheezing and asthma compared to the correlates of FeNO and Rint at age 6 years. Several socioeconomic and sociodemographic factors were independently associated with wheezing and asthma. Child's ethnicity was the only factor independently associated with FeNO. We encourage further studies on underlying pathways and public health intervention programs, focusing on reducing socioeconomic or sociodemographic inequalities in asthma.
Sociodemographic Factors and Clinical Conditions Associated to Hospitalization in Influenza A (H1N1) 2009 Virus Infected Patients in Spain, 2009–2010  [PDF]
Fernando González-Candelas, Jenaro Astray, Jordi Alonso, Ady Castro, Rafael Cantón, Juan Carlos Galán, Olatz Garin, Marc Sáez, Nuria Soldevila, Maretva Baricot, Jesús Castilla, Pere Godoy, Miguel Delgado-Rodríguez, Vicente Martín, José María Mayoral, Tomás Pumarola, José María Quintana, Sonia Tamames, Angela Domínguez, and the CIBERESP Cases and Controls in Pandemic Influenza Working Group
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0033139
Abstract: The emergence and pandemic spread of a new strain of influenza A (H1N1) virus in 2009 resulted in a serious alarm in clinical and public health services all over the world. One distinguishing feature of this new influenza pandemic was the different profile of hospitalized patients compared to those from traditional seasonal influenza infections. Our goal was to analyze sociodemographic and clinical factors associated to hospitalization following infection by influenza A(H1N1) virus. We report the results of a Spanish nationwide study with laboratory confirmed infection by the new pandemic virus in a case-control design based on hospitalized patients. The main risk factors for hospitalization of influenza A (H1N1) 2009 were determined to be obesity (BMI≥40, with an odds-ratio [OR] 14.27), hematological neoplasia (OR 10.71), chronic heart disease, COPD (OR 5.16) and neurological disease, among the clinical conditions, whereas low education level and some ethnic backgrounds (Gypsies and Amerinds) were the sociodemographic variables found associated to hospitalization. The presence of any clinical condition of moderate risk almost triples the risk of hospitalization (OR 2.88) and high risk conditions raise this value markedly (OR 6.43). The risk of hospitalization increased proportionally when for two (OR 2.08) or for three or more (OR 4.86) risk factors were simultaneously present in the same patient. These findings should be considered when a new influenza virus appears in the human population.
Bronchial asthma in intensive care department: the factors influencing on exacerbation severity
TA Pertseva, KE Bogatskaya, KU Gashynova
Critical Care , 2001, DOI: 10.1186/cc1082
Abstract: Ninety-eight of 620 asthmatics, surveyed in the diagnostic center 'Pulmis' in Dniepropetrovsk during 10 months of 2000, were referred to the intensive care department because of severe exacerbation of disease.The aim of present research was to study and to estimate the reasons for patients with BA hospitalizations in the intensive care department.Ninety-eight patients of intensive care department (63 men, mean age 45.5 ± 3.2 years, mean duration of disease 8.3 ± 1.7 years) with severe BA (according to GINA classification) were enrolled into the study.We evaluate patients' educational level, their medication and compliance. According to the results of our research, 34 patients (34.7%) did not receive any anti-inflammatory medicine, 17 (17.3%) used only systemic corticosteroids.Medication of 38 (38.8%) patients consist of short-acting β2-agonists only.Eighty-three (84.7%) patients have never applied long-acting β2-agonists. Thirteen (13.2%) of them visited 'Asthma-school', 4 (4.1%) patients monitor their peak expiratory flow every day, 12 (12.2%) used additional methods of drug delivery (spasers, etc.).The results show that inadequate anti-inflammatory and bron-chodilator therapy, low educational level of the patients, absence of compliance have significant importance in the development of BA severe exacerbation.
Childhood Asthma Management Pre- and Post-Incident Asthma Hospitalization  [PDF]
Marina Bianchi, Antonio Clavenna, Marco Sequi, Angela Bortolotti, Ida Fortino, Luca Merlino, Maurizio Bonati
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0076439
Abstract: Many hospitalizations for asthma could potentially be avoided with appropriate management. The aim of this study was to analyze data on disease management of a paediatric population with a hospitalization for asthma. The study population comprised 6–17 year old subjects belonging to three local health units of the Lombardy Region, northern Italy. Regional administrative databases were used to collect data on: the number of children with an incident hospitalization for asthma during the 2004–2006 period, anti-asthma therapy, specialist visit referrals, and claims for spirometry, released in the 12 months before and after hospitalization. Each patient’s asthma management profile was compared with GINA guideline recommendations. Among the 183 hospitalized subjects, 101 (55%) received therapy before hospitalization and 82 (45%) did not. 10% did not receive any therapy either before or after hospital admission and in 13% the therapy was discontinued afterward. Based on GINA guidelines, asthma management adhered to recommendations only for 55% of subjects. Results may suggest that for half of hospitalized subjects, inaccurate diagnosis, under-treatment/scarce compliance with asthma guidelines by physicians, and/or scarce compliance to therapy by patients/their parents occurred. In all these cases, hospitalization would be a proxy indicator of preventable poor control of disease, rather than a proxy indicator of severity.
Factores ambientales relacionados con la gravedad del asma ENVIRONMENTAL FACTORS RELATED TO ASTHMA SEVERITY  [cached]
MANUEL OYARZúN G.
Revista Chilena de Enfermedades Respiratorias , 2004,
Abstract: factores determinantes de la gravedad del asma. Se revisan brevemente las fuentes y los efectos respiratorios y sobre la salud de los principales contaminantes intradomiciliarios. Existe evidencia abundante sobre las respuestas de los asmáticos a la exposición a aeroalergenos intradomiciliarios, tales como los alergenos de los ácaros domésticos. Para alergenos de mascotas, algunos estudios encuentran que una exposición temprana en la vida se asocia a sensibilización y enfermedad alérgica, en tanto que otros comunican un efecto protector. Los efectos de contaminantes intradomiciliarios de la combustión han sido menos caracterizados. Sin embargo, algunos estudios sugieren que ellos podrían estar asociados con exacerbaciones del asma. La exposición a humo de tabaco ha sido relacionada con exacerbación de asma infantil. Además la prevalencia de asma infantil y los ingresos hospitalarios por asma en adultos también se han relacionado con la exposición a humo de tabaco. La exposición de atópicos y asmáticos a contaminantes atmosféricos (O3 y NO2) aumentan la respuesta de las vías aéreas a los aeroalergenos. Por lo tanto, el control de los contaminantes atmosféricos podría disminuir cualquier interacción de contaminantes con alergenos en atópicos y asmáticos This article review the role played by indoor and atmospheric air pollutants as factors determining asthma severity. Respiratory and health effects and sources of main indoor air pollutants are briefly reviewed. There is abundant evidence of asthmatic responses to indoor aeroallergens, such as exposure to house mite allergens. For pet allergens, some studies found that an early exposure in life was associated to sensitization and allergic disease, whereas others reported a protective effect. The effects of combustion indoor air pollutants have been less characterized. However, some studies suggest that they can be associated to exacerbations of asthma. Environmental tobacco smoke (ETS) exposure has been associated to exacerbation of asthma in childhood. Moreover the prevalence of childhood asthma and adult hospital admissions for asthma has been related to ETS exposure. Exposure of atopic and asthmatic subjects to atmospheric air pollutants (O3 and NO2 ) increases airways response to aeroallergens. Therefore control of atmospheric pollutants might decrease any interaction with allergens in atopic and asthmatics
Out-of-Pocket Costs of Asthma Follow-Up Care in Adults in a Sub-Saharan African Country  [PDF]
Cajetan Chigozie Onyedum,Olufemi Olumuyiwa Desalu,Kingsley Nnanna Ukwaja,Chinwe Chukwuka,Nnamdi Ikechukwu Nwosu,Chijioke Ezeudo
Journal of Respiratory Medicine , 2014, DOI: 10.1155/2014/768378
Abstract: Asthma care imposes economic burden on affected patients. Patient costs for asthma care have not been documented in Africa. We aimed to determine the out-of-pocket cost of asthma follow-up care incurred by patients in Nigeria. We conducted a cross-sectional study in three tertiary hospitals in southeastern and northwestern Nigeria. Poorly controlled asthma patients attending a follow-up visit in the respiratory clinic of the hospitals were surveyed. Sociodemographic, health-seeking behavior, and cost data were collected using a structured questionnaire. Of the 110 patients who completed the study, 56 (51%) were females. Also, 72 (65%) of the patients had known about their asthma illness for more than four years. Mean annual direct cost of asthma care was US$368.4 (±228) per patient. Medication cost accounted for the majority (87%) of this cost. Patient costs of care incurred did not differ significantly across age (P = 0.15), education (P = 0.23), marital status (0.49), residence (P = 0.47), or gender (P = 0.65) categories. We conclude that direct cost of care was found to be substantial among poorly controlled asthma patients. Further studies to estimate the costs incurred by patients with exacerbation and differing severity of the disease should be conducted. 1. Introduction Bronchial asthma is a common chronic respiratory disease worldwide [1]. According to the Global Initiative for Asthma (GINA), it affects 5.4% of adults in Nigeria, and its prevalence is increasing [1–3]. A recent study showed a low level of asthma control among adult asthmatics in Nigeria [4]. Poorly controlled asthma imposes a substantial economic impact on the patient and health system, primarily through direct costs from followup, hospitalization, and medications and indirect costs from lost productivity [5, 6]. A previous study showed that the cost of regular treatment of chronic diseases including asthma is unaffordable to families in low-resource settings [7, 8]. This results in a considerable high proportion of uncontrolled asthma, which is associated with greater economic burden to families and the health system and deterioration in quality of life [7–9]. In high-/middle-income countries, costs of asthma inpatient care [10], hospitalization [10–12], and exacerbations [13] have been previously documented. However, reports on cost of asthma followup among individuals with poorly controlled asthma are lacking worldwide. Furthermore, no data exists on the economic impact of asthma care on patients in Africa. In a recent systematic review, no single study from the region was
Prevalence, Risk Factors and Severity of Asthma Symptoms in Children of Kermanshah, IRAN: ISAAC Phase I, II  [PDF]
Mehdi Zobeiri
Acta Medica Iranica , 2011,
Abstract: Asthma is the most common chronic disorder of school-age children and youth, with rising prevalence in all over the world. By attention to the geographic area there is considerable difference in the prevalence of asthma. The International Study of Asthma and Allergies in Childhood (ISAAC), was founded to maximize the value of epidemiological research into asthma and allergic disease by establishing a standardized methodology and facilitating international collaboration. To determine the prevalence of asthma and related symptoms in Kermanshah (a city in west of IRAN) schoolchildren and also identifying the related variables that increased asthma risk using the ISAAC protocols. This descriptive analytic study was done by the ISAAC written questionnaire and additional questions about family number, demographic and socio-economic characteristics of two groups of first and second grade of primary and guidance schools (6-7 y, 13-14 y). Suggested sample size were applied and selected randomly. Results were analyzed by SPSS soft ware by 95% confidence interval. The ISAAC-written questionnaire was completed by a total of 6236 (48.7% were 6-7 and 51/3% were 13-14 years old) schoolchildren. 50.4% of students were girls and 49/6% were boys. The prevalence of diseases and symptoms were as follows: 20.6% had ever wheezing (27.4% in 13-14 years old and 13.4% in 6-7 years old children and it was 21.6% in girls and 19.5% in boys). Among which the estimated mean national 12-month prevalence of wheeze (current wheeze), speech limiting wheeze , exercise wheeze, night cough and physician diagnosed asthma (ever asthma) were respectively 30.1%, 5.4%, 9.4%, 7.3% and 3.3% for the 6-7 year age group and 44.2%, 13.5%, 28.9% , 17.4% and 2.1% for the 13-14 year age group. Current wheeze was higher in Childs and adolescents with family history of smoking and in higher family number. Comparing with regional study the results of this epidemiological survey of asthma in Kermanshah indicate that asthma is more common here, more prevalent in girls than boys and is higher in 13-14 years old than 6-7 years old but sever asthma is much less common. The results may be due to better diagnosis and better control of disease.
Effect of asthma severity on symptom perception in childhood asthma
Cabral, A.L.B.;Concei??o, G.M.;Saldiva, P.H.N.;Martins, M.A.;
Brazilian Journal of Medical and Biological Research , 2002, DOI: 10.1590/S0100-879X2002000300006
Abstract: individual ability to perceive airway obstruction varies substantially. the factors influencing the perception of asthma are probably numerous and not well established in children. the present study was designed to examine the influence of asthma severity, use of preventive medication, age and gender on the association between respiratory symptoms (rs) and peak expiratory flow (pef) rates in asthmatic children. we followed 92 asthmatic children, aged 6 to 16 years, for five months. symptom scores were recorded daily and pef was measured twice a day. the correlations among variables at the within-person level over time were analyzed for each child and for the pooled data by multivariate analysis. after pooling the data, there was a significant (p<0.05) correlation between each symptom and pef; 60% of the children were accurate perceivers (defined by a statistically significant correlation between symptoms and pef across time) for diurnal symptoms and 37% for nocturnal symptoms. the accuracy of perception was independent of asthma severity, age, gender or the use of preventive medication. symptom perception is inaccurate in a substantial number of asthmatic children, independently of clinical severity, age, gender or use of preventive medication. it is not clear why some asthmatic patients are capable of accurately perceiving the severity of airway obstruction while others are not.
Effect of asthma severity on symptom perception in childhood asthma  [cached]
Cabral A.L.B.,Concei??o G.M.,Saldiva P.H.N.,Martins M.A.
Brazilian Journal of Medical and Biological Research , 2002,
Abstract: Individual ability to perceive airway obstruction varies substantially. The factors influencing the perception of asthma are probably numerous and not well established in children. The present study was designed to examine the influence of asthma severity, use of preventive medication, age and gender on the association between respiratory symptoms (RS) and peak expiratory flow (PEF) rates in asthmatic children. We followed 92 asthmatic children, aged 6 to 16 years, for five months. Symptom scores were recorded daily and PEF was measured twice a day. The correlations among variables at the within-person level over time were analyzed for each child and for the pooled data by multivariate analysis. After pooling the data, there was a significant (P<0.05) correlation between each symptom and PEF; 60% of the children were accurate perceivers (defined by a statistically significant correlation between symptoms and PEF across time) for diurnal symptoms and 37% for nocturnal symptoms. The accuracy of perception was independent of asthma severity, age, gender or the use of preventive medication. Symptom perception is inaccurate in a substantial number of asthmatic children, independently of clinical severity, age, gender or use of preventive medication. It is not clear why some asthmatic patients are capable of accurately perceiving the severity of airway obstruction while others are not.
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