Asthma-related Emergency Room Visits Research Articles

Fast-Food Consumption and Asthma-Related Emergency Room Visits in California

Introduction Asthma is common, affecting up to 8% of adults in the United States. Several studies have shown an association between poorer diet and asthma. Despite the prevalence of fast-food consumption in the Western diet, research examining fast food consumption and asthma is limited. Objective This study aimed to examine the association between fast food consumption and asthma-related emergency room visits among adults with asthma in California from 2011-2016. Methods This cross-sectional study focused on 11,561 adults with asthma in California. Publicly available data from the California Health Interview Survey was used. The independent variable included fast food consumption, and the dependent variable was emergency room visits due to asthma. This study used logistic regression models and controlled for sex, race, self-reported overall health, BMI, and current smoking status. Survey weights were applied to ensure the analysis represented the general population. Results Consumption of fast food ≥3 times per week was associated with increased odds of emergency room visits for asthma among adults with asthma in California (unadjusted model: OR = 1.64 CI: 1.13-2.40, p = 0.01; adjusted model: ORadj =1.53, CI: 1.03-2.26, p = 0.03). Conclusion Our findings suggest that high consumption of fast food among adults with asthma may result in higher odds of asthma-related emergency room visits. Thus, decreasing fast food consumption may benefit adults with asthma by reducing emergency room visits.

Prevalence and burden of asthma among US working adults by industry and occupation—United States, 2020–2021

Objectives Assess the prevalence of current asthma, asthma attacks/episodes, and asthma-related emergency room (ER) visits by industry and occupation and estimate the proportion of current asthma cases associated with employment during 2020–2021. Methods The 2020–2021 National Health Interview Survey data for persons aged ≥18 years who were employed at any time during the 12 months prior to the interview were analyzed. Results An estimated 12.7 million US working adults had current asthma. Of those, 40% had an asthma attack/episode and 8.6% had an asthma-related ER visit. Prevalence varied by sociodemographic characteristics, industry, and occupation. Highest asthma prevalence was among workers in the administrative, support, waste management, and remediation industry and the community and social services occupation. Nearly half of workers with current asthma in the arts, entertainment, and recreation industry and arts, design, entertainment, sports, and media occupations reported having an asthma attack/episode. Workers in the accommodations and food services industry and food preparation and serving related occupation had the highest asthma-related ER visits. The proportion of current asthma cases attributable to employment was estimated to be 9.2% by industry and 12.2% by occupation. Conclusion An estimated 1.2–1.5 million asthma cases among workers might be attributable to employment by industry and occupation. Disparities in asthma prevalence, asthma attacks/episodes and asthma-related ER visits among workers exist. These findings underscore the importance of early identification of asthma cases in relation to work and implementation of targeted interventions (including, training and education, personal protective equipment use, health surveillance, workplace policies), especially among workers employed in industries and occupations with elevated asthma prevalence.

Do Health Disparities Narrow with Pollution Disparities? Trends from California

Pollution concentrations (PM2.5) in the United States have fallen in recent decades. Despite these improvements, disparities in concentrations between racial/ethnic groups persist. We combine administrative data on the universe of emergency room (ER) admissions across California with satellite information on PM2.5 concentrations and compare recent trends in racial/ethnic disparities for PM2.5 and asthma rates. We find that PM2.5 concentrations fell for the average Black, Hispanic, and White individual. Similarly, disparities in PM2.5 concentrations fell between Black and White individuals and between Hispanic and White individuals. However, racial disparities in asthma rates, as measured by asthma-related ER visits per resident, have increased overall and broadly across the income distribution.

Associations among Historical Neighborhood Disinvestment, Hazardous Air Pollutants, and Current Adult Asthma Prevalence

Associations among Historical Neighborhood Disinvestment, Hazardous Air Pollutants, and Current Adult Asthma Prevalence

Cardiovascular Disease Among Adults With Work-Related Asthma, 2012–2017

Asthma is associated with an increased risk for cardiovascular disease, and adults with persistent, severe asthma have a significantly higher risk of cardiovascular disease than adults with intermittent or no asthma. The objective of this cross-sectional study was to assess the association between work-related asthma status and cardiovascular disease among ever-employed adults (aged 18-64 years) with current asthma using data from the 2012-2017 Behavioral Risk Factor Surveillance System Asthma Call-Back Survey from 37 states and the District of Columbia. Weighted prevalence ratios and 95% CIs, adjusted for age, sex, race/ethnicity, education, household income, smoking status, chronic obstructive pulmonary disease, diabetes, and BMI, were calculated. In addition, the associations of cardiovascular disease with adverse asthma outcomes and asthma control among adults with work-related asthma were examined. Analyses were conducted in 2021. Among an estimated annualized 14.8 million ever-employed adults aged 18-64 years with current asthma, adults with work-related asthma (prevalence ratio=1.5; 95% CI=1.2, 1.8) and possible work-related asthma (prevalence ratio=1.2; 95% CI=1.0, 1.5) were significantly more likely to have cardiovascular disease than adults with non-work-related asthma. Among adults with work-related asthma, those with very poorly controlled asthma (prevalence ratio=1.8; 95% CI=1.3, 2.5) and an asthma-related emergency room visit (prevalence ratio=1.5; 95% CI=1.1, 2.0) were significantly more likely to have cardiovascular disease. Adults with work-related asthma were more likely to have cardiovascular disease than those with non-work-related asthma. Primary prevention, early diagnosis, and implementation of optimal work-related asthma management are essential for workers' health. Cardiovascular disease should be considered where appropriate when diagnosing and recommending treatment and interventions for adults with work-related asthma.

Effectiveness of a community-driven, asthma intervention: project asthma in-home response

Objectives: Project Asthma In-home Response (AIR) is a multilevel, home-based intervention to address childhood asthma. This study aims to assess the effectiveness of the community-driven, multilevel Project AIR intervention. We hypothesize that children participating in the Project AIR intervention will have reduced asthma-related emergency room visits, hospitalizations, and asthma exacerbations. Methods: Seventy-Five participants of an in-home asthma intervention were surveyed at the onset of intervention and six months after the intervention. Results: The mean age of clients in the sample population was ten years. Most clients in the sample population were 11–15 years old (34.7%), followed by 6–10 years old (29.3%) and 3–5 years (26.0%). Participation in the Project AIR intervention resulted in significant reductions in asthma attacks (p-value 0.0003), asthma-related emergency room visits (p-value > 0.0001), and asthma-related hospitalizations (p-value 0.008).Conclusion: The results of this study support that in-home environmental asthma programs are an efficient method of treating asthma in a smaller metro area. Our findings reinforce prior studies in larger metropolitan areas such as New York and Boston.

Dietary patterns in patients with asthma and their relationship with asthma-related emergency room visits: NHANES 2005–2016

Rationale Extensive interdependencies exist between dietary intake, metabolic dysregulation, and asthma; however, the dietary pattern in adults with asthma remains unknown. Objectives To evaluate the association between dietary patterns and asthma ER visits and explore the effect of the interaction between race and diet on asthma. Methods Using NHANES data, we compared dietary patterns between adults with asthma with and without asthma-related emergency room (ER) visits in the previous year, and between subjects of different races. The 2015 Healthy Eating Index (HEI-2015) was used to assess alignment between dietary patterns and the 2015–2020 Dietary Guideline for Americans. Results Among 1681 individuals included in the study, 193 reported asthma-related ER visit. Patients with asthma had low fruit and vegetable intake, and a low mean (SE) HEI-2015 score [52.6 (0.53)]. Individuals with asthma-related ER visits had lower vegetable consumption compared to those without (median 0.61 vs. 0.85 cup equivalents). Furthermore, non-Hispanic Blacks (NHB) reported lower amount of vegetable (median cup equivalent 0.58 vs. 0.89) and fruit intake (0.17 vs. 0.39) and had a lower HEI-2015 score (49.9 vs. 52.9) comparing to non-Hispanic Whites. No association was discovered between dietary patterns and ER visits in multivariable analysis, or significant interactions between diet and race in predicting the need for ER visits. Conclusions Dietary patterns in adult with current asthma are frequently misaligned with current dietary guidelines. Patients with asthma-related ER visits and of NHB race had lower vegetable consumption; however, the associations disappeared in multivariable analysis. The impact of diet on asthma is not straightforward and deserves further investigation. Supplemental data for this article is available online at at www.tandfonline.com/ijas.

Association of Metformin Use with Asthma Exacerbation in Patients with Concurrent Asthma and Diabetes: A Systematic Review and Meta-Analysis of Observational Studies.

Background Asthma and diabetes are both diseases that affect a wide range of people worldwide. As a common treatment for diabetes, metformin has also been reported to be effective in improving asthma outcomes. We conducted a combined analysis to examine the efficacy of metformin in reducing asthma exacerbation in patients with concurrent asthma and diabetes. Methods We searched the PubMed, Embase, and CENTRAL databases for articles published prior to April 2020 to find observational studies of individuals with concurrent asthma and diabetes that compared the risk of asthma exacerbation between metformin users and nonusers. Two researchers separately screened the studies, extracted data, and evaluated the risk of bias. The primary outcome was the adjusted risk of asthma exacerbation. The secondary outcomes were the adjusted risk of asthma-related hospitalization and emergency room visits. Review Manager was used for data analysis and plotting. I2 and χ2 tests were used to estimate heterogeneity. A random effects or fixed effects model was used depending on the heterogeneity. Odds ratios were calculated for dichotomous variables. Results We included two studies with a total of 25252 patients. The pooled effect size showed that metformin was inversely associated with a risk of asthma exacerbation (OR = 0.65, 95% CI 0.28–1.48; χ2 = 5.42, P=0.02; I2 = 82%), asthma-related emergency department visits (OR = 0.81, 95% CI 0.74–0.89; χ2 = 0.36, P=0.55; I2 = 0%), and hospitalizations (OR = 0.43, 95% CI 0.14–1.29; χ2 = 4.01, P=0.05; I2 = 75%). Conclusion This meta-analysis suggested that metformin decreased the risk of asthma-related emergency room visits for patients with concurrent asthma and diabetes. Metformin reduced the risk of asthma-related hospitalization and exacerbation but was not statistically significant. More randomized trials involving larger samples should be considered, and the mechanisms of these effects need to be fully elucidated.

Prevalence of COPD among workers with work-related asthma

Objective: Concurrent asthma and chronic obstructive pulmonary disease (COPD) diagnoses occur in 15%–20% of patients, and have been associated with worse health outcomes than asthma or COPD alone. Work-related asthma (WRA), asthma that is caused or made worse by exposures in the workplace, is characterized by poorly controlled asthma. The objective of this study was to assess the proportion of ever-employed adults (≥18 years) with current asthma who have been diagnosed with COPD, by WRA status.Methods: Data from 23 137 respondents to the 2012–2014 Behavioral Risk Factor Surveillance System Asthma Call-back Survey from 31 states and the District of Columbia were examined. Logistic regression was used to calculate adjusted prevalence ratios (PRs), examining six disjoint categories of WRA-COPD overlap with non-WRA/no COPD as the referent category.Results: An estimated 51.9% of adults with WRA and 25.6% of adults with non-WRA had ever been diagnosed with COPD. Adults with WRA/COPD were more likely than those with non-WRA/no COPD to have an asthma attack (PR = 1.77), urgent treatment for worsening asthma (PR = 2.85), an asthma-related emergency room visit (PR = 4.21), overnight stay in a hospital because of asthma (PR = 6.57), an activity limitation on 1–13 days (PR = 2.01) or ≥14 days (PR = 5.02), and very poorly controlled asthma (PR = 3.22).Conclusions: COPD was more frequently diagnosed among adults with WRA than those with non-WRA, and adults diagnosed with both WRA and COPD appear to have more severe adverse asthma outcomes than those with non-WRA and no COPD.

Asthma Actors: Estimating How Much Specific Air Pollutants Contribute to ER Visits.

Photograph of three adults receiving treatment for asthma attacks at an Atlanta emergency department

Disease burden and efficacy of mepolizumab in patients with severe asthma and blood eosinophil counts of ≥150-300 cells/μL.

In patients with severe eosinophilic asthma, treatment decisions can be determined by blood eosinophil counts; however, a specific blood eosinophil threshold has not been defined for starting mepolizumab treatment. We summarized the disease burden and efficacy of mepolizumab in patients with severe eosinophilic asthma and baseline blood eosinophil counts of ≥150-300 cells/μL and ≥300 cells/μL using data from the mepolizumab clinical development program (DREAM [NCT01000506], MENSA [NCT01691521], SIRIUS [NCT01691508] and MUSCA [NCT02281318]). The morbidity of asthma in patients with baseline blood eosinophil counts ≥150-300 cells/μL was similar to that in patients with blood eosinophil counts ≥300 cells/μL, with similar rates of exacerbations (2.8-3.5 events/year versus 2.8-3.8 events/year, respectively), asthma related emergency room visits, intubations and near fatal events. Use of maintenance oral corticosteroids (OCS) was similar across blood eosinophil count subgroups. Reductions in the rates of clinically significant exacerbations with mepolizumab versus placebo ranged from 27 to 49% in patients with blood eosinophil counts of ≥150-300 cells/μL for DREAM, MENSA and MUSCA. The odds of achieving a reduction in OCS in SIRIUS was 2.03 (95% CI: 0.53, 7.75) versus 1.79 (95% CI: 0.71, 4.52) in patients with blood eosinophil counts ≥150-300 cells/μL and ≥300 cells/μL, respectively. There is a high unmet clinical need in patients with blood eosinophil counts ≥150-300 cells/μL, and a clinically meaningful benefit is seen with mepolizumab in this subgroup. Mepolizumab is an efficacious treatment option for patients with blood eosinophil counts ≥150 cells/μL.

The Impact of the Patient-Centered Medical Home on Asthma-Related Visits to the Emergency Room: A Fixed Effects Regression Approach.

Objective To estimate the effect of a patient-centered medical home (PCMH) intervention on asthma-related emergency room (ER) visits of pediatric patients. Methods Patients receiving care at pediatric primary care practices participating in the Florida Pediatric Medical Home Demonstration Project as well as pediatric patients treated at non-participating clinics were identified from 4 years of claims and enrollment data. We estimate several fixed effects logistic regression models using one pre-treatment year and three post-treatment years to investigate whether asthma-related ER visits decreased because of the PCMH intervention. Results The estimation suggests that the intervention did have a negative effect on asthma-related ER visits in the earlier part of the intervention (OR 0.34; 95% CI 0.16-0.73). However, this effect was not detected in the later years. Because fixed effects models require repeated observations on the same individual, we believe our estimations of the PCMH model's impact is more accurate than previous studies. Conclusion for Practice Reducing asthma ER visits is a task that might be immediately actionable for PCMH practices, or those undergoing transformation. Our results adds to the others suggesting positive impacts of the PCMH.

Association of major California freight railyards with asthma-related pediatric emergency department hospital visits.

Asthma is a major health threat and leading cause of chronic morbidity among children. Air pollutants have been linked to exacerbations and promotion of initial development of asthma. Extensive research already conducted assessing adverse health impacts associated with exposure to pollutants from vehicular traffic. However, little research conducted assessing exposure to pollutants stemming from goods movement industry, such as freight railyards. This study's purpose to assess potential association between residential proximity to major freight railyards and asthma-related emergency room (ER) visits in children. This study included children ≤14 yrs. old, living within 30-mile radius of one of 18 freight railyards in California, and having utilized emergency room services between 2007 and 2009, identified through California Office of Statewide Health Planning and Development (OSHPD) database. Logistic regression modeling with all 18 railyards, and models with top 5 polluting railyards, conducted to assess for potential association between asthma related ER visit (asthma vs. non-asthma visit) and railyard residential proximity. A total 109,645 asthma related ER visits identified, majority among low income, minority populations. Within 18 railyard model, children closest to railyard (0–5 miles) were at significant increased odds (OR = 1.15, 95%CI: 1.10–1.20) for asthma related ER visit and stronger odds observed for 5 top emitting railyards (OR = 1.40, 95%CI: 1.29–1.52). Our findings indicate a strong link between asthma ER visits for children and residential proximity to railyards, especially among low-income and minority communities. There's a critical need to better understand complex health risks for individuals residing in these communities and mitigation efforts for this vulnerable population.

SNAP benefits and childhood asthma

Anecdotal and descriptive evidence has led to the claim that some low-income households may face a “eat or breathe” tradeoff, but quantitative evidence is scarce. We link Medicaid claims data to monthly Supplemental Nutritional Assistance Program (SNAP) participation data from the state of Missouri from 2010 to 2013 to explore monthly patterns in children's emergency room (ER) claims for asthma and to examine whether these patterns are sensitive to the timing and amount of SNAP benefits. This allows us to empirically test whether SNAP households with Medicaid insurance face trade-offs between food and medicine that increases the likelihood that a child in a SNAP and Medicaid household will go to the ER for asthma at the end of the month. While we do not find overwhelming evidence that the timing of SNAP benefits receipt are associated with the timing of asthma-related ER visits, we do find clear evidence that increased SNAP benefits are associated with a reduction in the overall probability of an asthma-related ER visit.

IMPACT OF BASELINE LUNG FUNCTION ON FUTURE EXACERBATIONS IN PATIENTS WITH MODERATE-TO-SEVERE ASTHMA

Introduction Although reduced lung function is associated with quality of life impairment and increased mortality risk, limited real-world evidence exists on the impact of forced expiratory volume in one second percent predicted (FEV1pp) on exacerbations among moderate-to-severe asthma patients. Methods Data from the Clinical Practice Research Datalink was used to identify adult patients with clinical diagnosis codes for asthma and having prescription utilization patterns indicative of moderate-to-severe asthma (Step 3–5 per British Thoracic Society 2011 guidelines). The date of first asthma prescription during 01JAN2010–31DEC2012 was the index date. Patients had 12-months pre-index and 36-months post-index date data. Additionally, patients having baseline FEV1pp results were selected to assess the relationship between FEV1pp and follow-up severe asthma exacerbations. Severe asthma exacerbations were identified by asthma-related emergency room visits, inpatient admissions, or acute oral corticosteroid use. Patients were stratified by baseline FEV1pp (nearest FEV1pp result ±180 days of index date): Group 1 (G1), ≥80%; G2, 50–79%; G3, Results Overall, 36,614 patients were identified of which 1,865 had baseline FEV1pp results. Patients with lower baseline FEV1pp (G2 and G3) had a significantly greater risk for and higher incidence of exacerbations compared with G1 (see Table). Conclusions Lower baseline FEV1pp levels are associated with a higher risk of severe exacerbations suggesting that baseline lung function is an important predictor of future asthma exacerbations. Table. Severe exacerbation risk over the follow-up period categorized by baseline FEV1pp group in patients with moderate-to-severe asthma

Association between Air Pollutants and Asthma Emergency Room Visits and Hospital Admissions in Time Series Studies: A Systematic Review and Meta-Analysis.

BackgroundAir pollution constitutes a significant stimulus of asthma exacerbations; however, the impacts of exposure to major air pollutants on asthma-related hospital admissions and emergency room visits (ERVs) have not been fully determined.ObjectiveWe sought to quantify the associations between short-term exposure to air pollutants [ozone (O3), carbon monoxide (CO), nitrogen dioxide (NO2), sulfur dioxide (SO2), and particulate matter ≤10μm (PM10) and PM2.5] and the asthma-related emergency room visits (ERV) and hospitalizations.MethodsSystematic computerized searches without language limitation were performed. Pooled relative risks (RRs) and 95% confidence intervals (95%CIs) were estimated using the random-effect models. Sensitivity analyses and subgroup analyses were also performed.ResultsAfter screening of 246 studies, 87 were included in our analyses. Air pollutants were associated with significantly increased risks of asthma ERVs and hospitalizations [O3: RR(95%CI), 1.009 (1.006, 1.011); I2 = 87.8%, population-attributable fraction (PAF) (95%CI): 0.8 (0.6, 1.1); CO: RR(95%CI), 1.045 (1.029, 1.061); I2 = 85.7%, PAF (95%CI): 4.3 (2.8, 5.7); NO2: RR(95%CI), 1.018 (1.014, 1.022); I2 = 87.6%, PAF (95%CI): 1.8 (1.4, 2.2); SO2: RR(95%CI), 1.011 (1.007, 1.015); I2 = 77.1%, PAF (95%CI): 1.1 (0.7, 1.5); PM10: RR(95%CI), 1.010 (1.008, 1.013); I2 = 69.1%, PAF (95%CI): 1.1 (0.8, 1.3); PM2.5: RR(95%CI), 1.023 (1.015, 1.031); I2 = 82.8%, PAF (95%CI): 2.3 (1.5, 3.1)]. Sensitivity analyses yielded compatible findings as compared with the overall analyses without publication bias. Stronger associations were found in hospitalized males, children and elderly patients in warm seasons with lag of 2 days or greater.ConclusionShort-term exposures to air pollutants account for increased risks of asthma-related ERVs and hospitalizations that constitute a considerable healthcare utilization and socioeconomic burden.

Improved asthma control in patients with severe, persistent allergic asthma after 12 months of nightly temperature-controlled laminar airflow: an observational study with retrospective comparisons

IntroductionContinuous or episodic allergen exposure is a major risk factor of frequent symptoms and exacerbations for patients with allergic asthma. It has been shown that temperature-controlled laminar airflow (TLA) significantly reduced allergen exposure and airway inflammation and improved quality of life of patients with poorly controlled allergic asthma.ObjectiveThe objective was to evaluate the effects of nighttime TLA when used during real-life conditions for 12 consecutive months in addition to the patients’ regular medication.MethodsThis multicenter, pre- and postretrospective observational study included patients with inadequately controlled moderate-to-severe allergic asthma who received add-on treatment with TLA for 12 consecutive months. Data on medication use, asthma control, asthma symptoms, lung function, use of hospital resources, and exacerbations were collected after 4 and 12 months and compared with corresponding data collected retrospectively from medical records during the year prior to inclusion in the study.ResultsData from 30 patients (mean age 28; range 8–70) completing 4 months and 27 patients completing 12 months of TLA use are presented. The mean number of exacerbations was reduced from 3.6 to 1.3 (p<0.0001), and the ratio of asthma-related emergency room visits or hospitalizations diminished from 72.4 to 23.3% (p=0.001) or from 44.8 to 20.0% (p<0.05), respectively, after 12 months of TLA use. The Asthma Control Test index increased from 14.1 to 18.5 (p<0.0001). After 4 months of TLA use, clear improvements can be shown for most variables in line with the data collected after 12 months.ConclusionsThe addition of TLA to the patients’ regular medication significantly reduced exacerbations, asthma symptoms, and the utilization of hospital resources. The data support that TLA may be an important new non-pharmacological approach in the management of poorly controlled allergic asthma.

Association of adenotonsillectomy with asthma outcomes in children: a longitudinal database analysis.

Childhood asthma and obstructive sleep apnea (OSA), both disorders of airway inflammation, were associated in recent observational studies. Although childhood OSA is effectively treated by adenotonsillectomy (AT), it remains unclear whether AT also improves childhood asthma. We hypothesized that AT, the first line of therapy for childhood OSA, would be associated with improved asthma outcomes and would reduce the usage of asthma therapies in children. Using the 2003-2010 MarketScan database, we identified 13,506 children with asthma in the United States who underwent AT. Asthma outcomes during 1 y preceding AT were compared to those during 1 y following AT. In addition, 27,012 age-, sex-, and geographically matched children with asthma without AT were included to examine asthma outcomes among children without known adenotonsillar tissue morbidity. Primary outcomes included the occurrence of a diagnostic code for acute asthma exacerbation (AAE) or acute status asthmaticus (ASA). Secondary outcomes included temporal changes in asthma medication prescriptions, the frequency of asthma-related emergency room visits (ARERs), and asthma-related hospitalizations (ARHs). Comparing the year following AT to the year prior, AT was associated with significant reductions in AAE (30.2%; 95% CI: 25.6%-34.3%; p<0.0001), ASA (37.9%; 95% CI: 29.2%-45.6%; p<0.0001), ARERs (25.6%; 95% CI: 16.9%-33.3%; p<0.0001), and ARHs (35.8%; 95% CI: 19.6%-48.7%; p = 0.02). Moreover, AT was associated with significant reductions in most asthma prescription refills, including bronchodilators (16.7%; 95% CI: 16.1%-17.3%; p<0.001), inhaled corticosteroids (21.5%; 95% CI: 20.7%-22.3%; p<0.001), leukotriene receptor antagonists (13.4%; 95% CI: 12.9%-14.0%; p<0.001), and systemic corticosteroids (23.7%; 95% CI: 20.9%-26.5%; p<0.001). In contrast, there were no significant reductions in these outcomes in children with asthma who did not undergo AT over an overlapping follow-up period. Limitations of the MarketScan database include lack of information on race and obesity status. Also, the MarketScan database does not include information on children with public health insurance (i.e., Medicaid) or uninsured children. In a very large sample of privately insured children, AT was associated with significant improvements in several asthma outcomes. Contingent on validation through prospectively designed clinical trials, this study supports the premise that detection and treatment of adenotonsillar tissue morbidity may serve as an important strategy for improving asthma control. Please see later in the article for the Editors' Summary.

Unmet needs in asthma treatment in a resource-limited setting: findings from the survey of adult asthma patients and their physician in Nigeria

IntroductionThe prevalence of asthma in our society is rising and there is need for better understanding of the asthma patients’ perception and treatment practice of physicians. The study was aimed at determining asthma attitudes and treatment practices among adult physicians and patients in Nigeria, with the goal of identifying barriers to optimal management.MethodsTo assess asthma attitudes, treatment practices and limitations among adult physicians and patients in Nigeria, a questionnaire survey was conducted among 150 patients and 70 physicians.ResultsMajority (66.7%) of the patients reported their asthma as moderate to severe, 42.7% had emergency room visit and 32% had admission due to asthma in the previous 12 months. Physicians and patients perceptions significantly differed in the time devoted to educational issues (31.4% vs.18.7%) and its contents: individual management plan (64.3% vs.33.3%), correct inhaler technique (84.0% vs.71.0%), medication side effects (80.0% vs.60.0%) and compliance 100% of time (5.7% vs. 18.7%). Patients reported that non-compliance with medication causes increased symptoms (67.0%), exacerbations (60.0%), bronchodilator use (56.0%), urgent physician visit (52.0%) and hospitalizations /ER visits (38.7%). Asthma medication in patients caused short term (10.7%) and long term side effects (20.0%). Due to side effects, 28.0% skipped and stopped their medications. Most physicians (85.7%) and patients (56.0%) agreed on the need for new medication options. The need for new medication in patients was strongly related to asthma severity, limitation of activities, side effects, cost and lack of satisfaction with current medication. With the exception of pulmonologists, physicians did not readily prescribe ICS and their prescriptions were not in line with treatment guidelines.ConclusionThis study has highlighted the gaps and barriers to asthma treatment which need to be addressed to improve the quality of care in Nigeria.

Do statins improve outcomes in patients with asthma on inhaled corticosteroid therapy? A retrospective cohort analysis

ObjectivesAnimal studies and clinical trials have examined the potential benefits of statins in asthma management with contradictory results. The objective of this study was to determine if asthma patients on...