Asthma In Chicago Research Articles

Asthma knowledge, attitude and prescribing behavior of primary health care physicians in the Kingdom of Bahrain

Background: Asthma is a serious public health problem, affecting people of all ages. When uncontrolled it can cause significant morbidity and mortality. Poor implementation of the guidelines is considered one of several barriers for achieving asthma control. Objectives: To determine the asthma knowledge, attitude and prescribing behavior of primary health care physicians in the Kingdom of Bahrain. Methods: A cross–sectional survey was carried out from March 2012 to March 2013 among primary health care physicians (PHC) attending asthma workshops as part of a continuing medical education program. During the study period 5 workshops were conducted which were attended by PHC physicians. A self-administered questionnaire was designed to achieve the research objective. The questionnaire was based primarily on a previous study carried out by the Chicago Asthma Surveillance Initiative (CASI) in the USA; a similar questionnaire was used in a study conducted in 2004, and permission was taken from the investigators to use it in our study. Questionnaires were distributed to the study groups at the beginning of each workshop and 192 of the 240 attending doctors completed the questionnaire, an 80% response rate. Results: The responders were mainly family physicians (66.7%), of whom 73.4% were following asthma guidelines. The study showed that slightly more than half of PHC physicians (56.8%) were able to assess the level of asthma control appropriately and the majority of them reported scheduling regular follow-ups for their patients. However, only 39.1% of PHC physicians were aware of the appropriate medication recommended for step 1 and only 37.3% of them reported that they provided written plans for their patients. Conclusion: Various aspects of GINA guidelines appear to have been integrated into clinical practice by primary care physicians in the Kingdom of Bahrain, whereas other recommendations do not seem to have been readily implemented.

Assessment of Metal Concentrations and Associations with Pulmonary Function among Children with Asthma in Chicago, Illinois.

Individuals living in areas with the potential for elevated metal exposure from industrial sources may have reduced pulmonary function. We evaluated cross-sectional associations of toenail concentrations of 17 metals within a community area of residence and asthma control in 75 children, and pulmonary function measures [forced expiratory volume in one second (FEV1; liters), forced vital capacity (FVC; liters), FEV1 to FVC ratio (FEV1:FVC), and mid-exhalation forced expiratory flow rate (FEF 25–75%; liters/second)], in a subsample of 39 children with diagnosed asthma in Chicago, Illinois. Linear regression models were used to estimate adjusted regression coefficients and standard errors (SE) for the associations between ≥ median versus <median metal exposures and natural log-transformed (ln) pulmonary function test parameters. Toenail levels of cadmium, cobalt, iron, manganese, and vanadium were higher among children residing near an industrial corridor than those in a comparison community. Copper concentrations were inversely associated with lnFEV1 (β = −0.10, SE = 0.04, p = 0.01), lnFEV1:FVC (β = −0.07, SE = 0.03, p = 0.02) and lnFEF 25–75% (β = −0.25, SE = 0.09, p = 0.01); manganese concentrations were inversely associated with lnFEV1 (β = −0.11, SE = 0.04, p = 0.01), lnFEV1:FVC (β = −0.07, SE = 0.03, p = 0.02), and lnFEF 25–75% (β = −0.28, SE = 0.10, p = 0.004), and vanadium concentrations were inversely associated with lnFEV1 (β = −0.08, SE = 0.04, p = 0.05) and lnFVC (β = −0.07, SE = 0.03, p = 0.03). Nickel and copper were associated with uncontrolled asthma (OR = 6.8; 95% CI 2.0, 22.8 and OR = 4.6; 95% CI 1.0, 21.0, respectively). These data suggest that selected metal exposures may be associated with impaired pulmonary function parameters and reduced asthma control among children with preexisting asthma.

Childhood Asthma Disparities in Chicago: Developing Approaches to Health Inequities.

We conducted a needs assessment to develop an evidence-based, locally tailored asthma care implementation plan for high-risk children with asthma in Chicago. Our team of health policy experts, clinicians, researchers, and designers included extensive stakeholder engagement (N = 162) in a mixed-methods community needs assessment. Results showed the lines of communication and collaboration across sectors were weak; caregivers were the only consistent force and could not always manage this burden. A series of recommendations for interventions and how to implement and measure them were generated. Cooperative, multidisciplinary efforts grounded in the community can target wicked problems such as asthma.

What Really Happens in the Home: The Medication Environment of Urban, Minority Youth

Asthma disproportionately affects minority youth. Understanding the home medication environment and its relation to medication adherence can shape interventions to improve health outcomes. The objective of this study was to describe the asthma medication environment in the homes of urban minority youth and to determine predictors of medication use and technique in this population. Baseline data from 2 cohorts of minority youth with asthma in Chicago were combined for cross-sectional analysis. Bilingual research assistants (RAs) collected data in the home. RAs asked caregivers and children to self-report medications using pictures and observed children's asthma medications and inhaler technique. The sample contained 175 mainly Latino youth (85.6%) ranging from 5 to 18 years old. Most were on public insurance (80%) and had uncontrolled asthma by self-report (89.7%). Only 27.4% had a spacer, 74.9% had a quick relief medicine, and 48.6% had any controller medicine. RA observations of controllers agreed with children (36%) and parental self-report (42.3%) but did not match the specific observed controllers. Children reported less parental help with medications (43%) than their parents (58.1%). One child was able to properly demonstrate 100% of the inhaler steps and 35.6% achieved >70% of inhaler steps. A better medication technique was associated with having a controller (b= 12.2, SE= 3.0, P<.0001), quick reliever (b= 8.05, SE= 3.5, P= .023), and a spacer (b= 9.3, SE= 3.54, P= .009). This rigorous evaluation of the home medication environment of high-risk youth demonstrated that many families lack critical medications, devices, and a technique for proper management of asthma.

What Really Happens In The Home: The Medication Environment Of Urban, Minority Youth

To describe the asthma medication environment in the homes of urban minority youth, and to determine predictors of medication use, technique, and asthma control in this high risk population. Baseline data from two cohorts of minority youth with asthma in Chicago were combined for cross-sectional analysis. Bilingual research assistants (RAs) asked caregivers and children to self-report medications using pictures and observed children’s asthma medicines and inhaler technique. Adherence was determined using electronic actuation monitors and/or medication counters. The sample contained 162 mainly Latino (93%) youth ranging from 5-18 years old. Almost all were on public insurance (79%). Most had uncontrolled asthma (69% in last 4-weeks, 79% in last 12-months). Only 25% had a spacer, 78% had a quick relief medicine, and 49% had any controller. RA observations controllers showed good agreement with parent self-report (kappa=0.64) and child self-report (kappa=0.57). Children reported less parental help with medications (41%) than their parents (53%) (kappa=0.40). Only 6% of children with inhaled corticosteroids (n=54) took 4 doses/day. For the metered dose inhaler (n=141), 37% were able to properly demonstrate ≥ 6 correct steps; 33% did not actuate the medicine. Improved medication technique was associated with having an observed controller (p=0.05), having a spacer (p=0.01), more English spoken at home (p=0.02), and caregiver education level (p=0.01) but not with asthma control. This rigorous evaluation of the medication home environment of high risk youth demonstrated that many families lack critical medications, devices, technique, and adherence for proper medical management of asthma.

Asthma care practicing among general practitioners in Lebanon: a cross-sectional study

Objectives: The aim of this study was to characterize the current practice of asthma among general practitioners (GPs) in Lebanon. Methods: Out of 2450 Lebanese registered GPs, a representative sample of 330 were stratified by region to fill out the questionnaire constructed on the basis of surveys developed mainly by the Chicago Asthma Surveillance Initiative Report Team in newly moderate persistent asthma patients aged 5 years and above. The questionnaire included information about ascertaining diagnostic techniques, pharmacotherapeutic approaches, formal patient education program; asthma related continuing medical education and asthma practice guidelines. Results: Totally, 302 completed the questionnaire achieving a response rate of 91.5%. Chest radiography was the most commonly used diagnostic test (98%), while stain for eosinophilia was the less commonly used (7.9%). For clinical monitoring, cough and wheezing (98.7%) were mostly assessed. Short acting inhaled β2-agonists were often the most prescribed (94.3%) followed by inhaled corticosteroids (87.4%) then by long acting β-agonist (LABA) and theophylline (27.5% and 20.9%, respectively). Moreover, 10% of GPs provided formal asthma education program, 72.2% attended professional education and 65% adopted guidelines. Conclusion: Based on current international guidelines, the overall Lebanese GPs practice of asthma management is not at an acceptable standard. Therefore, it is recommended to improve monitoring parameters, implement the asthma guidelines nationally and improve patient education.

Home Asthma Triggers: Barriers to Asthma Control in Chicago Puerto Rican Children

We sought objectively to measure, summarize, and contextualize the asthma triggers found in the homes of urban high-risk Puerto Rican children and adolescents with asthma in Chicago. Data were from the baseline home assessments of Project CURA. Research assistants interviewed caregivers, conducted a home visual inspection, and collected saliva samples for cotinine analysis. A trigger behavior summary score was created. The housing inspected was old with multiple units and obvious structural deficiencies. Many allergic and irritant triggers were observed. Having a controller medicine or private insurance was associated with lower trigger behavior summary scores; caregiver depression, caregiver perceived stress, and child negative life events were associated with high trigger scores. The final multivariate model retained had a controller medicine, private insurance, and caregiver perceived stress. The data from this high-risk cohort identified modifiable areas where environmental interventions could reduce morbidity in Puerto Rican children and adolescents.

Advances in adult asthma diagnosis and treatment in 2012: Potential therapeutics and gene-environment interactions

In the Journal of Allergy and Clinical Immunology in 2012, research reports related to asthma in adults clustered around mechanisms of disease, with a special focus on their potential for informing new therapies. There was also consideration of the effect of the environment on health from pollution, climate change, and epigenetic influences, underlining the importance of understanding gene-environment interactions in the pathogenesis of asthma and response to treatment.

The state of pediatric asthma in Chicago's Humboldt Park: a community-based study in two local elementary schools.

BackgroundPediatric asthma is a serious public health problem in Chicago and has been designated a high priority concern by residents of Chicago's Humboldt Park, a diverse community area with a large number of Puerto Rican, African American, and Mexican American families.MethodsIn May 2009, following the principles of community-based participatory research, a cross-sectional asthma screening survey was administered to adult caregivers of children attending two Humboldt Park elementary schools. Data were analyzed to determine the prevalence of diagnosed and probable asthma as well as the degree of asthma control among affected children; associations between asthma outcomes and mutable triggers were evaluated.ResultsSurveys from 494 children were evaluated. Physician-diagnosed asthma was reported for 24.9% of children and probable asthma identified in an additional 16.2% of children. Asthma was poorly or moderately controlled in 60.0% of diagnosed children. Smoking occurred inside 25.0% of households and 75.0% of caregivers reported idling of vehicles in their community. Report of general stress among caregivers, stress due to community crime, and/or an inability to cope with everyday life were significantly and positively associated with poor asthma morbidity and control among affected children.ConclusionsDespite high prevalence rates and poor asthma morbidity and control in Humboldt Park, the association of these measures with mutable variables is promising. A community-based asthma intervention to address the issues identified in this study is needed to affect positive change.

A community-based study of tobacco smoke exposure among inner-city children with asthma in Chicago

Little is known about the level of tobacco exposure and the factors that influence exposure in children with persistent asthma. We sought to measure tobacco smoke exposure and determine factors associated with exposure in a large urban sample of asthmatic children. This cross-sectional study is based on a community-based cohort of 482 children (8-14 years old) with persistent asthma. Caregiver and household tobacco use were reported by the caregiver. Child tobacco smoke exposure was assessed by using salivary cotinine level. Multivariate linear regression of log-transformed salivary cotinine levels were used to characterize the relationship between smoke exposure and caregiver, household, and demographic characteristics. We used a multivariate logistic model to characterize associations with caregiver smoking. Overall, 68.5% of children had tobacco smoke exposure. Compared with nonexposed children, those exposed to smoking by a caregiver or another household member had cotinine levels that were 1.68 (95% CI, 1.45-1.94) or 1.40 (95% CI, 1.22-1.62) times higher, respectively. Compared with Hispanic children, African American and white/other children had 1.55 (95% CI, 1.16-2.06) and 1.59 (95% CI, 1.18-2.14) times higher cotinine levels, respectively. Child exposure was also associated with caregiver depression symptoms (odds ratio, 1.01; 95% CI, 1.01-1.02), and higher household income was protective (odds ratio, 0.73; 95% CI, 0.56-0.95). Independent predictors of caregiver smoking included a protective effect of higher education (odds ratio, 0.35; 95% CI, 0.15-0.83) and a positive association with potential problematic drug/alcohol use (odds ratio, 2.30; 95% CI, 1.39-3.83). Tobacco smoke exposure was high in this urban sample of asthmatic children. Caregiver smoking was strongly associated with child exposure and also was associated with lower socioeconomic status, non-Hispanic ethnicity, and depression symptoms.

Are We Closing the Disparities Gap?: Small-Area Analysis of Asthma in Chicago

Disparities in asthma outcomes in the Chicago area have been observed between geographic areas and ethnic and socioeconomic groups. As efforts to close this gap have moved beyond the initial characterization of the problem to implementation of concrete programs to address these disparities, objective measures of success are essential. We present a variety of data from the Chicago area to assess whether any improvement in previously reported disparities can be demonstrated. While some process outcomes such as medication usage have improved over time, death from asthma has failed to demonstrate an equivalent improvement. More importantly, the differential in asthma mortality and hospitalization rates between African Americans and European Americans has failed to close in the years following the release of the National Asthma Education and Prevention Program asthma guidelines.

Associations of physician-diagnosed asthma with country of residence in the first year of life and other immigration-related factors: Chicago Asthma School Study

Among Mexican Americans in the United States, US-born children have higher rates of asthma than their Mexico-born peers. To evaluate the associations of immigration-related variables with physician-diagnosed asthma in a sample of Mexican American children. We analyzed data from the ongoing Chicago Asthma School Study, a population-based cross-sectional study, for 10,106 Mexican American schoolchildren in Chicago, Illinois. Mexican American children who lived in the United States in the first year of life were more likely to have physician-diagnosed asthma than their peers who lived in Mexico in the first year of life, independent of age, sex, income, language, and country of birth (odds ratio [OR], 1.79; 95% confidence interval [CI], 1.09-2.94). The risk of asthma in US-born children was higher (but not significantly) than that observed in Mexico-born children after accounting for covariates, including country of residence in the first year of life (OR, 1.37; 95% CI, 0.86-2.18). Long-term immigrants (lived in the United States for 10 years) had an increased risk of asthma compared with short-term immigrants (lived in the United States for <10 years), independent of country of residence in the first year of life (OR, 1.93; 95% CI, 1.00-3.73). These findings confirm the importance of early childhood exposures and environmental factors that are modified with migration and acculturation in asthma development.

Success of a Comprehensive School-Based Asthma Intervention on Clinical Markers and Resource Utilization for Inner-City Children with Asthma in Chicago: The Mobile C.A.R.E. Foundation's Asthma Management Program

Children with asthma in low-income households in Chicago were participants in a school-based mobile van clinic, Mobile C.A.R.E. Our objective was to investigate whether long-term follow-up changed clinical markers and resource utilization. Children were evaluated by a pediatrician in a mobile allergy clinic and classified and treated based on National Asthma Education and Prevention Program (NAEPP) guidelines. Intervention consisted of assessment of allergic environment with avoidance recommendations, institution of appropriate controller therapy and inhaler technique, education on asthma and asthma management, and expectations for asthma control. Over 20,000 children were screened, 2041 were examined at least once, and 677 children had four follow-up visits. With follow-up, there was a decrease in hospitalizations and emergency room visits. Symptomatic markers (daytime and nighttime cough, wheezing, and dyspnea symptoms), frequency of rescue inhaler use, and a quality-of-life score improved from baseline. These findings suggest that ongoing school interventions may reduce resource utilization and improve clinical symptoms. Primary care physicians may be able to deliver specialized care to large numbers of inner-city children with asthma.

Abstracts

Abstracts

Differences in medication compliance among elderly patients with asthma in Chicago

Rationale Medication noncompliance is one of many factors that lead to the sub-optimal management of asthma in elderly patients. Several hypotheses as to why elderly patients are non-compliant have been made including multiple medical problems requiring numerous prescriptions and the high cost of prescription medications. Our study compares medication non-compliance rates in two different populations of elderly patients with asthma in an effort to better understand the obstacles to appropriate management of asthma in elderly patients. Methods Surveys regarding asthma symptoms and treatment were given to two distinct groups of elderly individuals with asthma. The first group was recruited from senior centers subsidized by the Chicago Department on aging catering to disadvantaged seniors. The second group was recruited from Northwestern University's Aging Research Registry and although these individuals represent a spectrum of incomes, they all entered the registry through their healthcare providers. Results From a total of 86 disadvantaged participants with asthma, only 24 (28%) took their prescribed medications on a regular basis. From a total of 35 registry participants with asthma, 28 (80%) took their medications on a regular basis. All but 12 (34%) of the registry participants had either a prescription plan or senior discount for obtaining their medications. Conclusions Although medication non-compliance is common in elderly patients with asthma, our survey results suggest that good access to healthcare and a prescription coverage plan that helps cover the cost of medications improves compliance.

Trends in Emergency Department Asthma Care in Metropolitan Chicago : Results From the Chicago Asthma Surveillance Initiative

The purpose of this study was to assess trends in emergency department (ED) asthma care in a single large community and to address how these trends meet expectations of national guidelines for asthma care. This study is based on a repeated cross-sectional, self-administered survey of ED directors (or designees) in the Chicago area. Fifty-one EDs that responded to both the 1996-1997 and 2000 surveys comprise the database for this study. Areas of significant improvement from 1996-1997 to 2000 include reduction in the use of theophylline (10.1% vs 3.1%, p < 0.0001), increased use of systemic steroid prescriptions at discharge (57.7% vs 77.2%, p < 0.0001), decreased use of arterial blood gas (ABG) analyses as part of the initial patient assessment (10.2% vs 4.5%, p = 0.02) and to document improvement after treatments (18.8% vs 8.9%, p = 0.03) and increased use of pulse oximetry as part of the initial patient assessment (95.1% vs 98.1%, p = 0.05). Areas of significant worsening of asthma care from 1996-1997 to 2000 include reduction in the use of ABG analyses in the assessment of severe cases (71.5% vs 47.5%, p < 0.0001), decreased use of instructions to inform patients what to do in the event of inability to attend their follow-up appointment (94.4% vs 38.9%, p = 0.0004), and decreased use of peak expiratory flow rate measurements to document improvement after treatments (82.7% vs 78.6%, p = 0.04). From 1996-1997 to 2000, ED asthma care in metropolitan Chicago has improved in some areas and worsened in others. However, most aspects of asthma care have continued to fall short of national asthma guidelines. The lack of overall improvement with the current widespread knowledge of national guidelines suggests that a dissemination strategy of medical education by itself is not sufficient to improve ED asthma care.

The Chicago Asthma Consortium: A Community Coalition Targeting Reductions in Asthma Morbidity

The problem of asthma in Chicago remains a complex one, and it is too early to know whether any programs and efforts have had a discernible effect, but the Chicago Asthma Consortium continues to expand its membership and to define its mission. The successes have come from harnessing the passion of the individual members to move the projects forward. As the focus of the consortium moves to addressing system-wide problems in asthma care and the delivery of that care, the consortium is undertaking the construction of a guide for future efforts. In this way, the consortium will fulfill its vision of creating a comprehensive, community-wide plan for the management of asthma, impacting on the unacceptable current levels of morbidity and mortality of the disease.

Targeting Asthma in Chicago: Community Stories

1999;116;204S-206S Chest Eckenfels Claudia Baier, Evalyn N. Grant, Steven R. Daugherty and Edward J. * The Henry Horner Pediatric Asthma Program http://chestjournal.chestpubs.org/content/116/suppl_2/204S.full.html services can be found online on the World Wide Web at: The online version of this article, along with updated information and ISSN:0012-3692 ) http://chestjournal.chestpubs.org/site/misc/reprints.xhtml ( written permission of the copyright holder. this article or PDF may be reproduced or distributed without the prior Dundee Road, Northbrook, IL 60062. All rights reserved. No part of Copyright1999by the American College of Chest Physicians, 3300 Physicians. It has been published monthly since 1935. is the official journal of the American College of Chest Chest

The American Red Cross of Greater Chicago's Asthma Program

The American Red Cross is a nonprofit organization whose mission is to provide relief for victims of disaster and help people prevent, prepare for, and respond to emergencies. Within the larger organization is the Community Services Department, focused on helping people lead healthier, safer lives. The American Red Cross of Greater Chicago serves the city and surrounding seven-county area. This chapter is a pioneer of sorts, in that they are the only chapter to have developed an asthma program in addition to the other standard programs.

The Chicago Asthma Surveillance Initiative: A Community-Based Approach to Understanding Asthma Care

Nearly all of the asthma surveillance literature focuses on national-, regional-, or state-based estimates of prevalence, health-care utilization (specifically hospitalizations, emergency department, and ambulatory care visits), and mortality. Although these are important events, they reveal little about asthma's impact at the community level and provide little information that could be used to design specific interventions for improving clinical outcomes. A useful representation of asthma care across a community could guide an effective community response to the burden of asthma. The goal of the Chicago Asthma Surveillance Initiative (CASI) is to develop a community-wide surveillance program that characterizes and monitors asthma care in the Chicago area, beyond existing public health surveillance. To accomplish this, CASI surveyed Chicago-area hospitals, emergency departments, primary care physicians, specialty care physicians, pharmacists, managed care organizations, the general public, and persons or families affected by asthma to learn about asthma care and its outcomes. A variety of techniques (including brochures, slide kits, and the Internet) were used to achieve rapid public dissemination of study findings. The value of this comprehensive community-based data surveillance effort will rest on how the community uses this information to stimulate new efforts to improve asthma care and reduce untoward outcomes.